Terra Linda Christian Homes, Inc. # 2

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required - 1 yr. visit of the facility. LPA was welcomed by staff Loida Paningbatan. Anabelle Bautista - Licensee was contacted by staff and arrived during the visit. There is a total of 6 residents, 3 with a diagnostic of dementia. There is 3 residents currently on Hospice. LPA toured the facility on 11/07/2023 at 9:10 AM with administrator Anabelle Bautista; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 5/15/2023 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured between 105.1 degrees F and 128.3 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees F in 1 of 2 resident’s bathrooms while touring facility on 11/07/2023 although facility has required signage indicating caution, water temp may exceed 125. However, facility licensee is working with a professional to fix the hot water temperature. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in the closet in the hallway over laundry. The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Resident’s beds were outfitted with mattress pads as required by Title 22 Regulations # 87307 on 11/07/2023. A review of 6 resident & 3 staff records as well as two resident’s medications was conducted during this visit. LPA reviewed resident’s files at 10:30 AM on 11/07/2023 and learned that 6 of 6 residents have an updated re-appraisals/needs & care plans and updated physician’s assessments (LIC 602A) on file. Continue LIC 809-C Medications were centrally stored in locked cabinet in the facility kitchen area. The Medications of 2 out of 2 residents were found to be given according to physicians’ directions on 11/07/2023 at 1:30 PM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be completed and accurate. LPA reviewed a sample of staff records and learned that all facility staff present and a sample of other individuals who require caregiver background checks have received criminal record clearances or exemptions. Direct care staff files have proof of annual training requirements for 2022 and 2023 on file. LPA was presented with proof of CPR & 1st Aid certification for staff that files were reviewed. Ana Belle Bautista Administrator Certificate # 6001738740 expires on 3/12/2025. Facility to ensure that approved Admissions Agreements are always posted and/or accessible to public view in the facility as per Title 22 Regulations # 87507 (e)(2) Admissions Agreement “The licensee shall conspicuously post in a location accessible to public view in the facility a complete copy of the approved admission agreement, modifications and attachments, or notice of their availability from the facility.” LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; ensure that disaster drills are conducted in different shifts, and review facility emergency plan to ensure accuracy according to the needs of facility residents. Disaster Drills are conducted quarterly with the latest on 9/15/2023. There were no deficiencies cited at this time. Continue on LIC 809-C LPA Hansen is requesting facility to submit the following documents to CCL by 11/30/2023: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Current Administrators Certificate Copy of New 3 yr Lease of Property Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Nov 7, 2023

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Shannan Hansen arrived Unannounced at Terra Linda Christian Homes, Inc #2 for the purpose of conducting a Required 1 year Infection inspection. LPA was greeted at the door by Care Giver, Crisostomo Nario. Licensee, Ana Belle Bautista arrived 20 minutes later. Facility has 6 residents, 1 with dementia, and 2 on hospice. LPA toured the facility with licensee, Ana Belle Bautista. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 04/07/2022 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Water temperature in resident's bathroom faucets measured between 107 degrees F and 120 degrees F which are within acceptable range of Title 22 Regulations of 105 to 120 degrees F. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. LPA observed toxins stored in unlocked closet underneath kitchen sink (see LIC 809D). The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers instead of individual hand towels. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Medications are centrally stored in locked cabinet in kitchen but on today’s inspection there were also medications stored in separate kitchen cabinet without lock, accessible to residents in care (see LIC 809D). Infection Control: Facility has submitted a mitigation program plan and infection control plan. Posters have been placed at facility and entrance has hand sanitizer and other items designated for visitors and staff before coming into work. Facility has PPE supply stored in front room & kitchen. Continue LIC 809-C In addition, facility has a designated area for visitors which are being allowed for visits. Residents also have available Zoom, Facetime, and telephone calls when contacting with family members and others. Staff had all PPE training required on file and have obtained N-95 fit testing. LPA Hansen reviewed Licensing Information System (LIS) with Licensee who stated that is corrected and updated at this time. LPA advised facility to contact Local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. LPA was presented with proof of current CPR & 1st Aid certification for staff. Administrator Certificate is for Ana Belle Bautista 6001738740 Exp. 3/12/2023 All staff have received COVID booster vaccinations. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. LPA Hansen is requesting Licensee to update and submit the following documents to CCL by 11/04/2022: LIC 308 Designated LIC 309 Administrative Organization LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Oct 19, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Farhaan Sarangi arrived Unannounced at Terra Linda Chrisitian Homes, Inc #2 for the purpose of conducting a Required 1 year inspection. LPA was greeted at the door by Care Giver, Nario Crisostomo. Administrator, David Sekiranda arrived 20 minutes later. LPA toured the facility with administrator, David Sekiranda. Facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 04/2021 at the time of the visit. Smoke detectors and carbon monoxide detectors were found to be operational during the visit. Hot water temperature measured at 115 degrees in residents bathrooms. The facility serves residents with dementia and has a plan of operation for special care and programming. There was a sufficient supply of both perishable and nonperishable food as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in the locked closet in the hallway over laundry. The bathrooms designated for residents at the facility were supplied with individual paper towels and hand soap dispensers instead individual hand towels. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. All bedrooms have lighting & appropriate furnishings. Resident’s beds were outfitted with mattress pads as required by Title 22 Regulations # 87307. LPA requested the following documents be updated and sent to licensing, LIC 309, LIC 400, LIC 308, LIC 500, LIC 402, Facility sketch, liability insurance and updating the facilities Program Plan of Operation. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE in the office located and at other sister sites. Facility is in the process of being N95 Fit tested on September 22, 2021. No deficiencies were observed or cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator, David Sekiranda.the state’s words, verbatim · CDSS document, Sep 14, 2021