New Life Seniors Guest Home

Type of visit: Required - 1 Year

On 08/09/23, Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Caregiver, Harriet Achor, and introduced self and stated purpose of the visit. LPA was informed that there are currently 5 residents in care who are in their bedroom. The facility has 4 resident bedrooms, 3 bathrooms, kitchen, dining area, living room, attached garage, and backyard. LPA completed a walk through of facility and review of records. Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees farenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. Water temperatures tested at 122.7 degrees farenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms, 2 fire extinguishers and emergency kit. Posters such as; the personal rights, ombudsman and emergency disaster plans were posted in a common area. LPA observed the emergency disaster plan not reviewed since 02/22/21. Technical violation issued. LPA also observed cleaning supplies, toxins, sharps, and other dangerous items were left unlocked in cabinets made accessible to residents. Deficiency issued. There was a designated storage space for resident/staff files. Medications were observed in a secured filing cabinet and inaccessible to residents. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Facility has a wide variety of food available for residents. Dishes, cups, and utensils were also stored properly. Yards/Outside: One shaded patio, a side gate with self-latching handle on the right side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed 2 resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed administrator's file for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed that the facility does not perform quarterly emergency disaster drills. Deficiency issued. Two deficiencies and one technical violation were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102 and appeal rights were discussed and copies were provided to the Administrator Glory Anne Mangangey who later arrived.the state’s words, verbatim · CDSS document, Aug 9, 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.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Melody Brown conducted an announced visit to the facility 06/02/2022 for purpose of a Change of Ownership evaluation. At approximately 10:20 AM, LPA met with Administrator/Applicant Glory Anne Mangangey. An initial application for change of ownership to operate a Residential Care for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 10/10/2021 for a total capacity of six (6) non-ambulatory residents. Fire clearance was granted on 03/24/2022 for six (6) non-ambulatory residents. LPA Brown observed the following: Structure: Facility was a one-story house with four (4) resident bedrooms, three (3)resident/staff bathrooms, living room, dining area and kitchen. There was an attached two (2) car garage in the left side of the house. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control the entire house. Bedrooms: Each resident bedrooms accommodate any non-ambulatory resident. All resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: The three (3) resident/staff bathrooms have a working toilet, wash basin, and shower with an adequate supply of toilet paper and soap. At 11:15 AM, LPA tested the water temperatures in the resident bathroom. LPA verified water temperature was measured at 113 degrees Fahrenheit. ***CONTINUED ON LIC 809-C*** ***CONTINUED FROM LIC 809*** Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots, and pans were observed. Knives/sharp instruments were secured in a locked drawer located in the kitchen. There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. There is sufficient storage for perishable food. There was adequate seating for meals for all residents. Laundry room with washer and dryer was in the hallway. Laundry detergents and cleaning supplies were observed in the garage, garage door is locked away from residents. Living/Family room: There was a living/family room with adequate seating for all residents and a working TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outside: Patio furniture for outdoor seating observed. Self-latching handle on right side of the house that leads into the backyard. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the hallway leading to the residents bedroom. There were Ombudsman poster, and Let-Us-No poster observed. with Emergency Disaster Plan posted. General items: One (1) fire extinguisher were charged and located in the hallway leading to the residents’ bedrooms, six (6) smoke alarms and two (2) carbon monoxide detectors were tested and were observed to be in working order. Resident records were stored in a locked cabinet in the hallway. First Aid kit with required components, and locked area for medication storage was observed. LPA observed a facility phone and was operational as evidenced by LPA dialing the number. The phone number designated for the facility is 760-493-1582. There is enough Emergency water supply observed and the required 72-hour emergency food supply was discernible from the regular food supply. Component III was completed on this day as well. ***CONTINUED ON LIC 809-C*** ***CONTINUED FROM LIC 809*** Additionally, LPA Brown observed facility to have required single entry point for COVID screening, upon entering facility. LPA Brown observed required COVID signages throughout the facility, Visitation Vaccination Requirement and soap and paper towels in bathrooms for washing hands. LPA observed activities for the residents such as books and games. The facility was evaluated in accordance with the California Code of Regulation (CCR), Title 22, Division 6, Chapters 1 and 6 to ensure the health and safety of residents in care. Facility appears to be ready for licensure. An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator/Applicant Glory Anne Mangangey.the state’s words, verbatim · CDSS document, Jun 2, 2022

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 Method: Telephone call with CAB COMP II Participants: Glory Mangangey, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Staff training 4. Applicant and Administrator qualifications 5. Grievances, Complaints, Community resources 6. Food service 7. Medication management 8. Application document review and technical assistance: Pre-licensing inspectionthe state’s words, verbatim · CDSS document, Apr 20, 2022