Happy Nest III

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kathleen Banrasavong and Licensing Program Manager(LPM) Jazmond Harris 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 five (5) clients reside at this facility and there are currently two (2) caregivers present. Acting Administrator, Claire Itchon arrived during the inspection to do the facility tour. There is an Infection Control Plan on file. Client Records-Incident Reports/Clients Rights-Information/Dental- LPA began review of client records. Five (5) 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- Three (3) 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 administrator certification; expiration date 12/02/2023. 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 chemicals and 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 home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 105.0 degrees F. Laundry facilities and a locked room is present 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 home. There is no pool and no bodies of water observed. Medications- are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained. 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. 4 smoke detectors and 1 carbon monoxide detectors were tested and found to be operational. Fire extinguisher was recharged this year, 02/20/2023. The facility is conducting emergency disaster/fire drills monthly; last done on 01/23/2023. Based on the information received during this visit today in the areas reviewed, there are no deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809 was reviewed and a copy will be emailed to the facility representative and a confirmation of receipt will be requested.the state’s words, verbatim · CDSS document, May 30, 2023

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with Administrators Claire Itchon & George Camua and advised them of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Below is a summary of what was observed: Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator George Camua & Claire Itchon, who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap and handwashing guides. LPA Colvin observed 1 of 3 resident bathrooms to not have any paper towels. LPA Colvin inquired with staff about the lack of paper towels, to which they informed LPA Colvin that one of the residents flushes paper towels down the toilet and clogs it, so they only provide them with paper towels themselves when the resident uses the restroom. LPA Colvin will be issuing a Technical Advisory Note for the lack of paper towels in one resident bathroom. LPA Colvin cautioned the Administrators regarding using this approach, and recommended looking into other options. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns) which LPA Colvin observed to be sufficient for a 30-day supply and is accessible to staff. LPA Colvin went over the various recommended training for facility staff in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE. LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator George Camua stated that they have not conducted fit testing for staff, as the facility uses KN95 masks. LPA Colvin will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA Colvin will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. Administrators confirmed that both staff and visitors are screened for COVID-19 symptoms prior to entering the facility. LPA Colvin confirmed this as LPA Colvin's temperature was taken upon entry to the facility, and LPA Colvin signed in on the visitor log & temperature was recorded. An exit interview was conducted with Administrators George Camua and Claire Itchon and a copy of this report and LIC9102-TA Advisory Notes was provided.the state’s words, verbatim · CDSS document, Aug 1, 2022

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Faciltiy has pests.

Licensing Program Analyst (LPA) Jesse Gardner arrived at the facility unanounced in order to investigate the above allegation. LPA identified himself and discussed the purpose of the visit and the elements of the allegation with Caretaker Michelle Hashimoto. LPA then toured the facility. According to the statement provided in the allegation, LPA inspected the drawer where the facility keeps silverware and immediately saw a roach walking through the drawer, and quickly out of sight. LPA also noticed multiple roach carcasses, in which pictures were obtained. Administrator Claire Itchon arrived at the facility. Continued on LIC9099-C. Substantiated Due to the located evidence of bugs, LPA substantiated the allegation. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. Thus a Type B citation was issued per Title 22 Division 6 Chapter 8 Article 10 87555(b)(27) General Food Service Requirements. An exit interview was conducted with Administrator Claire Itchon, in which this report was discussed with and a copy of this report along with copies of the LIC9099-C, LIC9099-D, as well as Appeal Rights were provided.the state’s words, verbatim · CDSS document, Apr 11, 2022 · control 18-AS-20220408133815

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(27) · Plan of correction due date: Apr 18, 2022

GENERAL FOOD SERVICE REQUIREMENTS: (b) The following..shall apply:(27)All kitchen..shall be..clean and free..of insects.. This was not met as evidenced by: Based on LPA's observation, Licensee did not adhere to the regulation by the evidence found of insects. This poses a potential health and safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 11, 2022

Plan of correction: Licensee agrees to provide an updated cleaning plan, and proof of continued pest control service, and provide LPA proof of such via email by the POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA arrived at 10:01 AM, LPA were met by Caregiver Michelle Hashimoto and explained the purpose of the visit. Administrator George Camua arrived and joined the inspection. Present in the facility during time of visit were two (2) staff as well as six (6) residents. There are currently no cases of COVID-19 within the facility. During today's visit, LPA toured the facility and made observations pertaining to the facility's infection control measures. LPA observed proper signage throughout the facility, 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. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. The facility also has a plan in place to monitor resident(s) regularly for any changes in condition and to subsequently notify the resident(s) physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. Based on the observations made during today’s visit, one (1) deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 12, 2021

Type of visit: Case Management - Deficiencies

Licensed Program Analyst Yolanda Delgado arrived at the facility to complete the Annual Inspection with an emphasis on Infection Control. During the inspection S1 was found to not have a Criminal Background clearance and no association to the facility. Deficiency has been cited and immediate civil penalties has been assessed for $500.the state’s words, verbatim · CDSS document, Aug 12, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(b) · Plan of correction due date: Aug 13, 2021

Criminal Record Clearance: Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement was not met by: The facility failed to meet this requirement as evidence by (S1) does not have a criminal record clearance on file in our department. The Licensee did not comply with the above regulation with (S1). (S1) has been working in the facility without the Licensee submitting a background clearance and association to the facility. This is an immedaite safety risk to all residents in care.the state’s words, verbatim · CDSS document, Aug 12, 2021

Plan of correction: Licensee agrees to remove (S1) from the schedule until a criminal background clearance request is submitted for (S1) and to be associated to this facility. Licensee shall either submit an updated staff schedule to LPA Delgado or submit proof of request of clearance. Plan of Correction due by 8/13/2021. (S1) left the facility immediately as observed by LPA. Licensee agrees to not have (S1) return to the facility unless and until (S1) obtains a criminal record clearance for this facility. This is an immediate safety risk.