Manhattan Place Residence

Type of visit: Case Management - Deficiencies

On 4/27/2023 at 11:24AM, Licensing Program Analyst (LPA) Alfonso Iniguez conducted a Case Management – Deficiencies visit to Manhattan Place Residence INN. LPA met with Mariel Sheryl Ventura /Administrator and the purpose of the visit was explained. On 4/26/2023 LPA Iniguez conducted an unannounced Annual Inspection and found out the facility has 1 hospice patient. LPA asked for proof of hospice waiver, but administrator told LPA she will send proof by email on 4/27/2023. On 4/27/2023 LPA received by email a letter request for hospice waiver dated on 8/8/2019. After reviewing this document, the facility history profile and talking with LPM Alvarez, LPA Iniguez will render a citation for the following: 87632 (a) Hospice Care Waiver In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. To obtain this waiver the licensee shall submit a written request for a waiver to the Department on behalf of any residents who may request retention, and any future residents who may request acceptance, along with the provision of hospice services in the facility. Exit interview conduct, appeal rights discussed and a copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 27, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87632(a) · Plan of correction due date: Apr 28, 2023

87632 (a) Hospice Care Waiver In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. To obtain this waiver the licensee shall submit a written request for a waiver to the Department on behalf of any residents who may request retention, and any future residents who may request acceptance, along with the provision of hospice services in the facility. This requirement is not met as evidence by: Based on facility inspection. This violation possess a potential Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 27, 2023

Plan of correction: Licensee will adhere to Title 22 87632 regulations and will ensure to request a Hospice Waiver with CCLD. Licensee will ensure to provide proof of correction sent by email to LPA.

Type of visit: Required - 1 Year

On 4/26/2023 Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced visit to this facility. The purpose of today’s visit was to conduct an Annual Inspection. LPA/Iniguez met with Mariel Sheryl Ventura/Administrator. Facility is licensed for (6) residents (3) non-ambulatory and (3) ambulatory residents. There are (0) residents diagnosed with mild Dementia residing in the facility. There is (1) Hospice resident at the facility. The facility handles residents’ cash resources. The facility is a single-story structure located in a residential neighborhood. It consists of the following: 5 bedrooms, 3 bathrooms, office/living room, kitchen, dining room/laundry area, covered front porch and back porches both with ramps, indoor and outdoor activity area, storage hut, and an attach 2 car garage. LPA/Iniguez inspected the following during visit: documents are posted as mandated. Bedrooms contain the furniture mandated, Bathrooms are clean and operational. Personal accommodations were observed for safety, privacy, and comfort, including grab bars, 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. Evaluation Report continues LIC 809-C Medications are locked, and records are current. Common areas observed for the ability to safely serve the needs of the residents, including cleanliness, and clear of any potential hazards to the residents. The first aid kit is fully stocked. Manual, smoke, and carbon monoxide detectors were in compliance. The water temperature properly measured between 105F°-120F° degrees (Kitchen 110.3F° & Bathroom #1 112.4F°, Bathroom #2 110.6F°, Bathroom #3 109.8F° ). fire extinguishers are fully charged, adequate linen supply, the facility telephones are working. All exit doors were in compliance, the yard was free of debris hazards, and trash cans were covered. LPA conducted a records review of (5) client records, (5) staff records and reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (5) Client Medication Administration Records (MAR) and did not observe any discrepancies at the time of visit. A copy of the liability insurance and administrator certification will be email to LPA/Iniguez. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to the Administrator Mariel Sheryl Venturathe state’s words, verbatim · CDSS document, Apr 26, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual inspection visit and infection control inspection to the above facility. LPA was met by Rosanne Germille, Care giver and later met with , Hai Nguyen administrator and the purpose of today’s visit was explained. There are currently (5) Westside Regional Center consumers in placement. All (3) clients are ambulatory. (2) non-ambulatory. The facility is a single-story brown stucco structure located in a residential neighborhood. It consists of the following: 4 bedrooms, 3 bathrooms, office/living room, kitchen, dining room/laundry area, covered front porch and back porches both with ramps, indoor and outdoor activity area, storage hut, and an attach 2 car garage. LPA and Rosanne toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. Bedrooms 1 - 4 are occupied by clients and contain the mandated furniture. Bedroom 3 is a staff bedroom. The (2) bathrooms are clean and operational. Smoke detectors and carbon monoxide detector are inter-connected and in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to clients. 1 staff file is current, 1 resident file is current along with medications. The water temperature is at 106.2 degrees. A comfortable temperature is maintained in the facility (70 degrees). Ample supply of perishable and nonperishable food, linens and personal hygiene supplies are adequate, hazardous toxins and sharp knives and/or items are inaccessible to clients, (1) fire extinguishers is fully charged. First Aid kit complete and with manual. Exit, walkways and/or passageways, front and back yard 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 temperatures are checked and logged, sanitizer/soap and paper towels in all the bathrooms and additional sanitation supplies are stored in the garage. LPA observed staff wearing masks, clients rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, No fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & IPAD for clients to use, clients temperatures are checked and logged (once a day). Emergency contacts updated and posted, and PPE's are enough for 30 days. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. Technical Advisory (TA) issued: 1. No fit testing done for staff member. An exit interview conducted with Paul Phan, Administrator Due to technical difficulties (printer not working), copy of report and TA will be provided via emailthe state’s words, verbatim · CDSS document, Sep 10, 2022

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.