Anaverdes Villa

Type of visit: Required - 1 Year

LPA Spaeth conducted an unannounced visit and was greeted by the Administrator. LPA stated the purpose of the facility was to conduct an annual inspection. Staff confirmed there are four residents living at the facility. The facility is licensed for six non-ambulatory residents; three of which can be bedridden. The facility has been approved for six hospice residents. LPA and Administrator toured the facility at 12:00 pm until 12:30 pm. Common Areas – LPA observed the living room contained comfortable seating along with a television. The dining room area contained a dining room table and chairs. Kitchen – LPA observed the kitchen was neat and clean. The knives were securely locked in a kitchen cabinet. The facility contained a two day supply of perishable food and a seven day supply of non-perishable food items. LPA tested the water temperature at 11:25 am, which was 105 degrees F. A fire extinguisher is also located in the kitchen. The resident medications along with the first aid kit were locked in a kitchen cabinet. Resident Bedrooms - There are five bedrooms in the home which are furnished with a bed, linens, night stand, chest of drawers and a closet. Hallway Closets – LPA observed two hallway closets. Closet #1 is used for linens. Closet #2 was locked and contained hygiene, cleaning solutions and PPE supplies. Bathrooms - LPA observed the two bathrooms contained hand soap, paper towels, grab bars, and slip resistant mat. Laundry Room – LPA observed the room was locked and contained washer, dryer and laundry detergent. Smoke/Carbon Monoxide Detectors – The detectors were tested at 11:30 am and were operable. Backyard - LPA observed the backyard which has a shaded area with seating. Garage - LPA observed the garage was locked. There were no safety issues to report. Delayed Egress Devices - LPA observed delayed egress devices on all exit doors and all devices were properly working. LPA reviewed client records at 12:30 pm until 1:00 pm. LPA reviewed staff records at 1:00 pm until 1:30 pm. LPA reviewed the residents’ medications at 1:45 pm until 2:15 pm.. There are no deficiencies to report. Exit interview was conducted, appeal rights discussed, and a copy of the signed report was given to the Administrator.the state’s words, verbatim · CDSS document, Sep 5, 2023

Type of visit: Case Management - Other

LPA Spaeth conducted an unannounced visit and was greeted by two caregivers. LPA observed both caregivers were wearing masks. LPA explained the purpose of the visit is to tour the facility and ensure there are no safety issues. LPA conducted a tour of the facility with caregiver from 10:00 am until 10:15 am. LPA observed all cleaning supplies, medications, and knives were safely locked in the facility. The facility had a seven day supply of non perishable food and a two day supply of perishable food. At 10:10 am, LPA and Caregiver walked into Resident Room One and LPA observed the door leading outside from Room One contained a portable door locking mechanism. The caregiver stated there is no resident living in the room and the lock mechanism is to ensure the door does not blow open when there is a windy day. LPA stated any door leading outside cannot contain the locking mechanism. The Administrator arrived to the facility at 10:15 am. Pursuant to Title 22 Division 6 of the CA Code of Regulations, a deficiency is cited (refer to LIC 809-D). and a civil penalty issued (See LIC 421FC). Exit interview conducted, Appeal Rights discussed, and a copy of the report was given to the Administrthe state’s words, verbatim · CDSS document, Mar 8, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: Mar 8, 2023

87307 Personal Accomodations & Services (d)The following space and safety provisions shall apply to all facilities. (6) All outdoor & indoor passageways...shall be kept free of obstruction. This requirement was not met as evidenced by: Based on LPA's observation of the portable lock used in Room One to the door that leads out of the facility, staff did not comply with the section cited above which poses a potential health, safety & personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 8, 2023

Plan of correction: LPA observed Caregiver removed the lock. LPA discussed with Caregivers and Administrator that the lock mechanism cannot be used on any exit door.

