The Anton Pointe

Type of visit: Required - 1 Year

At approximately 9:15AM, Licensing Program Analysts (LPAs) Felias and Rummonds arrived unannounced to conduct a Required 1-Year visit and met with Administrator, Cleda Odiwe. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file. Facility has an approved fire clearance and capacity for 10 non-ambulatory residents. Facility has an approved hospice waiver for 2 individuals. Upon arrival, LPAs were informed that there were currently 8 residents in care and 3 staff members on-site. At approximately 9:30AM, LPAs reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. At approximately 9:45AM, LPAs conducted a walk-though of the facility and observed the following: Facility is a 1 story building with 6 Resident bedrooms, 2 bathrooms, and common spaces. Facility had emergency lighting. Facility has an Infection Control plan on file. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. There was an appropriate supply of cleaning products, linens, hygiene products and paper products available for Residents. Mattress pads were in place or available for Resident use. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. LPAs observed a structure on the property not identified on facility's sketch. Investigation of the structure indicated that it is a two room structure. LPAs observed that one room is for storage, and the other is a living unit. Per conversation with Administrator, they sleep there when they decide to spend the night at the facility and the structure has been there since the facility was opened in 2001 (pictures of structure taken). During walk-through, LPAs observed the following deficiencies: Cleaning products and supplies located in residents' bathroom were unlocked and accessible to residents in care. Knives and other sharps were unlocked in a drawer accessible to residents in care (These deficiencies have been cited, see LIC809D, Regulation 87705(f)(1) and Regulation 87705(f)(2)). Three facility exits were obstructed by resident belongings in 2 of 6 bedrooms, and in the living room. LPAs saw a night stand and lamp obstructing the exit sliding door in Bedroom 1, a night stand, lamp, and dresser obstructing the exit sliding door in Bedroom 5, and a resident's walker obstructing the exit door to the backyard in the living room (This deficiency has been cited, see LIC809D, Regulation 87202(a)), and LIC421IM). Continued on LIC809C Continued from LIC809 LPAs saw expired food cans and yogurt, moldy sausages, and unlabelled and uncovered meals in fridge. Facility staff immediately discarded expired and moldy food (This deficiency has been cited, see LIC809D, Regulation 87555(b)(8)). LPAs observed feces and a soiled disposable pad in a resident's bedroom. The bedroom also had a strong smell of urine. During visit, LPAs observed facility staff clean the bedroom and replace the bed pad. LPAs observed that there was no longer a smell of urine. LPAs observed a pile of discarded items including wood, nails, caulk, and cardboard located on the side of the facility. LPAs also saw mold located on the exterior of the house, wood rot on the roof, facility's living room ceiling was observed to be caving in and the tiles in Bathroom 1 were moldy and were in need of replacing. LPAs saw that the bottom bathroom tiles were shown to be broken and peeling off from the wall (pictures of disrepair and items to be discarded taken) (This deficiency has been cited, see LIC809D, Regulation 87303(a)). LPAs unable to complete Required 1-Year/Annual visit. Annual Continuation Visit to be conducted at a later date. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. ***An immediate civil penalty in the total amount of $500.00 has been issued for being out of compliance with fire clearance regulation 87202(a). Exit interview conducted. Copy of report, LIC809D, LIC421IM, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Oct 12, 2023

Allegation investigated: Resident's care needs are not being met. Facility did not provide medical care to resident in a timely manner Facility in disrepair Facility is not providing activities to Residents

