Family Care - Pepita Home

Type of visit: Required - 1 Year

An initial copy of this report had been generated under an incorrect facility number (306002428) and was amended to the right facility. On 08/16/2022 at 2:15pm, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA was greeted and granted entry by caregivers Edwin Abellana and Cathy Berdan after explaining the purpose of the visit. At approximately 2:20pm, LPA accompanied by caregiver toured the physical plant of the facility. There are currently five (5) residents in care, three (3) of which are receiving hospice care. The residents are observed relaxing in the common area or in their respective bedrooms and appear clean and well taken care of. The four (4) bedrooms include all necessary components. An ample supply of linen is observed. The two (2) shared bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. Sharp instruments are stored in a kitchen cabinet secured by a magnetic lock, along with the centrally stored medication and resident files. LPA observed a sufficient supply of food and water present. Cleaning supplies are located in the locked attached garage as well as in a locked cabinet under the kitchen sink, secured by a key lock. LPA observed the facility has COVID-19 Precautions posters and all required department postings. The Administrator certificate for Russell Venanzi is expired and will need to be replaced with a current print-out showing current status as an administrator. The facility has an adequate supply of PPE. Several fire extinguishers are present and charged. Exits are equipped with functional sound alarms indicating an egress. Caregiver Abellana is correctly cleared and fingerprinted in Guardian, however the staff association for Cathy Berdan has been terminated at the time of the visit in spite of being cleared. LPA provides guidance on the licensee's responsibility to maintain accurate and up-to-date staff association. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and caregiver toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture is present for the enjoyment of residents and visitors. The perimeter gate is self-latching and can easily be opened in an evacuation. There are no bodies of water of water on the premises. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. A Technical Advisory regarding the Administrator certificate on display is issued along with one regarding staff association. This report was reviewed with facility representative and a copy of this report was provided and left at facility.the state’s words, verbatim · CDSS document, Aug 16, 2022

Allegation investigated: ) Staff are not properly trained to handle and dispense medications. 3) Staff are not trained to care for resident with restricted health condition.

On 06/02/2022, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced to the facility to deliver findings made during the investigation of complaint 22-AS-20220204075525. LPA was greeted and granted entry by Paul Bartolome, caregiver and explained the purpose of the visit. Administrator Russell Venanzi was notified of the visit and arrived later to assist with the visit. Based on the observations, interviews and file review conducted during the visit on 02/10/2022, LPAs were able to determine that on the allegation that staff trained to handle and dispense medications, LPAs found two staff members for whom training had been completed but not documented. On the allegation that staff are not trained to care for resident with restricted health condition, LPAs confirmed no training had been documented at the time of the visit and no Home Health Services were involved in the colostomy care. The preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated and are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the report and Appeal Rights were left at the facility. Substantiatedthe state’s words, verbatim · CDSS document, Jun 2, 2022 · control 22-AS-20220204075525

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(c)(3)(D) · Plan of correction due date: Jun 2, 2022

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training (...) (3) The training shall include, but not be limited to, the following: (...) (D) Policies and procedures regarding medications, (...) This requirement is not met as evidenced by the observations and interviews conducted during the site visit.the state’s words, verbatim · CDSS document, Jun 2, 2022

Plan of correction: Licensee agrees to provide documentation of the onboarding and annual training on medication handlign and dispensation.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87621 · Plan of correction due date: Jun 2, 2022

87621 Colostomy/Ileostomy the licensees shall be responsible for the following: (A) The ostomy bag (...) may be changed by facility staff who have been instructed by the professional. (B) There shall be written documentation by an appropriately skilled professional outlining the instruction of the procedures delegated and the names of facility staff (...) This requirement is not met as evidenced by the absencethe state’s words, verbatim · CDSS document, Jun 2, 2022

