Pristine Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 08/19/2023. LPA was met by Staff#1 (S1) and explained the purpose of the visit. Administrator Alan Buan and Staff #3 (S3) later arrived to the facility to assist in tour. Facility is licensed to serve residents over 60 years old. The facility cares for elderly residents with dementia and is currently approved for three (3) hospice care residents. LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), and Resident Roster (LIC 9020). LPA OBSERVATIONS: Tour was led by S3. The facility is a single-story building located in a residential area with four (4) resident bedrooms, one (1) staff bedroom, two (2) resident bathrooms, kitchen, dining area, living room, laundry room, front yard, backyard, and attached garage. Facility has two (2) live in care givers and one (1) registered nurse/nurse practitioner (RN/NP) that provides care to residents on a regular basis. Front Yard: Was clean and well maintained. No hazards were observed. Kitchen: LPA Ramirez observed a sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to six (6) out of six (6) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to six (6) out of six (6) residents in care. Kitchen appliances were observed to be clean and in working order. LPA Ramirez observed fully charged fire extinguisher in this area. Water temperature in kitchen sink was measured at 117.6 degrees F. Dining area/Living room: Living room was observed plenty of seating and lighting. LPA Ramirez observed two (2) residents sitting in living room area and dining area during visit. Linen Closet: Contained plenty linens, towels, and hygiene products. LPA observed thermostat in this nearby area to read 76 degrees F. Resident Rooms 1 - 4: LPA Ramirez observed all resident bedrooms to contain the required linens, furnishings, and lighting. LPA Ramirez observed required auditory devices on exits. LPA Ramirez observed signs outside residents’ rooms cautioning “Oxygen in use.” see 809-C Bathrooms: Signs promoting hand washing were observed. Water temperature in resident bathroom#1 was measured at 109.4 degrees F which is in the required 105 – 120 degrees F. Bathroom #2 water temperature was measured at 116.7 degrees F. LPA Ramirez observed signs promoting hand washing in bathroom. Grab bars and non-slip mats were observed in both bathroom bathing areas. Centrally Stored Medications: LPA Ramirez observed locked closet near kitchen and living room area to inaccessible to six (6) out of six (6) residents in care. Backyard: LPA observed plenty of seating and shade. No large bodies of water were observed. Emergency Drills: Last documented fire drill was conducted on 7/1/23 at 10:15 am. Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide in hallways. LPA Ramirez observed posted Emergency Disaster Plan. LPA Ramirez observed smoke detectors to be operational during visit. Staff Personnel Files: LPA Ramirez reviewed five (5) personnel files that were maintained at the facility. Five (5) out of the five (5) personnel files reviewed did not document the required 20 annual training hours. Per staff S3, facility was in the process of conducting training. LPA Ramirez did observe prior annual training in 2022 and 2021 being conducted during the late days on JUNE AND AUGUST. LPA Ramirez issued Technical Violation. Licensee will submit proof of staff annual training based on title 22 regulations and email such proof to LPA Ramirez no later than 9/2/23. Resident Files: LPA Ramirez reviewed six (6) resident files. Liability Insurance & Infection Control Plan: Licensee will submit copy of Liability Insurance and Infection Control Plan by 9/02/23. LPA Ramirez issued Technical Violation for proof of Liability Insuramce. No deficiencies are being cited today. Exit interview was conducted S2 and a copy of this report, LIC 9102 and appeals rights was provided.the state’s words, verbatim · CDSS document, Aug 19, 2023

The state marks this report as 4 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

Licensing Program Analyst (LPA) Kruz Long conducted a site visit for the annual inspection. Upon arriving at the facility LPA met with Alan Robert Buan (Administrator) and explained the purpose of the visit. The facility is licensed to serve: AGE RANGE 60 AND OVER. 6 AMBULATORY, OF WHICH 6 MAY BE NON-AMBULATORY. HOSPICE WAIVER FOR 3. The facility is located in a residential area. A tour of the single-story facility includes: Living room, kitchen dining area, attached garage/storage/laundry, 4 resident bedrooms, 1 staff bedroom, and 2 bathrooms. During today's visit, LPA observed the following: The facility maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. Facility is not operating over-capacity or beyond any conditions and limitation on the license. No pools and bodies of water on the premises. Facility maintains a comfortable temperature for residents. All outdoor and indoor passageways is kept free of obstruction. Hot water temperature measured at 113.7 degrees F in bathroom #1. There is a presence of grab bars for each toilet, bathtub and shower used by residents. Bathtub or shower have non-skid mats or strips. The total daily diet is of the quality and in the quantity necessary to meet the resident’s needs. Minimum of one week supply of nonperishable foods and 2 days of perishable foods was observed. All readily perishable foods or beverages capable of growth of micro-organisms is stored in covered containers at appropriate temperature. The facility ensures sufficient and competent staff to provide the services needed to meet resident needs. Staff assisting residents with ADLs received required training. Criminal Record Clearance for all required persons is associated to the license. Staff responsible for direct care and supervision have current first aid training. Licensee has obtained and kept on file documentation of a medical assessment, signed by a physician. Facility have a disaster and mass casualty plan. Employees of CCLD is allowed to enter the facility to conduct inspections. A certified administrator is on the premise for a sufficient number of hours to manage and oversee the business operation. Medications is given per the physician’s directions. There is a signed and dated written order from a physician for every prescription and nonprescription PRN medication. Centrally stored medicines is kept in a safe and locked place. No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided to Alan Robert Buan.the state’s words, verbatim · CDSS document, Sep 6, 2022

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Christine Wong and Alberto Lopez conducted an annual required visit. LPA's met with caregiver Evangeline Mendoza and explained the reason for the visit. Shortly after, the administrator Alan Buan arrived and assisted with the visit. LPA's used the infection control tool to evaluate the facility. LPA's observed the facility plant, COVID-19 procedures, reviewed residents' medications, observed food supply, and reviewed resident and staff files. Facility submitted the mitigation plan and was approved on 4/24/21 The facility is a single story house located in the neighborhood. The facility consists of 4 resident bedrooms, two bathrooms, kitchen, dining area, living room, medication/storage room and attached garage. Each bedroom has required furniture, sufficient storage space and equipment. Bedroom#1 and #2 have single bed. Bedroom#3 and #4 have two beds. Each resident bedroom has all required linen including mattress pad. All 2 bathrooms were toured. Bathrooms have the required grabs bars and non-skid mats. While touring the dining room/kitchen area, LPA observed ample food supply of two (2) days of perishables and seven (7) days of non-perishables. Storage areas for cleaning solutions, toxics, knives, and hazardous items were secured and made inaccessible to Residents. The hot water temperature measured at the two bathrooms between 115.4 degrees and 123.6 degrees F which is beyond the required 105 - 120 degrees. All the appliances are clean and working properly. The common areas such as living room and dining room are clean and have the required furniture. The back yard has a shaded area and sitting area. Carbon Monoxide and smoke alarms were tested and were operational. LPA's reviewed 4 resident files to confirm emergency contact is updated. LPA's also reviewed staff files to confirm health screenings and fingerprint clearances. LPA's reviewed 4 residents' medications. All four residents' PRN medication are missing and there's no discontinuation order. Staff reported resident does not take the PRN medication for a long time. The deficiencies cited are documented on the attached 809D. A copy of the report and appeal rights will be provided to house manager via email.the state’s words, verbatim · CDSS document, Sep 10, 2021