Sarah's Good Life

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 9:35am to the facility to complete the unannounced required - 1 year annual inspection. LPA met with Caregiver, Casandra Geurkink at the front door and was granted entry. The purpose of today's visit is to inspect the facility to ensure that the facility is in compliance with California Code of Regulations, Title 22, Division 6. The facility is approved for 6 non-ambulatory residents with 3 residents in care. The facility has an approved hospice waiver for 4 residents. Infection Control: The facility has an approved infection control plan and a surplus of infection control supplies including but not limited to gloves, masks, gown and cleaning supplies. Operational Requirements: The facility has a plan of operation, an approved infection control plan, and has an approved fire clearance and liability insurance. Physical Plant & Environmental Safety: The facility is a one story home located in residential Sun City, CA. The facility temperature read at 72 degrees. The facility has 3 bedrooms, and 2 bathrooms, living room, kitchen, dining room and backyard. The bedrooms have beds with clean linen, dresser, TV and closet space. The bedrooms are clean and clear of obstruction. The bathroom temperature read at 114 degrees which is within regulation requirements. The kitchen, living room and dining room are all clean and clear of obstruction. The medications are kept in the hallway near the front door and inaccessible to residents in care. The facility has no bodies of water on the premises. Staffing: The facility has one staff member on site to care for the 3 residents in care during the day and one staff member on site during the night. The facility has adequate supervision of the residents in care. Personnel and Training Records: The staff have complete training records containing; applications, Fingerprint clearance, Health and TB screening, and in-service trainings. (Continued on LIC809-C) (Continued from LIC809) Residents Right Information: The facility has posted resident's right information. Planned Activities: The facility has planned activities for each resident based on their mobility and level of comfort. Food Service: A 7-day non-perishable and 2-day perishable food supply was observed and all food was properly stored and available to residents in care. Incidental Medical and Dental: The facility has the resident's medication properly stored in the hallway near the door. The facility documents the distribution of medication in the medication logbook. The facility is in compliance with physician's orders and regulations. Disaster Preparedness: The facility has an Emergency Disaster Plan with evacuation routes posted for both staff and residents in care. The facility has posted the Emergency phone numbers list. The facility has smoke and carbon monoxide detectors and fire extinguishers that are in working order. Residents with Special Needs: The facility has an approved Hospice Waiver for 4. The facility continues on-going training for residents with special needs and documents the training. Summary: Based on today's visit, no deficiencies were observed at this time. An exit interview was conducted with Caregiver, Casandra Geurkink and a copy of this report was printed, signature below confirms the receipt of these rights.the state’s words, verbatim · CDSS document, Oct 24, 2023

Allegation investigated: Lack of supervision resulting in residents leaving the facility

Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegation. The LPA met with Administrator, Thomas Uata, and informed him of the purpose of the visit. On this visit the LPA toured the facility, conducted staff/resident interviews, reviewed records, and took copies of pertinent documentation. Regarding the allegation, "Lack of supervision resulting in residents leaving the facility," it was alleged residents with cognitive disabilities wandered outside of the facility and required the assistance of law enforcement to be returned to the home. Third party interviews revealed no knowledge of any residents in care wandering out of the facility in the last month. Resident interviews revealed no knowledge of residents leaving the facility without staff supervision. The Administrator was interviewed and revealed there was one resident, Resident One (R1), who did leave the facility approximately four (4) months ago without staff assistance. He reported he arrived within thirty (30) minutes in order to assist in the search of the resident, and later contacted law enforcement when the resident could not be redirected. A records review Unsubstantiated revealed R1 has left the facility unassisted on approximately one (1) other occasion in the year 2022. R1 is diagnosed with a cognitive impairment and has exhibited behavior which would require supervision. Due to a lack of information, this allegation is deemed UNSUBSTANTIATED at this time. This report was reviewed with Uata and a copy was provided.the state’s words, verbatim · CDSS document, Aug 4, 2022 · control 18-AS-20220729163748

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to address concerns observed during the investigation of complaint #18-AS-20220729163748. The LPA met with Administrator, Thomas Uata, and informed him of the purpose of the visit. During the visit the LPA observed the following concerns: Uata was not able to locate the files for the residents in care, and required the assistance of Staff One (S1) to locate the files; the file for Resident Four (R4) could not be found and could not be reviewed by the LPA; a review of R1's Physician's Report for Residential Care Facilities for the Elderly (RCFE) revealed a resident, who requires an annual medical assessment, was last evaluated on August 25, 2020; no copy of the staff schedule was available for review; per Uata, no Absentee Notification Plan (AB 620) was established following discussion of the plan with LPA, Jesse Gardner. Administrator Uata has shown he is not operating the facility in compliance with regulatory requirements. Therefore, a citation will be issued. An exit interview was conducted; this report was reviewed with Uata and a copy was provided, along with LIC 811 and Appeal Rights.the state’s words, verbatim · CDSS document, Aug 4, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Aug 11, 2022

ADMINISTRATOR - QUALIFICATIONS AND DUTIES:...The administrator shall have sufficient freedom from other responsibilities & shall be on the premises a sufficient # of hours to permit adequate attention to the management & administration of the facility...The Department may require...the admin. devote additional hours in the facility to fulfill his responsibilities when the need for such additional hours is substantiated...This requirement wasn't met, as evidenced by: Based on observation, file review & interview, Admin. Uata has shown he is not operating the facility in compliance w/ requirements.the state’s words, verbatim · CDSS document, Aug 4, 2022

Plan of correction: The Administrator stated a plan will be submitted to the Department indicating how he will ensure the home is maintained in compliance.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA Gardner met with Caregiver Casandra Geurkink. Assigned to the home during time of visit were 4 clients. There are currently no cases of COVID-19 within the facility. During today's visit, LPA Gardner toured the facility and made observations pertaining to the facility's infection control measures. LPA Gardner observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. LPA Gardner discussed infection control practices and procedures with Ms. Geurkink. During the inspection LPA Gardner observed medication in a locked closet, but not in its original prescribed container, thus a Type B deficiency was issued. An exit interview was conducted and a copy of this report, was reviewed with and provided to Ms. Geurkink along with the LIC809-D, and Appeal Rights.the state’s words, verbatim · CDSS document, Oct 21, 2021

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Oct 21, 2021

Incidental Medical and Dental Care - (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Based on LPA Gardner's observation of medication not in its original prescribed container even though the medication was in a locked closet, the licensee did not comply with the section cited above which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 21, 2021