Weaver's Magnolia Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that six (6) clients live at this facility. There were two (2) staff members present. The Caregiver, Neneth Fojas conducted and completed the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Six (6) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/ Staffing/ Administration: LPA reviewed employee records. Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Tonya Weaver, Administrator’s certificate expiration date is 10/22/2023. (Continued on LIC809C) (Continuation from LIC809) Food Service: Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at 78 degrees for the client’s comfort. Lighting is sufficient for safety. Water temperature measured 108.0 degrees F. Laundry is done in the designated laundry room. There is a locked cabinet for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA dialed the facility’s landline number, which rang and was operable. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is one (1) secured fireplace at this facility. There is not a pool at the facility. There are two (2) gates that have a self-latching lock on the northwest and northeast side of the house. The facility performed their last fire and emergency drills on August 15, 2023. LPA reviewed the facility’s last disaster drills, which met the department's requirements. LPA observed emergency supplies and first aid with the required components. Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that all staff had infection control training. (Continued on LIC809C) (Continuation from LIC809) Medications/Health Related Services/Incidental Medical Services: The medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. LPA reviewed medication logs and observed if they were dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed five (5) dual fire alarms and carbon monoxide detectors. The caregiver tested the smoke alarms and carbon monoxide alarms on site. There is three (3) fire extinguisher on site, date bought 10/20/2021. Pursuant to the Title 22 of The California Code of Regulations Division 6, there are zero (0) deficiencies observed. An exit interview was conducted, this LIC 809 was reviewed with, and a copy of this report was provided to the Caregiver, Neneth Fojas.the state’s words, verbatim · CDSS document, Aug 31, 2023

Type of visit: Required - 1 Year

On August 17, 2022, Licensing Program Analyst (LPA), Venus Mixson arrived at the above facility for an unannounced annual with emphasis on infection control. LPA Mixson was greeted and granted entry by Lead Caregiver, Christine Telo introduced self and stated the purpose of the visit. Present in the facility were 6 residents and 2 caregivers. There are currently no cases of COVID-19 within the facility. LPA Mixson toured the facility and made observations pertaining to the facility's infection control measures. LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions and the proper use of 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, and cleaning and disinfection provisions are in adequate quantities. LPA Mixson later discussed infection control practices and procedures with Lead Caregiver. An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to Lead Caregiver.the state’s words, verbatim · CDSS document, Aug 17, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Eva Torres conducted an unannounced infection control inspection. LPA met with House Manager Babette Gardner. The purpose of today's visit is to inspect and ensure that the facility is following the California Code of Regulations, Title 22, Division 6. The facility is licensed for six (6) non-ambulatory elderly residents, in which one (1) out of the six (6) residents may be bedridden. The facility has a hospice waiver to serve four (4) residents. Tour included: Infection Control: LPA reviewed and discussed the Mitigation Plan with the House Manager. LPA also provided consultation on the facility's training records, staffing plan, and screening protocols. LPA also inspected the facility's disinfectant supply and the use of personal protective equipment (PPE). Mrs. Gardner was advised to remain updated on the changes and directions set forth by the department, so that their infection policy reflects the current information on COVID’s guidelines. Physical Plant: front entrance, interior, and exterior surroundings were observed to be clean with no pathway obstruction. LPA inspected the fire extinguisher and found it to be in compliance. The facility does not have firearms and or ammunition on the grounds. There was no body of water observed on the premises. Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Records: All staff present have a criminal record clearance in file and are associated with the facility. All required postings, including COVID’s postings, were posted near the entryway and throughout the facility. The administrator certificate expires on 10/22/21. Based on today’s inspection, there were no deficiencies observed per Title 22 Regulation. LPA conducted an exit interview with the house manager. A copy of this report and the Licensee Rights (LIC 9058 01/16) was emailed to administrator, and their signature on this form confirms receipt of documents.the state’s words, verbatim · CDSS document, Jul 27, 2021