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with License Cleda Odiwe. Regarding allegation of resident’s care needs are not being met. Per Reporting Party, resident (R1) doesn’t get their depends changed and nails had been noticed uncleaned. Also, R1 has not been assisted with a shower nor brushed their teeth for days. Based on records review of facility records of house rules states on item #10 “residents are encouraged to shower/bath and change clothing daily”. Also, facility staff weekly schedule task for the month of August and September indicates that staff have been instructed to check consistently every Friday resident’s fingernails. In addition, Facility shower calendar for the months of August and September 2022 indicates that R1 is scheduled to receive shower on Wednesdays and Sundays only. However, R1 did not receive a shower on Sunday (8/7/22 & 8/28/22) and Wednesday (8/31/22). Continue on LIC9099C... Substantiated Continued from LIC9099... Additionally, there was a reminder located on the kitchen refrigerator of the facility reminding staff to take R1 to brush their teeth daily and clean their fingernails as well. R1’s Physician’s report dated 4/1/2022 determines that R1 has a diagnosis of Dementia and needs assistance with basic bowel movement practices/toileting and gets resistant to bathing. Based on interviews conducted with facility staff, it was revealed that 4 out of 7 couldn’t recalled performing those task with R1 because resident gets combative so they leave them alone and come back a different time. Therefore, the facility staff did not follow their house rules, weekly staff schedule task procedures and R1’s Physician’s report about resident’s care needs. The preponderance of evidence standard has been met; therefore, the above allegation of resident’s care needs is not being met is found to be SUBSTANTIATED. Regarding allegation of facility did not provide medical care to resident in a timely manner. Per reporting party, on 8/18/22 suspected that R1 had a fall at night instead of an episode where R1 pulled down the commode, the lamp and everything was found on the floor by the licensee. Also, on 9/8/22 R1 sustained 2 inches in diameter bed sore on tailbone and 9/30/22 R1 was observed with a rash in their legs. Based on records review, R1’s LIC602 Physician's Report dated 4/11/22 does not indicate a history of skin condition or breakdown prior to the admission to the facility. LPA obtained pictures from outside party dated 9/27/22 at 8:05pm from licensee showing R1’s leg with rash. Although, licensee confirmed that the facility notified R1’s responsible party about the diaper rash and bruising, the facility staff did not contact R1’s Physician, they just put some ointment on R1, and they recovered. Per facility’s Medication Administration Record dated 10/1/22 for R1, there was a prescribed Betamethasone Dip 0.0520 cream 456 mg to be applied topically twice per day. Based on LPA’s interviews conducted with licensee, R1 sustained the bruise on their arm because of R1 pulled out the dresser and throwing all the stuff away, then their responsible party took R1 to their Physician. Per Licensee, the facility staff does not seek for medical treatment for R1 because R1's primary physician is located in Monterey and they did not take them to the ER/hospital because it was a little rash and not a big deal. However, LPA obtained R1’s diagnosis from the UCSF dermatopathology Specialist Services dated 10/28/22 confirming that the findings are consistent with a hypersensitivity reaction to an arthropod bite or a medication. The preponderance of evidence standard has been met; therefore, the above allegation of facility did not provide medical care to resident in a timely manner is found to be SUBSTANTIATED. Continues on LIC9099C... Continued from LIC9099C... Regarding allegation of Facility in disrepair. It was alleged that the toilet bathroom used by residents was wobbly and not secured to the floor properly, the aluminum/portable seating toilet handlebars were broken approximately 5 weeks ago representing a hazard to residents in care and as of 9/8/22 has not been addressed by the Licensee. Based on records review, the facility provided an amazon receipt dated 7/8/22, order #114-6289875-7477013 One Medline toilet safety rails, safety frame for toilet with easy installation, height adjustable legs, bathroom safety. Based on interviews, LPA obtained information from an outside agency that conducted a visit on 8/9/22, and brought up to Licensee’s attention the issue with toilet handlebars broken and Licensee have showed them the needed replacement parts that were inside a box waiting to be installed. Also, during LPA’s confidential interviews conducted with witness, it was revealed that as of 9/8/22 the broken handrails were not been addressed yet. LPA conducted a 10-day complaint investigation on 9/13/22, LPA/Licensee toured the facility, made observations, and conducted interviews with facility staff. During the tour of the physical plant the bathrooms appeared clean, safe and in good repair. Based on LPA’s interviews and observations, LPA has determined and confirmed that although the bathroom was in a good condition at the time of visit, the handrails were replaced, and toilet was secured properly to the floor a few days ago. The preponderance of evidence standard has been met; therefore, the above allegation of facility is in disrepair is found to be SUBSTANTIATED. Regarding allegation of facility is not providing activities to residents. It was alleged by reporting party that the facility does not conduct any activities for residents in care other than watching television. During LPA’s visits conducted on 9/13/22, 10/19/22 and 11/15/22 did not observe any activity being performed at the facility. Based on interviews conducted with the Licensee, the facility does have a daily schedule of planned activities. However, Licensee was unable to show LPA the supplies, equipment, volunteer assigned for activities was on vacations and there was no substitute to conduct activities. Based on records review, observations and interviews conducted the facility does not follow their plan of operation regarding daily activities. The preponderance of evidence standard has been met. Therefore, the allegation of facility is not providing activities to residents is SUBSTANTIATED. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. The Department will be reviewing the information obtained to determine if further actions are needed. Exit interview conducted with Licensee Cleda Odiwe and a copy of this report was given. Continued from LIC9099A... Regarding allegation of Facility does not have adequate perishable foods supply. Per Reporting party, food service not enough fresh vegetables and fruits for resident's nutrition. This Department has conducted unannounced site visits on 9/13/22, 10/19/22 and 11/15/22, LPA interviewed staff and residents, reviewed and obtained records during the course of this investigation. At each unannounced site visit the facility had adequate perishables and non-perishable food observed in adequate supply and menus were consistent with the requirements of Title 22 regulations. Based on interviews conducted by LPA, there is contradictory information about resident's food preferences, the quality of food service differs and this Department did not find a consensus of opinion when interviewing the residents. Although the allegations may be true or valid, there is not a preponderance of evidence to prove that the allegations are, or are not, true. Therefore the allegations are found to be UNSUBSTANTIATED. Exit interview conducted with Licensee Cleda Odiwe and a copy of this report was given.the state’s words, verbatim · CDSS document, Dec 6, 2022 · control 21-AS-20220908154002

