Ana's Elderly Care Home

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Annual/Random visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met with Licensee/Administrator Ana Ramos and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved Mitigation Plan Report and Infection Control Report. There is currently one (1), resident in placement. The facility's annual fees are current. The following Domains will be observed and reviewed: Infection Control, Operational Requirements, Physical Plant and Environmental Safety, Staffing, Personnel Records-Staff Training, Residents Records-Incident Reports, Resident Rights-Information, Planned Activities, Food Service, Incidental Medical and Dental, Disaster Preparedness, and Resident with Special Health Needs,. "LPA Bunker will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services facility inspections. The facility is a single-family home located in a residential neighborhood. Licensee/Administrator Ana Ramos and LPA Bunker toured the facility which consisted of the following: Living room, dining room, 2 kitchens, 5 bedrooms, 4 bathrooms, office area, laundry room, den/family room, shaded area, indoor/outdoor activity areas, and a detached garage. The front and back yard landscape is in good condition at the time of the visit. See continued LIC809-C on page 2 Continued LIC809-C page #2 During the tour, LPA observed the facility’s infection control practices. LPA observed sanitizer, visitor log, and thermometer at the facility entrance. Logs of daily COVID-19 screening and temperature checks of clients and staff were available and updated. PPE supplies are readily available to staff, and an additional supply of PPE was observed. Sufficient liquid soap, paper goods, cleaning, and disinfecting supplies were observed. LPA observed staff and residents wearing a face covering and social distancing. Documents were posted as mandated on the bulletin board wall in the living room. The following Title 22 regulated areas were audited and found to be in compliance: Bedrooms contain the required furniture. The client’s bedrooms were inspected for safety, privacy, and comfort. The living areas are clean, bathrooms are clean and operational. The first aid kit is fully stocked with a manual, the hot water temperature was measured at 115 degrees Fahrenheit, the telephones are working, smoke and carbon monoxide detectors were in compliance, fire extinguishers are fully charged, medications were centrally stored and properly locked in the kitchen file cabinet and records are current, ample supply of perishable and nonperishable food, adequate linen supply, fire/emergency drill conducted on July 26, 2023. No firearms on the premises, the client's bedroom windows had no sliding window lock with thumbscrew, all exit doors were in compliance, covered trash cans, and no bodies of water were present. Hazardous items are inaccessible to clients, the yard is free of debris and hazards. The Licensee/Administrator Ms. Ramos states staff was given training on dependent adult and elder abuse reporting. There were no deficiencies cited. LPA Bunker provided Licensee/Administrator Ms. Ramos with copies of the LIC809, LIC809-C, LIC858, and LIC859 documents. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 8, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced required 1- year visit with the primary focus on Infection Control measures and using the new CARE Inspection Tool. Upon arrival at the facility, LPA Bunker conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker was properly screened for COVID-19 symptoms and temperature was checked. LPA Bunker met with Licensee Ana Ramos and explained the purpose of today's Annual Inspection. LPA verified that the facility has an approved Mitigation Plan Report. There is currently one (1), resident in placement. The facility's annual fees are current. The following Domain will be observed and reviewed: Infection Control Practices "I will be using this tool and methods that have been developed to improve the efficiency and accuracy of the Department of Social Services' facility inspections." The facility is a single-family home located in a residential neighborhood. Licensee/Administrator Ana Ramos and LPA Bunker toured the facility which consisted of the following: Living room, dining room, 2 kitchens, 5 bedrooms, 4 bathrooms, office area, laundry room, den/family room, shaded area, indoor/outdoor activity areas, and a detached garage. The front and back yard landscape is in good condition at the time of the visit. See continued LIC809-C on page 2 Continued LIC809-C page 2 Documents are posted as mandated. Bedrooms contain the required furniture, Bathrooms are clean and operational. Personal accommodations were observed for safety, privacy, comfort, and non-skid surfaces mats. The kitchen was observed for the ability to prepare and serve food. The food service was reviewed for appropriate quantity and proper storage; there was an ample supply of perishable and nonperishable food. The resident’s medications were reviewed for proper storage, documentation, and system implementation. Medications are locked in the hallway closet, and records are current. Common areas were observed for the ability to safely serve the needs of the residents, including cleanliness, and clearness of any potential hazards to the residents. The first aid kit is fully stocked with manual, smoke, and carbon monoxide detectors were in compliance, hot water temperature measured at 111 degrees Fahrenheit within the normal limits (105-120F degrees), the fire extinguishers are fully charged, adequate linen supply, the facility telephones are working. The resident's bedroom windows have no sliding window lock with thumbscrews, all exit doors were in compliance, the yard was free of debris hazards, and trash cans were covered. Staff was given training on dependent adult and elder abuse reporting. The facility conducted a fire drill on 10/15/2021. There were no deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Apr 21, 2022

