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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 Nina Molano, Administrator, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE). License capacity of (6) clients with a current census of (3). Hospice waiver for (2). 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 sufficient indoor and outdoor space for client use. Facility outdoor pool is empty and observed secured with a locked fence inaccessible to clients in care. Facility backyard has a covered outdoor patio area sufficient for clients. LPA inspected the kitchen. The refrigerator and freezers are maintained in a safe and healthful manner. Hot water temperature is maintained with regulations. Facility has sufficient non-perishable and perishable food supply for the number of clients in care. Facility has sufficient cups, plates, and utensils for client in care. LPA inspected client bedrooms. Bedrooms are equipped with beds, linen, nightstands, chairs, storage space and sufficient lighting. LPA inspected client bathrooms. Bathrooms are operating in a safe and sanitary condition. Bathroom hot water temperatures tested within regulations. LPA observed the facility is equipped with operating carbon monoxide alarms. Facility has operating telephone service on the premises. Fireplace is adequately screened. Posters such as Ombudsman contact, "See Something, Say Something" contact, emergency plan and phone numbers are posted in a common area. Facility has sufficient supply of linen, towels, and personal hygiene products. Disinfectants, cleaning solutions, toxins, sharps are kept locked and inaccessible to clients in care. Client medications are kept in a safe and locked cabinet inaccessible to clients in care. Facility did not have documentation of when prescribed medication is being administered to clients. Deficiency cited. All staff files reviewed had first aid certifications, fingerprint clearances/exemptions, health screenings, employee rights and personnel records. All client records reviewed had admissions agreements, physician's reports, personal rights statements, safeguarded resources records. An exit interview was conducted, where reports (LIC809/LIC809D) were discussed and a copy of reports with appeal rights was provided to at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 18, 2023

Type of visit: Case Management - Other

The is an amended document originally delivered on 9/27/2022 On 9/27/2022 Licensing Program Analyst (LPA) Bernadette Allen was at the facility to initiate a complaint investigation CONTROL NUMBER 56-AS-20220629105809 An exit interview was conducted where this report was discussed and provided to xxxxx at the conclusion of the visitthe state’s words, verbatim · CDSS document, Dec 14, 2022

Allegation investigated: Staff yell at residents in care.

Licensing Program Analyst (LPA)Bernadette Allen made an unannounced visit to investigate the above allegation, At 8:14 AM-LPA was granted entrance by the administrator Nina Malamo. LPA explained the above allegations. Regarding the allegation “Staff yelled at resident” LPA interviewed facility staff and residents in the facility. All persons interviewed denied the allegation of staff yelling at the resident. The interviews conducted with residents and staff revealed that one of the residents living in the facility yells and makes outburst that are not directed towards anyone. The yelling heard in the facility is from one of the residents. There are no witnesses to corroborate that staff yells at residents. Therefore, based on interviews conducted the allegation "Staff yelled at resident" is UNSUBSTANTIATED. A finding of unsubstantiated means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview where this report was discussed with the Licensee. A copy of this report was provided to the Nina Molamoat the conclusion of this investigation. Unsubstantiated Disregard this LIC9099-C this form was created in error.the state’s words, verbatim · CDSS document, Jul 1, 2022 · control 56-AS-20220629105809

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jul 1, 2022

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility....(1) Obtain a California clearance or a criminal record :..... exemption as required by the Department.....This requirement is not met as evidenced by: Based on observation & file reiew the licensee failied to ensure that R3 had a criminal record clearance and associated to the facility prior to living in the residence.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: The administrator will ensure that R3 will be associated by 7/5/2022.

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 Administrator Nina Molano who confirmed that there are currently no cases/exposures of COVID-19 within the facility. At the time of visit there were three (3) staff and two (2) residents present. LPA Gardner toured the facility inside and out and went over COVID-19 best practices for infection control and prevention with Nina Molano. The facility has a COVID-19 mitigation plan on file that follows Community Care Licensing Division guidelines for the safety and care of the residents. 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. Residents have hand sanitizer available to them 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 at the in the hall cabinet. The facility has a full thirty (30) day supply of PPE items such as gloves, face shields, gowns, surgical masks, N95 masks, disinfectant, and hand sanitizer supply. LPA Gardner inquired as to if staff have been fit tested for N95 masks and was informed their staff have not been N95 fit tested yet. LPA Gardner will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. 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 found that the facility is pre prepping the resident’s AM and PM medications a week in advance (7 days) in plastic container cups. The medications are not being stored in the original containers from the pharmacy. This poses a potential health, safety, or personal rights risk to the persons in care. The facility will be issued a citation for not storing the resident’s medications properly. Based on the observations made during today’s visit, one (1) type B deficiency was 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 Nina Molano along with a copy of the TA Advisory Note, LIC-809D, and the appeal rights.the state’s words, verbatim · CDSS document, May 18, 2022

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'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 the Caregiver, Dalia Sanidad. The administrator 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 also provided to Caregiver, Dalia Sanidad at the conclusion of the inspection.the state’s words, verbatim · CDSS document, Jul 28, 2021

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.