Bella Casa 2

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 five (5) clients live at this facility. There were three (3) staff members present. The Administrator, Rommel Carlos conducted the facility tour. There is an Infection Control Plan on file. Client Records-Incident Reports/Clients Rights-Information/Dental- LPA reviewed 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- LPA reviewed 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. Rommel Carlos’s Administrator’s license expiration date is 08/21/2023. (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 76 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the hallway closet. 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 one (1) secured fireplace at this facility. There is not a pool at the facility. There are two (2) gates that have a self-latching lock on the northwest and northeast side of the house. The facility performed their last fire and emergency drills on June 1st, 2023. Medications- 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 made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed eleven (11) fire alarms and two (2) carbon monoxide detectors. The Administrator tested the smoke alarms and carbon monoxide alarms on site. There is one (1) fire extinguisher on site, last charged on July 5th, 2022. Pursuant to the Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to the Administrator, Rommel Carlos.the state’s words, verbatim · CDSS document, Aug 8, 2023

Allegation investigated: Resident is not being afforded privacy with phone calls and visits.

Licesning Program Analyst(LPA) made an unannounced visit to the facility to commence a complaint investigation in regards to the allegation listed above. LPA was greeted and granted entry by the Licensee Ursula Carlos, where explained the purpose of the visit and the elements of the allegation. The allegation was investigated, the investigation consisted of observation, interviews and record review. LPA conducted a tour of the interior and exterior and observed for there to be a video surveillance device in three (3) of the five (5) resident bedrooms. Per the Licensee Resident #1 (R1)s significant other installed the camera in their room, and is the one that monitors the device. However R1 has a roommate and there was no proof of consent, but the Licensee stated that verbal approval was provided agreeing to have a camera and or audio device inside their bedroom. R3 and R4 were observed to have a device inside their room as well, and their responsible parties are reported to have given writtenconsent, however the written approval was not at the facility at the time of LPA's visit. The facility did not obtain approval to utilize any form of video sureveillance from the department. Substantiated LPA attempted to interview R1 in regards to the matter but was not able to confirm or deny if they were not provided a response in regards to what their blood pressure reading was for the day. R1 stated that they were confused and became emotional. Based on LPA not being able to confirm what was alleged the allegation is UNSUBSTANTIATED. Regarding the allegation Facility is not following residents health care directive. It was alleged that R1's blood pressure has been elevated for approximately one week and the facility has dismissed R1's requests to be transported to the emergency room. On or around May 29, 2023, R1 had verbally requested to be transported to the hospital via paramedics and R1's Power of Attorney (POA) cancelled the paramedics resulting in R1 not receiving any medical attention. LPA was unable to confirm with R1 if they did in fact request to be sent out via 9-1-1. However the paramedics, as well as the Thermal Sheriff deputies responded to the facility. After an assessment was completed by the EMTs, it was determined that R1 did not need to be sent out for a medical evaluation. Therefore the allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that 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. An exit interview was conducted and a copy of this report was provided to Licensee's Rommel and Ursula Carlos. Based on observation the allegation is SUBSTANTIATED. A substantiated finding means that the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. An exit interview was conducted and a copy of this report, 9099D and appeal rights were provided to Licensee's Rommel and Ursula Carlos.the state’s words, verbatim · CDSS document, Jun 8, 2023 · control 18-AS-20230608093111

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2 · Plan of correction due date: Jun 22, 2023

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition.. residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy.. This requirement is not met as evidenced by: Based on observation, LPA observed video cameras in R1, R2, R3 and R4's bedooms. The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 8, 2023

Plan of correction: The licensee agrees to remove the device, and will encourage the the responsible to utilize usingoom. Proof is to be submitted to the department by 5pm on the due date indicated.

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 Administrator Ursula Carlos and advised 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 Ursula Carlos , 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 2 of 3 bathrooms had paper towels. LPA Colvin will be issuing a Technical Assistance (TA) Advisory Note during today's inspection, as residents do have cloth towels available for use to dry their hands. 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 was located in resident bedrooms and at screening station. LPA Colvin observed the facility have an adequate supply of PPE. LPA Colvin went over the various recommended training for facility staff with caregiver Jocelyn Lumaco 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 Ursula Carlos confirmed that staff have been fit tested. LPA Colvin observed a sign-in sheet at the front door of the facility, and confirmed that visitors and staff are being screened for symptoms prior to entering the facility, as LPA Colvin was today. Administrator Ursula Carlos confirmed that both new staff and new residents must present a negative COVID-19 test prior to start of employment or residence at the facility. An exit interview was conducted with Administrator Ursula Carlos and a copy of this report and LIC9102 TA Advisory Notes were provided.the state’s words, verbatim · CDSS document, Aug 30, 2022

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.