From the deficiency page — Deficiency type: Type A · Section cited: CCR 1569.269(a)(6) · Plan of correction due date: Dec 7, 2022

§1569.269 (a)(6) Enumerated rights (a) Residents of RCFE shall have all of the following rights: (6) To care, supervision & services that meet their individual needs & are delivered by staff that are sufficient in numbers, qualifications & competency to meet their needs. This requirement has not been met as evidence by: Based on LPA records review and interviews, the facility staff did not follow their house rules, weekly staff schedule task procedures and R1’s Physician’s report about resident’s care needs which poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2022

Plan of correction: Licensee agrees to submit a written plan to ensure compliance of the facility and how they will follow up on resident’s needs by POC due date

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466(a) · Plan of correction due date: Dec 7, 2022

87466 Observation of the Resident - (a)The licensee shall ensure that residents are regularly observed for changes in physical…& that appropriate assistance is provided when such observation reveals unmet needs...This requirement has not been met as evidence by: Based on LPA records review and interviews with licensee, the facility did not ensure to seek medical treatment for R1 after observed rash and bruising in resident’s body which poses an immediate risk to the health and safety of the residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2022

Plan of correction: Licensee agrees to submit a written plan and staff training in how staff will assess resident’s injuries and will seek properly medical treatment by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Dec 7, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement has not been met as evidence by: Based on LPA’s observations, records review and interviews with licensee & outside parties, the facility did not ensure to keep resident’s bathrooms clean, safe, sanitary and in good repair at all times which poses an immediate risk to the health and safety to residents in care.the state’s words, verbatim · CDSS document, Dec 6, 2022

Plan of correction: Licensee will submit a written statement describing how they will ensure compliance with this regulation to CCL by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(a) · Plan of correction due date: Dec 22, 2022

