Asahi Residential Care

Type of visit: Required - 1 Year

On 10/27/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced annual visit to the facility listed above. During today's visit LPA met with House Manager, Kristina Lacanilao , and explained the purpose of today's visit. The facility is serves clients age 60 and over, is approved for six non-ambulatory, two of which may be bedridden and a hospice waiver of 3. Currently there are 5 residents residing in the facility. Physical Plant/Structure The facility is a single-story home in a residential neighborhood. The home consists of five bedrooms , two bathrooms, living room, dining room, kitchen, front yard, backyard, and garage. LPA toured the facility and found it to be in good repair. The front and backyard are landscaped and maintained. LPA observed a shaded patio in the backyard with table and chairs. All ramp railings are secured. All walkways outside were observed clean, clear, and free of debris, hazards and obstructions. LPA did not observe any bodies of water on the property. Bedrooms LPA inspected all bedrooms and found them to be clean and in good repair. LPA observed the rooms to have the required items including a bed(s), dresser(s), chair(s), nightstand, and storage space for resident's personal belongings. All beds had the required linens including a mattress cover, fitted sheets, blanket, comforter, and pillows. LPA observed an ample supply of linens in a cabinet in the the hallway in good repair. All rooms had were observed to have ample lighting. Bathrooms LPA inspected all bathrooms and found them to be clean and operational. Showers were observed to have nonskid matts and shower chairs available. The safety hand rails were securely fastened. LPA observed an ample supply of hygiene products stored in a cabinet under the counter and are inaccessible to residents. Cleaning products were observed secured in a locked cabinet under the sink. LPA observed an ample supply of towels stored in a cabinet in the bathrooms. The water temperature measured 114.6- and 116.2-degrees Fahrenheit. Kitchen LPA inspected the kitchen and found it to be clean and sanitary. All appliances were observed in good working repair.LPA observed an ample supply of cutleries, pots, and pans in good repair. Continued on LIC809-C LPA observed a 3-day supply of perishable foods and a 7-day supply of non-perishable foods. All food was observed properly stored and dated. Sharps were observed in a secured locked drawer in the kitchen and are inaccessible to residents. Cleaning products were observed secured in a locked cabinet under the kitchen sink. The water temperature measured 112.4-degrees Fahrenheit. Common Rooms LPA inspected all common room and observed them to clean and in good repair. The living room has two couches and a recliner to accommodate all residents. There is a large table available for activities. The dining room has a large rectangle table and chairs to accommodate all residents. All walkways and hallways were observed to be clean, clear, and free of hazards and obstructions. All rooms were observed to have ample lighting. The facility was maintained at a comfortable temperature. Medications All Centrally Stored Medications were observed in a locked cabinet in the hall way and are inaccessible to residents. LPA reviewed the medications and MAR for two residents and found them to be consistent with properly documented records. Files and Interviews LPA reviewed all five residents files and found they contained required document. LPA interviewed all residents and all were happy with the service and care they receive from staff. LPA reviewed the Administrator and three staff files and found they contained the required training, certification, and clearance. Staff training are done on Relias and each staff completes 20-hours of training annually. LPA interviewed the two staff who were present during the inspection and both staff were able to answer questions regarding policy, and resident care and rights. Safety LPA observed all required postings on a board near the entrance. LPA observed a fully charged fire extinguisher mounted in the hallway last serviced on 09/11/23. The last inspection and fire sprinkler service was conducted by the local fire department on 04/06/23. All smoke and carbon monoxide detectors were in compliance and operational. The last emergency drill was conducted on 09/15/23. LPA inspected the First Aid kit and found it contained the required items and a manual. All doors in the facility sound when they are opened to notify staff. All gates on the side of the home are easily accessible for an exit. Infection Control LPA observed a visitor log and Covid-19 screening upon entry. LPA observed multiple sanitizing stations throughout the facility. LPA observed a 30- supply of PPE. All Infection Control signs were observed posted. According to the California Code of Regulations (Tittle 22, Division 6, Chapter 8) LPA did not observe or cite any deficiencies. An exit interview was conducted with House Manager Kristina Lacanilao, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 27, 2023

Allegation investigated: Questionable death. Resident sustained injuries while in care.

