The Gables

Type of visit: Required - 1 Year

On 5/16/23, Licensing Program Analyst (LPA) M. Medina arrived unannounced to conduct the Annual Inspection. LPA met with and explained the purpose of the visit with Administrator, Christina Marsy. During this visit, LPA toured the facility. Furniture and flooring in common rooms observed to be in good repair with adequate lighting throughout. Resident bedrooms have required furnishings, lighting and linens. The kitchen observed clean, in good repair with necessary items and appliances. LPA observed required food supply, paper products and PPE. Knives, cleaning/disinfecting supplies and chemicals are locked and stored separate from food. Medications are centrally stored and locked. 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. Doors and passageways are unobstructed throughout the home and outside. Fire Extinguishers dated 9/2022. Smoke and Carbon Monoxide detectors present and in working order. Emergency & Disaster Plan and Infection Control Procedures on site and available LPA conducted resident and staff file reviews and interviews. No deficiencies were cited during this inspection. An exit interview was conducted. A copy of this report was signed and left with Administrator for facility records. LPA requested the following forms to be submitted to Fresno Regional Office no later than 5/26/23: Designation of Facility Responsibility (LIC 308), Personnel Report (LIC 500), Emergency Disaster Plan (610E), Client Roster (LIC 9020), Current Liability Coverage.the state’s words, verbatim · CDSS document, May 16, 2023

Allegation investigated: Staff are not properly trained

On 05/12/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegation. LPA was greeted by Staff S1, explained purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken prior to entry. During the investigation, LPA reviewed facility files including staff records. LPA did not observe training records and facility was unable to provide proof of training for staff. Based on LPA’s observation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. An exit interview was conducted with Executive Director, Michelle Macias. A copy of this report and appeal rights were discussed and provided. A plan of correction was developed with Administrator and reviewed with LPA. Substantiated (Continued from 9099) An exit interview was conducted with Administrator. A copy of this report and appeal rights were discussed and provided. A plan of correction was developed and reviewed with LPA.the state’s words, verbatim · CDSS document, May 12, 2022 · control 24-AS-20220302153559

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c)(2)(D) · Plan of correction due date: May 25, 2022

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (D) Number of training hours per subject. This requirement was not met as evidenced by LPA's observation of personnel records. Personnel records did not have proof of staff training and facility did not provide proof of training as requested on 03/11/22.the state’s words, verbatim · CDSS document, May 12, 2022

Plan of correction: Administrator will submit proof of training records for all staff. Proof of training records will include initial and continued training required for staff and also the required dementia training according to CCR Title 22 - 87705 by POC date.

Type of visit: Case Management - Deficiencies

On 05/12/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on complaint allegations. During the visit, LPA observed Resident R1 sitting in a wheel chair moaning in pain. LPA was informed that R1 had broken a bone due to a fall in April and is still recovering. LPA asked to see a copy of LIC624 (Incident Report). Facility stated report was faxed to CCL but was unable to provide a hard copy of the incident report to LPA. LPA reviewed Hospice Care plan for R1 and Physician's statement (LIC 602). Records revealed R1 is total assist and is chair bound. LPA reviewed facility's license that states, "AGE RANGE 60 AND OVER. ALL MAY BE NON-AMBULATORY. HOSPICE WAIVER FOR TWO(2) RESIDENTS WITH APPROVED OPTIONAL TOTAL CARE PLAN" LPA will return at a later date to address deficiencies, if any, to the facility after the "total care plan" is reviewed in facility's plan of operation located at the Regional Office. No deficiencies cited on todays visit.the state’s words, verbatim · CDSS document, May 12, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst LPA Shawna Doucette conducted an Annual Inspection on this date. LPA was met by Staff Dena Jones and discussed the purpose of the visit. Administrator Stephanie Haro responded to the facility to assist with the inspection. LPA and Administrator began the tour at the front entrance/office of the facility. Visitor log-in/temperature check, masks, and disinfection station was observed upon entry. Facility has one entrance/exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas. LPA observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies were observed behind a locked door in garage and a locked cabinet in the laundry room. LPA observed the following personal protective equipment in a storage cabinet in laundry room; gowns, face shield, gloves, and masks. Staff records were reviewed for infection control training. Resident’s files have updated emergency contact information. No deficiencies were observed. Exit interview was conducted and a copy of this report was providedthe state’s words, verbatim · CDSS document, Apr 23, 2022

Type of visit: Case Management - Health Checks

On 02/25/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a Health & Safety check on residents is care. LPA was greeted by Staff S1, stated the purpose of the and was allowed entry into the facility. LPA toured the facility and observed a 5 bedroom, 3 bathroom house. LPA observed 3 out of 3 residents in care. Resident R1 and Resident R2 were watching TV in the living room, accompanied by family members. Resident R3, was in the living room with visiting with family. Facility has hospice waiver for two. 2 out of 3 residents are receiving Hospice Care, LPA observed hospice care plans on file for R1 and R2. LPA reviewed resident files with current LIC 602 physician's report. Fire extinguishers dated 08/26/21 and operating smoke detectors were observed. Current Emergency Disaster plan is posted along with other require posting. The Administrator on file recently retired leaving no Administrator on record at this time. Stephanie Haro, Administrator certificate #6049449740 is completing the paperwork process to become the Administrator. This poses a potential risk to resident's in care. Staff S1 is fingerprint cleared, however, S1 is not associated to the facility. This poses an immediate risk to residents in care. (continued on 809-C) (continued from 809) Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 809-D. Executive Secretary to Licensee has given verbal authorization for S1 to sign the report. Exit interview conducted and plan of correction was developed. Appeal rights and copy of the report were given at the time of visit.the state’s words, verbatim · CDSS document, Feb 25, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e) · Plan of correction due date: Feb 28, 2022

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by LPA's records review of the current facility roster. S1 is not associated to the facility. * Civil Penalty is being assessed.*the state’s words, verbatim · CDSS document, Feb 25, 2022

Plan of correction: Licensee will complete the LIC 9182 to associate Staff S1 by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Mar 25, 2022

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.the state’s words, verbatim · CDSS document, Feb 25, 2022

Plan of correction: Plan of Correction POC Licensee agrees to find an Administrator submit appropriate documentation to associate the Administrator to the facility by POC due date 3/25/22.