Elite Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that two (2) clients live at this facility and there are currently two (2) staff members present. The Administrator, Rhellynick Sevillano conducted the facility tour. There is an Infection Control Plan on file. Client Records-Incident Reports/Clients Rights-Information/Dental- LPA reviewed client records. Two (2) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/and Staffing- LPA began review of employee records. Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Rhellynick Sevillano, Administrator’s license expiration date is 11/04/2024. (Continued on LIC809C) (Continuation from LIC809) Food Service- Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 107.0 degrees F. Laundry is done in the laundry room. There is a locked cabinet for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is a secured fireplace at this facility. There is not a pool at the facility. Facility has no record of fire drill performed per regulations requirements. Medications- are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. (Continued on LIC809C) (Continuation from LIC809) LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed seven (7) fire alarms and three (3) carbon monoxide detectors. There was two (2) fire extinguisher on site, last charged 08/29/2022. Based on the information received during this visit today in the areas reviewed, there are zero (0) deficiencies observed per Title 22, Division 6 of The California Code of Regulations. LPA informed Administrator of two (2) technical assistance observed per HSC 1569.695 (c) and CCR 87465 (h)(5). Administrator states that he will perform and keep record of fire drills in response to HSC 1569.695 (c). Administrator states that they will not pre-plan pills in containers for the day, in response to CCR 87465 (h)(5). This LIC 809 was reviewed with, and a copy will be provided to the Administrator, Rhellynick Sevillano.the state’s words, verbatim · CDSS document, Jul 20, 2023

Allegation investigated: Staff sleeping in unpermitted room Resident's bedroom door had lock on outside

On October 28, 2022, Licensing Program Analyst (LPA), Chinwe Nwogene conducted an unannounced visit to conclude the complaint investigation into the allegation listed above. LPA met with Licensee, Myla Sevillano and Administrator, Rhellynick Sevillano and discussed the purpose of the visit. During the investigation LPA interviewed resident and staff and conducted an inspection of the facility. Regarding the allegation “Staff sleeping in unpermitted room”. It was alleged staff were sleeping in an unpermitted room. LPA interviewed Administrator who acknowledged the dining room was being used as a staff room and had two #2 beds but was removed during the Fire clearance inspection. LPA inspected the dining room and verified the beds has been removed. Regarding the allegation “Resident's bedroom door had lock on outside”. LPA interviewed administrator who stated the lock was put in place because resident one #1 (R1) has a mild cognitive disorder and the lock prevents R1 from wandering at night when staff is sleeping. Administrator also stated the lock was removed during the Fire clearance inspection. LPA inspected staff room and the fire door, LPA observed there was still a lock on the fire door. Administrator immediately removed the lock. Based on LPA observations and interviews, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be substantiated. California Code of Regulations (Title 22, Division & Chapter number 6) are being cited on the attached LIC9099D. An exit interview was conducted with, and a copy of this report was reviewed and provided along with appeal rights to Myla Sevillano. Substantiatedthe state’s words, verbatim · CDSS document, Oct 28, 2022 · control 18-AS-20220912111656

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(1) · Plan of correction due date: Oct 29, 2022

Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. (1) Non-ambulatory persons. Based on LPA's observation and interview the licensee did not comply with the section cited above by installin a lock on the fire door of resident bedroom one #1 which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 28, 2022

Plan of correction: Although Licensee removed the locks, Licensee, Myla stated a written statment of understanding of the regulation cited will be provided to LPA by the POC due date 10/29/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(7)(a) · Plan of correction due date: Nov 7, 2022

Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation. (7) Sketches, showing dimensions; (A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended… Based on LPA's observation and interview the licensee did not comply with the section cited above by using the dining room as a staff bedroom which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 28, 2022

Plan of correction: Although Licensee removed the two #2 beds, Licensee, Myla stated a written statment of understanding of the regulation cited will be provided to LPA by the POC due date 11/7/2022.

Type of visit: Case Management - Licensee Initiated

Licensing Program Analysts (LPAs) Chinwe Nwogene conducted an announced case management visit to increase the capacity per licensee request. LPA met with Licensee, Myla Sevillano and Administrator, Rhellynick Sevillano and explained the purpose of the visit. At the time of visit there was two #2 residents, and two #2 staff present. Licensee requested for a capacity increase from 2 residents to 4 residents. A Fire Clearance was approved on 9/2/2022 for two #2 additional non-ambulatory residents. Facility sketch on file shows sufficient square footage in the facility and activity rooms to accommodate the requested capacity. LPA Nwogene discussed the facility sketch with Licensee. Resident bedroom two #2 has been approved for two non-ambulatory clients. LPA Nwogene confirmed that Resident bedrooms one #1 and two #2 has an exit to the outside of the facility, as well as a walk-in shower. LPA Nwogene toured the interior/exterior of the building and visually inspected the resident bedrooms. LPA Nwogene confirmed that all identified shared rooms are large enough to accommodate the required furniture for two residents without inhibiting movement into and throughout the rooms. LPA Nwogene additionally confirmed that there are sufficient bathrooms in the facility to meet Title 22 requirements for ratio of residents to bathrooms. The physical plant is ready for increase in capacity. LPA will submit file for capacity increase approval. The final approval of capacity increase is contingent upon LPM's final file review. Licensee will be notified by LPA once capacity increase has been approved by licensing. If capacity increase is approved, new license will follow in the mail after phone notification by LPA with Licensee. An exit interview was conducted where this report was discussed and a copy was provided to Licensee, Myla Sevillano.the state’s words, verbatim · CDSS document, Oct 28, 2022

