Ridgeview Home Care Center

Allegation investigated: Resident sustained multiple pressure injuries while in care.

Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to investigate the above allegation. LPA met with the administrator, Mary Princess F. Manicdao, and explained the reason for the visit. --- Resident sustained multiple pressure injuries while in care. It was alleged that, due to neglect, Resident #1 (R1) sustained pressure injuries which appear severe. To investigate the allegation, on 11/29/2022, LPA requested documents at 11:30am and interviewed two (02) staff from 11:45am - 01:00pm. Record reviews from Home Health indicate that R1 has multiple stage three (03), stage four (04) and unstageable pressure injuries/wounds. (Cont. on LIC 9099-C) Substantiated During interviews, Staff #1 (S1) and Staff #2 (S2) stated that R1 was admitted with multiple wounds and admitted that, while in care, R1 developed an unstageable wound on the left hip that became dark and dry on the surface with a malodorous discharge. Based on record reviews and interviews, the allegation is substantiated at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D): Immediate $500.00 penalty was issued due to the neglect of R1's medical care which resulted in an immediate health and safety hazard to the resident. No health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 31, 2023 · control 31-AS-20221128163727

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Feb 1, 2023

Prohibited Health Conditions - (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by; Based on record reviews & interviews, R1 was admitted with stage 3 & 4 pressure injuries and developed unstageable wounds while in care which poses an immediate health and safety risk to residents in care. An immediate penalty of $500 shall be assessed as a result of the severe injury to R1.the state’s words, verbatim · CDSS document, Jan 31, 2023

Plan of correction: Licensee shall submit a written plan describing how the facility shall prevent injuries to residents as a result of any deficiencies incurred by the facility. Licensee shall submit to CCL no later than 02/01/2023. An immediate penalty of $500 shall be assessed as a result of the severe injury to R1.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(d) · Plan of correction due date: Feb 1, 2023

Basic Services. (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs…., either directly or through outside resources. This requirement is not met as evidenced by. Licensee did not ensure to provide required medical care to R1 requiring a higher level of care which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 31, 2023

Plan of correction: By the POC due date, the Licensee shall submit a written plan describing how the facility shall prevent admitting and/or retaining the residents with prohibited health condition. Licensee shall submit to CCL no later than 02/01/2023.

Type of visit: Required - 1 Year

A Required One (1) year - Infection Control visit was conducted today by Licensing Program Analyst (LPA) Gary Tan. LPA met with Co-Administrator Mary Lou Miranda. Purpose of visit was stated. LPA observed that all five (5) residents were at the facility during visit. A tour of the physical plant was conducted at 9:25 AM and the following were noted: The main door is the only entrance being utilized for entry. There is a sign on the door that everyone entering at the facility must wear mask and must be screened. Screening area is located around 10' upon entrance. Sign in sheet, hand sanitizer, gloves and masks are available. LPA was screened by the staff upon entry. All staff were observed to be wearing mask. There is a hand sanitizer all over the facility The facility had submitted and approved Mitigation plan. Signs to wear a mask and other Covid 19 prevention protocol signs were posted on the walls. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility. All trash cans were observed to be with cover. The facility has a designated visitors' area at the backyard. The facility has sufficient stock of PPE in the storage room. The facility has six (6) bedrooms and four (4) bathrooms currently occupying six (6) residents on one (1) shared bedrooms and four (4) private rooms. One (1) bedroom designated for staff use. The facility is fire cleared for six (6) bedridden residents and approved hospice waiver for two (2) residents. (continued on LIC 809-C) Physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, the following was noted: Living and dining room furniture were also checked. The living room is neat and clean along with the family room. The facility maintains a comfortable temperature at 78°F. Dual smoke and carbon monoxide are hardwired and inter connected and observed to be operational. The fire extinguisher was last inspected on 07/07/22. The facility is equipped with sprinkler system. The backyard of the facility has outdoor furniture, with a covered shaded area for clients. The front and backyard passageways were clear of any obstruction. There is no body of water in the facility. The garage detached to the home and was converted to staff quarter, storage for frozen food and laundry area. Food Service/Kitchen area was sufficiently stocked with two (2) days perishable and seven (7) days non-perishable food. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Cleaning supplies including detergents and pesticides and other toxins are stored in the converted garage. Dishwashing liquid, knives and sharps are kept at the cabinet below the kitchen sink and was locked and inaccessible to residents. Knives and sharps are observed to be kept in a locked drawer. The Clients' rooms are adequately furnished with appropriate furniture and lighting system. Clients have sufficient amounts of personal hygiene product which is provided by the licensee. Staff Rooms: Staff room was locked. No medications are observed in the staff room. The bathrooms were checked for cleanliness and proper operation. LPA observed the appropriate grab bars for each toilet, bathtub and shower. The hot water temperature measured at a range of 105.8°F to 113.5°F. Towels and washcloths are not shared. There is enough clean linen available in stock at the linen cabinet. Medications: LPA observed medication in the kitchen cabinet to be locked and inaccessible to residents. First aid kit is observed to be with complete tools and supplies. Exit interview conducted and copy of this report issued.the state’s words, verbatim · CDSS document, Sep 2, 2022

Type of visit: Prelicensing

At 10:01 a.m., Licensing Program Analysts (LPA) Melissa Ruiz, Angela Panushkina and LaQueena Lacy conducted an announced Pre-Licensing visit to this facility and met with applicant Mary Manicdao. This is a change of ownership application from (LIC 197608809) to (LIC 197610174). The applicant is "Ridgeview Home Care Center". LPA conducted an entrance interview with the Administrator. At the time of this visit LPAs observed and assessed four (04) residents present in the facility. All residents appear to be clean and groomed. Fire Clearance dated 05/20/2021 was received for six (6) bedridden residents. The purpose of today’s visit is to inspect the facility to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. The facility is a single-story building. Today's site visit consisted of LPAs touring the physical plant inside and outside and observed the following: The facility has a total of six (6) bedrooms, five (5) of which are designated for resident use and one (1) bedroom is designated for staff use. Resident bedrooms were observed to be appropriately furnished. There are three and a half (3.5) bathrooms in the facility and all were observed to have non-skid mats and appropriate grab bars installed. The common areas (living room, kitchen and dining areas) were appropriately furnished and lighting was adequate. The living room has a television and comfortable furniture. Resident and staff records will be stored in a locked cabinet near the entrance area. The fire extinguisher is located in the kitchen and was observed to be fully charged and was serviced on 05/24/2021. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 10:35 a.m. they were tested and observed to be operational. At 10:45 a.m. the hot water was tested in the common bathrooms and measured between 114.3-118.3°F. There is a functioning telephone on the premises. An emergency exit plan/sketch is posted by the entrance wall with other posting requirements. Medications are stored in a locked cabinet in the kitchen area. The first aid kit is readily available. (CONT. ON LIC 809-D) (CONT. FROM LIC 809) Facility appears to be clean, in good repair and kept at a comfortable temperature of 78°F. Appliances in the kitchen appeared to be functional. The necessary precautions have been made to the facility to safely house dementia residents such as auditory alarms on all doors. There is a shaded sitting area in the backyard for residents to conduct outdoor activities. The backyard is fenced. The detached garage is located behind the house and is kept locked. The garage is currently being used as a laundry area, perishable and non-perishable food storage, PPE storage and staff office/break room. Component III was conducted with the administrator. Facility is in compliance with Title 22 Regulations at this time. This report will be forwarded to the Centralized Application Bureau (CAB) and be notified by the CAB Analyst when your license has been approved. Exit interview was conducted with Licensee Representative Mary Manicdao and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 13, 2021