Gelzhen Guest Home

Type of visit: Required - 1 Year

Unannounced annual licensing visit made out to this facility on 08/09/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Knicole Carbonell, who was briefly interviewed. This LPA requested that the facility caregiver go ahead and contact the facility designated Administrator, Joy Laja, to inform her that CCL was present at this time. The facility designated Administrator, Joy Laja, arrived thereafter to this facility. A brief interview was conducted with the facility designated Administrator at this time. This facility is licensed to serve and accept up to 15 residents who are deemed to be ambulatory and non ambulatory. This facility is not vendorized to accept and retain any Regional Center residents at this time. Current census was 8 residents. It was learned that there was (1) resident currently on hospice. There were (3) dementia diagnosed residents and (6) residents with bowel/bladder incontinence. Tour of this facility was conducted. Kitchen area was toured. Cabinets and drawers were reviewed. Drawers and cabinets housing cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Drawers containing knives and other cutlery were observed to be locked and made inaccessible to the residents at this time. Food supply was reviewed for 2-day perishable and 7-day nonperishable food quantities at this time. Additional nonperishable food items were observed to be stored in the garage area along with additional refrigerator and freezer units. Dining room, living area, and all other areas designated for resident use were observed to be maintained and observed to be in compliance at this time. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be present and maintained in compliance at this time. A tour of the resident restrooms was conducted. Shower areas, toilets, and wash basins were reviewed and observed to be functional and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Medication for resident use, located in kitchen cart, was reviewed. Policies and procedures for dispensing, handling, and overall documentation of the resident medications were discussed with the facility designated Administrator at this time. Fire extinguishers (3) were observed to be placed in the kitchen, dining, and laundry areas were annually inspected on 03/15/2023 from the local fire extinguisher company, Nor Cal Fire Inc, and in compliance at this time. First aid kit was observed to be present and contained all of the required components at this time. Linen closet, located in facility hallway, was observed to contain a sufficient supply of blankets, sheets, and towels for resident use. Laundry area, located adjacent to kitchen area, was observed to be made inaccessible to the residents at this time. Laundry detergents, bleach, and all other cleaning supplies were observed to be stored in cabinets where they were locked and made inaccessible to the residents at this time. Exterior grounds of this facility was toured. Facility perimeter fence, side gates, and emergency exits were reviewed. Additional garage space was reviewed and observed to be contain materials and items intended for upkeep and maintenance of this facility. A review of (4) facility personnel files was conducted. A review of (5) facility resident files was conducted. The following forms were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Aug 9, 2023

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 12/08/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregivers, Ferdinand and Teresita Galla, who were briefly interviewed. This LPA requested that the facility caregivers go ahead and contact the Licensee/Facility designated Administrator to let him/her know that CCL was present at this time. Current census was 7 residents. The purpose of this visit was to clear the deficiencies that were cited on the previous complaint visit dated on 11/21/2022 for the following deficiencies: Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents' money or interfering with daily living functions such as eating, sleeping, or elimination. This LPA requested that the following forms and documents to be updated and completed and submitted into CCL for review by this LPA: LIC 308 LIC 400 LIC 500 LIC 610 Plan of correction letter was printed and a copy was given to the facility caregivers at this time. There were no additional deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 8, 2022

Allegation investigated: Staff handles resident in a rough manner

Unannounced Complaint visit made out to this facility on 11/21/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Nichol Carbonell, who was briefly interviewed. This LPA requested that the facility caregiver go ahead and contact the Licensee/Facility designated Administrator to let him/her know that CCL was present at this time. Current census was 7 residents. Facility Licensee, Floyd Laja, arrived later to this facility while this LPA was conducting this visit. The purpose of this visit was to deliver the findings of this investigation to the facility and its representative, Floyd Laja, at this time. Based on interviews conducted during this investigative process, it was learned that there was an eyewitness account of how facility staff person, S1, roughly handled facility resident, R1, during assistance with R1 for Activities of Daily Living (ADL). It was learned that S1 abruptly threw R1 onto the bed after attempting to transfer R1. It was learned that from this action, R1's face became buried in R1's pillow and required further assistance to turn away from it by the facility staff person. Substantiated It was learned that R1 required assistance with transferring in/out of bed and to/from R1's wheelchair, toilet, and living room furniture. It was learned that R1 was deemed to be bedridden and required assistance with transferring, toileting, and required to be turned/pivoted on set intervals throughout the day and night. Based on interviews, it was learned that staff person, S1, had dumped R1 onto R1's bed on several occasions and often times would cause the resident to roll. This caused R1 to roll towards the wall that was adjacent to R1's bed. It was learned that R1 would hit his head from this action by S1. No visible injuries were ever recorded or reported to CCL but happened more than once as stated in the interviews. As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Appeal rights were printed and a copy was given to the facility Licensee, Floyd Laja, at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 21, 2022 · control 27-AS-20220607151224

