Allen's Palm Cove Cerritos

Type of visit: Required - 1 Year

On 8/30/23 at 9:00 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced Annual/Required inspection to Allen Palm Cove. Upon arrival LPA was greeted by Direct Support Professional (DSP) Christopher Tablang who contacted the Administrator, Euphrosyne Dimaano, at 9:20 a.m. to assist with today's visit. This home is licensed to serve age range 60 and over. Approved for 6 Non-ambulatory. There were (5) residents in care during the time of this visit. The last emergency disaster/fire drill was conducted on 8/15/23. The Administrator Certificate expires on 2/12/2024 #6031893740. During today's visit LPA inspected the physical plant inside and outside, reviewed the food supply, tested the smoke/carbon monoxide detectors, reviewed (4) staff files, (5) resident files, medications, and medication administration records for (5) residents. This home contains 4 bedrooms, 2 bathrooms, living room, kitchen, 2 dining room and an attached garage. LPA toured the physical plant with the Administrator. and observed all (4) client bedrooms, contained required furniture, lamps, dresser, chair, and closet space. The two bathrooms contain a working toilet, basin and water faucet, walk in shower with grab bar, shower chair, and bathmat. The temperature measured at 114.4*F-118.7*F. The smoke detectors were battery operated and individually tested and observed to be working properly. The carbon monoxide detector was located throughout the facility, tested, and functioning properly. There were (2) fire extinguishers located in kitchen and garage fully charged and up to date. The kitchen was toured and contained working appliances; refrigerator, stove, oven and contained dishware, cups, plates, utensils, pots, and pans. The knives were secured and locked in a draw next to the stove. The cleaning agents and toxins are locked underneath kitchen sink. The pantry was well stocked with canned goods, pasta, cereals, and the food supply contained a sufficient supply with a two-day supply of perishables and a seven-day supply of non-perishables that met title 22 guidelines. Walls and floors, cabinets and counters were clean and sanitary throughout the home. (Report continued on LIC809C.) . The outdoor grounds were toured and inspected, and the patio was well maintained with a shaded seating area accessible for resident use. The garage contained a working washer and dryer, with cabinetry that contained emergency supply kits, bottled water, toiletries, personal care supplies, and toxins and cleaning agents stored locked and inaccessible to the residents. Exit interview conducted with Euphrosyne Dimaano, Administrator, a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 30, 2023

Allegation investigated: Uncleared staff working at the facility.

On 04/17/23 at 08:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint investigation to the facility. Upon arrival LPA met with staff#1 (S1) and explained the reason for the visit. House Manager Christopher Gosioco Joined the visit at 8:50 am. During today’s visit LPA toured the facility with S1, obtained resident/ staff roster, and staff schedule. LPA interviewed House Manager, S1 and S2. LPA also interviewed Residents # R1 through R3. R4 was sleeping and declined interview. Report continued on 9099c Unsubstantiated The investigation reveals the following: Regarding “Uncleared staff working at the facility “, it is alleged that the facility hires undocumented immigrants. Upon arrival LPA observed two (2) staff working at the facility. Both staff was check and observed to be associated. LPA toured the facility and did not observe additional staff members working at the facility. House Manager Christopher Gosioco provided LPA with a staff roster and weekly schedule. LPA cross referenced both documents with association list printed 04/11/23 and all names listed were cleared. House Manager Gosioco stated all staff is associated and fingerprinted prior to them starting work at the facility. During the interview S1 and S2 named all staff they have worked with, and all are associated to the facility. Residents R1 through R3 named staff that usually assist them in the facility, and all are associated to the facility. R4 refused interview. Based on LPA's interviews, file review and observation the investigation revealed: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with House Manager Christopher Gosioco and a copy of this record provided.the state’s words, verbatim · CDSS document, Apr 17, 2023 · control 28-AS-20230411103833

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) David Sicairos and Regional Manager (RM) Araceli Ramirez conducted a Case Management follow up visit to follow up on the items discussed during the visit conducted on 08/26/22. LPA & RM met with Euphrosyne Dimaano and Peter Nora. During today's visit, the following was discussed: LPA, RM, and Administrators met with C1 to discuss the next steps in relocation to a higher level of care facility. C1 will be transferred to Agape Congregate living on 09/01/22. This facility is licensed under the Department of Public Health. C1 has agreed to the transfer. Transportation has been arranged for 10am tomorrow. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 31, 2022

