Blessed Home for Seniors

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Vincent Moleski and Jason Lund arrived unannounced to conduct an annual inspection. LPAs Moleski and Lund met with administrator Merceditas Galito and explained the purpose of the visit. LPAs Moleski and Lund requested two staff files for S1 and S2 and two resident files for R1 and R2. LPAs Moleski and Lund received a copy of Galito's administrator certificate, number 6002571740, expiry 06/28/23. LPAs Moleski and Lund interviewed two residents and one staff member. LPAs Moleski and Lund toured the facility with administrator Galito. LPAs Moleski and Lund observed the kitchen, dining area, living area, resident bedrooms, resident bathrooms and outdoor areas. LPAs observed the required two-day supply of perishable food and seven-day supply of nonperishable food. LPAs observed smoke and carbon detectors, up-to-date fire extinguishers, and first aid kits with all required components. LPAs observed furniture and fixtures throughout the facility appeared sufficient to meet the needs of residents at this time. LPA Moleski measured the water temperature in a resident bathroom. LPA Moleski and administrator Galito observed a reading of 135 degrees, which is outside the required range of 105 and 120 degrees. The air temperature in the facility was observed to be 77 degrees, which is within the required range of 68 and 85 degrees. This facility is being cited per 22 CCR Section 87303(e)(2). An exit interview was conducted with administrator Galito. Appeal rights and a copy of this report was left with Galito.the state’s words, verbatim · CDSS document, Apr 6, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced Required 1 Year Annual Inspection today, LPA met with Administrator, Merceditas Galito (Certificate #: 6002571740 expires 06/28/2023). There are currently four residents who reside at this facility. This facility has a hospice waiver for 2 residents and currently one resident is receiving hospice care. LPA inspected the interior and the exterior of the facility including the common living spaces, Five resident bedrooms and three bathrooms, kitchen, and staff room. Bathrooms and bedrooms were clean and in good repair. LPA toured the backyard and all exits are accessible and unlocked. There is a locked storage for medications and toxins. Food supply is adequate for two day perishable and seven day nonperishable. Fire alarms were checked and found to be in working order. Fire Extinguishers expire May 11, 2022. LPA observed an adequate amount of linens and found the first aid kit to be complete. LPA reviewed four of four resident records and three staff records. LPA reviewed medications of three residents comparing with Centrally Stored Medication Record and physician orders. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates and training completed. Liability insurance for the facility is current. Per California Code of Regulations (CCR's) - Title 22, Division 6, Chapter 6, no deficiencies are being cited during this visit. Exit Interview conducted and copy provided to Administrator.the state’s words, verbatim · CDSS document, Mar 14, 2022

Type of visit: Required - 1 Year

On 7-22-21 Licensing Program Analysts (LPA)s Tirzah Hubbard and Avelina Martinez conducted an unannounced Annual visit. LPAs met with Administrator and Licensee Aurora Gatchalian to discuss the purpose of the visit. LPAs observed the facility in renovation. Administrator stated, "The facility has been in renovation for 2.5 weeks. The residents were transferred to Blessed Home for Seniors IV. A total of 3 residents were transferred. The families were not notified. Employees were transferred over to Blessed Care Home for Seniors IV. LPAs observed CCL has not been notified of the changes in renovation, staff transfer, and resident transfer. LPA Hubbard observed an email sent to LPA Yang 2/9/20. The email to LPA Yang contained questions about steps in renovating and transfer of residents and staff. LPA Yang requested a 60 day notice to residents family and CCL before renovation on 2/3/2020. LPA observed Administrator Aurora did not submit 60 day notice to CCL or Residents family. LPA Hubbard observed an email sent July 10,2020 from Administrator Aurora asking about renovation. The email did not contain renovation dates and transfer information for staff and residents. The email did not contain the requested 60 day notice to families or CCL.LPAs observed staff and residents were transferred over to Blessed Home for Seniors IV July 5, 2021. Census: 3 Continued... On 7-22-21 Administrator Aurora stated, Renovation start date: July 5, 2021 Renovation end date: July 22.2021 Residents and staff will be back into the facility on July 26, 2021. LPAs observed no finger print clearance for S1. LPAs observed no documentation of proof showing the residents family were notified within 60 days of renovation and return. LPA's requested Mitigation plan to be submitted to the department within 48 hours. Upon a file review the following items were discussed to be submitted with any changes annually: Licensing fees Criminal Record Clearances LIC536 Administrative Organization LIC309 Designation of Administrative Responsibility LIC308 Personnel Report LIC500 Qualifications of Administrator/Facility Manager- Administrator certificate Emergency Disaster Plan LIC610D Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiencies are being cited on the attached 809D during this visit. Civil penalties shall be assessed when the licensee fails to correct the violation to Health and Safety Code Section 1569.605 following any appropriate extensions to the plan of correction due date. The Licensee was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. Exit interview held and a copy of report was given.the state’s words, verbatim · CDSS document, Jul 22, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80019(e)(1) · Plan of correction due date: Jul 23, 2021

Record Review 80019(e)(1) All staff must have a criminal record clearance or a criminal record exemption. This requirement was not met as evidence by: Licensee did not ensure all staff to have finger print clearnace in order to work in facility which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 22, 2021

Plan of correction: Licensee will submit a revised LIC421 for each care giver associated with the facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87223(a)(2) · Plan of correction due date: Jul 22, 2021

Relocation of Resident 87233(a)(2) When a resident must be relocated by Department order...(2) contacting the person responsible for the resident to assist in transporting him or her, if necessary. This requirement was not met as evidence by: Licensee did not notify the residents family of relocation to another facility during renovation of facility.the state’s words, verbatim · CDSS document, Jul 22, 2021

Plan of correction: Licensee will notify the persons responsible for residents to assist in transporting.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(d) · Plan of correction due date: Jul 22, 2021

Reporting Requirements 87211(d) The licensee shall notify the Department, the State Long-Term Care Ombudsman, all residents, and, if applicable. their representatives, in writing.. This requirement is not met by evidence by: Licensee did not notify CCL, Representativces of persons in care, and LTC which poses an immediate health,safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 22, 2021

Plan of correction: Licensee will notify CCL, LTC, and Representatives of persons in care of renovation and relocation changes.