Park View Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit on 06/14/2023 at 10:54 a.m. LPA was granted entry and met with Administrator,Bianca Petra, who was informed of the purpose of the visit. At the time of the visit there was one (1) staff and three (3) client present. The facility is a one-story home with five (5) bedrooms and two (2) bathrooms with attached garage, and pool in the backyard. The clients served are elderly adults on hospice between the ages of 65 and up. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and client interviews. LPA observed the following: Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that all staff had infection control training. Physical Plant: LPA observed the client bedrooms and staff office. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed the facility pool was surrounded by a locked gate. LPA observed outdoor furniture and shaded area for clients. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational, and the hot water temperature 120F. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff are present for the supervision of clients during the visit. LPA also reviewed the staff scheduled showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator, possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed two (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Two (2) client files were reviewed, and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All client medication was locked in a cabinet in the dinning room. LPA reviewed client medications for (1) client and found all medication listed on the centrally stored medication list and all required labeling was found to be in place. LPA observed PRNs documented when taken. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the garage and first aid kit with all required items. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided to Administrator, Bianca Petra.the state’s words, verbatim · CDSS document, Jun 14, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Stephanie Torres, conducted an announced pre-licensing inspection to the facility. The LPA met with Licensee/Administrator, Bianca Petra. Application: The application is for a Residential Care Facility for the Elderly (RCFE). The fire clearance has been granted for six (6) non-ambulatory residents. A Hospice Waiver has been granted for four (4) Buildings and Grounds: The home is composed of four (4) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, two living room spaces, kitchen and dinning areas, a front/back yard areas (with seating), and a garage. The interior/exterior walkways of the home were observed to be clutter free with no obstructions present. Smoke and Carbon Monoxide detectors were tested and operable. There is a pool located on the premises, it is appropriately secured. According to Petra, there are no weapons stored in the home. Rooms, furniture, beds, mattresses are all in good repair. The bedrooms are completely furnished and privacy is available. The dining and living room areas are clutter free and in good condition. Bathrooms were observed to have non-slip tile available. The hot water was tested and measured at 112.0 degrees Fahrenheit, which is within regulatory limits. Outdoor areas had sufficient room for activities and leisure. A washing machine and dryer are available and in working order. Storage and Supplies: Activities were observed to be available and in sufficient amount for the requested census. Medications will be stored inaccessible to any unauthorized individuals. Secured areas are available for facility files and resident files. The first aid kit was observed to be available and complete. Cleaning supplies will be stored away in a secured kitchen cabinet. Linens, towels, and other equipment are all in good repair and sufficient for approved census. A Fire extinguisher was available and fully charged. Food Service: Utensils and dishware are sufficient for the requested capacity. The refrigerator and stove are in working order. Sharps will be stored in a locked kitchen drawer, available only to authorized individuals. Forms: The following signs were observed to be available at the home: Emergency Disaster Plan (LIC 610E), Theft and Loss Policies, Visitors Policy, Personal Rights, and Facility Sketch (LIC 999), and Complaint Information. No follow ups are required at this time. The LPA will inform the Centralized Applications Bureau (CAB) the home is ready for licensure. This report was discussed with and a copy provided to Petra.the state’s words, verbatim · CDSS document, May 6, 2022

Type of visit: Office

Facility Type: RCFE Application Type: INITL Capacity: 6 COMP II Participants: Petra, Bianca (Administrator & Corporate Board Member) Interview Method: Telephone interview On 4/5/2022, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 5, 2022