Cajucom Care Home #2

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual inspection on 06/02/2023 at 8:30 AM. LPA met with Lupe Cajucom and stated the purpose of today’s visit. LPA Martinez inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate and expires on 07/24/2024. The facility is licensed for twelve residents. The facility can accept six non-ambulatory residents and six ambulatory residents. There are currently seven residents who reside at this facility. LPA Martinez toured the facility with Lupe Cajucom on 06/02/2023 at 8:30 AM. The facility was furnished and in good repair. The facility water temperature measured at 108 degrees, and the facility temperature measured at 76 degrees. The facility fire extinguisher was in good repair, and the facility has installed a fire sprinkler system. The smoke detectors are in good repair. The facility had an adequate food supply, and kitchen sink was in good repair. The facility has a designated patio area for resident. LPA Martinez reviewed seven resident files, and they were up to date. LPA Martinez reviewed three staff files, and files were missing first aid. LPA Martinez reviewed two resident medication files, and it was learned Medication Administration Records (MAR) were not being filled out. However, staff 1 reported medication was being administered daily. It was also learned one resident 1 (R1) eloped from the facility. The elopement was reported to law enforcement and responsible parties. The Licensee reported they will continue to follow up with responsible parties. As a result of this visit, the following deficiencies were cited, per California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of the 809 report, 809-D page, and appeals right given were given to the facility at the end of visit.the state’s words, verbatim · CDSS document, Jun 2, 2023

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Jun 5, 2023

87411(a) Personnel Requirements - General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidence by: Based on interviews and record review. The Licensee did not ensure adequate supervision of residents in care. R1 AWOL'd from the facility. This poses an immediate health and safety risk to the R1 in care.the state’s words, verbatim · CDSS document, Jun 2, 2023

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Jun 23, 2023

Personnel Requirements - General 87411(c)(1):All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69... Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidence by: Based on file review S1, S2, S3 were missing first aid. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 2, 2023

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Jun 23, 2023

Incidental Medical and Dental Care 87465(h)(6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year...This requirement was not met as evidence by: based on file review and interviews, the licensee did not ensure R1 and R2 MAR was filled out. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 2, 2023

Allegation investigated: Staff do not maintain facility in good repair.

Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 05/26/2023 at 1:30 PM to open and close a complaint investigation, LPA met with Lupe Cajucom and explained the purpose of the visit. Throughout the course of the investigation, LPA conducted interviews and inspected the facility. Furthermore, Lupe Cajucom reported the facility water pipes were leaking, but they were repaired last week. During today's visit, LPA Martinez and Lupe Cajucom tested the kitchen water faucet pressure. The kitchen sink faucet had low pressure with a steady water stream. However, the facility maintenance employee was working on the kitchen plumbing during today's visit. The maintenance employee was able to fix the clogged kitchen sink pipe during today's visit. LPA Martinez inspected the kitchen water stream after it was repaired, observed it to be in good repair. Moreover, LPA Martinez inspected the facility bathrooms, and they are good repair. The bathrooms' water pressure was in good repair. Continued... Substantiated Moreover, LPA Martinez inspected the food supply with Lupe Cajucom, and LPA Martinez observed an adequate food supply. Residents also reported they had no issues in regards to meals being served at the facility. Furthermore, R1 reported they were able to leave the facility. R1 also, reported they are able to walk to a nearby restaurant to eat. LPA Martinez observed resident 2 (R2) walk out of the facility independently. LPA Martinez interviewed R2 when they returned back to the facility. R2 reported they walked to a nearby store to buy sodas. Resident 3 (R3) reported they are able to leave the facility, and walk around the facility. Due to the above noted information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility. As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The deficiency was cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted, and a copy of the 9099 report, LIC 9099-D, and appeal rights were given to the facility. As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted, and a copy of the 9099 report, LIC 9099-D, and appeal rights were given to the facility.the state’s words, verbatim · CDSS document, May 26, 2023 · control 27-AS-20230524111234

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 26, 2023

87303 (a) Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: Based on observation and inspection, the Licensee did not ensure facility plumbing was in good repair at all times. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 26, 2023

Plan of correction: During today's visit, the facility maintenance employee was working on the plumbing issue. The Maintenance employee was able to repair the kitchen plumbing issue during today's visit. POC was cleared at visit.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Avelina Martinez and Navdeep Singh made an unannounced visit to conduct an annual inspection on 06/23/2022 at 9:00 AM. LPA met with Carlomagno Esquillo and stated the purpose of today’s visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate # 6016558740 and it expired on 07/24/2022. The facility is licensed for six non-ambulatory and six ambulatory residents. There are currently 7 residents who reside at this facility. The LPA toured the facility with Carlomagno Esquillo on 06/23/2022 at 9:00 AM. The facility has submitted a LIC 808 mitigation plan, and the Department has approved the plan. The facility has one main entry screening point, and has a designated area for visitors. The facility has PPE postings throughout the facility. The facility has a 30 day supply of PPE, and is disinfecting the facility daily. The facility has an adequate supply of food. The facility common areas and resident bedrooms are furnished and in good repair. The fire extinguishers, carbon detectors, and smoke detectors are in good repair. The water temperature was 110 degrees, and the facility temperature was 75 degrees. The exterior fire exit door is in good repair. The facility medication and toxins are locked. The facility has a first aid kit. As a result of this visit, there were deficiencies cited, per California Code of Regulations, Title 22 and Health and Safety Code. Exit interview was conducted, and a copy of this 809 report was given to the facility.the state’s words, verbatim · CDSS document, Jun 23, 2022

Allegation investigated: Facility has bed bugs.