Type of visit: Case Management - Licensee Initiated

Licensing Program Analysts (LPA) Chinwe Nwogene conducted an unannounced case management visit to increase the capacity per licensee request. LPA met with Licensee, Myla Sevillano and Administrator, Rhellynick Sevillano and explained the purpose of the visit. Licensee requested for a capacity increase from 2 residents to 4 residents. During the visit LPA Nwogene toured the interior/exterior of the building and visually inspected the resident bedrooms. LPA observed the Resident’s bedroom two #2 was still being used by the Licensee. LPA observed clothes, books, papers, and other personal belongings in the bedroom. Licensee stated she wasn’t expecting the visit and wasn’t ready for the inspection. Licensee stated she will notify LPA when the room is clean and ready for inspection. Based on today’s visit, the facility is not ready for increase in capacity. Licensee will notify LPA when facility is ready for a capacity increase inspection. An exit interview was conducted where this report was discussed, and a copy was provided to Myla Sevillano.the state’s words, verbatim · CDSS document, Sep 20, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Chinwe Nwogene made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Licensee, Myla Sevillano who was informed of the purpose of the visit. At the time of visit there was 1 staff and 2 residents present. The facility currently has zero positive or suspected Covid-19 cases. During today's visit, LPA toured the facility inside and out with Myla Sevillano and made observations regarding the infection control measures that the facility has implemented. LPA did not observe Covid-19 postings. Myla stated the facility has no COVID-19 Posters. LPA informed Myla some COVID-19 posters will be emailed to the facility email address and that COVID-19 posters should be posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer and paper towels) in all restrooms. LPA did not observe any pools or bodies of water within the premises. LPA was informed that no weapons or ammunition is maintained at the home. No annual fees due. The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks. The Facility will contact the resident's physician should there be any event of COVID-19 related illnesses. The facility has a designated infection control lead. The facility also cleans and disinfects the highly touched surfaces during each shift, and as needed. LPA observed PPE supplies. No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Myla Sevillano.the state’s words, verbatim · CDSS document, Jul 26, 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.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Christine Le conducted an announced visit to the pending facility for a pre-licensing inspection. LPA met with applicant Rhellynick Sevillano. LPA toured the facility inside and out. The pending application is for two (2) non-ambulatory residents in a Residential Care Facility for the Elderly. The following was observed, reviewed, and inspected: there is one (1) resident bedroom and one (1) resident bathroom. There are no bodies of water. The physical plant, in general, was in good repair. Buildings and grounds were free from hazards. Outdoor and indoor passageways were kept free of obstruction. The outside of the facility had a shaded area with seating. The auditory devices used to monitor exits were functional. There are charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors. The facility has a working telephone. There is a locked area for medications and sharps. LPA toured the bedroom. Resident bedroom had the required bedding, furniture, and functional lighting. The facility had a supply of additional linen and extra hygiene items for the residents. LPA toured the kitchen. Food was stored in a safe and healthful manner. The facility had a 2 day supply of perishable food items and 7 day supply of nonperishable food items. The facility menu was available for review. Dishes, glasses, and utensils were in good condition. The facility has a designated area for staff and resident files. LPA toured the resident bathroom. The bathroom was operating in a safe and sanitary condition. LPA observed grab bars. The hot water temperature measured at 112 degrees F. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. The facility was equipped with a complete first aid kit (e.g. thermometer, tweezers, scissors, antiseptic, bandages, gauze). There is adequate seating in the common areas. Night lights were maintained in the hallways. The facility had a supply of activities for the residents. Emergency lighting (e.g. flashlights) were also maintained. The following needs to be corrected prior to licensing: 1) LPA observed unlocked cleaning supplies in the laundry room. The applicant shall ensure cleaning supplies are locked and inaccessible. 2) LPA did not observe non-skid mats in the bathroom. The applicant shall ensure non-skid mats are placed in the shower. 3) LPA observed a first aid kit but not a first aid manual. The applicant shall ensure the facility has a first aid manual. Proof will be submitted to the Department by 7/11/21. An exit interview was conducted where this report was discussed and provided to the applicant.the state’s words, verbatim · CDSS document, Jul 8, 2021