Majella Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 10:33 am. to conduct an unannounced annual visit. LPA met the Caregiver Chima Umolu at the front door and was granted entry. LPA met with Caregiver Juan Carlo Ponce de Leon regarding the visit. 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 12 non-ambulatory residents of which 4 may be bedridden, with 7 non-ambulatory and 3 bedridden resident 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, and cleaning supplies. Physical Plant and Environmental Safety: The facility temperature read at 71 degrees. The facility consists of 7 resident bedrooms, and 2 bathrooms, living room, kitchen, and backyard. The bedrooms are furnished with tv, lighting, closet space, and dresser. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 109 degrees within regulation requirements. The living room and kitchen clean and clear of obstruction. The medications are stored in a locked cabinet in the laundry room and inaccessible to the resident. The facility and has a current fire clearance for the facility, smoke and carbon monoxide detectors and fire extinguishers and are in working order. Personnel Records-Training: The staff records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings. Client Records-Incident Reports: The facility has identification and emergency information, physician’s report, resident appraisal, additional assessments, and admissions agreement for 4 residents in care. (Continued on LIC809-C) (Continued from LIC809) Client Rights-Information: The facility has client rights information posted in the facility. Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available. Health- Related Services: The facility has a medication logbook, however no records due to no residents in care, however previous resident records were found, and the facility documented the resident’s medication and in compliance with physician’s orders and regulations. 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 06/11/23. The facility has emergency supply of food and water. Items of Discussion: Physician’s reports are missing for residents R2, R3, R4, R6, R7, and R8. Residents R4 and R6 are missing identification and emergency information, physician’s reports, physician’s orders, pre-assessments, and admissions agreements. The facility currently does not have a resident roster or LIC9020. Summary: Deficiencies are being cited per Title 22, Div. 6, Chap 8 and listed on LIC 809-D. An exit interview was conducted, Appeal Rights (LIC 9098) along with a copy of this report was provided to Caregiver Juan Carlo Ponce de Leon and his signature on this form confirms receipt of these rights.the state’s words, verbatim · CDSS document, Oct 10, 2023

Allegation investigated: Licensee did not issue refund to responsible party after resident passed away.

On June 27, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to deliver the findings on the listed allegation. LPA Mixson met with Administrator introduced herself and stated the purpose of the visit. LPA Mixson toured the facility with the Administrator and made observations pertaining to the listed allegation. LPA Mixson requested pertinent documentation, the Administrator stated that he will email the LIC 500 and the clients roster by COBD on Friday 06/30/2023. There were no observable Title 22, Division 6, Regulation violations noted during the tour. On December 13, 2022, Community Care Licensing (CCL), received information regarding the listed allegation. After LPA Mixson conducted staff and resident interviews, record reviews and observations pertaining to the alleged violation, there was not sufficient evidence to show that the above listed allegation did or did not occur. After evaluation of the evidence reviewed, there was not a preponderance of the evidence strand to determine if the listed allegation happened. Information obtained from staff interviews demonstrated that attempts were made to contact the family and inform them of the refund process, but the calls went unanswered. Information obtained from the record reviews revealed that the refund process stated clearly in the Admissions Agreement and the Addendum to the Admission Agreement stated that the facility does not provide any refunds for payments within the current month. Assessments made by the LPA of the records review reveal that the Responsible Party signed the documentation. After additional staff and resident interviews information obtained demonstrated that the information pertaining to the facility does not provide any refunds was explained to the family during the orientation and tour of the facility. Therefore, the allegation findings and the outcome of the investigation are deemed to be UNFOUNDED. A finding of Unfounded means that the evidence obtained did not demonstrate that the alleged violation occurred, and/or that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to the Administrator. Unfoundedthe state’s words, verbatim · CDSS document, Apr 2, 2023 · control 18-AS-20221213145855

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.

Type of visit: Required - 1 Year

On September 30, 2022, Licensing Program Analyst (LPA), Venus Mixson arrived at the above facility for an unannounced required annual with emphasis on infection control. LPA Mixson was greeted and granted entry by Lead Caregiver, Joan Ponce-De-Leon introduced self and stated the purpose of the visit. Present in the facility were 8 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 Mixson 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 given to Lead Caregiver.the state’s words, verbatim · CDSS document, Sep 30, 2022

Allegation investigated: - Facility did not provide residents with hot water.

Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to the facility to deliver findings for a complaint investigation regarding the above-mentioned allegation. LPA Lopez identified herself and was granted entry by Karina Sanchez, Caregiver. LPA met with Jim Morrison, Licensee and stated the purpose of the visit. The Department’s investigation consisted of verifying water temperatures, interviews with staff, residents and an outside source pertinent to this investigation. On February 23, 2021, it was alleged that the facility did not have hot running water in one of the facility restrooms the residents used for bathing and personal care. Interviews with residents revealed that the hot water was not working on the upper level restroom of the facility. Interview with an outside source confirmed that hot water in the upper level of the facility was not working. Staff interviews acknowledged that the hot water was not Substantiated operable in the upper level restroom and staff had to heat hot water and take it over to the upper level restroom in order to bathe residents. During the investigation, hot water temperatures were taken, and the upper level restroom hot water measured at only 90 degrees Fahrenheit. According to Title 22 regulations, hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degrees and not more than 120 degrees Fahrenheit. Measurement of taps for hot water and interviews with staff, residents and an outside source supported the allegation that the facility did not provide residents with hot water as required. The Department has investigated the above-mentioned allegation and based upon the evidence obtained, it found that there is sufficient evidence to prove that the allegation occurred. Therefore, the allegation is determined to be substantiated. The report was discussed with Jim Morrison, Licensee, plan of correction was reviewed, and a copy of this report along with Applicant/Licensee Rights (LIC9058 01/16) was provided to the Licensee via email. An electronic email receipt confirms the documents were received.the state’s words, verbatim · CDSS document, Dec 20, 2021 · control 08-AS-20210223113039

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(e)(2) · Plan of correction due date: Dec 20, 2021

87303(e)(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. ... This regulation was not met as evidence by: Based on interviews and hot water temperature taps of the facility bathroom did not measure within regulation. This posed a potential threat to eight out of ten residents in care.the state’s words, verbatim · CDSS document, Dec 20, 2021

Plan of correction: Facility made repairs June 2021 which repaired the hot water temperature. LPA took temperatures for the restroom in question and temperatrures were in range. POC was cleared 12/20/21.

Allegation investigated: - Licensee did not provide modified activities to residents.

Licensing Program Analyst (LPA), Carmen Lopez, conducted an unannounced visit to the facility to deliver findings for a complaint investigation regarding the above-mentioned allegation. LPA Lopez identified herself and was granted entry by Karina Sanchez, Caregiver. LPA met with Jim Morrison, Licensee and stated the purpose of the visit. The Department’s investigation consisted of, review of records including photos, and interviews with staff and residents. On February 23, 2021, it was alleged that the Licensee was not providing residents with modified activities. Photographic evidence revealed that there was a monthly calendar posted at the entrance of the facility which allegedly staff were not adhering to. Interviews with other residents revealed that the facility was providing activities to the residents who were interested in participating in. Interviews with staff indicated that the staff did not Unsubstantiated always follow the planned calendar due to lack of resident participation. Staff stated they did follow the activities calendar on a monthly basis with the activities the residents enjoyed or accommodated the activity a resident was interested in. Based on records review and interviews, there was insufficient evidence to support the allegation that staff did not provide residents with modified activities. The Department has investigated the above-mentioned allegation and based upon the evidence, it found that there is insufficient evidence to prove that the allegation occurred. Therefore, the allegation is determined to be unsubstantiated. The report was discussed with Jim Morrison, Licensee, and a copy of this report along with Applicant/Licensee Rights (LIC9058 01/16) was provided to the Licensee via email. An electronic email receipt confirms the documents were received.the state’s words, verbatim · CDSS document, Dec 20, 2021 · control 08-AS-20210223113039

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 Maria Ortega, Caregiver. LPA met with Jim Morrison, Licensee and discussed the purpose of today’s visit. A tour of the facility was conducted inside and out. LPA 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; testing plan and procedures; plan 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 Licensee Morrison. A copy of this report, along with the Licensee Rights (01/2016) was emailed to Jim Morrison, Licensee, at the conclusion of the visit. LPA requested for the Licensee to send LPA an electronic message reply confirming receipt of these documents. LPA requested Licensee Morrison to submit a Designation of Administrative Responsibility LIC 308 and an Emergency Disaster Plan LIC 610-E to the licensing office within 10 business days. The facility had a current Personnel Report LIC 500. Forms are available at www.ccld.ca.gov.the state’s words, verbatim · CDSS document, Oct 21, 2021