On 6-2-2022 at 9:00 AM, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA met with Lupe Cajucom and explained the purpose of today's visit. LPA Martinez toured the facility and conducted interviews. It was learned the facility has bed bugs. The facility licensee is working with a pest control company. The facility will be undergoing bed bug treatment. As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D, per Title 22 Regulations, An exit interview was conducted with Lupe Cajucom. A copy of this 809 report, LIC 9099-D, and appeal rights were given to the facility. An exit interview was conducted, and a copy of this report was provided to facility at the end of this visit. Substantiatedthe state’s words, verbatim · CDSS document, Jun 2, 2022 · control 27-AS-20220516082146

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 16, 2022

87303 (a)Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met evidence by. Based on evidence the licensee did not ensure the facility did not have bed bugs. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 2, 2022

Plan of correction: Licensee will be conducting pest treatments 06/07/2022 and will follow up with LPA by POC Date 06/16/2022 in regards to clearance of bed bugs.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit on 12/09/2021. LPA Avelina Martinez met with Carlomagno Esquillo and explained the purpose of today's visit. The purpose of today's visit is in response to following up non-compliance conference. LPA Martinez toured the facility with Carlomagno Esquillo. In LPA Martinez followed up on the following issues: Meal Service Waiver Administrator recertification & administrator accountability Buildings and Grounds Staffing Facility Files LPA Martinez observed medication cabinets, facility files, building and grounds, meal services, and staffing. The facility has made some improvements, and the facility staff continue to work on the above mentioned issues. LPA Martinez obtained a copy of the plan of operation. Administrator certificates applications have been submitted, and certificates still pending. An exit interview was conducted, and a copy of the 809 report was given to the facility. No deficiencies were cited at this time.the state’s words, verbatim · CDSS document, Dec 9, 2021

Type of visit: Case Management - Legal/Non-compliance

A Non-compliance conference was conducted today in the Sacramento South Regional Office. The purpose of this Non-compliance meeting is to discuss the inability to remain in substantial compliance with the regulations the last 12 months. Present in the meeting are Regional Manager Krystall Moore, Licensing Program Manager Czarrina Camilon-Lee, and Licensing Program Analyst Avelina Martinez, Staff Services Manager Tricia Nishio, Associate Governmental Program Analyst Richard Gasparini, Licensees Guadalupe Cajucom, Edilberto Cajucom, and Carlomagno Esquillo and Celia Esquillo. The Non-compliance conference process was explained during this meeting to include the Administrative process. The facility has been cited two times in the last year. The facility was cited for the following issues: fingerprint clearances and administrator recertification. The facility was cited for one type A citation, and one type B citation. Moreover, the facility was cited five times in 2019. The facility received one type A citation and four type B citations. Issues discussed during the meeting were: · Meal Service Waiver · Fingerprint Clearances · Administrator recertification & administrator accountability · Buildings and Grounds · TSP Services · Staffing · Personnel Requirements · Medical Assessments · Resident Records Continued... The facility has stated they will do the following to achieve continued and substantial compliance: Increase the amount of training for each staff and log the information in staff file. Provide a list of trainings ( to include but not limited to; Universal Precautions, Personal Rights, Cleaning, Medication Management, Observation of the Resident, Appraisals, Record keeping and Record Keeping etc), they will train on with dates by August 31, 2021. Administrator shall be on the premises 40 hours a week to ensure attention to the management and administration of each facility and appropriately designate an Administrator for each facility. Create policies and procedures to ensure facility remain clean and in good condition at all time and provide to the Department by August 31, 2021. The Licensee will report incidents timely to the Department. Licensee will provide copies of R1 Physician Report and care plan Licensee will send LIC 500 and LIC 308 for each facility by August 16, 2021. Licensee will send a copies of Liability insurances for each facility by August 16, 2021 The facility to request for a waiver by August 16, 2021 to use only one kitchen to prepare and transport meals; to include the reason, policies and procedures to ensure meals that are transported in sealed containers and free of contamination. Until approved, this should not be occurring. Provide the Department by August 31, 2021 updated Plan of operation as required by Title 22 for each facility. Provide the Department by August 25, 2021 personnel requirements to include fingerprint requirements and personnel shall be sufficient in numbers necessary to meet resident needs, and other requirements by Title 22. Ensure all staff are fingerprint cleared and associated prior to working in the facility. Provide the Department by August 25, 2021 policies and procedures to ensure resident records are complete to include admissions agreement, medical consent forms, preplacement appraisals, re-appraisals, property inventory, physician’s report as required by Title 22 regulations. The Licensee will conduct a quality assurance check on resident and staff files every quarter to ensure records are current starting September 1, 2021. The Licensee will conduct a monthly mock inspection using the CARE tool to ensure compliance and provide copies to the LPA after each inspection starting September 1, 2021. The Licensee will provide a transition plan for the Change of Ownership prior to changing ownership. Continued... CCL will do the following: · Increase monitoring · TSP will continue in person engagement No deficiencies were cited during today's meeting. Completing the Non- Compliance Conference does not deprive the Department of its authority to take appropriate formal legal action under the Health and Safety Code if such action is deemed necessary by the Regional Manager.the state’s words, verbatim · CDSS document, Aug 12, 2021

Type of visit: POC

Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit on 07/19/2021. LPA Avelina Martinez met with Carlomagno Esquillo and explained the purpose of today's visit. The purpose of today's visit is in response to clearing plan of corrections. Plan of corrections associated to 06/29/2021 annual inspection visit and 06/30/2021 case management visit have been cleared. An exit interview was conducted, and a copy of this report was given to Carlomagno Esquillo. No deficiencies were cited at this visit.the state’s words, verbatim · CDSS document, Jul 19, 2021