Oxford Manor

Type of visit: Required - 1 Year

On 8/16/2023 at 10:15am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived at this facility unannounced to conduct a required annual inspection visit. LPAs met with Administrator, Penya Hll and explained the purpose of the visit. LPAs toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 3 resident bedrooms and 1 staff room. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A comfortable temperature is maintained at 70 degrees Fahrenheit. The hot water temperature in the residents’ shared bathroom was measured between 105 and 120 degrees Fahrenheit. Smoke alarms and carbon monoxide alarms were tested successfully. Residents’ bathrooms are equipped with grab bar and non-skid mats. Facility has an emergency food supply. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. All toxins and other dangerous items including sharp objects were locked and inaccessible. Medication storage area was observed to be locked and inaccessible. First aid kit was observed to have adequate supplies and accessible to staff. All staff noted on LIC 500 contained criminal background clearances. LPA completed 1 staff interview. Facility’s liability insurance is current and update to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights poster. Facility has appropriate internet access available for resident use. LPA reviewed facility’s disaster plan to ensure regulatory compliance.Updated copy of LIC 308 and LIC 500, and current liability insurance were provided to LPAs during the visit. Based on observation, interview, and record review, LPAs observed 2 of 3 residents maintaining a bedridden status without appropriate fire clearance. LPAs reviewed 3 residents charts and 2 staff charts. Staffing charts did not contain updated regulatory required training upon review. Per California Code of Regulations, Title 22, deficiencies were observed during this visit. Exit interview was held and a report was given to Penya Hill.the state’s words, verbatim · CDSS document, Aug 16, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst ( LPA) Ruth Wallace arrived at this facility unannounced to conduct a Required 1 Year Annual Licensing Inspection Visit. LPA was greeted by Licensee and LPA explained the purpose of the visit. LPA was screened upon entry for temperature and asked to sign in. LPA and Licensee inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 6-bed facility with a current census of 4. This facility has 3 bedrooms and 2 bathrooms as well as a formal living and dining room area. All knives, toxins, and other chemicals were inaccessible to residents in care. "See something, Say something" poster was in place. Resident rights and rights of resident council notices posted. Emergency disaster plan and facility sketch updated and posted. Administrator Certificate posted and expires 10/13/2023. Medications were locked and secured. The facility has submitted a COVID mitigation plan. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID-19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a COVID-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Water temperature reads 108.2*F in the bathroom and room temperature reads 75*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Facility has an emergency food and water kit. LPA reviewed two (2) staff files. All staff is fingerprint cleared and associated to the facility and staff have current First Aid or CPR certifications on file. Facility is conducting initial and continuing training as required. LPA reviewed two (2) resident facility files and all documents were in files required by Community Care Licensing (CCL). Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Licensee and a report was left at facility.the state’s words, verbatim · CDSS document, Sep 7, 2022

Type of visit: Case Management - Other

On 2/4/22, Licensing Program Analyst (LPA) Jason Lund arrived at this facility unannounced to conduct a case management visit. LPA was greeted by Administrator Simily Hill and Licensee Penya Hill by phone. LPA explained the purpose of the visit. On 2/2/22 it was reported that the facility pet dog (Sammy) had an altercation with another dog (Not facility dog) from the area on the grounds of the facility (Front yard). Sammy got of the facility through the side front door window. Sammy is know quarantined for the next 10 days per City of Stockton Animal Services. LPA Lund met with Sammy and she is very calm dog. LPA Lund, Administrator Simily Hill and Licensee Penya Hill spoke about how to try to have Sammy not to get out the facility again. The facility will not open the front windows any longer and have Sammy on a leash (With dog muzzle) when she is being walked outside the facility. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Administrator Simily Hill and Licensee Penya Hill by phone and a report was given to Administrator Simily Hill.the state’s words, verbatim · CDSS document, Feb 4, 2022

Type of visit: Post Licensing

On 12/28/21 at 10:06am, Licensing Program Analyst ( LPA) Michael Bilger arrived at this facility unannounced to conduct a post licensing inspection visit. LPA was greeted by Licensee Penya Hill and LPA explained the purpose of the visit. LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 6-bed facility with a current census of 2. LPA was screened upon entry for temperature and asked to sign in. This facility has 3 bedrooms and 2 bathrooms as well as a formal living and dining room area. All knives, toxins, and other chemicals were inaccessible to residents in care. "See something, Say something" poster was in place. Resident rights and rights of resident council notices posted. Emergency disaster plan and facility sketch updated and posted. Administrator certificate posted and expires 3/27/2023. Medications were locked and secured. The facility has submitted a COVID mitigation plan. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Refrigerator temperature measured at 40*F. Freezer temperature measured at 0*F. Water temperature reads 119.2*F in the bathroom and room temperature reads 76*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Facility has an emergency food and water kit. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Penya Hill and a report was given to Penya.the state’s words, verbatim · CDSS document, Dec 28, 2021

