Eden Assisted Living

Type of visit: Required - 1 Year

On 10/30/23 at 9:30 AM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced required one year inspection and met with Administrator (ADM) Samuel Tet and explained the purpose of the visit. LPA observed two (2) males and (2) female in bed and one (1) female watching TV in the living room during the visit. LPA inspected the facility inside and outside. Pathways were observed to be free of obstruction and fire hazards. The facility's fire clearance was approved for 4 non-ambulatory and two (2) bedridden residents which includes Hospice Waiver for two (2) residents. A written Emergency/Disaster plan dated 10/10/23 was posted on a bulletin board next to the dining area near a lane line phone. Centrally stored medications were locked in a plastic container above the wall next to the kitchen. Sharp objects were locked in the kitchen drawer next to the sink. Toxic chemicals were locked in the laundry area. There was at least 7 days of nonperishable and 2 days of perishable foods. Facility room temperature was maintained at 71 degrees Fahrenheit. Hot water temperature was measured at 112.8 degrees Fahrenheit in the resident's bathroom. Resident's bathrooms have grab bars inside the shower and next to the shower. The facility has trained staff in Dementia Care, Medication, and Basic Training. Last Fire drill was conducted on 10/10/23. Fire extinguisher was fully charged and last inspected on 03/23/23. Smoke and Carbon monoxide detectors were operational. LPA reviewed two staff and 2 resident files. Staff had criminal record clearances to work and are associated to the facility. Residents records all contain Admission Agreements, Physicians' reports, Consent forms, Personal rights, medical assessments, Needs and Services plans/Appraisals. The facility serves residents with Dementia. The facility has potentially dangerous objects locked and inaccessible to residents in care. Report continue on LIC 809C... Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/6/2022: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Oct 30, 2023

Allegation investigated: Facility staff failed to accord dignity to resident in care Facility staff pulled resident's hair

On 10/12/2022 starting at 10:45 am, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Samuel Tet, administrator and explained the purpose of the visit. During the course of investigation, LPA obtained information, collected documents; staff roster, resident roster, R1’s physicians report, R1’s ISP and interviewed staff and witnesses. Based on all information obtained, the allegation is UNSUBSTANTIATED. An unsubstantiated finding means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview conducted and a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 12, 2022 · control 15-AS-20201021093831

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 6/22/2022 at 11:45am, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct Infection Control Inspection. LPA met with Administrator, TET, SAMUEL and explained the purpose of the visit. During the Infection Control Inspection, LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing poster were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for residents and staff. During record review, LPAs reviewed a sample of 2 staff records and observed 2 of 2 have health screening with TB test on file. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 06/30/2022: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 22, 2022

Type of visit: Required - 1 Year

On 10/29/2021 at 1:20pm, Licensing Program Analysts (LPAs) L. Francisco and G. Clark arrived unannounced to conduct Infection Control Inspection. LPAs met with Administrator, Samuel Tet and explained the purpose of the visit. During the Infection Control Inspection, LPAs toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan. The following deficiency was observed: - At approximately 1:40pm LPAs observed hydrogen peroxide in residents bedroom. - At approximately 1:42pm LPAs observed unlocked cleaning supplies in common bathroom. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency by POC date may result in additional Civil Penalties. Administrator left for an appointment and authorized Care Staff Nadine Gabbidon to sign. Exit interview conducted with Care Staff. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 29, 2021