Sapphire Chardonnay

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced visit to the facility for the purpose of an annual review. LPA was greeted by Felipa Arango, Caregiver and explained the purpose of the visit. Administrator Elizabeth Rivera joined shortly. A tour of the facility was conducted inside and out. At the time of visit, all six (6) residents were home and two (2) staff were present. The facility is approved for six (6) elderly residents ages 60 and over, non-ambulatory, of which 1 may be bedridden. There is a hospice waiver for six (6) residents. The facility is a six (6) bedroom three (3) bathroom one story home. Four (4) bedrooms are private, one (1) bedroom is shared, two to a room. One bedroom is reserved for overnight staff. During the tour the following was observed: Resident bedrooms had the required furnishings and were observed to be in good condition. Bathrooms had required signage, hand rails, non-slip mats. Night-lights were observed in the hallways. Fixtures and furniture for an operational facility are present and in good repair. All passageways were free of obstructions, charged fire extinguishers and the fire alarm system was operable, medications are kept centralized and locked, hazardous items are kept inaccessible to residents. Hot water was tested at 115 degrees Fahrenheit. The backyard area is free of obstructions. Kitchen/Food Service: LPA observed the entire kitchen, food is stored properly and dishes are clean and in good condition. There is a sufficient supply of perishable and non-perishable foods. Area was observed to be clean and functional. Care & Supervision: Facility has sufficient care staff employed. Administration: Emergency exiting plans, telephone numbers and Ombudsman information and other required signage are posted throughout the facility. Drills are conducted quarterly. The last drill was 9/30/2023. Record Review and Client/Staff Files: LPA reviewed current staff and all staff have has Criminal Background Clearance, current CPR/First Aid certification, and trainings are current. Client records were reviewed and all contain required documents and are up to date. Medication Review: LPA reviewed medication and medication log. Residents' medications are being dispensed according to physician's orders. No deficiencies were cited per Title 22, Division 6 of the California Code of Regulations at this time. An exit interview was conducted and a copy of this report was provided to Elizabeth Rivera, Administratorthe state’s words, verbatim · CDSS document, Oct 6, 2023

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Stephanie Torres and Sara Martinez conducted an unannounced case management visit to amend LIC 9099 reports created on 12/21/2022, relating to complaint #18-AS-20221219140229. The LPAs identified themselves and discussed the purpose of the visit with Administrator, Elizabeth Rivera. The amended reports and a copy of this report were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Apr 13, 2023

Allegation investigated: Staff do not serve food of the quality and quantity necessary to meet resident needs Staff do not maintain facility at a comfortable temperature for resident Staff do not answer telephone calls Facility does not encourage socialization Resident is not treated fairly

Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit the facility to initiate the investigation into the above allegations. The LPA met with Administrator, Ali Naghibi, and informed him of the purpose of the visit. The LPA conducted staff/resident interviews, toured the interior/exterior areas of the facility, reviewed records and received copies of pertinent documentation. Regarding the allegation, "Staff do not serve food of the quality and in the quantity necessary to meet resident needs," it was alleged Resident One (R1) is not served nutritious meals, is served small portions, and is served food that is reheated in the microwave. Interviews revealed the resident is served nutritious meals and is served sufficient portions. Interview revealed R1 was served a reheated soup on one occasion, however, it was not an issue for R1. R1 was interviewed and denied the allegation. Resident interviews revealed staff do provide food items requeted and sufficient amount of food is provided. Therefore, based on interviews, this allegation is deemed UNSUBSTANTIATED. Unsubstantiated Pertaining to the allegation, “Staff do not maintain facility at a comfortable temperature for resident," it was alleged the bedroom of Resident One (R1) is cold and the resident is uncomfortable. Interviews revealed R1 has been known to open their bedroom exit door, causing cool air to come into the room. A tour of the facility revealed the home does have central heating, which is in working condition. Interview revealed the bedroom of R1 is occasionally cold, however, staff will accommodate the resident by turning on the heater. Additional interviews with residents revealed the temperature in the home is cold, however, requests by the residents to increase the thermostat have not been made. Therefore, based on interviews, this allegation is deemed UNSUBSTANTIATED. Regarding the allegation, "Staff do not answer telephone calls," it was alleged the facility is not answering telephone calls made to or regarding R1. Staff interviews revealed calls are not denied to R1 that are made to the facility land line. It was reported R1 also has a cell phone and receives calls on the device as well. R1 was interviewed and reported the staff have handed over the facility telephone when they have received a call. R1 also confirmed their cell phone is working and they have received calls in the last few days. Additional resident interviews could not corroborate or refute the validity of the allegation. Therefore, based on interviews, this allegation is deemed UNSUBSTANTIATED. Regarding the allegation, "Facility does not encourage socialization," it was alleged R1 remains in their bedroom and is not encouraged to socialize. Interviews revealed R1 enjoys remaining in their bedroom and does not come out frequently. According to Administrator, Naghibi, R1 was approved to attend a senior center, however, the resident declined to attend. R1 was interviewed and denied the allegation. Additional resident interviews revealed socialization does occur when meal periods take place and/or during group outings. Therefore, based on interviews, this allegation is deemed UNSUBSTANTIATED. Pertaining to the allegation, "Resident is not treated fairly," it was alleged facility staff permit other residents to utilize a portable heater, while R1 is not. A tour of the facility revealed there to be one portable heater in one (1) of five (5) resident bedrooms. Additionally, the LPA observed central heating to be available and in working order. R1 was interviewed and stated they had requested a heater; however, they did not get a response from staff. R1 also reported staff do turn on the central heater when requested. Additional resident interviews could not corroborate or refute the validity of the allegation. Therefore, based on interviews and observation, this allegation is deemed UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. This report was reviewed with Naghibi and a copy was provided. allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation occurred. This report was reviewed with Naghibi and a copy provided.the state’s words, verbatim · CDSS document, Dec 21, 2022 · control 18-AS-20221219140229

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Adam Hamer conducted an unannounced annual required licensing inspection on today's date. LPA was greeted at the front door and was granted entry after identifying himself and disclosing the purpose of the visit. An overall tour of the facility was conducted inside and out. The inspection included, but was not limited to, verifying compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices. LPA reviewed with Administrator Ms. Arango the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC 808) including the following sections: Persons in Care, Staff, Visitors, Facilities without COVID-19, Residents, Facility has Plans for Infection Control, and Physical Distancing. LPA assessed the strategies that the facility is employing for the prevention, containment and mitigation of COVID-19, implementation of infection control guidance, staff retention and essential health and safety. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy, and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE. The facility is in compliance with and has implemented infection control practices as outlined in its LIC 808. No deficiencies were observed during today's visit. An exit interview was conducted with Ms. Arango and a copy of this report along with Licensee/Appeal Rights (LIC 9058 FAS 01/16) was provided to her via email; she expressed that she would send LPA a confirmation email upon receipt of these documents.the state’s words, verbatim · CDSS document, Sep 21, 2021