Blueberry Hill

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived unannounced to conduct the Annual Inspection. LPA met with and explained the purpose of the visit with Licensee Ron Sandone. During this visit, LPA toured the facility inside & out. Resident bedrooms contained required furnishings and lighting. LPA observed required items in bathrooms which were clean. Resident hygiene supplies were properly stored and available. The kitchen was observed to be clean, in good repair with necessary items and appliances. LPA observed required food supply and paper products. Knives, cleaning/disinfecting supplies and chemicals are locked and stored separate from food. Medications are centrally stored and locked. First aid kit contained required items. Facility has designated visitation areas available inside and out. Outside of the facility toured. LPA observed a self-releasing gate and windows have screens in good repair. Smoke and Carbon Monoxide detectors present and in working order. Fire extinguisher was purchased 5/17/23. LPA conducted resident and staff file reviews including medication audit. Infection Control and Emergency Disaster Plans were reviewed. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D in the area of: Hospice Care for Terminally Ill Residents Appeal for deficiency CCR 87633(b)(6)(B) was granted. An exit interview was conducted and Plan of Correction (POC) was developed. A copy of this report and Appeal Rights were discussed with and emailed to Ron Sandone. LPA requested the following updated forms faxed to CCLD by 9/26/23: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Personnel Report (LIC 500), Client Roster (LIC 9020), Proof of current Liability Coverage, Infection Control Plan and Emergency Disaster Plan LIC610E.the state’s words, verbatim · CDSS document, Sep 19, 2023

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Katie Brown arrived unannounced and conducted a case management visit. LPA met with and explained the purpose of the visit with Administrator (AD) Yolanda Castigador. During the visit, LPA toured the facility, conducted interviews and reviewed resident records. LPA observed the following: 1. Chemicals & cleaning supplies were stored in an unlocked cabinet under the kitchen sink 2. Resident (R1) has personal PRN medications at bedside and in common area 3. R1, R2, R3 do not have Physician orders for ½ bed rails Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 9099-D. An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with Yolanda Castigador , whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jan 26, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87462(h)(2) · Plan of correction due date: Jan 27, 2023

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Licensee did not ensure all medications were centrally stored and locked. LPA observed tums at R1's bedside as well as Aleve and Vitamins on R1's personal table in the common area. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: AD immediately removed the medications from R1's bedside table as well as tray in common area. The deficiency is cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87608 · Plan of correction due date: Feb 3, 2023

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal…..Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record…. This requirement was not met as evidenced by: Licensee did not ensure that a physician's order was obtained for the use of 1/2 bedrails for R1, R2 and R3. LPA observed 1/2 rails on the resident's hospital beds. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: AD agrees to obtain a physicians order for R1, R2 and R3 for the use of the 1/2 rails. AD will submit a copy of the orders as well as a copy of proof of training on the use of postural supports. AD agrees to submit by the due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87039(a) · Plan of correction due date: Feb 3, 2023

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement was not met as evidenced by: Licensee did not ensure that all chemicals and disinfecting products were locked and inaccessible to residents. LPA observed cleaning and disinfecting products srored under the kitchen sink which was unlocked. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: Facility staff immediately removed and placed the items in a locked cabinet. AD has agreed to replace the lock on this cabinet. AD will submit pictures of the new locks on the cabinet to LPA by the due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Annual Infection Control Inspection. LPA met with and explained the purpose of the visit with facility Designee Grace Petil. LPA toured the facility inside and out. Infection control procedures which were observed and/or reviewed by LPA include: Daily symptom screenings for residents, staff and visitors, testing & vaccination requirements, Isolation room procedures, PPE and daily infection control procedures. Sanitizer is available throughout the home and bathrooms are stocked with soap and paper towels. Hand washing and other symptom related signs are posted. LPA observed supply of PPE, medications, paper goods and disinfecting products. Administrator has agreed to revise daily screening logs for residents, staff and visitors. Additional PPE will be purchased to increase supply. No citations were issued during this inspection. A copy of this report was provided, and an exit interview was conducted with Grace Petil. LPA requested the following updated forms by 8/26/22: LIC 308, LIC 309, LIC 500, LIC 610E, LIC9020, Current Liability Insurancethe state’s words, verbatim · CDSS document, Aug 17, 2022

The state marks this report as 8 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Resident sustained pressure injury while in care

Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to deliver complaint investigation findings. LPA met with and explained the purpose of the visit with Administrator (AD) Yolonda Castigador. The Department investigated the allegation: Resident sustained pressure injury while in care. Record review of R1’s hospice file and Physician’s Report reveal R1 did not have a pressure injury prior to admission. The resident was admitted to the facility on 1/13/22. Per Hospice Nurse Note dated 1/17/22, resident sustained a pressure ulcer since the previous visit. Based on record review, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. The following deficiencies were observed and noted on the attached LIC 809D. All violations that, if not corrected, will have direct and immediate risk to the health, safety or personal rights of clients in care. A copy of this report, Plan of Correction and Appeal Rights was emailed to ronald.sandone@yahoo.com. An exit interview with AD was conducted. Substantiatedthe state’s words, verbatim · CDSS document, Jun 29, 2022 · control 24-AS-20220131114428

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87633(b)(6)(A) · Plan of correction due date: Jun 30, 2022