87219 Planned Activities: (a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities…This requirement has not been met as evidenced by: Based upon interviews, observations and records reviewed, the facility did not ensure to provide recreational activities as required by regulation. This poses a potential risk to the health and safety of resident’s in care.the state’s words, verbatim · CDSS document, Dec 6, 2022

Plan of correction: Licensee will implement and document into the resident’s daily care notes their participation or non-participation in the activities. Weekly log will be submitted to CCL by POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required inspection and met with Licensee, Cleda Odiwe. The inspection is based on Infection Control practices of this facility. Upon arrival, LPA was screened by staff for Covid-19 which included a temperature check and signing in. LPA confirmed that facility is no longer requiring vaccination verification per recent guidance. LPA initiated a walk-through of the facility and observed the following: Facility has COVID-19 posters throughout that include hand washing signs in bathrooms. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Staff had masks on during this visit. Commonly touched surfaces are disinfected at least once per day. Facility does not perform daily screening of staff and residents just every other day. Facility has a designated visitation area outside and is allowing for visitation in resident rooms per CCL guidance. Staff continue to receive training on infection control and donning and doffing of Personal Protective Equipment PPE but have not been N95 fit tested. LPA/Licensee discussed visitation and activities. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has more than a 30 day supply of PPE including but not limited to masks, gowns, and hand sanitizer. Facility maintains a 30 day supply of medication. Fire extinguishers were last serviced October 2022. Smoke Detectors and Carbon Monoxide detector were tested and operational. At approximate 10:00am, LPA/Licensee observed staff (S1) was providing care to residents at the facility and was not associated to the facility. LPA informed Licensee that S1 is not associated to facility and should never be working and providing care to residents prior to a criminal record clearance or exemption. Civil penalties are being assessed in the amount of $100 per day for allowing a person to work, reside or volunteer in the facility without being associated. Licensee submitted updates of the following documents: LIC 308 Designated Administrator, LIC 500 Personnel Summary, LIC 610 Emergency Disaster Plan and Liability Insurance. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Nov 15, 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: Case Management - Incident

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management visit regarding an AWOL that occurred on 09/20/2022 and was greeted by staff Philomene Desire, Cleda Odiwe (Licensee) was available by phone and gave authorization for staff to sign the report. On 9/22/22 CCL received a self-incident report reporting resident's (R1) AWOL. Per incident report, on 9/20/22 R1 suddenly left the facility around 1pm. Licensee and staff followed R1 and asked them to return to the facility, but R1 refused then Licensee contacted a family member by phone and resident refused again to talk to them. Licensee contacted LPA Fernandes-Goes who advise them to contact the Police. At approximate 2:20pm, R1 got a taxicab from the North Bay Cooperative Service to return to their home. Per R1's responsible party, R1 was reported safe at their house. During today's visit LPA obtained pertinent documents and conducted confidential interviews with staff. Per Physician's report dated 8/10/2022, R1 is able to leave the facility unassisted. Facility staff followed all the proper procedures, they also remained with resident at all times until they got the taxi and contacted responsible parties including CCL to notify them about the incident. At approximate 10:30am, LPA/staff observed staff (S1) was providing care to residents at the facility and was not associated to the facility. LPA informed Licensee that S1 is not associated to facility and should never be working and providing care to residents prior to a criminal record clearance or exemption. Civil penalties are being assessed in the amount of $100 per day for allowing a person to work, reside or volunteer in the facility without a fingerprint clearance. Also, during walk through the facility, LPA/staff observed two out of two fire extinguishers were not charged and serviced since June 2021. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.***Civil Penalty is being assessed for the amount of $100 per day for Criminal record clearance. Exit interview was conducted with Licensee via phone and a copy of report was given to staff.the state’s words, verbatim · CDSS document, Oct 19, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Oct 20, 2022

