Amber Care Home

Type of visit: Required - 1 Year

On 10/11/23, Licensing Program Analysts (LPA) M. Yang and L. Padgett arrived unannounced to conduct an annual visit. LPAs introduce self, stated the purpose of the visit and request to meet with Administrator. LPAs met with caregiver Marqarita “Rita” Linares and toured facility. Administrator Pacita Baltazar was called and arrived shortly during tour. One resident was present during inspection. The facility was observed to be at a comfortable temperature of 74 degrees F, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Temperature maintained for refrigerator at 39 degrees F and freezer at 0 degrees F. An adequate supply of perishable and non-perishable food was observed. Medications observed kept locked in kitchen shelf. MARs were reviewed. Fire extinguisher was observed with a service date of: 04/02/2023. Fire drill last completed: 07/18/2023. Cleaning supplies and chemicals stored and locked in laundry closet. Washer and dryer was observed operational during inspection.All bedrooms were observed to have required furnishings and with adequate lightening. Bathrooms were properly equipped and operational. All bathrooms are observed with securely fastened grab bars and non-skid mat. Hot water temperature was tested range 113.5 and 115.3 degrees in bathroom 1 and range 117.3 and 117.7 degrees F in bathroom 2. Outside of facility toured and observed to be free of debris. Side gate observed self-closing and self-latching. Carbon monoxide and smoke detectors were tested and observed to be operational. All residents’ file reviewed to have update emergency contacts, Admission agreement, Physician report, and IPP. Staff files were also reviewed. Staff files were observed to have current First Aid/CPR, health screening, fingerprinted clear and associated to the facility. No deficiency cited during inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 10/17/23. Forms requested: Lic 308, Lic 400, Lic 402, Lic 500, Lic 610E, and current liability insurance. A copy of this report was provided to the Administrator whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Oct 11, 2023

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: Required - 1 Year

On 8/19/22, 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 Myrna Alonzo, Caregiver. Administrator Alex Babakhani and Administrator Pacita Baltazar was called and arrived shortly and conduct tour with LPA. Three 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. Staff records were reviewed for good health and infection control training. All resident records reviewed to have updated emergency contact information. LPA observed 30-day PPE supplies. Cleaning supplies were stored and locked in laundry closet. LPA observed fire extinguisher served date: 5/8/22. LPA observed four single occupant room to be adequately furnished and lit. 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 bathroom sinks. Food supply was checked and appeared to be an adequate supply. LPA checked residents’ locked medications. The exterior tour was conducted. Side gate was self-closing and free of obstruction. No deficiencies issued during this inspection. Exit Interview conducted. LPA received copy of Lic 308, Lic 610E, Lic 309, Lic 500, Lic 9020, Administrator certificate, current liability insurance. A copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Aug 19, 2022

Type of visit: Case Management - Deficiencies

On 03/29/22, Licensing Program Analyst (LPA) M. Yang conducted an unannounced case management inspection regarding incident report received from facility on 3/11/22. LPA met with caregiver Margarita Linares. Administrator Alex Babakhani and Pacita Baltazar was called and arrived shortly. The purpose of the today's visit is to follow up on the incident report that was submitted to department on 03/11/22. Staff did not initial Medication Administration Record (Mar) on 03/02/22 after administering medication to R3. LPA interviewed staffs and reviewed records. No further action needed regarding this incident at this time. LPA follow up on report department received regarding R3 expressed having difficult eating due to gum soreness from unfitted dentures. LPA interview staffs and resident. No further action needed regarding this incident at this time. LPA follow up on incident report that was reported on 03/11/22. R1 did not receive medication, Calcium, as directed during bedtime in the month of February 2022. R2 did not receive Vitamin C in the evening for the month of January 2022. Licensee reported incidents occurred on 01/01/22- 02/27/22 and 03/02/22 to department on 03/11/22. A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D. Exit Interview conducted. As a COVID-19 precautionary measure, a copy of this report and appeal rights will be provided via email. Report signed on site.the state’s words, verbatim · CDSS document, Mar 29, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Mar 30, 2022

