Alaminos Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced annual inspection visit at around 9:30 AM and met with Administrator Ruskie Ragasa. At the time of this visit LPA Duguma observed two (02) additional individuals working in the facility. LPA Duguma also observed and assessed four (04) residents present in the facility. All residents appear to be clean and well groomed. With the assistance of the Administrator, LPA conducted a facility tour of both the inside and outside. This is a single-story property. The facility is fire cleared for six (06) non-ambulatory of which one (01) maybe bedridden and has a hospice waiver for six (06). The facility has a total of five (05) bedrooms, of which four (04) are for residents and one (01) is for staff. The facility has two (02) bathrooms for both residents and staff. Residents’ bathroom has properly installed grab bars and shower has non-skid mats. Hot water temperature measured at 115.8ºF during the visit. All residents’ bedrooms were adequately furnished. The common areas were appropriately furnished. The LPA observed entertainment equipment and games for activities. The resident and staff records were stored in a file cabinet located near the dining area. The first-aid kit is complete. The linens were stored in the storage space located in the hallway. LPA observed a fireplace that was blocked with a screen. Smoke and Carbon Monoxide detectors were checked and function properly. There is one (01) fully charged fire extinguisher located in the kitchen area. Fire extinguisher was certified on 01/06/2023. LPA Duguma observed a washer and dryer in the garage. All chemicals, additional personal hygiene items were stored in a locked storage closet near the front entrance. (CONT on LIC 809-C) LPA inspected the kitchen and observed stove and refrigerator to be clean and working. Facility had sufficient quantity and variety of perishable and nonperishable food supply. Nonperishable food was stored in a pantry. The medications are stored in a locked cabinet located near the front entrance. Sharps are stored in a locked kitchen drawer. There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. The facility has a swimming pool/body of water which is gated and locked. No health and safety hazard were noted during this visit. Exit interview was conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Oct 18, 2023

Allegation investigated: Facility staff are not following proper COVID-19 mask guidance. Facility not properly securing medications. Facility cleaning supplies are accessible to residents in care.

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility. LPA met with the administrator, Ruskie Ragasa, and explained the reason for the visit. --- Facility staff are not following proper COVID-19 mask guidance. It was alleged that staff are not wearing masks while in the facility. To investigate this allegation, on 03/28/2023, LPA made observations during a physical plant tour at 9:30 AM and interviewed two (02) staff from 10:30 AM – 11:15 AM. Upon entry, LPA observed that all staff were not wearing masks. During the interviews, staff admitted to not following infection control protocols during a visit by other parties. Based on observations and interviews, the allegations are 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): (CONT. on LIC9099-C) Substantiated --- Facility not properly securing medications. It was alleged that staff are leaving medications unlocked and accessible to residents. To investigate this allegation, on 03/28/2023, LPA made observations during a physical plant tour at 9:30 AM and interviewed two (02) staff from 10:30 AM – 11:15 AM. During the physical plant tour, LPA observed that facility did not have medications in the refrigerator, however, staff left centrally stored medication unit unlocked with key hanging on the door. During interviews, staff admitted to leaving the medication unit unlocked during a visit by other parties. Based on observations and interviews, the allegations are 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): --- Facility cleaning supplies are accessible to residents in care. It was alleged that staff are storing toxins in an unlocked storage closet. To investigate this allegation, on 03/28/2023, LPA made observations during a physical plant tour at 9:30 AM and interviewed two (02) staff from 10:30 AM – 11:15 AM. During the physical plant tour, LPA observed that facility had cleaning supplies and other toxins in an unlocked storage closet. During interviews, staff stated that they were cleaning earlier today and planned to lock it. Staff also admitted that the storage closet containing toxic cleaning supplies was unlocked during a visit by other parties. Based on observations and interviews, the allegations are 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): No health and safety hazards noted during the visit. Exit interview was conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Mar 28, 2023 · control 31-AS-20230320165422

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Mar 29, 2023

87705 (f) Care of Persons with Dementia: The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on observation and interviews, the licensee failed to ensure that items were inaccessible to residents with dementia, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 28, 2023

Plan of correction: The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87705 Care of Persons with Dementia; The written letter must be sent to the LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(2) · Plan of correction due date: Mar 30, 2023

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on LPAs observation and interviews, the licensee did not ensure that medication was kept locked and inaccessible to residents in care which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 28, 2023

Plan of correction: The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87465 Incidental Medical and Dental Care; The written letter must be sent to the LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(c)(1)(F) · Plan of correction due date: Mar 30, 2023