Allegation investigated: Staff are using an inappropriate locking tool for the residents Staff are blocking doorways to prevent residents from leaving

LPA Spaeth conducted an unannounced visit and was greeted by two caregivers and a resident using a walker. LPA observed both caregivers were wearing masks. LPA’s temperature was taken and recorded. LPA observed the sign in station which contained masks, sign in sheet, thermometer and hand sanitizer. Upon entering the facility, the Caregiver asked LPA to enter the facility and Caregiver closed the front door. The Caregiver asked LPA to wait at the front door and Caregiver escorted the resident to the living room. LPA observed a portable door locking mechanism that was attached to the front door. LPA asked Caregivers what was the purpose of the portable door lock. Both caregivers stated used to make sure the door stays locked so that the resident (R1) does not open the door and leave the facility. The Administrator arrived at 10:30 am and greeted LPA. LPA stated the purpose of the visit was to investigate a complaint which states: staff are using an inappropriate locking tool for the residents; and staff are blocking Substantiated doorways to prevent residents from leaving. LPA and Administrator conducted a tour of the facility at 10:30 until 10:45 am. The facility contained a seven-day supply of non-perishable food items and a two day supply of perishable food. The knives, resident medications, and cleaning solutions were securely locked within the facility. LPA did not observe any other safety issues. LPA reviewed residents’ records and staff records at 11:00 am until 1130 am. LPA did not observe any issues with the records. LPA interviewed the Administrator and staff from 11:30 until 11:45 am. LPA interviewed two residents at 11:45 am until 12:00 noon. During interviews, staff and administrator stated that wheelchairs were previously used to deter residents from leaving the facility; however, LPA was informed this practice was no longer used. Since LPA observed the portable door lock and the two caregivers and the Administrator stated the portable door lock was used to deter residents from exiting the facility, the allegations are substantiated. Pursuant to Title 22 Division 6 of the CA Code of Regulations, a deficiency is cited (refer to LIC 9099-D). Exit interview conducted, Appeal Rights discussed, and a copy of the report was issues to Administratorthe state’s words, verbatim · CDSS document, Feb 1, 2023 · control 31-AS-20230126162552

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(d)(6) · Plan of correction due date: Feb 8, 2023

87307 Personal Accomodations & Services (d)The following space and safety provisions shall apply to all facilities. (6) All outdoor & indoor passageways...shall be kept free of obstruction. This requirement was not met as evidenced by: Based on LPA's observation of the portable lock & staff/administrator interviews stating wheelchairs were previously used to block the entrance & the portable lock currently used, staff did not comply with the section cited above which poses a potential health, safety & personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 1, 2023

Plan of correction: Administrator will conduct training with staff regarding care of dementia residents. Administrator will provide training content and staff sign in sheet upon completion of the training.

Allegation investigated: Facility staff are not wearing masks.

LPA Spaeth conducted an unannounced visit and was greeted by staff member at the front door. LPA stated the purpose of the visit was to conduct an investigation regarding the allegation, Facility staff are not wearing masks. LPA obsered two caregivers who were assisting residents with breakfast and both were wearing a mask. The Administrator arrived at 8:20 am and LPA observed Administrator was not wearing a mask. LPA advised Administrator to wear a mask and discussed the facility's infection control plan states all staff must wear a mask when entering the facility. The allegation therefore is substantiated. Pursuant to Title 22 Division 6 of the CA Code of Regulations, a deficiency is cited (refer to LIC 9099-D). Exit interview conducted, Appeal Rights discussed, and a copy of the report was issues to Administrator. Substantiatedthe state’s words, verbatim · CDSS document, Sep 23, 2022 · control 31-AS-20220919172357

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Sep 28, 2022

87468.1 Personal Rights of Residents in All Facilities(a)...(2) To be accorded safe, healthful... accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on observations made during the 9/19/2022 complaint investigation visit the staff did not comply with the section cited above by not wearing face mask/covering while working in the facility which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 23, 2022

Plan of correction: Licensee/Administrator will review facility's infection control plan and will send a signed document with staff members' signature stating staff reviewed infection control plan with Administrator.

