Joy in Caring

Type of visit: Required - 1 Year

On 10/26/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an annual visit. introduce self, stated the purpose of the visit and met Eddiemer Sison, Designated Representative. All four residents were present during inspection. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. The temperature is maintained for refrigerator at 37 degrees F and freezer at 0 degrees F. Fire extinguisher was observed with a service date of: 09/26/22. Fire drill last completed:10/02/23. Medications observed kept locked in kitchen shelf. MARs were reviewed. Cleaning supplies and chemicals stored and locked in garage cabinet. All bedrooms were observed to have the required furnishings and with adequate lightening. The bathrooms were toured. Bathrooms were observed operational during inspection. Non-skid mat and grabbed bars were observed. Hot water temperature was tested at 147.7 degrees F in the bathroom 1 and range between 148.6 and 147.8 degrees F in master bathroom. 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’ files were reviewed to have all the required documents. Staffs’ files were also reviewed. Staff files were observed to have current First Aid/CPR, fingerprinted clear and associated to the facility. A deficiency and an immediate Civil Penalty of $1000 was assessed. See Lic 421IM is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 11/02/23.Forms requested: Lic 308, Lic 500, Lic 610E, current Administrator Certificate, and current liability insurance. A copy of this report and appeal rights was provided to Designee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Oct 26, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 10/27/22, 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 Eddiemer “Bang” Sison, Designee and was granted entry. Administrator Innocent Idusuyi was called and stated unable to attend meeting. Administrator authorized Designee to receive and signed report. LPA conducted tour with Designee. All four residents were present during the inspection. Upon entry facility staff was observed with face mask on. 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. COVID-19 and cough etiquette postings observed. LPA checked residents’ locked medications. LPA observed fire extinguisher served date: 05/19/21. LPA observed 30 days PPE supplies. Food supply was checked and appeared to be an adequate supply. Cleaning supplies were stored and locked in cabinet in the garage. 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 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. All resident records reviewed to have updated emergency contact information. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 11/2/22. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, Lic 9282, and current liability insurance. A copy of this report and appeal rights was provided to Designated Representative.the state’s words, verbatim · CDSS document, Oct 27, 2022

Allegation investigated: Staff are denying resident visitors.

On 04/25/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an initial complaint on the above allegation. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. LPA met with designated representative Eddiemer (Bang) Sison. Administrator Innocent Idusuyi was called and stated unable to attend meeting. During the course of the investigation, interviews were conducted with staff and resident. Staff stated resident was not denied visitors. Staff stated resident choose to not have visitors. Resident stated the staff are no denying him visitors. Resident stated it is his choice on who can visit him. Based on interviews conducted, the allegation above is to be UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. Exit interview conducted with designated representative. No deficiencies issued. A copy of this report was provided to the designated representative. Unfoundedthe state’s words, verbatim · CDSS document, Apr 25, 2022 · control 24-AS-20220421154653

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Prelicensing

On 11/03/2021, Licensing Program Analyst (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection. LPA introduced self, stated the purpose of the visit, and was allowed entry into the facility. LPA met with Administrator (A1), Marietta Parangalan. Administrator (A2), Innocent Idusuyi arrived later during the tour. The facility is a 5 bedroom and 2-bathroom home and fire clearance was granted for 4 Non-Ambulatory and 2 Bedridden for a total capacity of 6. There are three residents present during this inspection. LPA toured the facility with A1. 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 to have dishes, plates, and utensils. Knives will be kept locked and secure in the kitchen cabinet. 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 under kitchen sink. A fire extinguisher was observed and had a service date of 05/19/2021. Bedrooms were observed to have the required furnishing and are ready for occupancy. Hot water temperature ranged between 108 to 111 degrees F. LPA observed an extra supply of bed linens. Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching. Smoke detectors and carbon monoxide were observed to be operational during this inspection. Staff records were reviewed for good health and infection control training. All residents’ records reviewed to have updated emergency contact information. Component III was conducted during today's pre-licensing visit. I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.the state’s words, verbatim · CDSS document, Nov 3, 2021

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): YES (3) Method: Telephone call with CAB COMP II Participants: INNOCENT IDUSUYI Applicant/administrator Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1.Facility operation: License type, client/resident populations, and program 2.Staff qualifications and responsibilities 3.Applicant and Administrator qualifications 4.Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5.Grievances, Complaints, Community resources 6.Physical plant, food service 7.Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of property 8. Discussed the COVID-19 Mitigation Plan & PIN emailedthe state’s words, verbatim · CDSS document, Oct 14, 2021