Asher's Residential Care Facility

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 six (6) clients live at this facility. There were two (2) staff members present. The Caregiver, Cherrylyn Adto conducted and completed the facility tour. The Administrator, Mark Maligaya later come to complete the annual. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Six (6) 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/ Staffing/ Administration: LPA reviewed employee records. Two (2) record 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. Mark Maligaya, Administrator’s certificate expiration date is 04/02/2024. (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 78 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the garage. 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. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is two (2) secured fireplaces at this facility. There is a pool at the facility, that is secured with a 5 foot locked gate. There are two (2) gate that have a self-latching lock on the northeast and northwest side of the house. The facility performed their last fire and emergency drills on 04/03/23. LPA reviewed the facility’s last disaster drills, which met the department's requirements. LPA observed emergency supplies and first aid with the required components. 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. (Continued on LIC809C) (Continuation from LIC809) Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed if they were dispensed accurately. LPA observed the medication pre-filled in another container out of the bubble packs. LPA informed the Administrator of the violation regarding the regulation, per 87465(h)(5), a technical violation will be issued. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed five (5) dual fire alarms and carbon monoxide detectors. The caregiver tested the smoke alarms and carbon monoxide alarms on site. There is four (4) fire extinguisher on site, last checked and tagged on 05/04/23. Pursuant to the Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. One (1) technical violation will be issued, per, 87465(h)(5). An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to the Administrator, Mark Maligaya.the state’s words, verbatim · CDSS document, Sep 13, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Stephanie Torres, conducted an announced pre-licensing inspection at the facility. The LPA met with Applicant, Mark Maligaya. There are currently six (6) residents in care. Application: The change of ownership application is for a Residential Care Facility for the Elderly (RCFE). The fire clearance has been granted for six (6) non-ambulatory residents, of which one (1) may be bedridden. Buildings and Grounds: The home is composed of six (6) resident bedrooms, two (2) staff bedrooms, seven (7) bathrooms, a laundry room, two living rooms, a kitchen, two (2) dining areas, and front/back yard areas. 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.Hot water temperature measured 107.4 degrees Fahrenheit, which measures within regulatory limits. There are no pools or other bodies of water located at the home. According to Maligaya, there are no weapons stored in the home. Rooms, furniture, beds, mattresses are all in good repair. The bedrooms are furnished, and privacy is available. The dining and living room areas/furniture are clutter free and in good condition. Bathrooms were observed to have non-slip flooring available. Outdoor areas had sufficient room for activities. A washing machine and dryer are available and in working order. Storage and Supplies: Medications will be stored inaccessible to any unauthorized individuals. Secured areas are available for facility, staff, and resident files. The first aid kit was observed to be available and complete. Cleaning supplies will be stored in the supply room, inaccessible to unauthorized individuals. Linens, and 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 posted at the home: Emergency Disaster Plan (LIC 610E),Theft and Loss Policies, Visitors Policy, Personal Rights, Resident/Family Council, Facility Sketch (LIC 999), and Complaint Information. The following was observed to require correction: Applicant did not have a file for himself, containing the required documents. The LPA will inform the Centralized Applications Bureau (CAB) the home is ready for licensure once corrections are received from the applicant. This report was discussed with and a copy provided to Maligaya.the state’s words, verbatim · CDSS document, Sep 1, 2022

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 Method: Telephone call with CAB COMP II Participants: Mark Maligaya, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Staff training 4. Applicant and Administrator qualifications 5. Grievances, Complaints, Community resources 6. Food service 7. Medication management 8. Application document review and technical assistance: Pre-licensing inspectionthe state’s words, verbatim · CDSS document, Jul 29, 2022