Northwood Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Martinez is conducting this unannounced visit for the purpose of completing an annual required inspection. LPA arrived at the facility and was greeted and granted entry by staff and LPA explained the nature of the visit. Danilo De Guzman, House Manager arrived shortly after and met with LPA. There are five residents at the facility and there are no residents receiving hospice services currently. Five residents reside at this facility. LPA began the tour of the inside and outside of the facility. LPA observed required department postings throughout the facility. Facility stays within the capacity limitations. There is a minimum of one week of non-perishables foods and two days of perishables foods available. There is additional food storage in refrigerator in garage. The facility is maintained at a comfortable temperature. LPA inspected that medication is centrally stored in a safe locked storage cabinet located in kitchen. LPA reviewed medication and observed medication was labeled and stored inaccessible to residents in care. LPA inspected the bathroom and LPA measured the hot water temperature which measured 108.1 Fahrenheit degrees. All bathrooms observed to have a supply of soap, toilet paper and towels. Bathrooms are equipped with required safety measures such as non-skid mats and grab bars. Lighting is sufficient to ensure safety and comfort. The facility is equipped with sufficient hand hygiene, cleaning, and disinfecting supplies. LPA observed that toxic chemicals, cleaning solutions and disinfectants are stored locked underneath kitchen sink and locked storage cabinet garage. The facility has an available clean supply of linens. LPA inspected residents’ bedrooms which has sufficient lighting to ensure the safety and comfort. All bedrooms observed to have all required components. Storage space is provided for residents in their bedroom. Smoke detectors were tested and found to be operational. LPA toured the outside of the facility and observed outdoor passageways are free of obstructions. LPA observed there are shaded seating areas for residents’ enjoyment. LPA observed a fire extinguisher with service date of May 09, 2023, in kitchen. LPA began review of records. Continued on LIC809-C LPA reviewed three resident records. All the required documentation was present and current in the residents’ files reviewed. LPA reviewed two employee records. All employees present have a criminal record clearance and are associated to the facility. Based on the observations made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with the facility representative, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Oct 11, 2023

Allegation investigated: Facility illegally evicted resident.

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Danilo De Guzman, House Manager and explained the reason for the visit. Administrator Teresa Alpuerto arrived at 9:20am with Francis Mallari, Manager. The department received a complaint on 04/04/2023 and the initial 10 day visit was conducted on 4/11/2023. During the course of the investigation LPA reviewed document such as Individual Program Plan (IPP), house rules and admission agreements. LPA Mendivil also interviewed staff and residents. Regarding the allegation facility illegally evicted resident, the investigation revealed the following: Based on interviews and incident report received on 3/14/2023, it was reported that Resident 1 (R1) was physically aggressive towards staff. 911 was called and resident was transported to the hospital. CONT on LIC 9099-C dated 4/11/2023. Substantiated Therefore based on the preponderance of evidence through interviews the allegation facility did not provide a safe environment for residents is UNSUBSTANTIATED, meaning, that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint. No deficiencies cited. An exit interview was conducted and a copy of this report was provided. Based on interviews with Administrators Francis Mallari and Teresa Alpuerto it was reported that facility staff refused to work if R1 returned to the facility after their hospital stay. Based on interviews with Administrators R1 was not provided an eviction notice and the department was not notified of facility's intent to evict resident. Therefore based on preponderance of evidence through interviews the allegation that facility illegally evicted resident is SUBSTANTIATED, meaning the complaint allegation was valid and that a violation has occurred. The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8. An exit interview was conducted and a copy of this report and appeal rights was provided to the facility representative.the state’s words, verbatim · CDSS document, Apr 11, 2023 · control 22-AS-20230404105310

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.682(2) · Plan of correction due date: Apr 17, 2023

The licensee shall, in addition to either serving the required thirty (30) days notice , sixty (60) days notice or seeking approval from the Department and service three (3) days notice on the resident, notify or mail a copy of the notice to quit to the resident's responsible person. This was not met as evidence by facility denied entry to a resident after discharge from hospital, which poses a potential risk to persons in care.the state’s words, verbatim · CDSS document, Apr 11, 2023

Plan of correction: Licensee to update eviction procedures and provide to LPA by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced case management visit to follow up on an incident report dated 09/16/2022. LPA was greeted and granted entry into the facility and explained the reason for the visit to Caregiver, Gloria De Guzman. Danilo De Guzman, House Manager arrived 11:30 AM. Incident report indicated Resident 1 (R1) went to Kaiser due to slip and fall on 09/15/2022. Per interview with staff 1 (S1) was assisting R1 to bed, R1's legs gave out and R1 started to fall. S1 went to grab R1, but R1's elbow hit the floor. S1 called House Manager Danilo De Guzman over to the room. Danilo called 911 and paramedics assessed R1. R1 was then taken to hospital for further evaluation with Danilo De Guzman. Facility staff notified Administrator Teresa Alpuerto and R1's responsible party. R1 returned to facility the next morning with a diagnosis of a fractured upper arm. During the visit, LPA reviewed LIC 602, Individual Program Plan (IPP) and hospital discharge paperwork. No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 22, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into facility by House Manager Danilo De Guzman and explained the reason for the visit. At 9:15 AM, LPA toured facility with House Manager Danilo De Guzman. Facility has 5 residents present during today’s visit. Facility is a 5 bedroom, 2 bathroom, single story home with an attached garage. LPA observed a screening and sanitizing station at entrance of the facility. LPA observed residents relaxing in the facility or in their respective rooms. Facility appears clean and sanitary. All resident rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and paper towels and have hand washing postings. Facility has 2 refrigerators with ample food supply. LPA observed facility has emergency food and water supply. Facility has a secured location for resident medication and files. LPA toured the outside grounds and observed outside visitation area. Exit gates are unlocked and self latching. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. LPA observed a 4 weeks supply of PPE. LPA reviewed all residents’ files and all contained required documentation including updated emergency information. All staff and residents are fully vaccinated for Covid 19. No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 21, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility by Staff and explained the reason for the visit.LPA's temperature was checked upon entry. During the visit LPA toured the facility with House Manager Danilo De Guzman. Facility is a 4 bedroom, (3 resident bedrooms 1 staff bedroom) and 2 bathrooms single story home. There are 5 Residents in care. LPA observed proper covid signage at front entrance of facility as well as a sign in, sanitization and temperature check station. Facility has required Department postings. LPA observed copy of Administrators Certificate expiring May 19, 2023. LPA toured all Residents rooms, all rooms where within regulations. All restrooms observed contained soap, Hand sanitizer, toilet paper, and paper towels. Restrooms had proper hand washing signs posted. Residents were observed relaxing in the Living room watching TV and relaxing in bedrooms. Facility has operating audible alarms for each sliding door entrance/exit. Facility has 3 fire extinguishers which are fully charged. Facility has ample supply of PPE. Facility has 2 refrigerators with ample food supply. LPA observed facility has emergency food and water supply. Facility has required Emergency Disaster Plan posted. Facility has a secured location for resident medication and files. Facility has 30 days supply of medications for Residents. LPA reviewed Residents files during visit. Residents emergency contact information and Physicians reports are current. Facility has designated visitation area. No deficiencies noted during todays visit. An exit interview was conducted with House Manager De Guzman and a copy of report was left at facility.the state’s words, verbatim · CDSS document, Sep 30, 2021