Royal Care

Type of visit: Required - 1 Year

On 9/29/2023, Licensing Program Analysts (LPAs) K. Kaur and L. Padgett arrived unannounced at the above facility to conduct an Annual Inspection. LPAs introduced selves, stated the purpose of the visit, and were allowed entry by staff Modesta Paz. Staff contacted Designee /Administrator Aurora Rigon, who arrived shortly after. LPAs conducted facility tour with staff. All pathways, entrances and exits were clear from obstruction. Fire extinguisher in Living Room room was purchased 1/25/2023. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions were observed inside or outside. At 9:06 AM LPA(s) observed unlocked medication in a cabinet in the office accessible to residents. The kitchen was observed to be clean, in good repair with necessary items and appliances. 7-day supply of non-perishable foods and a 2-day supply of perishable foods observed. At 9:10 AM LPA(s) observed unlocked disinfecting spray, Dish soap observed under kitchen sink. LPA(s) toured laundry area, and garage and observed from 9:11 AM to 9:14 AM Antiseptic Alcohol in unlocked cabinet above washing machine in laundry room and laundry detergent, bleach, and used syringes in unlocked garage. Used insulin sharps are kept in emptied laundry detergent/softener container, and were not labeled as Biohazardous Waste or Sharps Waste. Common areas were properly furnished and well-lit throughout. Facility has 3 residents who are at a day program. The dining room is equipped with a table and chairs, the living room is equipped with adequate sofas and chairs for seating. LPAs observed grab bars installed by toilet and in shower and non-skid mats in place. Residents' bedrooms were observed to be adequately furnished with bed, dresser, chair, and adequate lighting. Mattresses and linen were in good condition. Extra linen and towels are available in the hallway closet. Continued to Next page... At 10:53am LPA(s) tested water: 116.7F in hallway, 114.4F in bedroom 4. Carbon monoxide and smoke alarm detectors installed and operational. Adequate outside space for rest and recreational. The backyard gate is self-closing and self-latching. At 12:23 PM LPA(s) did not observe forms available at the facility for Licensee except for Administrator License. Staff files were reviewed for good health and first aid/CPR. Resident's records contained signed Admission Agreement, Physicians Report, and I.D Emergency Information. At 1:46 PM LPAs reviewed medication, Centrally Stored List and MAR(s) for Resident 1 (R1) which showed two extra pills in package which should have already been administered per MAR(s) that were not. Deficiencies are being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. LPA is requesting the following documents be submitted to the Fresno CCL office by 10/06/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. An exit interview was conducted with Administrator. Report signed on-site; a copy of this report, 809D with appeal rights was provided.the state’s words, verbatim · CDSS document, Sep 29, 2023

Type of visit: Required - 1 Year

On 09/08/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with administrator. LPA met with Modesta Paz, Caregiver. Aurora Rigon, Assistant Administrator (AA) was called and arrived shortly and conduct tour with LPA. All four residents were present during the inspection. Upon entry facility staff was observed with facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. Social distancing and cough etiquette postings observed. All resident records reviewed to have updated emergency contact information. LPA observed fire extinguisher served date: 02/18/22. LPA checked residents’ locked medications. LPA observed small amount of PPE supplies in facility. 30 days PPE supplies storage in a central location. Food supply was checked and appeared to be an adequate supply. Cleaning supplies were stored and locked in hall closet. All resident’s room toured and observed to be adequately furnished and lit. LPA observed four single occupant room. All bathrooms are observed with securely fastened grab bars and non-skid mat. All bathrooms observed trash bin with lid. Hand washing posting observed by all bathroom sinks. The exterior tour was conducted. Side gate was self-closing and self-latching. Staff records were reviewed for good health and infection control training. No deficiencies issued during this inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 09/16/22. The following updated forms were requested: Lic 308, Lic 309, Lic 400, Lic 402, Lic 610E, and Lic 9282. LPA received copy of current liability insurance and Lic 500. Administrator was informed that as COVID-19 precautionary measure, this report will be provided via email. Report signed on-site.the state’s words, verbatim · CDSS document, Sep 8, 2022

Allegation investigated: Facility staff verbally abuses resident(s) while in care.

On 05/05/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Assistant Administrator Aurora Rigon. During the course of the investigation, the Department conducted interviews with staff and residents. Residents were not verbally abuse by facility staff while in care. Based on interviews which were conducted, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted. A copy of this report was provided to Assistant Administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 5, 2022 · control 24-AS-20220415124148

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: POC

On 04/11/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an POC inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator is not available during this inspection. LPA spoke with Administrator Aurora Rigon via telephone. LPA received verbal permission to meet with Caregiver, Modesta Paz. The purpose of this visit is to follow up on a citation that was issued on 02/28/2022. As of 04/11/2022, Administrator has not submitted a written statement detailing the steps the facility will take to ensure that the facility will maintain accurate records for cash resources. LPA discussed the Plan of Correction with Administrator. No deficiencies issued during today's inspection. Exit interview conducted. A copy of this report was discussed and provided to Caregiver, Modesta Paz, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Apr 11, 2022

Allegation investigated: Resident is not receiving P & I funds while in care.

