Blessed Sacrament Sisters of Charity

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced visit at the facility for the purpose of conducting the required annual inspection. LPA utilized the Compliance and Regulatory Enforcement (CARE) Tool to evaluate the facility. LPA Gonzalez met with Administrator Eunmi Kong and explained the purpose for the visit. The facility is licensed to serve 6 non-ambulatory elderly residents age 59 and over. Approved Hospice Waiver for 2. Currently, there are two (2) residents in placement. There are currently (0) residents on hospice. The following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Resident Rights/Information, Planned Activities, Food Service, Incidental Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs (SHN). During the visit LPA observed the following: Infection Control: The facility staff are using appropriate hand hygiene and wearing gloves while assisting residents. There is a visitor sign-in/ screening station located in the main entrance. Staff are cleaning and disinfecting often for high touched surfaces. Facility has sufficient PPE supplies, has an Infection Control Plan and Mitigation Plan. Facility has COVID-19 signage posted throughout the facility. Bathrooms have hand washing signs, soap and paper towels. Per Facility Administrator two (2) residents have COVID-19 vaccines including boosters. Per Facility Administrator all staff also have the COVID-19 vaccines including boosters. Facility Administrator is adhering to infection control requirements. Refer to LIC 809C for continuation of report Operational Requirements: Fire Drills are conducted every three months, the last fire drill was conducted on 5/1/23. Emergency Disaster/ Earthquake Drills are also conducted every three months and the last one was conducted on 5/1/23. Facility Administrator is adhering to operational requirements. Physical Plant & Environment Safety: The home is located in a residential area. The facility consists of : 3 resident bedrooms, 4 bathrooms (1 bathroom is for visitor use), kitchen, family hall with a prayer room and recreation area, dining room, laundry room located inside the kitchen area. Resident rooms are located in the rear of the facility on the first floor. Physical plant inside and outside is in good repair. All resident rooms were checked. All resident beds have the required linens which were in good condition at the time of the visit. All bedrooms had sufficient closet/ storage space. Bathrooms are clean and operational and were observed to be within Title 22 regulations. Facility toilets and water faucets worked properly. Shower was free of mold/mildew, adequate lighting, and sufficient toiletries are accessible to clients. Bathrooms are clean, sanitary and operational with grab bars and non skid mats in place. Water temperature properly measured at 120F*. Facility temperature was comfortable throughout the facility. LPA observed the facility to be clean and in good repair. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. Hazardous toxins and/or items are inaccessible to clients, fire extinguisher is fully charged. Exit, walkways and/or passageways, front yard is free of debris and/or hazards. A shaded area with chairs is provided for residents in the front of the facility Staffing: There is sufficient staffing at the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator. Staff have current CPR/first aid training and sufficient on-going training that meets the annual requirement. Staff have their Health Screening and Tuberculosis Screening on file. Staff are also trained on Abuse Reporting. Administrator certificates expires 11/10/2023. Refer to LIC 809C for continuation of report Resident Records-Incident Reports: LPA reviewed Client files for R1 through R2. Resident files are maintained at the facility and have the following documents in their files : Admission agreements, Physician's Reports, Appraisals, TB clearance, Functional Capability Assessment/Appraisals, and emergency information. Resident Rights-Information: RCFE complaint poster and Personal rights were observed posted in the facility as well as LTCO poster. Per Facility Administrator, facility provides wi-fi services for facility residents. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed daily. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician order for modified diet is on file. Sanitation practices and kitchen cleanliness was observed. Incidental Medical Services: Two (2) centrally stored 30-day supply of medications were reviewed. Medical and dental transportation is provided by facility, and family members. Access is also used. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. The last quarterly fire/emergency drill was completed on 5/1/2023. Residents with SHN : Appraisals were observed in resident files. No residents have prohibited health conditions. No deficiencies noted. Exit interview and a copy of this report was provided to Administrator Eunmi Kong.the state’s words, verbatim · CDSS document, Aug 29, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced Annual Required / Infection Control Visit to the above facility. LPA was met by Ok Hee Kim, Administrator and the purpose of today’s visit was explained. The facility is licensed to serve (6) Non-Ambulatory residents ages 60 and above and hospice waiver for (2). There are currently (0) residents on hospice. There are currently (4) residents in the facility. The facility consists of : 4 resident bedrooms, 4 bathrooms (1 bathroom is for visitor use), kitchen, family hall with a prayer room and recreation area, dining room, laundry room located inside the kitchen area. LPA and Administrator Administrator Ok Hee Kim toured the entire facility inside and out. Documents are posted as mandated. All resident rooms were checked and mattresses and bedsprings are in good repair, adequate lighting and closet space observed. All resident bedrooms contain the mandated furniture. Sufficient toiletries, linens towels and bedding for residents. LPA found the facility to have a comfortable temperature at time of visit. The bathrooms are clean, sanitary and operational with grab bars and non-skid mats in place. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents in a locked file cabinet. All disinfectants, toxins, knives and cleaning solutions were locked an inaccessible to residents. Food supply was adequate for 2-day perishable and 7-day non-perishable. Hot water temperature is 115 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to clients, Exit, walkways and/or passageways, are free of debris and/or hazards. Physical plant inside and outside was in good repair at the time of the visit. The following were observed/inspected: COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility, and in all common rooms bathrooms and hallways. Facility is conducting COVID-19 screening for all visitors. Residents are able to use a designated isolation room that will be used as isolation room if a COVID-19 positive case should arise. 30 day supply of medication for residents Facility has an adequate amount of PPE and facility has enough PPE for approximately 3 months . Residents were socially distanced according to local public health guidelines. Staff responsible for direct care and supervision were observed wearing masks. Hand Sanitizer: Available throughout the facility for resident/ staff use. High touch areas are disinfected once a day and as needed. The resident's temperature is checked and logged daily and if they are exhibiting any symptoms. Staff temperatures are checked and logged daily and if they are exhibiting any symptoms. Staff and residents are tested every as needed or if exhibiting any COVID-19 symptoms. All residents and staff are fully vaccinated and have received both booster vaccines for COVID-19. According to the California Code of Regulations, LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview conducted with Administrator Ok Hee Kim, Administrator and copy of report provided.the state’s words, verbatim · CDSS document, Aug 18, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced Annual Required / Infection Control Visit to the above facility. LPA was met by Ok Hee Kim, Administrator and the purpose of today’s visit was explained. There are currently (3) residents in the facility. The facility consists of : 4 resident bedrooms, 4 bathrooms (1 bathroom is for visitor use), kitchen, family hall with a prayer room and recreation area, dining room, laundry room located inside the kitchen area. Physical plant inside and outside is in good repair. LPA and Administrator Ok Hee Kim toured the entire facility inside and out. Documents are posted as mandated. Resident bedrooms contain the mandated furniture. The bathrooms are clean and operational. First aid kit is fully stocked with manual, smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents in administrators office. Medications and files are current and kept in administrator's office. Food supply was adequate for 2-day perishable and 7-day non-perishable. Hot water temperature is 115 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to clients, Exit, walkways and/or passageways, are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged and temperature checked, sanitizer/soap located throughout the facility and additional sanitation supplies are stored in the facility. LPA observed staff and residents wearing masks and keeping 6 ft distance from one another. Client private rooms will be converted to isolation rooms (if needed) and required postings placed throughout the facility. The clients temperature's are checked and logged once a day. PPE's are enough for 30 days. According to the California Code of Regulations, LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview conducted with Administrator Ok Hee Kim, Administrator and copy of report provided.the state’s words, verbatim · CDSS document, Aug 9, 2021