A1 Senior Care 2

Type of visit: POC

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct a Plan of correction visit. LPA met with Administrator Daisyree Tacandong during today's inspection. On May 31, 2023 LPA cited for personal accommodations and services. During today's visit LPA toured the facility and observed closet utilized as a staff room had a bed in it. LPA had cited on accommodations and services again, and deficiencies cited on 809-D. Civil penalties assessed. Exit interview conducted.the state’s words, verbatim · CDSS document, Jun 29, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Jun 30, 2023

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement is not met as evidenced by: Based on observation, the licensee had a bed in a large closet in common bathroom which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 29, 2023

Plan of correction: Administrator agrees to send into LPA a plan of where staff will sleep during the night shift if staff are not awake during the shift. POC to be sent into LPA by 6/30/23.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to continue annual inspection. LPA met with Administrator Daisyree Tacandong during today's inspection. During today's inspection LPA toured the facility and the backyard and all exits are accessible and unlocked. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed an adequate amount of linens and found the first aid kit to be complete. LPA reviewed 2 of 6 resident files and 3 staff files. LPA reviewed medications of two residents comparing with physician orders. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates and training completed. LPA observed a copy of current liability insurance. During today's inspection LPA observed the following deficiencies: 2 of 3 staff members did not have a health screen on file. During annual inspection on 5/25/23, staff files were not available for LPA to review. Administrator did not have a Centrally Stored Medication Record for 2 of 2 residents. R1 and R2 did not have a needs and service plan. LPA observed medication for R1 was not being dispensed as the doctor ordered. LPA observed a closet in resident bathroom being used as a staff break room. Deficiencies cited on 809-C. Exit interview completed.the state’s words, verbatim · CDSS document, May 31, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with administrator Daisyree Tacandong during today's inspection. LPA toured the facility with administrator. LPA observed resident rooms, staff rooms, common areas, and kitchen area. Administrator did not have staff files for LPA to review. LPA will return on a later date to review documents. No deficiencies are being cited today. Exit interview conducted.the state’s words, verbatim · CDSS document, May 25, 2023

Type of visit: POC

On 07/06/22, Licensing Program Analysts (LPAs) Talwinder Bains and Kerry Hiratsuka came to the facility to do a follow up visit regarding POC from Annual /post licensing visit conducted on 06/02/22 and met with Administrator, Daisyree (Daisy) Tacandong. Facility currently does not have any COVID-19 positive cases. LPAs wore surgical masks while in the facility. LPAs were screened by facility staff upon entry. On 06/02/22, during facility tour, LPA observed the garage was converted into two bedrooms and Community Care Licensing Division (CCLD) was not notified. Administrator admitted no permits were obtained nor was there a fire clearance done. Because Administrator did not have permits, submit the changes to CCLD, and no fire clearance was obtained, deficiencies were cited pursuant to California Code of Regulations, Title 22, Section 87305(b) with POC date 06/30/22. On 06/06/2022, Administrator sent documents and updated facility sketch to LPA Bains via e-mail and stated that these two rooms in the garage will be used only for staff break room and storage area and they will not be used for residents in any manner. After receiving these documents and facility plan ,CCLD ordered a fire clearance. A Roseville Fire inspector visited the facility and inspected break room and storage room in the garage on 06/13/22 and advised Administrator to reach out to Roseville City to obtain a building permit for these 2 rooms in garage. On 06/14/22, an inspector Roseville from City Planning came out to do inspection for the two rooms in the garage and they were denied. continue on 809-C----- Continued from 809----- Today's visit, LPAs met with Administrator. The two rooms have not been removed. Administrator stated she was told by City Planning that she may appeal to the City Council. She has not yet as of today. She shall submit to LPA Bains by 07/30/2022, a written plan on how and when she will appeal to the City Council. She shall also submit a copy of her appeal to LPA Bains within 24 hours of submitting it to the City. THE ROOMS IN THE GARAGE SHALL NOT BE USED FOR ANYTHING. CCLD has the authority to conduct random checks to ensure the rooms are not being used for anything until the issue is resolved with the City. If any of the random checks finds the rooms in use there shall be a deficiency cited because the rooms do not have permits and if a staff person is found sleeping in the room an immediate civil penalty shall be issued and shall accrue. No deficiencies cited today. Exit interview conducted and copy of this report left at facility.the state’s words, verbatim · CDSS document, Jul 6, 2022

