Swan Lake Villa

Type of visit: Required - 1 Year

LPA Parks arrived on Monday June 16, 2023 to complete the unannounced annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed resident (6) and staff files (4). All resident files contained the required paperwork. Three out of four of the staff files reviewed did not contain TB test/results. LPA Parks and staff Aurora toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, garage, and backyard. Water temperatures in kitchen and bathrooms were within the required range of temperatures. LPA observed the garage was converted into two staff bedrooms. Based on the Fire Safety Inspection (STD 850) conducted on 6/7/2021 and facility sketch, the garage does not have fire clearance approval to be used as bedrooms. Please see 9099-D for citation issued. Due to technical issues, LPA was unable to cite for an immediate civil penalty of $500. This will be issued at a later date. Exit interview conducted. Appeal rights were printed and given to the facility. A copy of this report was emailed to Facility.the state’s words, verbatim · CDSS document, Jun 12, 2023

Type of visit: Required - 1 Year

On 7/13/2022 Licensing Program Analyst (LPA) Lavinia Muscan, arrived at the facility unannounced to conduct an annual visit using the infection control tool visit. LPA met with Facility Administrator, Andrew Makanoneng and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured she used hand sanitizer shortly after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Caregiver. LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, outside area and common restrooms. Facility has a 2 day perishable and a 7 day non-perishable amount of food. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. Facility has 6 residents 4 of which are on hospice. Administrator agrees to send in LIC500 and liability insurance. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Jul 13, 2022

Allegation investigated: Facility accepted a resident with a gastronomy tube.

On 10/28/2021 LPA traveled to the facility to complete the complaint. LPA was screened by the Administrator at the door, temperature taken, etc. The facility has no known COVID cases at this time. LPA has met with the Administrator and reviewed records for resident R1. It was found that the facility did accept Resident R1 on 10/13/2021 with a Prohibited Health Condition. The Administrator had attempted to contact CCL to discuss an exception, but did not make contact with anyone. At this point, there is not an exception in place for R1. The Administrator had submitted part of the exception request, but did not have all needed documents. Documents were given to LPA at the visit today. Through interview and review of records, LPA determined that the allegation is SUBSTANTIATED. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Substantiatedthe state’s words, verbatim · CDSS document, Oct 28, 2021 · control 25-AS-20211021094346

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(2) · Plan of correction due date: Oct 28, 2021

Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: Gastrostomy tubes. The facility accepted resident R1 with a gastrostomy tube.the state’s words, verbatim · CDSS document, Oct 28, 2021

Plan of correction: The facility will submit a request for an exception to Title 22 Section 87615 (a)(2) The facility has already submitted an exception request to CCL on this date 10/28/2021.