Precious Angels Care

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christina Valerio and Licensing Program Manager (LPM) Stephen Richardson arrived unannounced to the facility to conduct a case management visit. LPA Valerio was informed that residents were moving out from the facility and the last resident would be gone by COB 08/18/2023. LPA Valerio and LPM Richardson was met by facility staff Verly Mendoza. Staff stated there is only 1 resident in care. The other two residents moved out on 08/15/23 and 08/17/23. The last resident is to move out at 2:00 PM on 08/18/23. LPA and LPM contacted Licensee Antonette Tin via cell phone and requested her to come to the facility. Licensee Antonette Tin arrived to the facility at 02:00 PM. According to Licensee, the two residents were not told to move out and they left for personal reasons. Personal reasons were not disclosed to CCL or Licensee. At the end of the visit, 0 residents were observed to be in care. Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8 - no deficiencies are being cited. An exit interview was held with Licensee, and copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 18, 2023

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to the facility to conduct a case management visit. LPA met with facility staff, and explained the purpose of the visit. There is currently one staff on shift. LPA received notification that a family member was provided a letter titled "Licensee Initiated Closure Eviction - 60 days Forfeiture of License resulting from Surrender of the License". Based on LPA's observation, interviews, and record review, the Department did not receive formal notification that the Licensee intended to close the facility. LPA Valerio spoke to Licensee Antonette Tin and provided guidance regarding Facility Closures, Forfeiture of License, and Change of Ownership. Licensee was advised to review PIN 21-05 and Health and Safety Code 1569.692 to ensure proper closure of the facility. Licensee informed LPA that this is the first time closing Precious Angels Care and will be sure to follow proper protocols. LPA informed Licensee to send her formal letter of intent to LPA by COB 08/18/2023. LPA observed the facility to ensure no health or safety concerns. LPA observed the temperature inside the home to be a comfortable condition. Residents were observed eating snacks (peanut butter with bread, banana, and fruit) at the dinning table and inside the room. No health or safety concerns observed during the visit. Deficiencies are being cited today and can be found on LIC 809-D. Failure to correct deficiencies may result in civil penalties. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 15, 2023

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.682(a) · Plan of correction due date: Aug 18, 2023

§1569.682 ... (a) A licensee of a licensed residential care facility for the elderly shall... take all reasonable steps to transfer affected residents safely and to minimize possible transfer trauma, and shall, at a minimum, do all of the following:... This requirement was not met as evidenced by: Based on records review and interviews, the licensee provided an eviction letter to 3 out of 3 residents responsible parties on August 1st, 2023 without notifying Community Care Licensing. This poses a potential health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Aug 15, 2023

Plan of correction: Licensee stated she will review H&S Code 1569.682 and PIN 21-05 to its entirety and submit a letter of intent to LPA by POC due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct a case management - health and safety visit. LPA met with facility staff, and explained the purpose of the visit. LPA toured the facility's physical plant to ensure compliance with Title 22 regulations. LPA observed the facility's food supply. The facility has a minimum of 7 days of non-perishables and 2 days of perishable food items. An emergency food and water supply was also observed in the food cabinet. The home was fully stocked with PPE, office supplies, cleaning supplies, and hygiene supplies. LPA requested information regarding utility bills and/or any charges associated to the operation of the facility. According to the Licensee, all facility bills are paid and are not past due. According to interview with Licensee, food and supply orders come to the facility and there are no issues with getting the items at this time. Residents were observed eating lunch. Lunch was rice, Filipino longanisa sausage, and vegetables in addition to their drinks. Per Califonia Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, no health or safety concerns were associated to this visit. An exit interview was held was designated administrator Gloria, a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 7, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA met with facility staff, and explained the purpose of the visit. LPA called Administrator Gloria Alejo and arrived shortly after. LPA spoke to Licensee via cell phone. LPA Valerio and facility staff Lulu toured the facility. Today was the staff's first day at Precious Angels Care. LPA noticed the staff was sweating due to the temperature inside the home was 85*F. The regulatory range for the temperature in the home is between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside. The temperature outside of the home was 105*F. LPA advised staff how to turn the A/C down. The A/C was turned down to 70*F and ceiling fans were turned on throughout the home. LPA observed a broken chair in the staff area. A technical advisory was provided. LPA observed 4 bedrooms. All bedrooms were equipped with beds, a chair, lamp, night stand, and closet. Resident bathrooms were fully stocked with toilet paper, paper towels, soap, hygiene supplies, non-skid mats, handrails, and a trash can. The medication cabinet was observed to be lock and inaccessible to residents in care. A first aid kit was observed. LPA reviewed the Guardian Roster. LPA did not observe facility staff (S1) associated to the facility. This poses an immediate health and safety risk to residents in care. Licensee was made aware that a civil penalty in the amount of $100.00 will be assessed on 08/07/2023. LPA attempted to review staff and resident files. There was no key available to review the files that were in the locked cabinet. LPA requested the follow documents sent to LPA by 08/14/2023: LIC 500, LIC 610D, LIC 308, Liability Insurance. Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8 - deficiencies are being cited on LIC 809 - D. Appeal Rights provided. An exit interview held with Designated Administrator Gloria, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 7, 2023

