Happy Nest

Type of visit: Required - 1 Year

On 10/25/2023, Licensing Program Analyst (LPA) Chinwe Nwogene arrived unannounced at the facility to conduct an annual inspection. LPA Nwogene was greeted and granted entry by House Manger, Michelle Hashimo. Michelle called Administrator, Claire Itchon who arrived at the facility shortly after. LPA informed Michelle Hashimo and Claire Itchon of the purpose of visit. At the time of visit there was 3 staff and 5 residents present. LPA toured the facility inside and out with Michelle Hashimo and Claire Itchon. Tour included: Kitchen; LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. Utensils and dishware are sufficient for the capacity. The refrigerator and stove are in working order. Sharps are stored in a locked kitchen cabinet under the sink, available only to authorized individuals. Trash cans has tight-fitting lids. Dishwasher is used to clean and sanitize dishes. Fridge, Freezer, and all need appliances were present and shown to be in working condition and clean. Dining and Livingroom; LPA toured the dinning and Livingroom area. LPA observed area to be clean and furnitures in good condition. Temperature was 75 degrees Fahrenheit. Hallway; LPA toured the hallway and observed hallway to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance and record to be up to date. Carbon monoxide & smoke detector were tested and functioning properly. LPA observed additional linens and hygiene items. Medication; LPA observed medications were labeled and stored in separate bins inside of a locked medication cabinet and are distributed according to physician orders. The first aid kit was complete. Continue on LIC809-C Continued from LIC809. Bathroom; LPA toured hall bathroom and observed bathroom to be clean and equipped with grab bar and non-slip mat. There is also a good number of personal toiletries available for the residents in care. The hot water measured at 113 degrees Fahrenheit Bedroom; LPA toured three #3 out of #3 residents bedroom and observed bedrooms to be clean and furnished according to regulation, which includes proper furniture, dressers, chairs and lighting. Night lights were maintained throughout the facility. Resident bedroom #1 and #2 has a private bathroom. LPA observed bathroom to be clean and hot water was measured at 113 degrees Fahrenheit. Garage; LPA tour the garage and observed garage to be clean and not cluttered. Cleaning supplies are stored away in the garage, inaccessible to clients. Washing machine and dryer are all in good repair and sufficient for the census. Backyard; LPA toured the backyard and observed backyard to be clean and furnitures in good condition. The backyard was free from obstruction and the side gate remain unlocked. Facility has a pool, LPA observed pool to be adequately secured. Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Fridge and Freezer are large enough to accommodate required perishable foods. Records: All staff present have a criminal record clearance in file and are confirmed as being associated with the facility. Three #3 staff and #3 residents' records were reviewed. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 12/02/2023. Interview; Three #3 staff and #3 residents were interviewed. No deficiencies noted at the time of visit. An exit interview was conducted, and a copy of this report was reviewed and provided to Claire Itchon.the state’s words, verbatim · CDSS document, Oct 25, 2023

Allegation investigated: Staff caused injury to resident. Resident suffered a fall resulting in injuries.

Licensing Program Analysts (LPAs) Ryan Gardner and Mary Rico conducted an unannounced visit to the facility to deliver findings for the above complaint allegations. LPA met with Caregiver Jose Itchon and explained the reason for the visit. The investigation was initiated on 11/10/2020 which consisted of interviews and file review revealed the following: For allegation, Resident suffered a fall resulting in injuries: It was alleged that R1 suffered a fall on 11/5/2020 that sustained injuries to their arm. During interviews conducted with staff S1, S1 stated that they heard a loud noise coming from R1’s bedroom on 11/5/2020 around 3:00am. S1 went to R1’s bedroom to investigate the noise. Unsubstantiated S1 found that R1 had fallen and was caught on the right side of the bed and the left side/stomach of R1’s body was on the floor. S1 found minor injuries to R1’s arms. S1 called R1’s hospice nurse immediately to address the situation. R1’s responsible party was called and informed of R1’s fall. R1’s responsible party lives outside the state of California so as a precaution the responsible party called the police to check on R1. When police and hospice arrived, they did not note major injuries. Hospice cleaned the wound and applied dressing to the wound. During interview with R1’s responsible party, LPA discovered R1’s responsible party was immediately informed of R1’s fall and police were only called as a precaution due to the responsible party living outside of the state of California. R1’s responsible party noted that they did not have any suspicions of elder abuse towards R1, and they were satisfied with the care being provided to R1. During document review, LPA found that the facility submitted a special incident report to state licensing detailing R1’s fall on 11/5/2020. The report included the police report number and the same recollection of events that was provided in the interview with facility staff. For allegation, Staff caused injury to resident: Based on the information gathered on the allegation of the resident suffered a fall resulting injuries, LPA found that R1 did fall and sustain injures to their arm, but the injuries were not caused by a staff. The staff took the correct actions to help the resident during and after R1’s fall. Based on the evidence found during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Caregiver Jose Itchon, along with a copy of the appeal rights.the state’s words, verbatim · CDSS document, Apr 17, 2023 · control 18-AS-20201106164914

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA Gardner met with Administrator Jose Itchon. Present in the home during time of visit were two (2) staff as well as three (5) clients. There are currently no cases of COVID-19 within the facility. During today's visit, LPA Gardner toured the facility and made observations pertaining to the facility's infection control measures. LPA Gardner observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. During the inspection LPA Gardner discussed infection control practices and procedures with Ms. Itchon. An exit interview was conducted and a copy of this report, was reviewed with and provided to Ms. Itchon. Based on the observations made during today’s visit, LPA Gardner noted an unlocked cabinet under the sink which contained stored knives. An exit interview to review this report was conducted and a copy of this report as well as the LIC809(d) was provided to Ms. Itchon.the state’s words, verbatim · CDSS document, Sep 2, 2021

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Sep 2, 2021

Care of Persons with Dementia: (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement was not being met as evidenced by: LPA Gardner observed unlocked cabinet accessible to residents in care. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 2, 2021

Allegation investigated: Resident has multiple unstageable pressure injuries. Illegal eviction.

On 7/29/21 Licensing Program Analyst (LPA) conducted an unannounced visit for the purpose of delivering the findings to the above allegations. LPA met with Myrna Lomboy, explained the nature of the visit and was granted entry. The investigation, which consisted of interviews and file reviews reveled that the Resident 1 (R1) did not have multiple unstageable pressure injuries and was not illegally evicted. On 1/26/20, staff took a picture of a red spots on Resident 1 (R1)'s buttocks and notified Claire and George Camua. R1 sustained redness more consistent with a stage 1 wound. On 1/27/20 R1 was taken to the hospital for a decline in health and would be discharged back to the facility onto hospice. R1 was placed on life support and was removed by their Power of Attorney (POA). R1 expired on 2/1/20, which is the reason he did not return to the facility. In regard to the illegal eviction, R1's POA called the facility from the hospital and told the facility that R1 would not be returning to the hospital because R1's health was declining and R1 would be passing soon. There was never any conversation about an eviction. ***continued on 9099C*** Unsubstantiated *** continued from 9099*** 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 allegations are UNSUBSTANTIATED at this time. An exit interview was conducted where this report was discussed with and provided to Myrna Lomboythe state’s words, verbatim · CDSS document, Jul 29, 2021 · control 18-AS-20200129112320