Boundless Care for the Elderly

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 four (4) clients live at this facility and there are currently four (4) staff members present. The Caregiver, Dante Chocobar (S1) conducted the facility tour. There is an Infection Control Plan on file. Client Records-Incident Reports/Clients Rights-Information/Dental- LPA reviewed client records. Four (4) 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- LPAs 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. Sandra Chocobar, Administrator’s license expiration date is 12/14/2024. 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. (Continued on LIC809C) (Continuation from LIC809) 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 108.0 degrees F. Laundry is done in the laundry room. There is a locked room 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. The last fire drill was conducted on 06/19/2023. Medications- are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed nine (9) dual fire and carbon monoxide detectors. There was two (2) fire extinguisher on site, last serviced 08/26/2022. 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. This LIC 809 was reviewed with, and a copy will be provided to the Director, Sandra Chocobar.the state’s words, verbatim · CDSS document, Jul 12, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility for the purpose of an annual inspection with focus on infection control. LPA met with Licensee/Administrator Sandra Chocobar, who was informed of the purpose of the visit. LPA conducted a walk through of the interior and exterior of the facility. LPA observed resident bedrooms that would be used as isolation rooms. LPA observed proper signage posted throughout the facility promoting proper cleaning, social distancing, and hand washing for COVID-19. Facility has a plan for isolating those who have or suspected to have COVID-19 and have a plan in place to clean, disinfect and attend to those in the isolation room. LPA observed hand hygiene supplies in facility restrooms such as hand sanitizer, access to water, hand soap, and paper towels. LPA observed hand washing signs in facility restroom. LPA observed the facility's PPE supply, which was a sufficient 30-day supply, and observed facility PPE cart for COVID-19 isolation room. LPA also observed hand sanitizer and PPE at the facility entry point. Licensee stated staff have been training in the proper usage of PPE supplies, and designated staff member has been N95 Fit tested. LPA was informed of staff COVID-19 leave and when staff can return to work after being positive. LPA was also informed of staffing contingency plan for COVID-19. The facility has one central entry point with a symptoms screening and sign in process for visitors. Temperatures are taken and recorded for residents, staff, and visitors. There is also a designated visitation area for visitors at the facility. LPA checked facility LIC610E and checked that resident emergency contacts have been updated. LPA checked staff members for background clearance. No deficiencies were observed during the time of the visit. An exit interview was conducted where this report was reviewed and provided to Licensee/Administrator.the state’s words, verbatim · CDSS document, Sep 1, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Deborah Mullen conducted an unannounced annual inspection. LPA met with Sandra Chocobar, Licensee. LPA conducted a walk through inspection of the home. The home is a two story, seven bedroom, three bathroom home with a living room, dining room and kitchen. Residents rooms are on the first floor of the home. The home is licensed for four residents and a hospice waiver for two. The home is approved for one bedridden resident in bedroom #1. The bedrooms were observed to have a bed, dresser, night stand and lighting for residents comfort. The bathroom was observed to be clean, safe and sanitary, with grab bars and non-slip mats for residents safety. The kitchen was observed to have the minimum three days perishable and two days non-perishable foods. Chemicals, cleansers and sharp items were locked and inaccessible to residents. The medications are locked and stored in a cabinet in the laundry room. The home was observed to be clean, safe and sanitary and to be in compliance with Title 22 regulations. During the inspection LPA reviewed infection control practices and procedures with the Licensee. LPA observed the facility to be following current infection control guidelines. No deficiencies were observed or cited. An exit interview was conducted and a copy of this report was reviewed with and provided to Mrs. Chocbar.the state’s words, verbatim · CDSS document, Aug 24, 2021

Allegation investigated: Facility failed to acknowledge the residents change of condition leading the resident reoccurring unexplained injuries. Facility staff required visitors to give advance notice before visiting resident Facility staff did not use residents wheelchair in a safe manner

Licensing Program Analyst Yolanda Bejarano conducted an unannounced visit to deliver findings. LPA explained the purpose of the visit to Sandra Chocobar. Allegation "Facility failed to acknowledge the residents change of condition leading the resident reoccurring unexplained injuries". LPA was provided documentation for R1 that revealed a change of condition had occurred on 10/4/2019. Facility provided the responsible party an increase of fees but failed to document change of condition. Administrator provided a time line, photos, text, documentation of injuries that had occurred. However, no change of condition was in file. Based on the documentation gathered the allegation is deemed to be SUBSTANTIATED. A finding that the complaint SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met. Substantiated Allegation:"Facility staff required visitors to give advance notice before visiting residents". LPA interviewed administrator and stated families and outside agencies are to call prior to visiting due to housekeeping hours and to prevent families from visiting all at the same time. Based on the interview, LPA found administrator limited visitations, this is a violation of residents personal rights. Families should be able to visit during reasonable hours without prior notice. The allegation is deemed to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met. Allegation: Facility staff did not use residents wheelchair in a safe manner LPA Yolanda Bejarano visited the facility on 12/17/2019, resident #1 was no longer living at the facility therefore was unable to interview. Administrator admitted the legs on the wheelchair had been removed to prevent injury to resident legs. R1 was able to transfer to and from the wheelchair with assistance. File review for R1 was conducted but there was documentation indicating legs could be removed on wheelchair. Based on the information gathered the allegation is deemed to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met. Exit interview conducted and copy of report provided. **** LIC9099 & LIC9099C were signed by LPA Colvin and sent via email to Licensee Sandra Chocobar. Signatures needed for amended report to change status of report from confidential to public. Signature of Licensee on file.the state’s words, verbatim · CDSS document, Jun 17, 2020 · control 18-AS-20191213161336

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Jun 30, 2020

OBSERVATION OF THE RESIDENT The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is no met as evidence by: Administrator did not observe R1's change of condition and ensure the needs and assistance was met that lead R1 to have reoccurring unexplained injuries.the state’s words, verbatim · CDSS document, Jun 17, 2020

Plan of correction: Administrator is to ensure at all times that residents are regularly observed for changes and the appropriate assistance is provided when such observation reveals unmet needs. Submit statement indicating how this will take place and training will be provided.

From the deficiency page — Deficiency type: Type B · Section cited: ILS 87468.1(a)(11) · Plan of correction due date: Jun 30, 2020

PERSONAL RIGHTS Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is no met as evidence by: Facility requires vistors and any agency to give advance notice before visiting the facility or any of the residentsthe state’s words, verbatim · CDSS document, Jun 17, 2020

Plan of correction: Administrator is to understand the regulation that visitors are permitted to have vistors without prior notice. Statement of ccorections is to be submitted to CCL by the due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(3) · Plan of correction due date: Jun 30, 2020

POSTURAL SUPPORTS Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is no met as evidence by: Facility did not use the wheel chair in a safe manner and removed the foot pedals without a written order from a physician which caused injuries.the state’s words, verbatim · CDSS document, Jun 17, 2020

Plan of correction: Administrator is to ensure at all times that there is a written order from a physician prior to making an changes to the use of Postural Supports. Administrator is to review and understand the regulation and submit statement and corrections to CCL by the due date.