Lifestream Home Care for Elderly

Type of visit: Case Management - Other

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit for the purpose of obtaining additional information for Complaint Control # 22-AS-20221107110951. LPA interviewed residents and responsible parties. An exit interview was conducted and a copy of this report was left at facility.the state’s words, verbatim · CDSS document, Jan 27, 2023

Allegation investigated: Staff did not follow COVID-19 protocols. Staff worked at facility prior to obtaining a background check clearance.

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver findings. LPA identified themselves and was met by Florence Tolentino, Administrator and discussed the above allegations. On 11/07/2022 the Department received allegations that staff did not follow COVID-19 protocols and staff worked at facility prior to obtaining a background check clearance. During the course of the investigation the Department interviewed staff as well as reviewed pertinent documents such as negative covid test, lic 500, staff schedules and background clearance documentation. The investigation revealed the following: For the allegation that staff did not follow COVID-19 protocol, per interview with Administrator Florence Tolentino staff is tested prior to working in the facility. The Administrator stated that she was utlizing a lab PCR test until October 2022. CONT on LIC 9099- C dated 12/13/2022 Unfounded Administrator and 2 out of 2 staff interviewed stated they know if they are feeling sick to not come into work. Staff indicated they would quarantine while they await their COVID test results and isolate if they test positive. Per interview with Administrator Florence no staff is allowed to work prior to obtaining a background check clearance. Review of documents revealed Staff 1 (S1) S1 was cleared on 08/12/2022 and LIC 500 indicated S1 started work on 08/18/2022. Therefore based on the preponderance of evidence the allegations that staff did not follow COVID-19 protocol and staff worked at facility prior to obtaining a background check clearance are UNFOUNDED meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint and an exit interview was conductedthe state’s words, verbatim · CDSS document, Dec 13, 2022 · control 22-AS-20221107110951

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) Florence Tolentino about visit. AD Tolentino arrived to facility at 2:43 PM. As of 11/1/22, there are 0 active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted at the entrance of the facility. The PUB475 "See Something, Say Something" poster was also observed to be in the facility hallway. LPA De Perio observed the Administrator's Certificate for Florence Tolentino, which expires on 12/4/22. LPA De Perio toured the interior and exterior portions of the facility with AD Tolentino. The facility is a single level structure and is licensed for 6 non-ambulatory residents, of which 1 may be bedridden and a hospice waiver for 4. For this visit, there are a total of 4 residents in care, of which 0 are on hospice and 0 bedridden. There are a total of 5 bedrooms, of which 2 are private resident rooms, and 2 are shared resident rooms and 1 room is for staff use. NOTE: in the living room, facility has placed a divider and has placed a bed designated for staff usage. LPA De Perio toured each bedroom in the facility and observed that 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. There are a total of 3 restrooms. 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 108.6 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. Sharp items and knives were locked and inaccessible to residents in care and located in a kitchen drawer. Fire extinguisher was charged, mounted and located in the kitchen. LPA De Perio observed the emergency disaster and evacuation plan, which is posted in the facility hallway. 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 a facility hallway cabinet. Medications were inaccessible to residents in care and locked in a cabinet. Toxins were also observed to be locked and inaccessible to residents and located under the kitchen sink. 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 were self-closing and self-latching. LPA De Perio observed bodies of water in the backyard of the facility. Bodies of water were made inaccessible to residents in care and is closed off by a fence. LPA De Perio verified the Coronavirus 2019 (COVID 19) mitigation plan of the facility with AD Tolentino. 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 Tolentino 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. LPA De Perio discussed the California Code of Regulations Section 87466 Observation of the Resident and Section 87211 Reporting Requirements with AD Tolentino. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued. LPA De Perio advised AD Tolentino 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 Tolentino and a copy of this report and copies of the regulations discussed were provided to the facility.the state’s words, verbatim · CDSS document, Nov 1, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Kathrina Chin conducted an unannounced visit for the purpose of conducting a required annual visit. LPA were greeted by Florence Tolentino, Administrator and explained the purpose of the visit. LPA toured the facility. There are six residents residing in the facility and no active COVID-19 cases. All residents appeared clean and well taken care of. LPA observed required postings in the facility as well as hand washing signs in the restrooms. All bathrooms observed had ample soap/sanitizer and appeared clean. Resident bedrooms appeared clean and sanitary and had all required components. LPA observed the emergency disaster and evacuation plans. Facility has back-up emergency food and water supply as well as PPE supplies. LPA reviewed the COVID-19 mitigation plan of the facility. Smoke detectors, carbon monoxide and auditory exit alarms were tested and were operational. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Hot water was measured at 120 degrees Fahrenheit. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had patio furniture in good repair and a covered patio, and grounds were free of tripping hazards. No deficiencies cited this review as per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 20, 2021