Emerald Estate Senior Living

Type of visit: Post Licensing

Post Licensing visit is conducted in today's inspection. No deficiencies are cited. See 809 for Annual visit for details. Exit interview done and copy of the report left at facility.the state’s words, verbatim · CDSS document, Jan 11, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 01/11/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with staff- Garrison Costar (Garry) and explained the purpose of the visit. Garry stated that administrator -Kimi Costar is his wife and had the permission to do the inspection with LPA. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted facility and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA and Garry toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathrooms, kitchen, staff room and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Garry completed the infection control domain together and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility. Administrator to send in updated copy of LIC 308 - Designation of Facility Responsibility, LIC 500 - Personnel Report, and current copy of Liability Insurance to Community Care Licensing by 01/25/2023.the state’s words, verbatim · CDSS document, Jan 11, 2023

Type of visit: Prelicensing

On February 16, 2022, at 2pm, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived announced to conduct a Pre-Licensing Inspection. LPA met with Administrator Kimi Costar. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) An N-95 mask was worn. The facility is a single floor facility and has 7 bedrooms and 3 bathrooms. It has a capacity of 6. The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 71 degrees. LPA inspected the interior and the exterior of the facility including the common living spaces, resident's bedrooms and bathrooms, kitchen and dining room. In the kitchen area, Knives and sharp objects are locked and made inaccessible to the residents. The first aid kit was complete with scissors, thermometer, tweezers and a guide. The hot water temperatures were taken and measured degrees F. There’s appropriate lighting throughout the facility. Dining room, and areas designated for residents, were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident's bedrooms and bathrooms were toured. All Bedrooms had all the required items of furniture. Window screens appeared to be in good repair. Bathrooms were clean and sanitary. The sinks, toilets, showers and tub operate properly. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguishers are maintained and ready for emergency use. LPA observed a medication room with locked cabinets and an area were files will be held. There are no medications or staff and client files available for review because the facility has no residents at this time. To continue see 809-C LPA inspected the exterior grounds of this facility. There are no bodies of water on the premises. Indoor and outdoor passageways are free of obstruction and potential hazards. The porch and patio area have no potential hazards to residents. At the time of this inspection, the facility is in compliance and meets the minimum requirements for residential care facility for the elderly. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. Application is pending further review.the state’s words, verbatim · CDSS document, Feb 16, 2022

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: LLC Capacity: 6 Census (if any clients in care): NO Method: Telephone at CAB COMP II Participants: Kimi Costar (Applicant/Administrator) Applicant/Administrator participated in COMP II at CAB via telephone with analyst at CAB. Identification of the Applicant and Administrator was verified by providing California Driver License number. During COMP II, Applicant and Administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and Administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Jan 20, 2022