1st Pacific Coast Homes II

Type of visit: Case Management - Other

LPA Grace Donato made an unannounced case management in the facility. LPA met with Licensee Deborah Dahlen. LPA explained the purpose of the visit. This case management visit is with regards to following up about staff personnel files in the facility. LPA is here to check if staff files are all organized and that first aid training are up to date. 3 personnel files were reviewed. 2 out of 2 are all up to date and trainings are complete. One staff member hasn't had training as of the moment due to being out of the country. No citations given for todays visit. A copy if this report is provided.the state’s words, verbatim · CDSS document, Jun 30, 2023

Type of visit: Required - 1 Year

LPA Grace Donato & LPM Jackie Jin conducted an unannounced annual visit to the facility. LPA & LPM met with the administrator Deborah Dahlen. LPA & LPM toured the facility inside and outside with the administrator. While touring the facility it was observed that the temperature was af 78 deg F. Hot water was also tested and temperature was 110 deg F.Each resident rooms were checked. The residents have adequate amount of linens and incontinence care items. All personal belongings are intact. All residents are comfortable and taken care of. Carbon monoxide monitor is working properly. All fire extinguishers have been checked. Bathrooms were observed to be in good repair equipped with non-skid mats and grab bars. There is also adequate amount of food. 2 days for perishables and & 7 days non-perishable. Medication review was done and all medications are accounted for and centrally stored medication records are updated. One staff record was reviewed. All staff has criminal record clearance and are associated with the facility. Based on record reviews, it was noted that the facility does not have updated CPR & First Aid training. Personnel records are not maintained resulting for some documents being unavailable when needed. Resident records are checked and all are complete and updated. One out of one resident is in hospice and it was observed that the Hospice agreement was not in the file. Outside the facility, there were several sharps found around the garden area, the administrator corrected the deficiency by storing them on a locked shed. While touring around the facility, it was observed in the bathroom that chemicals were unlocked cabinet. Administrator cleared the deficiency by installing a lock for the cabinet. It was also observed that there were several chemicals in the garage. Deficiency was cleared by fixing the lock for the garage door so it won't be accessible to the residents. Facility doesn't have a record of Emergency Disaster drill log. LPA & LPM advised administrator that drill shall be completed quarterly. LPA requested licensee to submit the following by 4/28/2023: LIC 308 Designation of Facility Responsibility LIC 610D Emergency Disaster Plan LIC 500 Personnel Report Updated Administrator Certificate Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in civil penalties. Report is reviewed with Co-Administrator and a copy is provided with appeal rights.the state’s words, verbatim · CDSS document, Apr 24, 2023

The state marks this report as 11 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On this day at 1400 hours, Licensing Program Analysts (LPA) Jaime Vado conducted an unannounced infection control annual required inspection. LPA met with administrator Deborah Dahlen and explained purpose of today's inspection. LPA toured facility's building and grounds. Upon entry LPA was screened for COVID with temperature taken and COVID related questions asked. It is suggested that more COVID signs be present within facility. Additional social distancing signs, cough etiquette signs, face covering, and COVID symptoms signs to be posted in main hallway. There are no accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident monitoring and staff monitoring, containment strategies, environmental preparation and cleaning are in place. PPE supply is observed as in place. LPA informed administrator that additional PPE is available from the regional office upon request. Medications, toxins and sharps are stored appropriately and inaccessible to clients on the second floor. Facility ambient temperature is comfortable and lighting is sufficient for residents and staff safety. Toilet and bathing facilities are equipped with grab bars and non-skid flooring material. Liquid soap is available in resident bathrooms and paper towels for resident use. Hand washing signs are present. First-aid kit is inspected as complete. A Disaster and Mass Casualty Plan observed. There are 3 residents and 1 staff present. All staff wearing masks. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed as current. Administrator certificate expires 7/27/2022. All residents and staff are fully vaccinated and with booster. Mitigation plan is present and reviewed with administrator. According to her it is current and is still in use. Facility does not handle cash resources. The following updated forms are requested to be submitted to CCLD by 04/01/2022: • LIC 308 Designation of Administrative Responsibility • LIC 500 Personnel Report • LIC 610E Emergency Disaster Plan • LIC 9020 Resident Roster • Updated copy of administrator certificate No deficiencies cited. Report is reviewed with Deborah.the state’s words, verbatim · CDSS document, Mar 25, 2022