87470(c) Infection Control Requirements shall be developed by the licensee... (1) The Infection Control Plan shall include: (F) Staff shall demonstrate knowledge... appropriate to the job assigned and as evidenced by safe and effective job performance. This requirement is not met as evidenced by; Based on observations and interviews, the licensee did not ensure that staff are wearing mask at all times while at the facility and that all visitors are screened upon entry which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 28, 2023

Plan of correction: The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87470 Infection Control Requirements; The written letter must be sent to the LPA by the POC due date.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Abeye Duguma conducted an announced Pre-licensing visit at 2:20 PM and met with Administrator Ruskie Ragasa. This is a change of ownership application from D’Elders “R” US (197606449) to Alaminos Home Inc (197610299). LPA conducted an entrance interview with the Administrator. At the time of this visit LPA Duguma observed three (03) additional individuals working in the facility. LPA Duguma also observed and assessed five (05) residents present in the facility. All residents appear to be clean and well groomed. With the assistance of the Administrator, LPA conducted a facility tour of both the inside and outside. The facility was inspected for Fire Safety, Personal Accommodations and Services, Medication Procedures and Food Service. This is a single-story property. The facility is fire cleared for six (06) non-ambulatory and a hospice waiver for one (01). The facility has a total of six (06) bedrooms, of which five (05) are for residents and one (01) is for staff. The facility has two (02) bathrooms for both residents and staff. Residents bathroom has properly installed grab bars and shower has non-skid mats. Hot water temperature measured at 118.3ºF during the visit. All residents’ bedrooms were adequately furnished. The common areas were appropriately furnished. The LPA observed entertainment equipment and games for activities. The resident and staff records were stored in a file cabinet located near the dining area. The first-aid kit is complete. The linens were stored in the storage space located in the hallway. LPA observed a fireplace that was blocked with a screen. The facility has working alarms on all exits. Smoke detectors and Carbon Monoxide detectors were checked and function properly. There is one (01) fully charged fire extinguisher located in the kitchen area. Fire extinguisher was certified on 01/07/2022. (cont. on 809-C) LPA Duguma observed a washer and dryer in the garage. All chemicals, additional personal hygiene items were stored in a locked storage closet near the front entrance. LPA inspected the kitchen and observed stove and refrigerator to be clean and working. Facility had sufficient quantity and variety of perishable and nonperishable food supply. Nonperishable food was stored in a pantry. The medications are stored in a locked cabinet located near the front entrance. Sharps are stored in a locked kitchen drawer. There is sufficient outdoor space with seating and a shaded area with proper furniture for outdoor use. The facility has a swimming pool/body of water which is gated and locked. At the time of this visit the physical plant is meeting Title 22 requirements. The Component III is waived as the Administrator attended a component III meeting on 06/28/2022. No health and safety hazard were noted during this visit. Exit interview was conducted and a copy of report was issued.the state’s words, verbatim · CDSS document, Jul 19, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Abeye Duguma conducted an announced Pre-licensing visit at 2:20 PM and met with Administrator Ruskie Ragasa. This is a change of ownership application from D’Elders “R” US (197606449) to Alaminos Home Inc (197610299). LPA conducted an entrance interview with the Administrator. At the time of this visit LPA Duguma observed three (03) additional individuals working in the facility. LPA Duguma also observed and assessed five (05) residents present in the facility. All residents appear to be clean and well groomed. With the assistance of the Administrator, LPA conducted a facility tour of both the inside and outside. The facility was inspected for Fire Safety, Personal Accommodations and Services, Medication Procedures and Food Service. This is a single-story property. The facility is fire cleared for six (06) non-ambulatory and a hospice waiver for one (01). The facility has a total of six (06) bedrooms, of which five (05) are for residents and one (01) is for staff. The facility has two (02) bathrooms for both residents and staff. Residents bathroom has properly installed grab bars and shower has non-skid mats. Hot water temperature measured at 118.3ºF during the visit. All residents’ bedrooms were adequately furnished. The common areas were appropriately furnished. The LPA observed entertainment equipment and games for activities. The resident and staff records were stored in a file cabinet located near the dining area. The first-aid kit is complete. The linens were stored in the storage space located in the hallway. LPA observed a fireplace that was blocked with a screen. The facility has working alarms on all exits. Smoke detectors and Carbon Monoxide detectors were checked and function properly. There is one (01) fully charged fire extinguisher located in the kitchen area. Fire extinguisher was certified on 01/07/2022. (cont. on 809-C)the state’s words, verbatim · CDSS document, Jul 18, 2022

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.