Type of visit: Post Licensing

Post Licensing visit is conducted in 06/02/22 inspection. See LIC809 for 06/02/22 Annual visit for details. See LIC809D for deficiency cited during today's visit. Exit interview done and copy of the report will be sent via e-mail due to printer issue.the state’s words, verbatim · CDSS document, Jun 2, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(b) · Plan of correction due date: Jun 30, 2022

87305 Alterations to Existing Building or New Facilities (b) The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement is not met as evidenced by: Based on observation, the Licensee converted 2 bedrooms connected the garage and did not notify CCL or update facility sketch. No permits were obtained and a fire clearance has not been complete, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 2, 2022

Plan of correction: The Licensee shall submit an updated facility sketch which includes 2 bedrooms connected to the garage. In addition, the licensee shall submit approved permits from Roseville City Building Department. Lastly, the licensee shall submit a letter to CCL indicating the rooms connected to the garage will be for staff use or storage use only. POC shall be submitted by 06/30/22.

Type of visit: Required - 1 Year

Licensing Program Analyst Talwinder Bains arrived at the facility unannounced on 06/02/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with facility staff ,Ezra Ternate , and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms, and contacted facility to complete a facility risk assessment. LPA wore the following Personal Protective Equipment (PPE) during today's visit: surgical mask. LPA was screened by facility staff before entry to facility. Upon arrival, LPA spoke to facility administrator Daisyree Tacandong over facility phone and she gave permission to complete annual inspection for today with facility staff Ezra Ternate since she is unable to come because she is going to work today. LPA and facility staff Ezra toured facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to: kitchen, common areas, five bedrooms , two bathrooms, medication closet , staff break room, garage, laundry room and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and facility staff Ezra completed the infection control domain together. During facility tour, LPA observed that the Licensee converted 2 bedrooms connected the garage and did not notify CCL or update facility sketch. No permits were obtained and a fire clearance has not been complete, which poses a potential health, safety or personal rights risk to persons in care.As a result of today's inspection, deficiencies are cited pursuant to California Code of Regulations, Title 22, Section 87305(b). Deficiencies are listed on 809-D. Appeal rights provided. Exit interview conducted and copy of report will be sent to facility via e-mail due to printer issue.the state’s words, verbatim · CDSS document, Jun 2, 2022

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff are not following Covid-19 protocols

Licensing Program Analysts (LPAs) Kerry Hiratsuka and Lavinia Muscan arrived at the facility unannounced on 03/08/2022 to conduct a Complaint Investigation Visit to deliver the results of the allegation above. LPAs conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility. LPAs were screened by Caregiver. LPA Hiratsuka, investigated the allegation “Staff are not following Covid-19 protocols.” LPA Hiratsuka, interviewed Administrator Daisyree Tacandong, over the phone on a previous date. Administrator stated one time there were a couple of visitors to this facility that did not wear masks, which is mandated per the State of California. Since then, staff have been instructed to ensure all visitors and staff wear masks while in the facility until or if the mandate is lifted. There is a sign on the the front door that requires all staff and visitors to wear masks. Based on the above, the allegation is substantiated. Deficiency is cited on 9099-D, per Title 22 Regulations, Division 6. Appeal rights were provided to the caregiver on duty. Substantiatedthe state’s words, verbatim · CDSS document, Mar 8, 2022 · control 25-AS-20211101110835

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Mar 9, 2022

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: A couple of A couple of visitors were not wearing masks in the facility per the CA Public Health Mandate. This poses an immediate threat to residents in care.the state’s words, verbatim · CDSS document, Mar 8, 2022

Plan of correction: By 03/09/2022, Licensee stated she posted a sign on the door, everyone is told to wear one and masks are provided upon entrance. She is going to email LPA the mask policy.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Kerry Hiratsuka and Lavinia Muscan arrived at the facility unannounced on 03/08/2022 to conduct a case management visit during a complaint visit. LPAs conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility. LPAs were screened by Caregiver. It was discovered during today's visit the caregivers are giving insulin injections to a resident at the resident's request. The caregivers are not licensed skilled medical professionals and they are not allowed to give injections per Title 22 regulations. Deficiency is cited on 809-D, per Title 22 Regulations, Division 6. Appeal rights were provided to the caregiver on duty.the state’s words, verbatim · CDSS document, Mar 8, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Mar 9, 2022

Diabetes. The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement was not met as evidenced by: the caregivers, who are not licensed skilled medical professionals are giving insulin injects at the resident's request. This is an immediate safety risk to residents.the state’s words, verbatim · CDSS document, Mar 8, 2022

Plan of correction: By 03/09/2022, the licensee shall submit in writing how she is going to ensure either a resident who requires injections does it by themselves or have a licensed skilled medical professional do it.