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Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Abdoulaye Zerbo, Debbie Palacio and LPM Tricia Danielson conducted an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPAs were greeted by Mircea Dolha, notified of the purpose for the visit and were allowed to enter the facility to conduct the inspection. Facility Overview: The facility is a single story building with 6 residents bedrooms, 1 staff bedroom and 6 bathrooms. There is no gated pool and there are no firearms on the premises. Infection Control: LPAs observed that hygiene and cleaning supplies were available for regular facility maintenance. The facility’s infection control plan was reviewed and found to meet department requirements. Physical Plant: The physical plant, including floors, windows, and doors, was clean and well maintained. Fixtures and furniture were in good repair. Laundry equipment was in good working condition. Sharp and dangerous objects were securely locked in kitchen cabinet next to the fridge and inaccessible to residents. The smoke detector and carbon monoxide detector were hard wired together and operational. LPAs observed fire extinguishers to be in compliance with the department requirements and with and expiration date of 09/20/2025. LPAs observed the hot water temperature to meet requirements at 106.2°F. Food Service: The facility’s kitchen was clean and equipped to prepare food. The facility maintained the required two-day supply of perishable foods and a seven-day supply of non-perishable foods. Continued on LIC809-C..... Care & Supervision/Administration: Adequate staff were present to supervise clients during the visit. The administrator holds a current administrator’s certificate with expiration date of June 22th, 2026 and a CPR certification with the expiration date of 10-25-25 Record Review and Resident/Staff Files: LPAs reviewed files for two(2) staff members, confirming criminal clearances, updated training, and CPR/First Aid certification. Three residents' files were reviewed and contained all required documentation. LPA's observed Staff, resident files, were stored in a cabinet next to the kitchen and emergency food was stored in the laundry room. The first aid kit was stored in the kitchen area Health-Related Services/Incidental Medical Services: All residents' medications were securely locked and located in the kitchen area. LPAs reviewed medications for three residents, confirming that all medications were listed and accounted for. Disaster Preparedness: LPAs reviewed the facility’s emergency and disaster plan, including documentation of the last fire drill conducted on 10-01-2024, which met department requirements. All facility exits were clear of obstructions. No deficiencies were cited during the visit. An exit interview was conducted, during which this report was reviewed, and a copy was provided to Mircea Dolhathe state’s words, verbatim · CDSS document, Oct 21, 2024

Allegation investigated: Staff denied the residents visitations during specific hours.

Licensing Program Analyst, (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA met with Administrator, Mircea Dolha and explained the purpose of the visit and the elements of the allegation. The investigation consisted of interviews with staff members, residents, and additional witnesses, observation, and records review. On 02/07/2024, Community Care Licensing received a complaint alleging that Staff denied the residents visitations during specific hours. It was reported that on 01/10/2024, at approximately 1:30 PM, a representative visited the facility and was advised that the facility was currently closed. During interviews conducted with additional witness, it was reported that visitor arrived at the facility at approximately 1:30PM. The staff member advised the visitor that the facility is closed during the time period of 1PM-3PM. The visitor explained their occupation and which resident they were there to see. Without hesitation, the staff member allowed the visitor in. Administrator, Mircea Dolha stated the time indicated for no visitors is typically nap time for residents as it is right after lunch. Administrator stated that staff members complete chores during that time as well. Unfounded Additional information obtained during interviews with staff advised there was no denial once the visitor explained their purpose for visiting the facility. Information obtained from interviews with residents indicated there are no issues with visitation and they are allowed visitors whenever they chose. During record reviews, LPA reviewed the sign posted in the front of the facility, which listed business Hours as the following: Sunday through Saturday, 9:00am to 6:00pm. Information obtained stated the facility is closed every day from 1:00pm to 3:00pm. LPA reviewed the facility’s program plan, the signed admissions agreement, and the Written Record of Care. The information regarding visitation hours can be found under “Visitation Hours” and “Policies Concerning Family Visits,” which list the visitation hours. Hours outside the scheduled visitation can be requested and approved in advance. All documents were signed by each resident and their responsible party. Based on interviews with staff members, residents, and additional witnesses, observation, and records review, the information obtained indicated that the staff member followed the approved plan of operation, but still made provisions for the representative to visit the facility without delay. Therefore, the allegation that Staff denied the residents visitations during specific hours is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided to Administrator, Mircea Dolha.the state’s words, verbatim · CDSS document, Jun 26, 2024 · control 18-AS-20240207122858

Allegation investigated: Staff were sleeping while caring for the residents.

Licensing Program Analyst, (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA met with Administrator, Mircea Dolha and explained the purpose of the visit and the elements of the allegation. The investigation consisted of interviews with staff members, residents, and additional witnesses, observation, and records review. On 02/07/2024, Community Care Licensing received a complaint alleging that Staff were sleeping while caring for the residents. It was reported that on 01/10/2024, at approximately 1:30PM, a representative visited the facility and the staff member appeared like the staff member just woke up. It was reported that staff member’s hair and clothes were disheveled. Administrator denied that staff members sleep during the time period from 1-3 PM. Administrator stated staff complete chores and housekeeping around the facility. Information obtained from interviews with staff also denied that they sleep during their shift. Staff members corroborated that they are expected to complete tasks and continue providing assistance to residents as needed. During interviews with the residents, it was stated they have not observed any staff member sleeping while working. Residents reported they are still able to get assistance during the time period of 1:00PM to 3:00PM. Unsubstantiated Based on interviews with staff members, residents, and additional witnesses, observation, and records review, the allegation that staff were sleeping while caring for the residents is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report was provided to Administrator, Mircea Dolha.the state’s words, verbatim · CDSS document, Jun 26, 2024 · control 18-AS-20240207122858

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to the facility to conduct a case management visit on the health, safety, and welfare of residents in care. LPA met with Licensee, Mircea Dolha. LPA was informed that four (4) residents currently reside at this facility. There were two (2) staff members on duty, during the time of the visit. LPA toured the facility and observed all facility utilities to be on and operating without issue, food supply is sufficient, there is no immediate concern for residents in care. Licensing Program Analyst (LPA) Kathleen Banrasavong spoke to the Licensee, Mircea Dolha regarding the Incident Report submitted to Community Care Licensing Riverside Regional Office on June 24, 2024. The incident occurred on 06/19/2024. It was reported that Resident 1 (R1) passed away from a heart problem due to a UTI. The LPA reviewed and requested documents pertinent to R1’s medical health condition. Based on the information obtained during today’s visit, there are no deficiencies or civil penalties being cited per California Health & Safety Code and Code of Regulations, Title 22, Division 6. An exit interview was conducted with Licensee, Mircea Dolha and a copy of this report is left with him, as evidence by his signature.the state’s words, verbatim · CDSS document, Jun 26, 2024