87355 Criminal Record Clearance (e)All individuals... shall prior to working, residing or volunteering in a licensed facility: (1)Obtain a California clearance or a criminal record exemption as required by the Dpt... This requirement is not met as evidence by: Based on LPA observation, record review and interview with Licensee did not ensure to obtain a criminal record clearance for staff (S1) prior to work, reside or provide care to residents in care which poses an immediate health, safety and personal rights risk to residents in care. ***Civil Penalty is being assesed for the amount of $100 per day.the state’s words, verbatim · CDSS document, Oct 19, 2022

Plan of correction: Licensee must remove staff (S1) from the premises until S1 has a clearance as required by law. Licensee will submit a written plan to ensure that regulation was understood along with self-certification that S1 was removed from facility to CCL by POC due date 10/20/2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR87203 · Plan of correction due date: Oct 20, 2022

87203 Fire Safety - All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in 2 out of 2 fire extinguisher was charged but not serviced which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 19, 2022

Plan of correction: Licensee to contact Fire Department or Fire Safety company to have the fire extinguishers serviced. Licensee to submit copy of invoice/receipt and pictures of newly dated tags by POC due date.

Allegation investigated: Unlawful Eviction

The Department conducted a complaint investigation regarding the allegation listed above. Licensing Program Analyst Fernandes-Goes arrived unannounced for the purpose of closing the investigation and met with Cleda Odiwe. On January 6, 2022, LPA Fernandes-Goes toured the facility; conducted interviews; acquired documentation; and made observations of the facility. During tour of the facility with Cleda Odiwe licensee/administrator, interviews with resident R1, staff, and family member on 1/6/22 and 3/19/22; and documentation review, LPA learned that facility had accept a Kaiser placement of resident R1 on 11/12/21 and Kaiser is supposed to be making payments to facility. Facility staff stated that has spoken with resident R1 family member regarding Kaiser placement, payments, and if family still wants resident to stay after 3 months stipulated by Kaiser, however; has never spoken regarding eviction. (Cont. LIC 9099-C) Unsubstantiated Complainant contacted Department to shared concerns regarding facility wanting resident to move. Family member stated that resident R1 would like to move, but family is very happy with placement and facility services. Based on interviews and documentation review, Department is not able to prove or disprove that resident R1 might have received a verbal unlawful eviction notice. A finding that the complaint allegations of "Unlawful eviction.” is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Mar 25, 2022 · control 21-AS-20211231101126

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced post-licensing infection control inspection to this facility and was welcome by Cleda Odiwe. Facility has 7 residents with 1 under hospice care at this time. LPA arrived at the facility and observed hand sanitizer at the entrance and a log in binder for temperature of visitors. During tour of the facility on 3/25/2022 with licensee/administrator Cleda Odiwe, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Sample tour of resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 06/21. Hot water temperature measured between 113.2 degrees F and 117.3 degrees F in 2 out of 2 resident’s bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. Toxins are stored in a locked laundry room. Dangerous items were stored inaccessible to residents in care. There was a supply of cleaners, hygiene products and paper products available for residents. The bathroom designated for residents at the facility were supplied with individual paper towels; hand soap dispenser was available. Sample resident’s bedrooms have lighting & appropriate furnishings. Facility understands that unvaccinated staff must have an exception on file and be tested once a week if PCR. Infection Control: Facility has submitted a mitigation program plan that has been approved at this time. Posters have been placed throughout of facility and entrance. Facility has PPE supply stored in the office and cabinet by entry door. Facility has not hired new staff, however; has admitted new residents since licensed. Resident’s medications are stored and locked in office room. Continue LIC809-C Facility has a 30-day supply of medication for residents. Residents aren’t wearing masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit. Facility has acquired N-95 fit testing which is on file for Department to check per licensee/administrator. There were no deficiencies cited at this time. Department is requesting the following to be submitted to CCLD by 4/1/2022: LIC 308 LIC 500 LIC 9020 Copy of Administrator Certificate Copy of liability insurancethe state’s words, verbatim · CDSS document, Mar 25, 2022

