Escueta Care Home 3

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual required inspection that was started on May 10, 2023. LPA met with staff, Joana Tiglao and Soledad Escueta, assistant administrator. LPA informed the reason for visit. Milanette Escueta, administrator, arrived after several hours. LPA reviewed 4 resident and 5 staff files, and interviewed 2 residents and 2 staff. On this same day, LPA received copies of current administrator certificate of the following: Milanette Escueta and Soledad Escueta LPA observed the following: -staff (S2 and S4) have not completed the required 20 hours annual training for 2022. -staff (S2) and S4) administer medications to residents but only have 2 hours medications training on file for 2022. -staff (S2) and S4) do not have the required 8 hours annual dementia training and required 4 hours annual training of which shall be specific to postural supports, restricted health conditions, and hospice for 2022. -at 4:30 pm, residents' (R1, R2 & R4) reappraisal not current. -at 5:15 pm, residents (R1, R2, R3, R4) do have doctor's order of medications on file. ......continued on 809C Deficiencies are cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of corrections (POCs) by plan of correction due dates, and any repeat violations within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, May 17, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(e) · Plan of correction due date: May 18, 2023

87465 Incidental Medical and Dental Care: (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file.,.... -This is not met as evidenced by: -Based on records review, the licensee did not comply with the section above for 4 out of 4 residents not having doctor's orders on file which pose immediate health risks to persons in care.the state’s words, verbatim · CDSS document, May 17, 2023

Plan of correction: Administrator to obtain copies of doctor's order and submit copies by 5/18/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: May 31, 2023

87463 Reappraisals: (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition..... -This is not met as evidenced by: -Based on records review, the licensee did not comply with the section above for 3 out of 4 residents not having a current re-appraisal on file which pose potential health and personal right risks to persons in care.the state’s words, verbatim · CDSS document, May 17, 2023

Plan of correction: Administrator to do the reappraisals, and submit a self-certification by 5/31/23 indicating it's completed.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.625(2) · Plan of correction due date: May 31, 2023

§1569.625 Staff training; legislative findings; contents (2).... training requirements shall also include an additional 20 hours annually, 8 hours of which shall be dementia care training, ... and four hours of which shall be specific to postural supports, restricted health conditions, and hospice -This is not met as evidenced by: -Based on records review, the licensee did not comply with the section above for 2 out of 5 staff with incomplete required annual training on file which poses potential safety and personal right risks to persons in care.the state’s words, verbatim · CDSS document, May 17, 2023

Plan of correction: Administrator to have the staff complete the required training and submit proof by 5/31/23.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69(b) · Plan of correction due date: May 31, 2023

§1569.69 Employees assisting residents with self-administration of medication; training requirements: (b) Each employee .... who continues to assist with the self-administration of medicines, shall also complete four hours of in-service training on medication-related issues in each..... .....succeeding 12-month period. -This is not met as evidenced by: -Based on records review, the licensee did not comply with the section above for 2 staff not having the total required number of annnual medication training on file.the state’s words, verbatim · CDSS document, May 17, 2023

Plan of correction: Administrator to have the staff complete the training and submit proof by 5/31/23.

Type of visit: Required - 1 Year

On this day, May 10, 2023, at 4:30 p.m., Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with staff, Joana Tiglao and Edwin Villarin. LPA called and spoke over the phone with Milanette Escueta, administrator. The administrator authorized Joana Tiglao to be with LPA during inspection, and to sign and receive this report. Facility has an approved LIC808 Mitigation Plan but has not submitted the current/updated LIC9282 Infection Control Plan. LPA inspected the facility inside and out including but not limited to living room. bedrooms, bathrooms, kitchen, dining area, garage, front, side and backyard. Facility has sufficient perishable and non-perishable foods. Fire extinguisher was observed fully charge with tag showed serviced March 15, 2023. Facility has carbon monoxide and smoke detectors that were tested, and observed functional. Hot water temperature in the common bathroom was tested, and measured at 109.1 degrees Fahrenheit. Facility conducts disaster drills, and records showed last conducted March 31, 2023. First aid kit inspected, and observed complete with manual. LPA observed the following: -at 4:59 m. collapsed boxes, toilet, mattress and bed frame in the backyard -at 5:00 pm. side fence leaning towards neighbor's side -at 5:30 pm, records showed Edwin Villarin fingerprinted and cleared but not associated to this facility. ......continued on 809C Administrator to submit the following current/updated documents by May 24, 2023: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. LIC9282 Infection Control Plan 5. Proof of $3M liability insurance. Due to time constraint, LPA will come back to continue inspection and review files. Deficiencies are cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of corrections (POCs) by plan of correction due dates, and any repeat violations within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with Joana Tiglao. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, May 10, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 24, 2023

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. -This requirement is not met as evidenced: -LPA observed the following: collapsed boxes, toilet, mattress and bed frame in the backyard; side fence leaning. These pose potential safety risks to persons in care.the state’s words, verbatim · CDSS document, May 10, 2023

Plan of correction: Administrator to do the following and submit pictures by 5/24/23: 1. Have the yard cleaned 2. Have the fence repaired/fixed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87355(e) · Plan of correction due date: May 24, 2023

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review.. 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 is not met as evidenced: -Based on record review,, the licensee did not comply with the section above for a staff not associated to this facility which poses potential safety risk to persons in care.the state’s words, verbatim · CDSS document, May 10, 2023

Plan of correction: Administrator to have the staff associated by 5/24/23.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Delmundo conducted an unannounced infection control annual inspection. LPA was granted entry by staff, Ernesto Cochico. LPA met with Soledad Escueta, assistant administrator, and informed the purpose of visit. LPA also met with other staff, Joana Tiglao. Facility has LIC808 Mitigation Plan on file. LPA toured the facility inside out with Soledad Escueta. LPA inspected the living room, dining area, kitchen, bathrooms, bedrooms, side and backyard. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. LPA observed screening station by the front entrance with hand sanitizer, surgical masks and no touch temperature probe. Visitor's temperature and symptom checks are done at entry and recorded. Residents and staff are screened for COVID-19 symptoms and temperature checked daily and recorded. Supplies of PPEs checked and observed adequate for 30 days for staff. All trash bins were observed with foot operated pedal lids. Antigen test kits are readily available. COVID-19 signages were posted in prominent areas in the facility. Fire extinguisher checked and observed fully charge with tag showed serviced March 31, 2022. First aid kit was observed complete with manual. Hot water temperature in one of the bathrooms tested and measured at 106.5 degrees Fahrenheit. Carbon monoxide and smoke detectors were operational. At 5:03 pm, LPA observed staff's medications and supplements stored in unlocked closet close to the dining area. .....continued on 809C Administrator to submit updated copies of the following documents by May 25, 2022: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. Proof of $3M liability insurance Deficiency is cited per Title 22 California Code of Regulations on LIC809D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with Soledad Escueta. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction copy of this report provided.the state’s words, verbatim · CDSS document, May 11, 2022

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.