The state marks this report as 8 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Erik Brown conducted an unannounced visit to Ana's Elderly Care Home. The purpose of today’s visit was to conduct the annual inspection. LPA met with Administrator, Ana Ramos. Facility is licensed for 6 non-ambulatory residents and 1 bedridden resident. The facility has an approved hospice waiver for 1 resident. The facility currently has 1 ambulatory resident. 0 of the residents are diagnosed with Dementia or are receiving home health or hospice services. The facility does not handle any of the residents’ money. LPA Brown toured the physical plant and checked food service. The facility conducted a fire drill on December 3rd when the fire department came out and did an inspection. The home consists of 3 resident bedrooms, 2 staff bedrooms, 4 bathrooms, including 1 staff bathroom, living room, dining room, and two kitchens. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets worked properly, water faucets worked properly in 3 out of 4 bathrooms, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature properly measured between 105- and 120-degrees Fahrenheit. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. All doors have auditory alarms. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview conducted and a copy of this report was given to Administrator, Ana Ramos. No deficiencies cited during this visit. Advisor Note: Auditory alarms were not operable; however, facility does not have any residents with Dementia. Advised Administrator, Ana Ramos to repair auditory alarms. Advisory Note: Water pressure and sink drain not working properly. Advised Administrator Ana Ramos to have plumber come out and repair drain and faucet. Also advised Administrator, Ana Ramos to send over an invoice of the repairs. Advisor Note: Advised Administrator, Ana Ramos to remove alcoholic beverages from cabinet or place a lock on the door. Administrator chose to lock it up in storage room.the state’s words, verbatim · CDSS document, Jan 29, 2019

The state marks this report as 8 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Annual/Random

Licensing Program Analysts (LPAs) Christine Wong and Eva Alaverez conducted a facility visit for an annual Inspection. LPA met with administrator/licensee Ana Maria Ramos who assisted with this visit. The facility is licensed to serve Six (6) Non-Ambulatory (only) residents (age 60 and above) but now is only serving one (1) resident. The facility’s latest fire inspection was conducted on 07/06/17 by Culver City Fire Department. The fire extinguishers was observed to be fully charged. During today's visit, LPA's reviewed staff files, resident file, resident medication and toured the physical plant. LPAs toured resident rooms, bathrooms, living room, kitchen, dining room, and patio. The patio was enclosed and no bodies of water were observed. Each bedroom is equipped with proper furniture and linen. The bathrooms were observed to be clean and operational w/ grab bars. The hot water temperature throughout the facility was measured at 111.6 degrees and met Title 22 Regulations. Carbon Monoxide and Smoke Alarms were tested and were operational. The medication is centrally stored and it was kept in a locked cabinet. LPA observed food supply of two (2) days of perishables and seven (7) days of non-perishables. Storage areas for cleaning solutions, toxics, knives, and hazardous items were secured and made inaccessible to Resident. The following deficiencies were observed to be in violation Under California Code of Regulations Title 22. (refer to 809D). An exit interview was conducted and a copy of this report was provided along with the appeals rights to facilitythe state’s words, verbatim · CDSS document, Jul 20, 2017

From the deficiency page — Deficiency type: Type B · Section cited: 87465(e) · Plan of correction due date: Jul 27, 2017

87465 (e) For any PRN medication for which a licensee provides assistance, there shall be a physician’s order on file and a label on the medication container. Specific information must be on both the order and the label. LPA observed Resident #1 all PRN medication include Allei-Tec 10mg, B12 Vitnamin 1000mcg, Calcium 600mg and Spectra-Vite 365 tab.the state’s words, verbatim · CDSS document, Jul 20, 2017

From the deficiency page — Deficiency type: Type B · Section cited: 87476(e) · Plan of correction due date: Jul 27, 2017

87465 (e) For any PRN medication for which a licensee provides assistance, there shall be a physician’s order on file and a label on the medication container. Specific information must be on both the order and the label. LPA observed Resident #1 all PRN medication include Allei-Tec 10mg, B12 Vitnamin 1000mcg, Calcium 600mg and Spectra-Vite 365 tab.the state’s words, verbatim · CDSS document, Jul 20, 2017

The state marks this report as 8 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.