Summer Breeze Manor

Type of visit: Required - 1 Year

On 10/27/2023 at 11:11 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with staff Tula Thaxter. Four residents and two (2) staff were present during this inspection. Facility is licensed to serve six (6) non-ambulatory residents and has an approved hospice waiver for six (6) residents. The facility has two bathrooms, four bedrooms (two rooms are shared), staff room, kitchen, living room, dining rooms, two outdoor patios, and laundry room. During the tour, LPA did not observe bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. A comfortable temperature was maintained in the facility. There are no security bars or weapons on the premises. Resident bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew, and a non-skid mat was in place. The water temperature measured at 109.0 degrees Fahrenheit. Smoke detectors are interconnected and operational. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced March 17, 2023 was observed in the kitchen area. Five staff and five resident records were reviewed. Two staff and two residents were interviewed. Two resident medications were reviewed. Based on LPA observation, interviews conducted and records review, no deficiencies are being cited. An exit interview was conducted and a copy of this report was discussed and left with Tula Thaxter.the state’s words, verbatim · CDSS document, Oct 27, 2023

The state marks this report as 6 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 11/28/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. LPA Montoya conducted a risk assessment with Staff Joel Morales. Based on the assessment, the facility is clear of Covid-19 infection. LPA verified that the facility has an approved mitigation plan report. LPA met with Staff Joel Morales and they toured the inside and outside grounds of the facility. The facility is licensed for six (6) non- ambulatory; approved hospice waiver for six (6) residents. LPA observed six (6) residents and 2 direct caregivers during the visit. During the tour, LPA did not observe bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. A comfortable temperature was maintained in the facility. There are no security bars or weapons on the premises. Resident bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew, and a non-skid mat was in place. The water temperature measured at 112.0 degrees Fahrenheit. A comfortable temperature was maintained in the facility. Smoke detectors are interconnected and operational. LPA observed the facility was found to be 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 supplies. The facility has (2) fire extinguishers that were charged, smoke detectors, and carbon monoxide were operable. The facility conducted a Fire/Safety Drill on August 1, 2022. A working telephone (424-731-7075) remains available. REPORT CONTINUED IN LIC 809C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for residents, staff and visitors, and sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report on file with CCLD. Outside grounds were toured, and no bodies of water were observed. LPA observed clutters in the backyard and left side yard of the facility. Deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided to Staff Joel Morales.the state’s words, verbatim · CDSS document, Nov 28, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jey Cardenas conducted an unannounced required annual visit with a primary focus on Infection Control measures using the new CARE Inspection Tools. Upon arrival at the facility, LPA Cardenas was met by house manager/ caregiver staff, Tula Thaxter, LPA conducted a risk assessment, Based on the assessment, the facility is clear of Covid-19 infection. LPA was properly screened for Covid-19 symptoms and temperature was checked. Tula granted access and allowed LPA to enter the facility to conduct inspection. Back up Administrator, Joel Morales arrived shortly after and assisted LPA with the visit LPA verified that the facility has an approved mitigation plan report. The facility is licensed for 6 non-ambulatory residents and 6 hospice approved waivers. There are currently, 6 residents; three (3) residents are in hospice care. LPA and staff Tula both toured the inside and outside grounds of the facility. The one-story residential house consists a kitchen, dining room, living room, family room, one (1) staff bedroom, four (4) resident bedrooms, two (2) bathroom, washer/dryer room, shaded backyard patio, and two (2) storage sheds. During the tour, LPA observed the facility’s infection control practices. LPA observed a sanitizing station at the facility entrance; visitors log with Covid-19 screening and temperature log, and records of daily Covid-19 screening and temperature checks of residents and staff. PPE supplies are readily available to staff, and an additional 30-day supply of PPE was observed. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility’s designated visitation area is the back patio. LPA observed staff and residents maintain 6 feet physical distancing, and all staff wear a face covering. All rooms were inspected. Beds in shared bedrooms are 6 feet apart. Beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Furniture in the living room are marked or separated, and 6 feet apart from each other. Resident bathrooms were checked, sufficient liquid soap and paper towels were observed. Toilets and water faucets worked properly, grab bars were secure, the shower was free of mold/mildew. On 10/12/21 LPA measured bathroom water temperature and observed water temperature measured at 126 degrees F. Comfortable temperature was maintained in the facility. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxins were kept in a locked storage drawer. On 10/12/21 LPA observed kitchen stove burner located left back was not operable, staff turned knob and it didn’t turn on. Staff indicates burners were working earlier that morning. Centrally stored medications were observed stored in their originally received containers and kept safe and locked and inaccessible to residents in care. One (1)Carbon Monoxide and Smoke Detectors (connected) were tested and are in operable condition. On 10/12/21 LPA heard one smoke detector located in the livingroom area chirping as if battery was low charge. The facility has (2) Fire Extinguishers fully charged and accessible, extinguishers were serviced on March 23, 2021. Outside grounds were toured, and no bodies of water were observed. Walkways around the home were clear of hazards. Common areas were clean and clear of hazards; doorways were free of obstructions. Deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted and appeal rights discussed. A copy of this report and appeal rights provided via email to facility representative.the state’s words, verbatim · CDSS document, Oct 12, 2021