Summer's Residential Care Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Avelina Martinez and Pang Lee made an unannounced visit to this facility to conduct an annual required inspection on 05/04/2023 at 2:00 PM. LPAs met with Wane Tambunan and Juli Susanti Gultom and explained the purpose of today's visit. LPAs 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. The facility is licensed for five non-ambulatory residents. There are currently five residents who reside at this facility. The facility is approved for a hospice waiver for one resident. The LPAs toured the facility with Juli Susanti Gultom on 05/04/2023 at 2:45 PM. The facility has and adequate food supply, and the kitchen was sanitary. The facility water temperature measured at 110 degrees. In addition, all toxins were made inaccessible to clients in care. The resident bed rooms and bathrooms were furnished, and the facility has a public telephone. The facility has an area for visitors and has covid-19 postings throughout the facility. The facility has the required posting throughout the facility. The facility hall light was not in good repair. LPAs inspected smoke detectors, carbon detectors, and fire extinguisher, which they were all in good repair. the facility has a first aid kit. The facility resident and staff files were current. LPAs conducted a medication file review. LPAs reviewed two medication files. The two medication files did not have a current Centrally Stored Medication and Destruction Records. 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, May 4, 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 Analysts (LPAs) Avelina Martinez and Pang Lee made an unannounced visit to this facility to conduct an annual required inspection on 05/04/2023 at 2:00 PM. LPAs met with Wane Tambunan and Juli Susanti Gultom and explained the purpose of today's visit. LPAs 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. The facility is licensed for five non-ambulatory residents. There are currently five residents who reside at this facility. The facility is approved for a hospice waiver for one resident. The LPAs toured the facility with Juli Susanti Gultom on 05/04/2023 at 2:45 PM. The facility has and adequate food supply, and the kitchen was sanitary. The facility water temperature measured at 110 degrees. In addition, all toxins were made inaccessible to clients in care. The resident bed rooms and bathrooms were furnished, and the facility has a public telephone. The facility has an area for visitors and has covid-19 postings throughout the facility. The facility has the required posting throughout the facility. The facility hall light was not in good repair. LPAs inspected smoke detectors, carbon detectors, and fire extinguisher, which they were all in good repair. the facility has a first aid kit. The facility resident and staff files were current. LPAs conducted a medication file review. LPAs reviewed two medication files. The two medication files did not have a current Centrally Stored Medication and Destruction Records. 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, May 4, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection on 07/06/2022. 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 courtyard of the facility to ensure compliance with Title 22 regulations. The LPA toured the facility with Lucas Manurung on 06/07/2022 at 9:00 AM. A LIC 808 Covid-19 Mitigation Plan and an Infection Control Plan have been submitted to the Department, The facility has a main Covid-19 Screening entry point, and has a designated area for visit. The facility has a 30 day supply of PPE. The facility has Covid-19 postings throughout the facility. Additionally, the facility conducts disinfecting cleaning and common furniture is spaced 6 feet a part. The facility water temperature measured at 110 degrees, and the facility temperature measured at 76 degrees. The facility has an adequate food supply and has emergency food and water. All toxins and cleaning supplies are locked, and the facility is sanitary. The facility smoke and carbon detectors are in good repair. The fire extinguisher is in good repair. The exterior of the home is clear of debris. The exterior emergency exit door is good repair. The facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. Exit interview was held, and a copy of this was report was given to the facility.the state’s words, verbatim · CDSS document, Jul 6, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection on 07/06/2021. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyard of the facility to ensure compliance with Title 22 regulations. The LPA toured the facility with Lucas Manurung on 06/07/2021 at 2:00 PM. The facility has submitted a mitigation plan to CCLD. The mitigation plan has been approved by CCLD. One central entry point has been designated for universal entry screening. All visitors, staff, and essential workers are screened for Covid-19 symptoms. Moreover, hand hygiene postings are posted in bathrooms. The facility has hand sanitizer dispensers throughout the facility Furthermore, the facility has provided hand hygiene and PPE donning/doffing training to residents and staff. The facility conducts hourly disinfection cleaning. The facility dining area is sanitary, and tables are spaced six feet apart. Facility common areas are sanitary, and the furniture is spaced 6 feet apart. The facility temperature is 76 degrees. The facility smoke and carbon detectors are in good repair. The facility exterior patio is clear of derbies. The facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. Exit interview held and a report given at the end of the visit.the state’s words, verbatim · CDSS document, Jul 6, 2021