Fresno Guest Home #11

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by Administrator Angelica Kutnerian (AD1) and Jaycee Sanderson (AD2). The residence was set at 76 F temperature and free of passageway obstructions inside and outside. LPAs observed six bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Hot water temperature was measured at 116.5 degrees F. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medication and knives are locked in the kitchen area. Cleaning supplies were locked in the laundry room. Smoke detectors and carbon monoxide are dual detectors, they were checked and operating. Fire extinguishers were charged and was serviced on 8/2/2023. Emergency disaster drills are conducted quarterly, last drill completed on 9/01/23. There was outdoor seating for the residents. Outdoor area was clean and free of obstruction. An exit interview was conducted, and a copy of this report was provided to AD1 whose signature confirms receipt. LPA requested the following updated forms faxed to CCLD by 10/27/23: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage.the state’s words, verbatim · CDSS document, Oct 18, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lady Cabrera arrived unannounced for an Annual Required Inspection. LPA met with Administrator Angela Kutnerian. LPA stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Facility has one entrance/exit point. Facility appeared clean 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. Bathrooms have trashcans with lid. Hand washing posters were observed by the bathrooms and kitchen. Bedrooms were checked. The exterior tour was conducted. LPA checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. Exit interview was conducted. A copy of this report was provided to Administrator. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 11/14/2022the state’s words, verbatim · CDSS document, Nov 7, 2022

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: Resident fell while in care Staff are not providing adequate laundry services for resident Kitchen sink is in disrepair Facility doesn't have toiletry products for resident's

Licensing Program Manager (LPM) Sergiy Pidgirny and Licensing Program Analyst (LPA) Lady Cabrera the subsequent complaint visit. LPA met with Administrator Angela Kutnerian and delivered investigation findings regarding the above allegations. During the course of this investigation LPA reviewed facility files relevant to the complaint investigation. It was determined that the above allegations: Resident fell while in care, Staff are not providing adequate laundry services for resident, Kitchen sink is in disrepair, and Facility doesn't have toiletry products for resident's are UNFOUNDED. We have found that the complaint was Unfounded, therefore we have dismissed the complaint. The Department conducted interviews with staff and reviewed records. Based on interviews and records, on 08/15/2022 Resident (R1) fell at the facility and staff immediately evaluated and assisted R1. Facility Administrator reported R1 had no injuries from the fall and R1’s responsible party was notified. According to R1’s Primary Physician, R1 had history of falls. Unfounded Based on interviews and records, R1 received a full shower twice a week and as needed showers if resident experienced an accident. A photo was submitted to Community Care Licensing (CCL) indicating R1 had dried fecal material on foot. LPA was unable to determine from the photo if R1 had dried fecal material. Per Administrator, she was unaware of this incident. Per interviews, staff would shower R1 twice a week and more if needed and assist residents with hygiene needs. A photo was submitted to CCL regarding R1’s sippy cup with built in straw had mold. LPA was unable to determine from the photo if R1’s sippy cup had mold. Per Administrator, this was not reported to her. Per interviews, the sippy cups are soaked in one-part bleach and three cups of water over night and the morning staff will wash by hand. Based on interviews conducted, Resident’s (R1) family notified Administrator regarding missing personal belongings. R1’s belongings were not returned to R1’s responsible party upon discharge and a signed receipt was not provided. According to the Administrator, the day of R1’s discharge all personal belongings were found and provided to R1’s responsible party. Per records reviewed, R1’s Personal Property and Valuables form (LIC621) was not updated and did not indicate missing belongings. It was reported that staff did not notify resident’s authorized representatives of incidents and lack of communication regarding resident’s care; such as when R1 was scheduled for the flu shot, chest x-ray, urine analysis and blood work. It was reported R1’s responsible party was notified after R1 was seen by her primary physician. Per primary physician, in care homes where administrators are actively involved in all facets of care for their residents, they deem it more efficient to notify them of all the changes, so they can relate the messages and updates to the resident or their responsible party. Based on interviews and records reviewed, R1’s responsible party signed the flu and pneumonia vaccine consent, the new patient enrollment form and acknowledgement of their acceptance policies for R1 to be seen by the primary physician at the facility. Based on the interviews conducted and records reviewed the above allegations are UNSUBSTANTIATED. Although the allegation 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.the state’s words, verbatim · CDSS document, Jul 19, 2022 · control 24-AS-20211202090745

Type of visit: Case Management - Other

Licensing Program Manager (LPM) Sergiy Pidgirny and Licensing Program Analyst (LPA) Lady Cabrera met with Administrator Administrator and George Kutnerian, Chief Executive Officer to review Theft and Loss Policy.the state’s words, verbatim · CDSS document, Jul 19, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lady Cabrera arrived unannounced for an Annual Required Inspection. Administrator Angela Kutnerian. LPA stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. 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. Bathrooms have trashcans with lid. Hand washing posters were observed by the bathroom sink. Bedrooms were checked and beds are six feet apart. The exterior tour was conducted. LPA checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. Exit interview was conducted. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 12/10/2021. As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.the state’s words, verbatim · CDSS document, Dec 3, 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.