Plan of correction: Licensee agrees to provide LPA with documentation of adequate training provided to all facility staff involved in caring for resident R1 colostomy bag.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 06/02/2022 at 10:30am, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced case management visit to the facility. LPA arrived at facility, was greeted and granted entry by Paul Bartolome, caregiver after explaining the purpose of the visit and undergoing the facility's COVID-19 screening and sign-in procedure. LPA observed a check-in station in proximity to the facility entry point used for visitors. Administrator Russel Venanzi was called and arrived shortly afterwards to assist with the visit. LPA verified the staff present and their association status in Guardian. Staff present are background checked but their facility association is for another of the facilities managed by the licensee/administrator under license number 306002428. LPA consults with licensee to remind them of their responsibility to ensure staff are not only background checked but also associated to all facilities to which they may be assigned to work. LPA along with licensee also verified the centrally stored medication is no longer being pre-poured. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. A Technical Advisory is however being issued in regard to adequate staff association to the facility. This report was reviewed with facility representative and a copy of this report and appeal rights was provided and left at facility.the state’s words, verbatim · CDSS document, Jun 2, 2022

Type of visit: Case Management - Deficiencies

On this day Licensing Program Analysts (LPAs) Kevin Saborit-Guasch, Jerome Haley and Kathrina Chin made an unannounced case management visit in addition to a complaint investigation. LPAs identified themselves and were granted entry by staff. LPAs were met by Ginger Venanzi, Manager who was later called upon by caregiving staff. Upon entry, the caregivers present did not perform the mandatory COVID-19 screening and temperature check. At approximately 10:05am, LPAs were shown the location of medication by caregivers. The medication stock present is stored in a locked cabinet to the right of the refrigerator. However, the medication being prepared in advance for the five (5) residents present is located in an unlocked drawer on the other side. Based on the observations made during today's visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with the caregivers present. A copy of the report and appeal rights were delivered.the state’s words, verbatim · CDSS document, Feb 10, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Feb 10, 2022

Personal Rights of Residents in all facilities-(a)(2) To be accorded safe, healthful and comfortable accomodations, furnishings and equipment. The licensee failed to protect the personal rights of residents in care as evidenced by the LPA's observation. This poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Feb 10, 2022

Plan of correction: Licensee will train staff to perform screening before entry as well as ensure appropriate screening is being systematically performed before entry of any visitor into the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Feb 10, 2022

Incidental Medical and Dental Care Services. Centrally stored medications shall be kept in a safe locked place that is not accessible to persons ther than employees responsible for the supervision of the medication. This requirement is not met as evidenced by: LPAs observed 24hr supply of prepared medication being stored in an unlocked drawer. This poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Feb 10, 2022

Plan of correction: The 24hr supply of medication will be stored in the locked cabinet.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michelle Reed made an unannounced visit to the facility to conduct an Annual visit. Upon arrival LPA met with Staff Jolly Ann Jiao and Edwin Abellana. Both staff were wearing a mask. Administrator Russell Venanzi was spoken to at El Mar home. The focus of the visit was Infection Control. During the visit LPA toured the facility with Jolly Ann and the following was observed: Covid signage was posted at the front entrance of facility with a sanitization station. LPA's temperature was taken upon arrival and a sign in sheet was made available. Facility has required Department postings. Administrator Certificate for Russell Venanzi expired on 9/5/21. Mr. Venanzi stated that he has renewed his Certificate and is waiting on Sacramento. LPA toured all resident rooms. Rooms were clean and sanitary. All restrooms observed contained soap, paper towels and toilet paper. Hand sanitizer, soap, wipes and gloves were present. The Licensee has at least a 30 day supply of PPE. LPA observed an outside visitation area with ample shading. Residents were observed watching napping, playing on a laptop, singing and watching tv. Licensee has required Mitigation plan and Emergency Disaster Plan. LPA observed emergency food and water supply. Facility has a secured location for resident medication and files. During the visit, LPA consulted with Staff regarding the importance of maintaining a 30 day supply of PPE on site. Additionally, LPA advised the importance of mask wearing and handwashing for staff. Administrator is reminded to review Department PINS in regards to Visitation, Dining, Group Activities, Non-essential services, Outings, New Admissions Entertainment. PIN 21-32 -ASC provides Masking Guidelines. No citations issued at this time. An exit interview was conducted and copy of this report was provided to Jolly Ann as instructed by Mr. Venanzi.the state’s words, verbatim · CDSS document, Sep 21, 2021