Type of visit: Required - 1 Year

LPA Spaeth conducted an unannounced visit and was greeted by caregiver. LPA stated the purpose of the visit was to conduct an annual inspection. LPA observed two caregivers were wearing masks. LPA's temperature was taken. LPA signed in at the sign in station and answered the COVID questions. Caregivers confirmed there are four residents LPA conducted the tour with Administrator. LPA observed the kitchen/dining room/family room are combined. LPA observed comfortable seating was located in the family room and the dining room contained chairs and table. LPA observed the knives and medications are locked in a kitchen cabinet. The cleaning supplies were securely locked underneath the kitchen sink. LPA observed paper towels, trash can, and hand soap were located in the kitchen. LPA observed a 90-day supply of PPE in a kitchen cabinet. The facility also contained three-day supply of fresh vegetables and fruits, frozen meats, and a seven-day supply of canned goods, pasta, and snacks. LPA observed the facility was neat and clean. LPA observed two residents eating breakfast and a resident participating in a you tube exercise class. LPA observed the residents rooms which all contained bed, linens, chest of drawers, night stand and lamp. The bathrooms contained wash your hands sign, hand soap, paper towels, and trash can. The backyard contained comfortable seating and the gate leading to the front yard was not locked. The hallway closet was locked and contained resident hygiene items. Another hallway closet contained clean linens. LPA observed the staff room which was not locked. LPA was granted permission to enter the room and observed staff member's medication was not securely locked in the room. LPA stated staff room should be locked at all times. Pursuant to Title 22 Division 6 of the CA Code of Regulations, a deficiency is cited (refer to LIC 809-D). Exit interview conducted, Appeal Rights discussed, and a copy of the report was given to the Administrator.the state’s words, verbatim · CDSS document, Sep 23, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Sep 23, 2022

87468.1 Personal Rights of Residents in All Facilities(a)...(2) To be accorded safe, healthful... accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on LPA's observation of the staff room, staff 's personal medication was not securely locked which poses a potential health safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 23, 2022

Type of visit: Required - 1 Year

At 12:00 pm Licensing Program Analysts (LPAs) Angela Panushkina, Shira Staps and Licensing Program Manager (LPM) Nichelle Gillyard conducted an unannounced annual inspection at the facility mentioned above. Team was greeted by staff who granted access to the facility. LPA team met with Administrator Erwin Estrella and a physical tour was conducted at 1:05pm and team observed the following: Infection control: LPA reviewed the facility mitigation plan (approved on 02/14/2021) to make sure licensee was following current infection control recommendations. Upon arrival, staff took LPAs temperatures and was asked to sign-in the visitors’ log and were asked all infection control questions. Proper signage was observed inside along the hallway and in the restrooms. Hand sanitizer was also observed. Administrator stated they have sufficient PPE supplies for residents and staff. Team observed all trash can throughout the facility have fitted lids and protected from cross contamination. Kitchen: At approximately, 1:10pm LPA team toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. Food storage and preparation areas are clean and inaccessible to pests. All knives and sharp objects are locked and inaccessible to residents in care. During inspection, LPAs reminded the Administrator that the locking magnets shall maintain with the staff at all time. At 1:15pm LPAs observed the burner in the middle and right side is not functional on the stove. LPA team reminded the Administrator to clean it and make it functional. Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 1:50pm they were tested and observed to be operational Continue on LIC809-C Resident rooms: All residents bedrooms were properly furnished, had sufficient lighting and appeared to be clean and had appropriate bedding. Bathrooms: The hot water temperature measured within regulation, at 112°F. LPA observed appropriate hand washing signs posted in each bathroom, grab bars and non-skid mat. Laundry service: At approximately 1:45pm, LPA team toured through the laundry area and observed cleaning products/chemicals inaccessible to residents. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents Medications are centrally stored and locked in the kitchen cabinet and inaccessible to residents in care. Outside areas: At approximately, 1:30pm LPAs toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents There are no bodies of water Administrative: LPA collected Certificate of Liability Insurance, Administrator Certificate and LIC.500. Annual fees are current. Two staff on duty were hired today and had not been fingerprint cleared and/or associated with the facility. Deficiencies issued per Title 22. Appeal rights issued. Exit interview.the state’s words, verbatim · CDSS document, Sep 16, 2021