Eastern Manor

Type of visit: Required - 1 Year

On 08/31/2023 at 8:00 AM, Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced annual inspection. LPA Lee met with administrator, Maria Apuya and administrator assistant, Geronima Bautista. LPA Lee explained the purpose of the visit. Maria Apuya and Geronina Bautista assisted with today’s visit. Administrator certificate # is 6005486740 and will expire on 07/19/2024. The current census is 10 with 3 facility staff. This facility is a single story building licensed to serve thirteen (13) non-ambulatory residents and approved for 7 hospice residents. The LPA Lee toured the facility with Geromina Bautista at 8:30 AM. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA Lee observed resident bathrooms #1, #2, and #3 did not have non-slip mat; however, during today’s visit administrator had another staff purchased three non-slip mat and it was placed in the three resident bathrooms. LPA Lee observed the facility to be free of odor and clean. LPA Lee observed the sliding door in the dinning area not in good repair. The sliding screen is broken and has a tear. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee observed sufficient seven day non-perishable and two day perishable food supplies. LPA Lee observed 3 condemns in the refrigerator had expired. Hot water temperature was measured at 130.5 degrees Fahrenheit in resident bathroom sink, which is not within the required regulation of 105 to 120 degrees Fahrenheit. Licensee adjusted the hot water and LPA Lee remeasured the hot water and it then measured at 105.6 degrees Fahrenheit. Fire extinguishers, smoke and carbon monoxide detectors are in compliance with fire safety. Fire extinguisher was last serviced on 04/14/2023. Continued LIC 809-C The last fire drill was conducted in July of 2023. LPA Lee observed the facility has a has a public telephone in the common room and one in the kitchen. The facility has the required posters posted. The facility has infection control plan and has an emergency disaster plan. Facility thermostat observed at 73 degrees Fahrenheit. LPA Lee checked medication storage and found medication to be locked away and inaccessible to residents. LPA Lee reviewed 3 out of 3 Centrally Stored Medication Destruction Record (CSDMR) and 2 out of 3 (CSDMR) was not accurate. First aid kit was checked and is complete. LPA Lee requested resident and staff files for review. LPA Lee reviewed 5 out of 10 resident files and 5 out of 11 staff files and they were complete. LPA Lee reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. The following documents will be email to LPA Lee (pang.lee@dss.ca.gov) by 09/08/2023 by 5:00 PM by end of day: (1) LIC 308 Designation of Administrative Responsibility (2) LIC 500 Personnel Report (3) Copy of Administrator Certificate (4) LIC 610 Emergency Disaster Plan (5) Proof of Current Liability Insurance As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809 D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D, LIC 9102, and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Aug 31, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff force fed resident in care Staff does not provide proper medication assistance to resident in care Staff did not provide repositioning assistance to resident in care Staff did not provide proper night supervision to residents in care

Licensing Program Analyst (LPA Victoria Brown arrived unannounced on 6/29/23 at 9:30am to further investigate the above mentioned allegations. LPA met with Geronima Bautista and stated the purpose of the visit. LPA reviewed interviews, hospice records, and contacted Vitas during this visit. Regarding allegation, Staff force fed resident in care, Staff does not provide proper medication assistance to resident in care, Staff did not provide repositioning assistance to resident in care, Staff did not provide proper night supervision to residents in care, the investigation revealed that no preponderance of evidence was observed or obtained to substantiate the facility failed to uphold resident rights and provide appropriate care and supervision. Based on interviews and insufficient evidence allegation is deemed UNSUBSTANTIATED. A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, nothe state’s words, verbatim · CDSS document, Jun 29, 2023 · control 27-AS-20230327130639

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 08/05/2022. 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 Geromina Bautista on 08/05/2022 at 10:20 AM. Administrator holds current certificate. The facility is licensed for 13 non-ambulatory residents, and has a hospice waiver for 7 residents. There are currently 10 residents who reside at this facility. The facility has submitted a Covid-19 mitigation plan and infection control plan to the Department. The facility has one main entry screening location. The facility has Covid-19 posting throughout the facility. The facility has a 30 day supply of PPE. All visitors, staff, and essential workers are screened for Covid-19 symptoms. The facility conducts hourly disinfection cleaning. Facility common areas are furnished and furniture is spaced 6 feet apart. The facility has a 7 day supply of food. The facility is sanitary, and resident rooms are furnished. The facility fire extinguishers and carbon detectors are in good repair. The facility has a first aid kit, and medication are locked. Facility files were up to date; LPA Martinez reviewed 1 employee file and 1 resident file. The exterior of the facility is clear of debris. 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 the report was given at the end of the visit.the state’s words, verbatim · CDSS document, Aug 5, 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 08/26/2021. 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 Geromina Bautista on 08/26/2021 at 11:10 AM. Administrator holds current certificate and expires on 02/15/2022. The facility is licensed for 13 non-ambulatory residents, and has a hospice waiver for 7 residents. There are currently 12 residents who reside at this facility. There are no residents on hospice. The facility has submitted a mitigation plan to the Department. The facility has one main entry screening location. The facility has Covid-19 posting throughout the facility. The facility has a 30 day supply of PPE. All visitors, staff, and essential workers are screened for Covid-19 symptoms. The facility conducts hourly disinfection cleaning. Facility common areas are furnished and furniture is spaced 6 feet apart. 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, Aug 26, 2021