Eben Haven

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 8:48 am to conduct an unannounced annual visit. LPA met the Caregiver Angelica Alamillo Ochoa at the front door and was granted entry. The Administrator, Elizabeth Odunjo arrived at 9:07am. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. The facility is a single-story home located in a residential area in Menifee, CA licensed to serve six (6) non-ambulatory and approved for 1 bedridden with 4 residents in care. The facility has a Hospice Waiver for 4 residents. Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies. Physical Plant and Environmental Safety: The facility temperature read at 73 degrees. The facility consists of 4 resident bedrooms, and 3 bathrooms, living room, kitchen, and backyard. The bedrooms are furnished with lighting, closet space, tv and dresser. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 110 degrees which is within regulation requirements. The living room and kitchen clean and clear of obstruction. The medications are stored in a locked cabinet in the hallway and inaccessible to the resident. The facility has a current fire clearance, smoke and carbon monoxide detectors and fire extinguishers and are in working order. Personnel Records-Training: The staff records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings. Client Records-Incident Reports: The facility has identification and emergency information, physician’s report, resident appraisal, client rights, and admissions agreements. (Continued on LIC809-C) (Continued from LIC809) Client Rights-Information: The facility has client rights information posted in the facility. Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available. Health- Related Services: The facility has a medication logbook; the facility documents the resident’s medication and in is compliance with physician’s orders and regulations. Disaster Preparedness: The facility has a disaster plan and has posted the evacuation plan, visible for staff and residents in care. The last fire drill was completed 09/23/23. The facility has emergency supply of food and water. Summary: No deficiencies were observed at the time of the visit. An exit interview was conducted and a copy of this report was provided to Administrator, Elizabeth Odunjo and her signature on this form confirms receipt of these rights.the state’s words, verbatim · CDSS document, Oct 20, 2023

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 Caregiver Angelica Alamillo. Present in the facility during time of visit were 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. LPA Gardner discussed infection control practices and procedures with Ms. Alamillo. An exit interview was conducted and a copy of this report was reviewed with and provided to Ms. Alamillo.the state’s words, verbatim · CDSS document, Oct 15, 2021

Allegation investigated: Staff failed to provide proper supervision, which resulted in a fall.

Licensing Program Analyst (LPA) Anna Bueno conducted a subsequent unannounced visit for the purpose of concluding this agency's investigation into the complaint allegation mentioned above. The investigation consisted of file reviews, observations, and staff interview. The complaint alleges that staff failed to provide supervision that resulted in a fall. Based on interviews and observations, findings for the above allegations is UNSUBSTANTIATED. Resident 1 (R1) slipped when she stood up on her own as Staff 1 (S1) was grabbing toileting supplies. S1 did not leave R1 unsupervised but rather turned her back to grab the supplies, which were in a basket, an arm's away from S1's person. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies have been cited at this time. An exit interview was conducted where this report was discussed, and a copy was provided to the Ms. Odunjo. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 12, 2021 · control 18-AS-20201202130150