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: Prelicensing

Licensing Program Analyst (LPA) Fernandes-Goes conducted a continue pre-licensing inspection and met with Licensee/Administrator Cleda Odiwe. This is a change of ownership. Fire clearance has been approved for 10 non-ambulatory residents by the County Fire Department. There is a total of 7 residents and no residents under Hospice care. This is a continuation pre-licensing visit that occurred on 11/15/21. During today's tour of this facility 12/17/2021, the following pending items were observed: - Facility is in in good repair: items that were requested to be fixed on 11/15/21 are in place at this time. - Post the following: all necessary postings in place. - Proof of quarterly disaster drill - on file during this visit. - Request for underage resident exception - has been submitted and granted. Pre-Licensing is complete and this facility has no apparent deficiencies. Facility is ready for licensure. There were no deficiencies cited at this time.the state’s words, verbatim · CDSS document, Dec 17, 2021

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Fernandes-Goes conducted a pre-licensing inspection and met with Licensee/Administrator Cleda Odiwe. This is a change of ownership. Fire clearance has been approved for 10 non-ambulatory residents by the County Fire Department. LPA will conduct a component III orientation with Cleda & Ken Odiwe Administrator/Licensee. There is a total of 7 residents and no residents under Hospice care. Facility tour/inspection began at 10:45 AM: Facility is a one floor facility. LPA toured the facility on 11/15/2021 with Licensee/Administrator Cleda Odiwe; facility was found to be at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 06/2021. Sample test of facility smoke detectors and carbon monoxide detectors were found to be operational. Sample hot water temperature measured 111.7 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 1 of 1 resident’s bathroom faucet. The facility has special care plan of operation and programming for residents with dementia. Facility does grocery shopping on Tuesdays. Food stored in the kitchen refrigerator were properly stored as per regulations. LPA observed that provisions are made for individuals with special dietary needs. Food is available for residents any time of the day. Toxins are stored in a locked cabinet in the office room. There was a supply of cleaners, hygiene products and paper products available for residents. All bathrooms designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. Continue LIC 809-C Facility floor includes kitchen, laundry room, living room area, bathrooms, office room, dining room, and resident's bedrooms, and bathrooms. There is outdoor space for activities. Resident's & Personnel records, medication, first aid supplies, and toxins will be locked in the office. Postings noted to be current and in compliance with guidelines. First aid kit has been placed by medications. PPE is being stored in a supply room. Disaster Drills have been conducted often and in different shifts with the last one being conducted on 7/2021. Community Care Licensing has requested the following items be corrected prior to licensure: (LPA will be revisiting facility unannounced after licensee communicates that facility is ready for a visit.) - Facility must be in good repair: facility need to have walls clean/painted, carpet needs to be repair and clean, residents bedrooms missing night stands and lamps, ceiling in the living room coming off and spots of water stain, resident's bedroom shades; outside area to have any tripping hazards. - Post the following: Calendar for plan activities, resident's personal rights, and non-discrimination notice. - Proof of quarterly disaster drill - last was 7/2021. - Request for underage resident exception - pre-assessment, LIC 602, letter from POA, letter from facility requesting underage exception with name and DOB for resident. (due on 11/19/2021) There were no deficiencies cited at this time.the state’s words, verbatim · CDSS document, Nov 15, 2021

The state marks this report as 7 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: INDIVIDUAL Capacity: 10 Census (if any clients in care): 7 Method: Telephone at CAB COMP II Participants: Cleda Odiwe (Applicant/Administrator) and Ken Odiwe (Applicant) Applicant/Administrator participated in COMP II at CAB via telephone with analyst at CAB. Identification of the Applicant and Administrator was verified by providing California Driver License number. During COMP II, Applicant and Administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and Administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Oct 25, 2021