87465(a)(5) Incidental Medical and Dental Care The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not ensure staff administering R1 Calcium during bedtime on 02/01/22-02/27/22. R2 did not received Vitamin C in the evening from 01/01/22-01/31/22 which poses an immediate health and safety risks to persons in care.the state’s words, verbatim · CDSS document, Mar 29, 2022

Plan of correction: Licensee has staff retrained on administering medication. Copy of training on 03/05/22 provided to LPA. A has a plan of correction with an action plan that included facility MAR to be reviewed by Administrator and ongoing staff training on administering medications will be submitted to department by 03/30/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Apr 4, 2022

87211 (a)(1) Reporting Requirements (a) Each licensee shall furnish to the licensing agency... (1) A written report...to the licensing agency and to the person responsible for the resident within seven days of the occurrence. This requirement was not met as evidenced by: This requirement was not met as evidenced by: Based on record reviews, Incident report that incident occurred 01/01/22-01/31/22, 02/01/22-02/27/22, and 03/02/22 was reported to department on 03/11/22. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 29, 2022

Plan of correction: Licensee agrees to submit a plan detailing steps the facility will take to ensure incident reports are submitted to the Fresno CCL office and responsible party. The plan will be submitted to the Fresno CCL office by 03/04/22.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) M. Yang arrived unannounced for a Post Licensing -Infection Control Inspection. LPA met caregiver Amalia (Amy) Mallari. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. Upon entry staffs was observed not wearing facial covering. Administrators, Pacita Baltazar and Alex Babakhani was called and arrived shortly. LPA conducted a complete tour of the facility with the Administrators. All three residents present during visit. LPA observed cough etiquette and social distancing posting. Facility was observed at a comfortable temperature, clean, and no passageway obstructions or fire hazards inside. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. Kitchen was toured and observed. Knives were observed kept locked and secure in the kitchen pantry. LPA observed a 2-day supply of perishable and 7-day supply of non-perishable food. Medications observed locked in two cabinets in the kitchen. A fire extinguisher was observed and had a service date of 07/25/2021. Cleaning supplies and chemicals observed to be locked in a closet in the laundry room. LPA observed an extra supply of bed linens and personal hygiene products. Bedrooms were observed furnished and lit. LPA observed hand washing signs by bathroom sinks. Hot water temperature ranged between 109.6 to 112 degrees F. Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching. All resident’s file reviewed to have updated emergency contact information. LPA observed a 30 day PPE supplies. Resident’s MARS reviewed. Staff’s file was also reviewed with current 1st Aid/ CPR. No deficiencies issued during this inspection. Exit interview was conducted. Due to COVID-19 precautionary measures, a copy of this report will be provided via email and an electronic read receipt confirms receiving this email. Report signed on-site.the state’s words, verbatim · CDSS document, Oct 8, 2021

Type of visit: Prelicensing

On 08/18/2021, Licensing Program Analysts (LPAs) Walton and Yang conducted an announced Pre-licensing / Component III Inspection. LPAs introduced selves, stated the purpose of the visit and was allowed entry into the facility. LPAs met with Facility Staff (S1), Pacita Baltazar and Administrator (A1), Alex Babakhani. The facility is a 5 bedroom and 2 bathroom home and fire clearance was granted for 6 Non-Ambulatory for a total capacity of 6. There are no residents present during this inspection. LPAs toured the facility with A1 and S1. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. Bedrooms were observed to have the required furnishing and are ready for occupancy. Hot water temperature ranged between 108.1 to 110.3 degrees F. LPAs observed an extra supply of bed linens and personal hygiene products. Kitchen was toured and observed to have dishes, plates, and utensils. Knives will be kept locked and secure in the kitchen pantry. Medications will be locked in two cabinets in the kitchen. First aid kit was observed and contained all required items. Cleaning supplies and chemicals observed to be locked in a closet in the laundry room. A fire extinguisher was observed and had a service date of 07/25/2021. Smoke detectors and carbon monoxide were observed to be operational during this inspection. Outside of facility toured. Exits were open and free of obstructions. LPAs observed side gate to be self-latching. Component III was conducted during today's pre-licensing visit. We have found that the applicant has met all pre-licensing requirements. LPAs will submit documentation to CAB in Sacramento for final review prior to license being issued.the state’s words, verbatim · CDSS document, Aug 18, 2021