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Nov 28, 2022

Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents' money or interfering with daily living functions such as eating, sleeping, or elimination. This facility was found to be deficient as evidenced by the violation of the resident's rights by facility staff while assisting and performing ADLs. This posed an immediate threat to the Health, Safety, and Personal Rights of the residents in care.the state’s words, verbatim · CDSS document, Nov 21, 2022

Plan of correction: Facility representative stated that staffing will be sufficient and competent at all times for adequate care and supervision unto all facility residents. A statement of correction, along with facility wide training for all staff providing care and supervision to the residents will be conducted. This training will be for no less than (2) hours in duration on the topic of resident rights, resident dignity/respect, and proper transfer techniques. Proof of training will be submitted to include name of trainer, length of training with topics covered, and list of attendees by the due date of 11/28/2022.

Type of visit: POC

Unannounced Plan of Correction visit made out to this facility on 11/21/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Nichol Carbonell, who was briefly interviewed. This LPA requested that the facility caregiver go ahead and contact the Licensee/Facility designated Administrator to let him/her know that CCL was present at this time. Current census was 7 residents. Facility Licensee, Floyd Laja, arrived later to this facility while this LPA was conducting this visit. The purpose of this visit was to clear the deficiencies that were cited on previous annual visit dated on 08/03/2022 for the following deficiencies: (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. 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 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. (6) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered medications shall be limited to the following: 5. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Plan of Correction correction letters were printed and a copy was left with the facility designated representative, Floyd Laja, at this time. There were no further deficiencies observed or cited during today's Plan of Correction visit. Exit Interviewthe state’s words, verbatim · CDSS document, Nov 21, 2022

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 08/03/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility kitchen staff person, Apol Santos, and caregiver Nick Carbonell. Mr. Carbonell stated that there was also another caregiver present named Adrianna Sanchez-Garcia. He informed this LPA that they have only been employed for one month here so far. This LPA requested that the caregiver go ahead and contact the facility designated Administrator, Joy Laja, to inform her that CCL was present at this time for an annual visit. The facility designated Administrator arrived later to this facility while this LPA was conducting the annual review. Current census was 7 residents. There were hospice residents in care at this time. In addition, there were residents who required assistance with glucose monitoring and diabetes related tasks everyday. Tour of this facility was conducted. Living room, dining room, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. Food storage units were reviewed to make sure that they were functional and in good repair at all times. A review of the food supply was conducted for adequate 2-day perishable and 7-day nonperishable quantities at all times. An additional food storage unit was used and placed in the garage area. Garage area was toured. The car of the facility designated Administrator was placed in there at this time as she had just arrived while this LPA was reviewing the garage area. A tour of the facility resident bedrooms was conducted. Bedroom furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the facility resident restrooms was conducted. Grab bars and non skid mats were observed to be present and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Fire extinguishers, located throughout this facility, were observed to have been annually inspected by the local fire extinguisher company, Nor Cal Fire, and observed to be in compliance at this time. Linen closet was observed to contain a sufficient supply of blankets, towels, and linens sufficient to meet the needs of the residents at this time. First aid kit, located in the kitchen area, was reviewed and observed to contain all of the required components at this time. Medication cart, located in the kitchen area, was reviewed. Brief interview was conducted with the facility designated Administrator Joy Lajas. Tour of the facility exterior grounds was conducted. A review of the facility perimeter fence, side gates, and emergency exits was conducted. There was a total of (4) storage units/areas being used at this time to house old mattresses and furniture for this facility at this time. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was left with the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Aug 3, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facilities annual inspection. LPA met with Facility staff Lillibeth Sarmiento .There are currently 6 residents who reside at this home and there is 1 resident on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 118.9 F degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Administrator and copy of report left at facilitythe state’s words, verbatim · CDSS document, Aug 10, 2021