Villa Adriana

Type of visit: Required - 1 Year

On 08/25/23 at 8:26 a.m. Licensing Program Analyst (LPA) Cheryl Goodrich arrived to conduct an unannounced annual visit. LPA met with the Administrator, Adriana Dragovic) at the front door and was granted entry. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. Facility is approved for six (6) ambulatory residents, having 4 residents in care. Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, cleaning supplies, protective eye equipment and cleaning supplies. Physical Plant and Environmental Safety: There are a total of 6 resident bedrooms, and three bathrooms, a kitchen, living room, office area, backyard area with furniture for residents and staff. All rooms, Living room, office area, kitchen and dinning room are all clean and clear of obstruction. The resident bedrooms were clean and clear from obstruction. The resident’s rooms were complete with and clean linens and bedding, a television, dresser, and closet space. The bathroom water temperature read at 110.1 degrees which is within regulation requirements. There are no bodies of water or pools on the premises. Operational Requirements: The facility was staffed with 2 caregivers. The facility meets the operational requirements for an RCFE and has a current fire clearance for the facility, smoke and carbon monoxide detectors and fire extinguisher. (Continued on LIC809-C) (Continued from LIC8029 Personnel Records-Training: All staff have fingerprint clearances, current CPR/First Aid certification, Health screen and TB test completed. All staff complete monthly in-service training and fire drills and disaster training. Client Records-Incident Reports: The resident records are complete with pre-assessments, admissions agreement, physician reports, identification and emergency information, resident’s cash resources, house rules, medication log, daily logs of the resident’s health condition, and additional medical assessments. Client RIGHTS INFORMATION: The resident’s right documentation is present. The resident records also contain needs assessment information for each resident. Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available to residents. Health- Related Services: The caregivers at the facility are dispensing medications within the guidelines of the physician’s order and the regulations. The facility is documenting the date and time of the dispensing of medication for each resident. Disaster Preparedness: The facility has a disaster plan and has posted the evacuation plan, visible for staff and residents in care. The last fire drill was completed 06/30/23. The facility has emergency supply of food and water. Summary: Based on today's visit, no deficiencies were observed at this time. An exit interview was conducted with Administrator Adriana Dragovic and a copy of this report was printed Signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Aug 25, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Janira Arreola, made an unannounced visit on 10/28/2022 at 10:05 a.m. in order to conduct an annual visit with a focus on infection control. LPA met with Administrator, Adriana Dragovic, who was informed of the purpose of the visit. At the time of the visit there were (3) staff and (5) residents present. LPA proceed to conduct a walk through of the facility's interior and exterior. LPA observed there was a central entry point where screenings are conducted for facility visits. LPA observed COVID-19 postings throughout the facility. The facility has a 30-day supply of PPE equipment that is readily accessible for residents and staff. The facility has a designated visitation area in the facility. LPA observed the resident bedrooms that would be used as isolation rooms. The resident bathrooms were observed to be clean and have the appropriate hand hygiene supplies such as hand sanitizer, soap, running water and paper towels. The facility has a cleaning plan in place to disinfect and clean the high touch surfaces of the facility and the isolation rooms. The staff have leave in case of contact or testing positive for COVID-19. The staff have been trained on how to properly don and doff the PPE equipment, and there is a plan of care in place to attend to those residents that would be in the isolation rooms. The staff have also been FIT tested for an N95 respiratory. No deficiencies were cited at the time of the visit. An exit interview was conducted where this report was reviewed and provided to Administrator, Adriana Dragovic.the state’s words, verbatim · CDSS document, Oct 28, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carmen Lopez made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself and was granted entry by Valerie Bell, Caregiver. LPA met with caregiver Bell and discussed the purpose of today’s visit. A tour of the facility was conducted inside and out. LPA, accompanied by Valerie Bell, Caregiver conducted a general overall inspection, with specific focus on infection control protocols. During today's inspection LPA observations include the following: Symptom screening procedures/ for staff, residents and visitors; posted signs regarding visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; Hand hygiene practices; testing plan and procedures; plans for containing infections, PPE supplies procedures and training; and disinfection procedures. Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with Valerie Bell, Caregiver. A copy of this report, along with the Licensee Rights (01/2016) was emailed to Adriana Dragovic, Licensee, at the conclusion of the visit. LPA requested Licensee Dragovic to send LPA an electronic message reply confirming receipt of these documents. LPA requested Licensee Dragovic to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-E to the licensing office within 10 business days. Forms available at www.ccld.ca.gov.the state’s words, verbatim · CDSS document, Aug 12, 2021

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.