The Patchwork Quilt Guest Home for the Elderly

Type of visit: POC

Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 09/06/2022. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty, who contacted facility administrator (AD) Rizalina Reyes about visit. AD Reyes was unable to be present during time of visit, but provided consent for Lead Caregiver (CG) Emelyn Read to receive and sign report. For today's visit, LPA De Perio verified that there are currently 4 residents in care and 2 staff members present. On 9/6/22, LPA De Perio observed that facility failed to keep the centrally stored medication in a safe and locked place that is not accessible to residents in care, other than employees responsible for the supervision of centrally stored medication. LPA observed resident 1 (R1) having possession of tubes of prescribed ointment that is used orally and topically. LPA De Perio reviewed R1’s files, which did not indicate or specify that R1 was able to have possession of any prescribed items. LPA also observed an open bottle of Milk of Magnesia Suspension in the kitchen. *Deficiency cited under Title 22 Regulation 87365(h)(2) pertaining to Incidental Medical and Dental Care has been CLEARED. Licensee has provided staff with training on 9/12/22 on this regulation and LPA De Perio observed that facility has secured medications in a location that is inaccessible to residents in care. On 9/6/22, LPA De Perio observed that licensee failed to lock disinfectants, cleaning solutions, poisons, and other items which could post a danger. LPA observed cleaning supplies and disinfectants stored in an unlocked cabinet located under the bathroom sink. LPA also observed bottles of rubbing alcohol in an unlocked kitchen cabinet. *Deficiency cited under Title 22 Regulation 87309 pertaining to Storage Space has been CLEARED. Licensee has provided staff with training on 9/12/22 on this regulation and LPA De Perio observed that facility has secured disinfectants, cleaning solutions, and poisons in a locked location and is inaccessible to residents in care. On 9/6/22, LPA De Perio observed that licensee failed to lock knives, and other items that could constitute a danger to the resident(s) which could post a danger. LPA De Perio observed knives, sharps and scissors in an unlocked kitchen drawer. * Deficiency cited under Title 22 Regulation 87705(f)(1) pertaining to Care of Persons with Dementia has been CLEARED. Licensee has provided staff with training on 9/12/22 on this regulation and LPA De Perio observed that facility now has a locked box located in the kitchen of which is designated to secure knives and sharps. LPA De Perio conducted an exit interview with caregiver Read, and AD Reyes via phone, and a copy of this report and Letter of Cleared Deficiency has been provided to the facility.the state’s words, verbatim · CDSS document, Sep 23, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, 2 staff were on duty, who contacted facility administrator (AD) Rizalina Reyes about visit. AD Reyes was unable to be present during time of visit, but provided consent for Lead Caregiver (CG) Emelyn Read to conduct tour, and receive and sign report. As of 9/6/22, there are 0 active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted throughout the facility. The PUB475 "See Something, Say Something" poster was also observed entrance. LPA observed the Administrator's Certificate for Rizalina Reyes, which expires on 6/30/23. LPA De Perio toured the interior and exterior portions of the facility with LG Read. The facility is a two level structure and is licensed for 6 non-ambulatory, 0 bedridden and 4 hospice. LPA De Perio toured the second level of facility and observed no residents residing on the second floor and verified that the second level is not for resident use. For this visit, there are a total of 4 residents in care, 2 on hospice, 0 bedridden. All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. The restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 109.8 degrees Fahrenheit and hand washing signs were also posted in each restroom. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Fire extinguisher was charged, mounted and located in the kitchen. LPA De Perio observed the emergency disaster and evacuation plan, which is posted at the entrance of the facility. Facility had back-up emergency food and water supply, located in the garage. LPA De Perio observed that First Aid Kit had all the required components. The facility had an adequate supply of PPE that was located in the garage. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which was self-closing and self-latching. A swimming pool was observed to be in the backyard, of which there is a locked gate surrounding it. LPA De Perio verified the Coronavirus 2019 (COVID 19) mitigation plan of the facility with AD Reyes. LPA De Perio discussed Assembly Bill 665 requires that a licensee of any adult or senior care residential facility that has internet service provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. LPA De Perio discussed with AD Reyes to review, and subscribe for emails regarding the Provider Information Notices (PINs) as well as to attend the CCLD Informational Calls to ensure that facility and staff are up to date. The PINs can be accessed at: www.ccld.ca.gov. For today's visit deficiencies were issued per Title 22 Division 6 of the California Code of Regulations and Appeal Rights were printed and provided. LPA De Perio advised AD Reyes to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA. LPA De Perio conducted an exit interview with AD Reyes via telephone and CG Read and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 6, 2022

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted, COVID-19 screened and granted entry into the facility by Licensee/Administrator (L/AD) Rizalina Reyes and explained the nature of the visit. This facility is licensed to provide services to residents age range 60 and over, 6 Non-Ambulatory Residents; and has a hospice waiver for four (4) residents. L/AD Rizalina Reyes has an Administrator Certificate with expiration date of 06/30/2023. On or about 2:06pm LPA Quiroz along with L/AD Reyes toured the inside and outside of facility. There are five residents in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz observed five (5) residents in their bedroom resting watching television, five of five residents appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected residents’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. L/AD Reyes indicated facility is taking temperatures daily; and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs for resident’s enjoyment. Facility has completed the LIC 808 Mitigation plan dated 1/09/2021. L/AD Reyes update changes to LIC 808 during today's visit. L/AD Reyes will resubmit LIC 808 to CCL for approval. During today's inspection visit, L/AD Reyes indicated "all residents and staff at facility are fully vaccinated for COVID-19." LPA Quiroz reviewed 5 of 5 resident's records during today's visit. CONTINUED ON NEXT PAGE... CONTINUED... Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. (See LIC 9102- Technical Violation) This report was reviewed with L/AD Rizalina Reyes, and a copy of this report, LIC 9102 and LIC 811 were provided at exit.the state’s words, verbatim · CDSS document, Nov 2, 2021