Type of visit: Prelicensing

On 9/8/21 at 11:49am, Licensing Program Analyst (LPA) Michael Bilger conducted an announced pre-licensing visit to this facility. LPA was met by the Applicant, Penya Hill. Brief interview was conducted with the Applicant. It was learned that this facility will be licensed to serve up to 6 non-ambulatory clients . There were no clients present during today's pre-licensing visit. Tour of the facility was conducted. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. COVID Precautions in place including signage, PPE storage and 30-day supply. Isolation rooms designated. LPA observed no obstruction of emergency exits. Exit signs in place as appropriate. Fire extinguisher in place at kitchen entry way and fully charged. Facility map indicating emergency exits posted in appropriate locations. Complaint poster and Ombudsman Poster observed. Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. All sharps objects and toxins are secured and locked. Food supply for 2-day perishable and 7-day nonperishable quantities were reviewed to make sure that this facility was in compliance at this time. Medication cabinet, located in the hallway, was toured. First aid kit was observed to be present and contained all required components at this time. A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time. A tour of the resident bathrooms was conducted. Hot water temperatures were taken and measured at 111.7* F which is within the allowed range of 105-120 degrees. Facility temperature was 79*F. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. A tour of the exterior grounds was conducted. {Cont. on 809C} A review of the facility perimeter fence, side gates, and walkways were observed to be maintained in compliance at this time. Wheelchair ramps are in place at entry way and exit areas to the backyard. This facility has been found to be in compliance at this time. There were no deficiencies observed during today's Pre-licensing visit. Component III completed with applicant during visit. COVID-19 Mitigation plan has been received and approved. Exit Interview conducted with Penya Hill. A copy of this report was left with the Applicantthe state’s words, verbatim · CDSS document, Sep 8, 2021

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Michael Bilger conducted an announced pre-licensing visit to this facility on 08/24/2021 at 9:44am and was met by the Applicant, Penya Hill. A Brief interview was conducted with the Applicant. It was learned that this facility will be licensed to serve up to 6 non-ambulatory clients. There were no clients present during today's pre-licensing visit. Tour of the facility was conducted. Dining area, living area, and all other areas intended for resident use were toured and observed to be furnished and maintained in compliance at this time. COVID Precautions in place. Isolation rooms designated. LPA observed no obstruction of emergency exits. Fire extinguisher in place in kitchen and fully charged. Complaint poster observed. Kitchen area was toured. Cabinets and drawers were opened and reviewed by this LPA along with the Applicant. Food supply for 2-day perishable and 7-day nonperishable quantities were reviewed to make sure that this facility was in compliance at this time. Medication cabinet located in hallway was observed. First aid kit was observed to be present and contained all required components at this time. A tour of the resident bedrooms was conducted. Furnishings and furniture intended for use by the clients were observed to be sufficient and able to meet the needs of the clients at this time. A tour of the resident bathrooms was conducted. Hot water temperatures were taken and measured within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels and linens able to meet the needs of the residents at this time. LPA received COVID mitigation plan during visit. {Cont. on 809C} A tour of the exterior grounds was conducted. A review of the facility perimeter fence, side gates, and walkways were observed. This facility has been found to require the following in place before considered for licensure: 1. Ramp to be installed at outside exit from main sliding door and resident room #3 sliding door 2. Facility flooring to be free of dirt and clutter 4. Facility sketches to be posted 5. Ombudsman poster to be posted 6. COVID-19 signage to be posted Exit Interview conducted with Penya Hill. A copy of this report was left with the Applicantthe state’s words, verbatim · CDSS document, Aug 24, 2021

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Simily Hill, Administrator; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Staff training 4. Applicant and Administrator qualifications 5. Grievances, Complaints, Community resources 6. Food service 7. Medication management 8. Application document review and technical assistance: Pre-licensing inspection, COVID19 Mitigation Plan Reportthe state’s words, verbatim · CDSS document, Jul 22, 2021