On 02/28/2022, Licensing Program Analyst (LPA) A. Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and reqeusted to meet with the Administrator. Facility staff contacted Administrator, Aurora Rigon who arrived a short time later. Today's inspection included staff interviews and records review. Interviews with staff and record reviews revealed that the facility stores cash resources for 2 out of 4 residents in care in one shared bank account. Administrator was unable to provide an accurate bank statements reflecting the current balance for resident R1. Per Administrator, residents do not withdraw money from the account and do not request money. Administrator will withdraw money from the shared account and give the money to residents when residents go on an outing with family. CONTINUED TO LIC9099C Substantiated It was found during records review, that R1 has two account ledgers on file each showing a different account balance. Administrator is unable to provide bank records for transactions of cash resources deposited in and drawn from the account. Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the allegations: Resident is not receiving P & I funds while in care is found to be SUBSTANTIATED. A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6, see attached LIC9099D. An exit interview was conducted. A Plan of Correction was reviewed and developed with the Administrator. A copy of this report and appeal rights will be provided via email due to COVID-19 precautionary measures. Report signed on-site by facility representative.the state’s words, verbatim · CDSS document, Feb 28, 2022 · control 24-AS-20211011084147

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(g)(1) · Plan of correction due date: Mar 28, 2022

87217 Safeguards for Resident Cash, Personal Property, and Valuables(g)(1): Records of residents' cash resources maintained as a drawing account shall include a ledger accounting (columns for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. This requirement was not met as evidenced by: Based on interviews and record review, Licensee did not maintain accurate records of cash resources for R1, which posess a potential health and safety risk to client in care.the state’s words, verbatim · CDSS document, Feb 28, 2022

Plan of correction: Licensee agrees to submit a written statement detailing how the facility will maintain accurate records for cash resources and provide the last 6 months of bank statements and account ledgers for residents in care to the Fresno CCL office by 03/28/2022 Licensee agreed that staff will be trained on requirements of Safeguards for Resident Cash, Personal Property, and Valuables. Documentation of training topics and attendace will be submitted to the Fresno CCL office by 03/28/2022.

Type of visit: Required - 1 Year

On 09/15/2021, Licensing Program Analysts (LPA) M. Yang and A. Walton arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPAs introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPAs met with caregiver Modesta Paz. Caregiver call Administrator. Assistant Administrator Aurora Rigon arrived in a short time. LPAs conduct tour with Assistant Administrator . One resident was present during the tour. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. All bathrooms are observed with trash cans with lid and securely fastened grab bars. There are non-skid surfaces in the bathrooms. LPAs observed hand washing posting by all sinks. Bedrooms are single occupant. LPAs checked residents’ locked medications and observed a 30-day PPE supplies. Food supply was checked and there appeared to be an adequate supply. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. LPAs reviewed 1 out of 2 residents have updated emergency contact information. Facility has not submitted LIC 808 Mitigation plan to CCL. Assistant Administrator agrees to submit LIC 808 to CCL by 9/21/21. Please submit the requested forms/information to Fresno CCL by: 09/28/21. The following updated forms were requested: LIC 308 Designation of Facility Responsibility, LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan for Residential Care Facilities for The Elderly, LIC 9020 Register of Facility Clients/Residents, updated Liability Insurance, LIC 309 Administrative Organization, current Administrator Certification, current liability insurance, LIC 400 Affidavit Regarding Client/Resident Cash Resources, and LIC 402 Surety Bond. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit interview was conducted and Plan of Correction was reviewed and developed with Assistant Administrator. Due to COVID-19 precautionary measures, a copy of this report and appeal rights will be provided via email and an electronic read receipt confirms receiving this email.the state’s words, verbatim · CDSS document, Sep 15, 2021

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff caused resident to become distressed. Staff made inappropriate comments towards resident.

Licensing Program Analyst (LPA) Les Xiong conducted complaint investigation visit to the facility. I met with Administrator Aurora Rigon and inform her the purpose of the investigation. During this visit LPA delivered investigation findings regarding the above allegations.The Department has investigated the complaint alleging: Staff caused resident to become distressed, and staff made inappropriate comments towards resident. Based on the interviews conducted and/or records review the above allegation is UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 4, 2021 · control 24-AS-20210723153748

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.