87633 Hospice Care of Terminally Ill Residents (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: (6) Identification of the training needed, which staff members need this training, and who will provide the training relating to the licensee’s responsibilities for implementation of the hospice care plan. (A)The training shall include but not be limited to typical needs of hospice patients, such as turning and incontinence care to prevent skin breakdown, hydration, and infection control. This requirement was not met as evidenced by: Licensee did not ensure that a Current & complete hospice care plan was maintained at the facility which included identification of training needed related to repositioning of R1 to prevent skin breakdown. This poses an immediate health & safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 29, 2022

Plan of correction: Administrator (AD) has agreed to submit a written statement which will include the plan to obtain training for all staff by a Hospice Agency representative. Training will include skin breakdown prevention and how to properly reposition a resident in care. The statement will include the agency that will provide training, date and time. The statement will include that the regulation 87633 has been reviewed and understood by AD by 5PM 6/30/2022. A copy of the regulation was provided. AD will provide a copy of each of the 3 current hospice resident Hospice Plans. AD will also submit proof of training to CCLD by 7/5/2022.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Katie Brown arrived unannounced and conducted Case Management visit. LPA met with and explained the purpose of the Case Management with Administrator (AD) Yolanda Castigador. During the visit, LPA reviewed R1 resident file and interviewed AD. Record review revealed that the resident file is incomplete. The following deficiencies were observed and noted on the attached LIC 809D. All violations that, if not corrected, will have direct and immediate risk to the health, safety or personal rights of clients in care. A copy of this report including Plan of Correction and Appeal Rights were provided via email to ronald.sandone@yahoo.com. An exit interview was conducted with AD.the state’s words, verbatim · CDSS document, Jun 29, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Jul 13, 2022

87506 Resident Records (a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidenced by: Licensee did not ensure the complete and current record for R1. This poses a potential health & Safety risk to persons in carethe state’s words, verbatim · CDSS document, Jun 29, 2022

Plan of correction: Administrator (AD) has agreed to conduct an audit of the current 5 resident's files using LIC311 as a checklist. A checklist will be created and completed for each resident currently in care and for future resident admissions. AD agrees to submit a copy of the checklist for each resident currently in care to CCLD by 7/13/22 via email. A copy of LIC311 was provided.

Type of visit: Case Management - Other

LPA Katie Brown arrived at the facility to return the file of R1 that was removed 2/1/22. A copy of R1's file was made by the LPA for the purpose of the complaint investigation. Care provider Carmencita Solomon signed for the return of the file and a copy of the letter was provided. A copy of this report was provided via email to Administrator at ronald.sandone@yahoo.com.the state’s words, verbatim · CDSS document, Feb 3, 2022

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct a Health & Safety Inspection in conjunction with opening a complaint (24-AS-20220131114428). LPA explained the purpose of the visit with Administrator (AD) Yolanda Castigador. LPA and AD toured the facility inside and out. 5 residents were observed in their rooms or watching television. Medications were observed in a locked cabinet in the kitchen. Residents rooms were clean and required furnishings and lighting was observed. LPA observed 2 day perishable and 7 day non-perishable food supply. Bathrooms were clean and without odor. Towels, linens, hygiene items and paper products were stored properly. Bathroom water temperature was 113 degrees F. Outside of the facility toured. No bodies of water or other hazards were observed. LPA observed a self-releasing gate and windows have screens in good repair. LPA removed R1’s file from the facility to make a copy at the CCLD office. The file will be returned to the facility within 3 business days. See Lic809-D for deficiencies and Plan of Correction An exit interview was conducted with the Administrator. A copy of this report along with Appeal Rights were provided to Administrator via email at ronald.sandone@yahoo.comthe state’s words, verbatim · CDSS document, Feb 1, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: Feb 1, 2022

87307 Personal Accommodations and Services (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by Licensee did not ensure that passageways were clear and free of obstruction. A locked gate was placed by the facility on both entry ways into the kitchen. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 1, 2022

Plan of correction: DEFICIENCY CLEARED. The safety gates were both removed from the walls and disposed of during the inspection.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87309(a) · Plan of correction due date: Feb 2, 2022

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement was not met as evidenced by: Licensee did not ensure that disinfectants and cleaning supplies inaccessible in the laundry room and kitchen. The magnetic locks under the kitchen sink were broken or not functioning properly. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 1, 2022

Plan of correction: DEFICIENCY CLEARED Disinfectants and cleaning supplies were removed and locked in a cabinet in the garage. Licensee has agreed to place a lock on the door knob leading to the laundry room and garage. Magnetic locks to be replaced under the kitchen sink. Pictures of the new door knob with lock and repaired magnetic locks will be provided to CCLD by 2/10/22

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Infection Control Inspection. LPA met with Care Provider, Cita Solomon. The Covid Contact questionnaire completed at entry. LPA spoke to Administrator Yolonda Castigador who authorized Ms. Solomon to conduct the visit. LPA entered through the central entry point where hand sanitizer and visitor symptom screening was conducted. Facility Mitigation plan has been approved by CCL. Infection control procedures described in the plan which were observed or reviewed by LPA include: Daily symptoms screenings (for staff, persons in care and visitors), testing, visitation, quarantine/isolation procedures, staffing, PPE storage, use and training, and daily infection control procedures. All residents are fully vaccinated. LPA toured the facility inside and out. Required postings to encourage face coverings and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Staff were all observed wearing face coverings. Facility has multiple designated visitation areas available. LPA observed 30-day PPE and resident medication supply. Common and resident bathroom sinks are well stocked with liquid soap for hand washing. Through LPA’s observations, documentation review and interview with Administrator, the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.the state’s words, verbatim · CDSS document, Aug 4, 2021