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) David Sicairos and Regional Manager (RM) Araceli Ramirez conducted a Case Management follow up visit to follow up on the items discussed during the Case Management visit conducted on 08/24/22. LPA and RM met with Direct Support Staff Rebecca Blake and explained the reason for the visit. Administrators Euphrosyne Dimaano and Peter Nora arrived shortly thereafter. Administrators notified LPA and RM that R1's Physician came to the facility to assess him today. Per Administrators, Physician recommended a higher level of care (Skilled Nursing Facility). According to Administrators Physician will be following up with R1 at a later date. R1's Case Manager will be working with Administrators to initiate R1's transfer to a Skilled Nursing Facility per Physician's recommendations. R1 is in agreement with the transfer, R1 disclosed a Skilled Nursing Facility of choice. LPA and RM also discussed with Administrators the importance of providing timely services on a as needed basis for R1 while a resident of the facility. Administrators were reminded that they are responsible for the care and supervision of the resident for as long as he is a resident of the facility. LPA, RM, along with Administrator Euphrosyne had a discussion with R1 regarding the following steps moving forward in transferring him to the Skilled Nursing Facility of choice. LPA reviewed Administrator's file and obtained copies of the following documents: current Administrator Certificates, and Employee Training Records. Administrator will email R1's updated Care Plan. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 26, 2022

Type of visit: Case Management - Health Checks

Regional Manager(s) (RM) Angela Kendrick and Benita Yates conducted a case management visit for the purpose of conducting a health and safety check. Licensing Program Analyst (LPA) Jose Villalobos attended the visit virtually. RM's Angela and Benita were met by staff Rebecca Blake. Administrators Euphrosyne Dimaano and Peter Nora arrived shortly after Licensing received information regarding possible health and safety concerns involving residents of the facility. During the visit the following was observed: pads with urine and feces in Resident #1s (R1) bedroom Oxygen tank observed in Resident #2's (R2) room without required signs being posted Deficiencies cited under California Code of Regulations, Title 22, Division 6 and Chapter 1, documented on LIC 809D. Exit interview was conducted, Appeals right and a copy of this report were provided via email for signature.the state’s words, verbatim · CDSS document, Aug 24, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87618(b)(3)(B) · Plan of correction due date: Aug 25, 2022

Oxygen Administration - Gas and Liquid. In addition to Section 87611(b), the licensee shall be responsible for the following:(3)Ensuring that the use of oxygen equipment meets the following requirements: (B) "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. This Requirement is not met as evidenced by; Resident #2 had an oxygen machine and a "No Smoking-Oxygen in Use" sign was not posted in the appropriate area. This poses and immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 24, 2022

Plan of correction: Administrator Shall place appropriate signs needed and place on R2's door. *** Citation cleared at the time of visit. LPA observed staff place required sign in a visable area.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Sep 2, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Residents #1's room had feces and urine on the floor. This poses a potential health and safety risk for residents under care and sueprvision.the state’s words, verbatim · CDSS document, Aug 24, 2022

Plan of correction: Staff to clean R1's room and provide proof to licensing by POC due date. *** Citation was cleared at the time of the visit as LPA oberved staff clean R1's room of feces and urine.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Administrator Peter Nora and explained the reason for the visit. Physical Plant was toured, medications were reviewed, and food supply was inspected. The following was observed/inspected: LPA and Administrator toured the home and observed: (4) bedrooms, (2) bathrooms, living room, activity room, kitchen, dining room, and attached garage. The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded seating area for the residents located in the backyard. Passageways and exits are free of obstruction. The water temperature was tested in bathroom #1 in the hallway and measured at 125F which is above the required 105F - 120F degrees. Administrator lowered the water temperature during the visit. Grab bars and non-skid mats were observed in the bathrooms. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen and the linen is in good condition. Smoke detectors were observed throughout the facility and were tested and operable during the visit. There is a carbon monoxide detector located in the hallway of the home. There is a fire extinguisher located near the kitchen which is fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in a kitchen drawer and are inaccessible to residents. Cleaning supplies and disinfectants are locked under the sink and are inaccessible to the residents. First Aid kit was fully stocked with current manual. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Staff were observed wearing masks and screening visitors at entry. Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed. (3) out of the (3) resident medications were reviewed. Medications are centrally stored in a cabinet in the kitchen. Medications are documented properly and given as prescribed. Staff and Resident files were not reviewed during today's visit. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit is documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 4, 2022