Fern Home III

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Joi Mae Guabalane,Administrator, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). License capacity of (6) with a current census of (6). Facility is operating within capacity. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: LPA inspected the facility inside and out. Indoor and outdoor passageways are free of obstruction. The facility has sufficient lighting and is maintained at a comfortable temperature. Facility has no outdoor bodies of water. Facility backyard is enclosed by a fence with self-closing gates and covered patio is sufficient for outdoor client use. LPA inspected the kitchen. The refrigerator and freezer are operating in a healthful manner. Hot water temperature is maintained at 105 degrees F. Facility has sufficient non-perishable and perishable food supply for clients in care. Facility has sufficient cups, plates, and utensils for client use. LPA inspected client bedrooms. Bedrooms are equipped with beds, bed linen, nightstands, chairs, and sufficient lighting. LPA inspected client bathrooms. Bathroom equipment is operating in safe and sanitary conditions. Bathroom hot water temperatures tested between 105 and 110 degrees F. LPA observed the facility is equipped with operating carbon monoxide alarms and operating telephone service. Posters such as Ombudsman contact, emergency phone numbers, evacuation plan, and personal rights are posted in a common area. Facility has a complete first aid kit. Facility has sufficient linen, emergency supplies, and personal hygiene products for clients. Sharps, disinfectants, cleaning solutions, and toxins are kept in a locked cabinet. Client medications are kept in a safe and locked cabinet, inaccessible to clients in care. All medications are labeled and administered as prescribed. LPA reviewed staff files for first aid certifications, fingerprint clearances/exemptions, health screenings, training, and personnel records. Staff 1 (S1) health screening is incomplete. Deficiency cite. All client records reviewed had admissions agreements, physician's reports, assessments, personal rights, and safeguarded resource records. An exit interview was conducted, where the licensing reports were discussed and a copy of the reports with appeal rights was provided to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 8, 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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Gardner met with Caretaker Rafael Colorina who confirmed that there are currently no cases and or exposures of COVID-19 within the facility. At the time of visit there were two (2) staff and five (5) residents present. LPA Gardner toured the facility inside and out and went over COVID-19 best practices for infection control and prevention with Rafael Colorina. LPA Gardner observed all staff members with a properly fitted face covering. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE. The residents have hand sanitizer available to them throughout the facility and the bathrooms were stocked with hand soap and paper towels. LPA Gardner observed the facility to have multiple postings throughout the facility for cough etiquette, proper hand washing procedure, and social distancing. LPA Gardner requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was located in the staff closet. The facility has a full thirty (30) day supply of PPE items such as gloves, face shields, gowns, N95 masks, disinfectant, and hand sanitizer. All residents and staff are practicing all other COVID-19 precautions, which minimize the risk of them contracting COVID-19. During today’s visit, LPA Gardner observed pre-prepped medications that were placed in an alternative containers than the original containers received from the pharmacy. The medications were not stored in the original received containers from the pharmacy which poses an immediate health, safety, or personal rights risk to persons in care. During today’s visit, LPA Gardner observed unlocked medications in the refrigerator. The medications were not in a lock box in the refrigerator which poses an immediate health, safety, or personal rights risk to persons in care. Based on the observations made during today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Caretaker Rafael Colorina, along with copies of the LIC-809D forms, and the appeal rights.the state’s words, verbatim · CDSS document, Jun 9, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Jun 16, 2022

87465. Incidental Medical and Dental Care. (h)The following requirements shall apply to medications which are centrally stored:(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Based on observation, the licensee did not comply with the section cited above by pre-prepping medications and storing medications in alternative containers. The medications were not stored in the original received containers from the pharmacy which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 9, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Jun 16, 2022

87465. Incidental Medical and Dental Care. (h)The following requirements shall apply to medications which are centrally stored:(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Based on observation, the licensee did not comply with the section cited above by storing medications in the refrigerator without a lock box. The medications were not locked in a box in the refrigerator which makes medications accessible to the residents in care which poses an immediate health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 9, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst's (LPA) Elecia Weathersby made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Weathersby arrived and was greeted and granted entry by caregiver Tayag Liwayway who confirmed that there are currently no cases/exposures of COVID-19 in the facility. During the inspection, LPA Weathersby conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures. The facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a 30+ day supply of Personal Protective Equipment (PPE). LPA Weathersby also observed that all staff members were properly fitted with face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining clients, and properly caring for clients with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the client presents any COVID-19 symptoms. LPA Weathersby observed no health and safety concerns at the time of visit. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview was conducted where this report was discussed, and a copy of this report was given to caregiver Raphael Colorina and Administrator Joi Mai Gubaline the conclusion of the inspection.the state’s words, verbatim · CDSS document, Aug 6, 2021