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff are not documenting medication administration appropriately

Licensing Program Analyst (LPA) Christina Valerio arrived at the facility unannounced to conduct a complaint investigation. LPA met with facility staff, and explained the purpose of the visit. The department has concluded the following as it relates to the following allegation: Staff are not documenting medication administration appropriately. Administrator/Licensee gave facility staff permission to sign on their behalf. LPA Valerio reviewed the facility's form of medication tracking. LPA learned the facility utilizes the Centrally Stored Log, Destruction Logs, and physician's orders. Licensee stated staff know if a resident took or refused their medications for the shift based on daily notes. The facility does not use Medication Administrator Records (MAR), which is not a requirement of Title 22 regulations. LPA Valerio checked the centrally stored log for residents and observed the orders on the LIC 622 to match the prescription bottle and doctors orders. Based on the above information, the allegation is UNFOUNDED. Per California Code of Regulations, no deficiencies were observed. Exit interview held, and a copy of the report was provided to facility staff. Unfoundedthe state’s words, verbatim · CDSS document, Sep 1, 2022 · control 27-AS-20220721132854

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct annual visit. LPA met with facility staff and explained the purpose of today's visit. The facility is licensed for 6 non ambulatory, and has a hospice waiver for 2. LPA observed 6 residents in care. Administrator/Licensee gave facility staff permission to sign on their behalf. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. Resident rooms were furnished with required furnishings. Resident bathrooms were stocked with paper towels, soap, hand sanitizer, and a trash can with a lid. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 76*F, which is within the required range of 68-85*F. The hot water temperature was measured at 109.5*F, which is within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA requested the following items to be submitted: Designation of Facility Responsibility (LIC308), Updated Liability Insurance, Personnel Report (LIC500), Administrator Certificate, Emergency Disaster Plan Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies are being cited. An exit interview was conducted with facility staff, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 1, 2022

Type of visit: Required - 1 Year

On 07/26/21 at 9:10 AM, Licensing Program Analyst (LPA) Christina Valerio arrived at this facility unannounced to conduct an annual inspection visit. LPA Valerio introduced herself, explained the purpose of the visit, and was met by Administrator Analiza Lobo, LPA Valerio was screened by facility staff for COVID-19 symptoms with temperature prior to being allowed inside the facility. The physical plant was toured inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. LPA also conducted the infection control domain tool. The facility has an approved LIC 808 mitigation plan on file. The facility has one central entry point and has implemented screening and sign in procedures at the front of the home. LPA observed the facility to have hand washing signs and COVID-19 Informational posted at the front door and throughout the facility. The facility is able to designated and dedicated a Covid-19 bedroom and bathroom if needed. LPA observed the temperature inside the facility was measured at 74 *F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 112.3*F, which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed the centrally stored medications area and cleaning supplies to be locked and inaccessible to clients. Resident rooms was sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher located in the living room was not up to date with last check on 03/17/2019. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies were observed during this visit. Please see LIC 809-D. An exit interview was held, and a copy of the report was given to Administrator Analiza Lobo.the state’s words, verbatim · CDSS document, Jul 26, 2021