Rose Garden Capo

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 five (5) clients live at this facility. There were two (2) staff members present. The Administrator, Rolando Corpuz later came to complete the facility tour. Client Records/Incident Reports/Clients Rights Information: LPA reviewed client records. Five (5) 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. Rolando Corpuz, Administrator’s certificate expiration date is 08/12/2022. The Administrator submitted his Administration application for renewal on 09/23/2023. (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 a secured pool at the facility, with a 5-foot locked gate. 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 February 01, 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 Administrator tested the smoke alarms and carbon monoxide alarms on site. There is three (3) fire extinguisher on site, date bought within the last year. 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 Administrator, Rolando Corpuz.the state’s words, verbatim · CDSS document, Aug 31, 2023

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct a case management visit to address a deficiency discovered during the processing of the facility's annual inspection. Facility staff phoned Licensee/Administrator Bobby Corpuz to notify him of LPA's presence in the facility. LPA spoke with Corpuz via telephone. Corpuz was unable to return to the facility, but did send house manager Janet Moster from the sister facility, Rose Garden. During today's visit, LPA interviewed Staff #1 (S1), reviewed documents in S1's file, and interviewed Corpuz via telephone. LPA discovered that in 2017, S1 had been excluded from being employed by any licensed facility of the Department of Social Services (DSS), being present in any licensed facility of the Department of Social Services, and having contact with any resident of a facility licensed by the Department of Social Services for the remainder of his life. On August 9, 2022, S1 was observed to be employed at the facility and subsequently caring for residents during the facility's annual inspection. During today's visit, LPA requested S1 leave the facility immediately to which he complied and LPA observed him vacate the property via Uber shortly thereafter. Licensee/Administrator Bobby Corpuz was educated of the 2017 public Decision and Order regarding the prohibition of S1's presence in ANY licensed facility. S1 may petition DSS for reinstatement and may only return to any licensed facility if and when the petition is approved/granted. Licensee Corpuz acknowledges S1 may not be present in any licensed facility until such petition is approved/granted and stated S1 will not be allowed to return until then. A copy of the public Decision and Order was provided to the facility as well. There are no health, safety, or personal rights concerns noted at the facility at this time. The following deficiency was cited per Title 22, Division 6 of the California Code of Regulations. See LIC 809D. An exit interview was conducted and this reported was provided along with appeal rights.the state’s words, verbatim · CDSS document, Aug 10, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(a)(13)(A) · Plan of correction due date: Aug 15, 2022

Personnel Records- (a) The licensee shall ensure that personnel records are maintained on... each employee. Each personnel record shall contain...(13) For employees that are required to be fingerprinted...(A) A signed statement regarding their criminal record history as required by Section 87355(d). This requirement was not met as evidenced by: The licensee did not ensure S1 completed form LIC508 prior to employment and a copy of this form was not stored in the file of S1. This poses an potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 10, 2022

Plan of correction: Licensee agrees to complete LIC508 for all employees and/or prospective employees and a copy of such form will be maintained in facility records. Proof of completion of LIC508 for S1 will be sent to LPA by 8/15/2022 and maintained in facility records.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct an annual inspection with emphasis on infection control. LPA met with Caregiver Paul Bein and explained the purpose of today's visit. Bein phoned Administrator Bobby Corpuz and notified him of LPA's presence and he arrived shortly thereafter. During today's visit, LPA inspected the facility for regulatory compliance for the mitigation of COVID-19. LPA observed appropriate postings in the facility which were in accordance with the Department's guidelines. LPA observed that the facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). The facility has an approved COVID-19 Mitigation Plan Report (Report) on file which identifies a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases and ensures that staff are trained in the facility's infection control measures. The Report also indicates the facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolation, and properly caring for residents with COVID-19 positive results and/or exposures. Also detailed in the Report is a plan to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms. No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 9, 2022

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Adam Hamer conducted an announced Pre-Licensing and Component III visit at the facility on today's date to inspect the facility for compliance with Title 22, Division 6, Chapter 8 of the California Code of Regulations and the Health & Safety Code. This is an initial application for licensure; the facility has no residents in care. LPA identified himself at the door and was granted entry by Applicant Rolando Corpuz. LPA and Applicant toured the physical plant, inside and out, and LPA observed the following: Resident accommodations were in compliance with regulations, including furnishings, linens, and personal hygiene items; resident bathrooms were equipped with grab bars, non-skid mats, and water temperature measured at 106.8 degrees Fahrenheit in a bathroom to be used by residents; the facility’s ambient room temperature was 72 degrees Fahrenheit at the time of the visit; there was a cabinet with locked doors for medications and for staff and resident records; food service, including dishes, utensils, food storage, and a seven day supply of non-perishables and a two day supply of perishables were present, and knives and sharp objects were locked in a cabinet in the kitchen; toxic substances were stored in a locked cabinet; first aid kits and first aid manuals and proper supplies were stored in a facility closet; activities, supplies and sufficient space in which to conduct activities were present; fire extinguishers, smoke and carbon monoxide detectors were also present and operable; required facility postings were present and visible in a common area of the facility. According to Applicant, there are no guns, weapons, or ammunition stored on the facility property. A swimming pool was observed on the facility property with locked gates outside the perimeter and in compliance with regulations. The administrator's certificate expire on August 12, 2022. (continued on 809C) LPA also conducted and completed the Component III with Applicant during the visit. LPA verified that Applicant’s understanding of Title 22 continuing requirements, including physical environment, reporting requirements, personnel and resident records, incidental medical care, health related services and activities. All items reviewed during the visit are in compliance with Title 22, Division 6, Chapter 8 of the California Code of Regulations and the Health and Safety Code. Applicant was advised that the application is pending management final review and approval. An exit interview was conducted with Applicant and a copy of this report and Applicant Rights (LIC 9058) were provided to Applicant via electronic mail; Applicant expressed to LPA that he would send an email confirmation upon receipt of these documents.the state’s words, verbatim · CDSS document, Aug 5, 2021