On 02/03/23, Licensing Program Analyst (LPA) Jeremiah Randle conducted a subsequent unannounced visit at this facility and was greeted by Administrator Edna Lacanilao. LPA explained the purpose of this visit is to deliver the findings on the allegations mentioned above. The investigation consisted of the following: Licensing Program Analyst (LPA) Jeremiah Randle conducted a visit on 9/21/22 and 2/3/2023. LPA interviewed Administrator Edna Lacanilao (S1) and support staff (S2-S4). Resident R1 was not available to be interviewed due to death. LPA interviewed Residents (R2-R4) reviewed copies of staff/resident rosters, SIR reports, physician's reports, appraisals/needs and services plans, and service records of Residents. The Department of Social Services investigator Peter Zertuchi conducted a separate investigation that included interviews with Complainant, Clinical Manager of Hospice Agency providing care, Hospice Nurse providing care to R1 and County Registrar to obtain cause of death information. Unsubstantiated The investigation consisted of the following: Allegation #1: Questionable death It was alleged R1 was badly beaten while in care at the facility and passed away shortly after possibly due to R1 injuries. IB Investigator Peter Zerrtuche obtained and reviewed R1 Death Certificate on 10/20/22 and the review revealed; R1's cause of death was listed as prostate cancer with no other factors related to R1 death. The date and time of death was 05/01/2022 @2155 hours. The death certificate shows no autopsy was performed and the death was not reported to the coroner. IB investigator interviewed witnesses and conducted records review and there was no evidence to support R1’s death was caused by R1 being badly beaten. LPA Randle conducted interviews of staff members (S1)-(S4) and support staff (S2-S4).. LPA reviewed documents from the facility. It was alleged that R1 sustained a Questionable death. Reporting party called CCL to report. On February 3, 2023 LPA interviewed Administrator Edna Lacanilao (S1) and support staff (S2-S4). LPA asked S1 if she was aware of the allegation listed above. S1 denied the allegation LPA also met with (S2-S4) all staff denied the allegation as to R1 or any other resident that had been in care. Resident R1 was not available to be interviewed due to death. Based on CDSS Investigations Branch Interviewees and Investigation including LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. Allegation #2: Resident sustained injuries while in care. LPA interviewed Administrator Edna Lacanilao (S1) and support staff (S2-S4) regarding allegation Resident sustained injuries while in care. LPA asked S1 if she was aware of the allegation listed above. S1 denied the allegation regarding Resident R1 or any other resident sustaining injuries while in care. LPA interviewed staff (S2-S4) regarding allegation Resident R1 sustained injuries while in care. all staff denied the allegation as to R1 or any other resident in care. LPA interviewed Residents (R2-R4) regarding sustaining injuries while in care. Residents (R2-R4) reported that they have not sustained injuries while in care at this facility. LPA conducted a visual observation of residents no signs of injury or trauma was noted. Based on Investigation including LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 1, 2023 · control 11-AS-20220919210318

Allegation investigated: Created in error

Created in error Unsubstantiated Created in error Created in error Created in error Created in errorthe state’s words, verbatim · CDSS document, Feb 3, 2023 · control 11-AS-20220919210318

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Edna Lacanilao Administrator and the purpose of today’s visit was explained. There are currently (6) residents in the facility. (6) residents are ambulatory, (0) are non-ambulatory, (0) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (5) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry room and detached 2 garage. LPA and Edna Lacanilao Administrator toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-4, are occupied by residents bedroom 5 is for staff, all contain the mandated furniture. The (2) bathrooms have grab bars and non-skid mats and 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. (1) Resident file along with medications are current. (1) Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is within title limits, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (2) fire extinguishers is fully charged. 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 and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in the garage. LPA observed staff and residents wearing masks, resident private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing not completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & IPAD for residents to use, resident’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days. All residents and staff are vaccinated and boosted. Technical Advisory (TA) issued for Staff Fit Testing 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 An exit interview was conducted with Edna Lacanilao Administrator , and a hard copy was provided.the state’s words, verbatim · CDSS document, Nov 28, 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.

Type of visit: Required - 1 Year

On 10/21/2021, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Administrator Edna Lacanilao and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory elderly residents ages 60 and above. The facility is approved for two (2) bedridden and three (3) hospice. The facility is a single-story structure located in a residential neighborhood. The facility consists of the following: four (4) resident's rooms, two (2) bathrooms, a living room area, dining area and kitchen. There is an attached garage with access only through the garage door. There is a refrigerator and laundry area in the garage. There is a shaded patio area with ample seating area for the residents. LPA and administrator toured the physical plant. There are no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 105.1 F to 106.6 F in the kitchen and bathrooms. A comfortable temperature of 74 degrees was maintained in the facility. Evaluation Report Continues on LIC 809-C. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. Three are (3) fire extinguishers fully charged, one in the kitchen area, one in the hallway and one in the garage. First aid kit was available. Smoke detectors and carbon monoxide were operable. A review of Medication Administration Records (MAR) was maintained in order and accurate. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff wearing face coverings, LPA observed four (4) clients and three (3) staff present during the tour. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. Advisory Notes – One (1) Technical Assistance were issued, please see LIC9102-AN. No deficiencies were cited during this inspection visit. An exit interview was conducted and a copy of this report was provided to Edna Lacanilao.the state’s words, verbatim · CDSS document, Oct 21, 2021

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.