Sara's Home Away From Home

Type of visit: Required - 1 Year

At 12:45pm Licensing Program Analyst (LPA), Angela Panushkina, conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by Staff #1 (S1), who granted access to the facility. Administrator was contacted over the phone and LPA explained the reason for the visit. At 1:00pm, LPA conducted a tour of the facility and the following was observed: Infection control: LPA reviewed the facility mitigation plan (approved on 04/15/2021) to make sure licensee was following current infection control recommendations. Upon arrival, LPA was screened and asked to sign-in the visitors’ log. In addition, LPA was asked all infection control questions. Proper signage was observed inside along the hallway and in the restrooms. Hand sanitizer was also observed. S1 stated they have sufficient PPE supplies for residents and staff. LPA observed all trash can throughout the facility have fitted lids. Kitchen: At approximately, 1:00pm LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. At approximately, 1:05pm LPA observed medications are centrally stored and locked in the kitchen cabinet and inaccessible to residents in care. Bedrooms: There are four (4) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. Bathrooms: At 1:20pm LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. The hot water temperature measured at 120°F. Continue on LIC809-C LPA observed appropriate grab bar and non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. Common Areas: The facility maintains a comfortable temperature at 73°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Facility has two (2) fire extinguishers; one (1) in the kitchen and one in the living room. Both fire extinguishers were last serviced on 03/17/21. Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 1:25pm they were tested and observed to be operational Outside areas: At approximately, 1:30pm LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. The garage: Laundry area is located in an attached garage and kept locked and inaccessible to residents. Extra PPE supplies and food storage was also observed. Administrative: LPA collected Certificate of Liability Insurance and LIC.500. No citations issued during this visit. Exit interview conducted. Copy of report emailed to Licensee.the state’s words, verbatim · CDSS document, Mar 15, 2022

Allegation investigated: Staff are not wearing PPE Staff are not allowing visitors in the facility

At 2:57pm Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent complaint visit to deliver the finings for the above stated allegations. LPA met with staff - Dulce Catajay, and explained the reason for the visit. Upon arrival, LPA was screened and asked to sign-in the visitors’ log. In addition, LPA was asked all infection control questions. LPA conducted a physical walk through, at approximately, 3:05pm to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit. An initial 10-day complaint visit conducted on 11/09/2021. During that visit LPA Panushkina conducted interviews (between 10:25amd to 12:00pm) with the Administrator, 2 out of 2 staff, 3 out of 3 residents and reviewed facility records which include: Facility Visitor's Log, Physician Report and Appraisal Needs and Services for R3 the same day, at approximately 10:45am. Continue on LIC9099-C Unsubstantiated Allegation: Staff are not wearing PPE. Interviews with an Administrator and 2 out of 2 staff indicated that staff always wears their mask, with an exception, when R3 is being assisted by a staff, staff usually don’t wear the mask because R3 is afraid of the mask and gets agitated. Interviews with 2 out of 3 residents, who were able to communicate, also indicated that staff always wearing mask. During today’s visit, LPA observed staff member wearing their face mask and following facility Mitigation Plan (RE: COVID). Allegation: Staff are not allowing visitors in the facility. Interviews with an Administrator and 2 out of 2 staff indicated that aside from requiring proof of vaccination the facility allows visitations with no other restrictions. Interview with 1 out of 3 residents indicated that the facility always allows family to visit (at any time), but due to Government restrictions family doesn't visit as often as they used to. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that alleged violations did or did not occur, therefore the above two allegations are unsubstantiated. No deficiencies issued. Exit interview conducted, and a copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Dec 21, 2021 · control 31-AS-20211102115001

Allegation investigated: Staff is leaving residents unattended while in care

This is an amendment of the report issued on 09/30/21 to change the findings. Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to further investigate the above allegation. LPA met with staff Dulce Catajay and explained the reason for the visit. LPA conducted physical plant tour at 9:15 AM. Requested and reviewed facility documents relevant to the investigation at 9:45 AM and interviewed staff at 10:15 AM. Regarding the allegation that Staff is leaving residents unattended while in care, It was alleged that upon Credible Witness (CW)'s entrance at the facility on 06/07/21, no staff was present with the residents. LPA's interview with staff on 06/24/21 at 10:00 AM and today at 10:15 AM, revealed that S1 was at the garage when CW came but was coming in and out to periodically check the residents while Staff #2 (S2) was running an errand. (continued on LIC 9099-C) Substantiated (continued from LIC 9099-A) LPA's interview with S1 today at 11:00 AM, revealed that R1 was not wearing mask only because S1 was at the garage computer alone and looking for staff training. Further, R1 denied refusing to wear mask and was not able to take CW's temperature as the CW let self in into the house before S1 got into the house from the attached garage and found CW already talking to a resident. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at the this time. Exit interview conducted. Copy of this report issued. (continued from LIC 9099-C) LPA's interview with Staff #2 (S2) on 06/24/21 at 10:22 AM, also revealed that S2 ran a quick errand to buy some grocery for dinner and only took only about fifteen (15) to twenty (20) minutes because the grocery store is just nearby. Based on the information gathered during this and prior visit, the allegation is deemed substantiated at this time. Citation issued. Appeal rights discussed and given. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Nov 12, 2021 · control 31-AS-20210621155044

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87413(a)(1) · Plan of correction due date: Nov 15, 2021

When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement is not met as evidenced by: Based on CW's observation, there was not staff present nearby resident when CW arrived. Licensee did not ensure that there is a staff present when another staff left the facility. This poses a potential health and safety risk to the resident in carethe state’s words, verbatim · CDSS document, Nov 12, 2021

Plan of correction: Administrator agreed to submit a statement of understanding the regulation cited and ensure that there is adequate coverage when a staff is absent at the facility and submit to CCL on or before the POC date.