Home Sweet Home for the Elderly

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 11/08/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator Sarah Suzara who was briefly interviewed at this time. Current census was 5 residents. It was learned that (1) resident was out of the home at the local hospital at this time. It was learned that there weren't any residents under the care of hospice at this time. It was learned that there weren't any residents under the care of home health at this time. A tour of this facility was conducted. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Sarah Suzra. Additional forms and documents were reviewed to make sure that the renewal process was initiated prior to the certificate expiration date of 011/15/2023 with certificate # 6005038740. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe an additional food storage unit which was present and functional at this time in the garage area. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in the facility kitchen cabinet, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility designated Administrator at this time. This medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restrooms was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperature was taken and measured to make sure that it was within the allowed range of 105-120 degrees. Linen closet, located in the hallway, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Garage area was toured. This area housed additional furniture and supplies for the facility residents. Laundry area was toured. Cabinets storing detergents and bleach were observed to be locked and made inaccessible to the residents at this time. Fire extinguisher, located in facility kitchen area, was observed to have been annually purchased on 03/20/2023 by the local hardware store and in compliance at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gate, and exits was conducted. A review of (5) facility resident records was conducted. A review of (3) facility staff records was conducted. The following forms and documents 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, Nov 8, 2023

Type of visit: POC

The following deficiencies, initially cited during a visit on 05/18/2023, have been cleared:the state’s words, verbatim · CDSS document, May 26, 2023

Allegation investigated: Resident eloped from facility due to lack of supervision Staff blocked resident's door with a couch

Based on the interview with the Administrator, R1 did leave the facility and was missing for an unknown amount of time on 3/12/2023. R1 was brought back to the facility by the local Paramedics at approximately 6:45am on 3/13/2023 The Administrator stated that R1 was unable to speak English and was having a difficult time developing relationships with her peers. She also stated that R1 was having problems sleeping and would be awake until 2:30am or later. On 3/12/2023 R1 went AWOL from the facility and was missing until she was returned by the local Paramedics on 3/13/2023. Staff was sleeping when R1 went missing. The Administrator confirmed that they used the couch to block R1 into her room as a last resort to keep her and the other residents from having physical confrontations. Continued Substantiated Based on interview with the Administrator and review of records the above allegations were SUBSTANTIATED meaning that there was a preponderance of evidence to prove that the allegations occurred as alleged. The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with facility representative and a copy of this report was provided along with appeal rights.the state’s words, verbatim · CDSS document, May 18, 2023 · control 27-AS-20230405142636

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: May 19, 2023

87411(a)- Personnel Requirements - General-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.-This requirement is not met by interviews conducted and records review R-1 AWOL'd from the facility. The LIC 602 states the resident was not allowed to leave the facility unassisted. This presents an immediate health and safety risk to the resident in care.the state’s words, verbatim · CDSS document, May 18, 2023

Plan of correction: The facility shall conduct an in-service training with staff to go over what and how staff shall ensure that residents do not AWOL. Administrator shall send the in-service training materials, plan on how staff will ensure residents do not AWOL and a signature sheet of all staff who attended. The Administrator will email the date of the in-service training to LPA by 05/19/23 to meet the 24 hour POC requirement.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: May 26, 2023

87468.1 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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. R1 was blocked in the room by a couch. Although it was to prevent a confrontation and used as a last resort. It was a rights violation.the state’s words, verbatim · CDSS document, May 18, 2023

Plan of correction: The facility administrator will ensure that all staff receive in-service training regarding the personal rights of the clients and proof of this training will be submitted to CCL by the POC due date.

Type of visit: Required - 1 Year

On 10/17/2022 at 1:15pm, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual infection control visit. LPA Pascua was greeted by staff member, Shirley Callorina and was asked to call the Administrator, Sarah Suzara to let her know that licensing was present at this time. Upon arrival the LPA observed a centralized screening point equipped with hand sanitizer and masks. Shortly after, LPA Pascua met with Administrator Suzara explained the purpose of the visit. The purpose of the visit is to conduct an annual infection control visit. This facility is licensed for 6 residents, two of which may be non-ambulatory. The administrator has an active certificate #6005038740 and expires on 11/15/2023. Current census was 6. At 1:25pm, LPA Pascua initiated a tour with Administrator Suzara. At 1:25pm, LPA Pascua toured the laundry room and garage. Washer and Dryer were observed to be in good repair. A linen closet was identified in the garage and was observed to be a sufficient amount of linens for 6 residents at this time. LPA observed toxins, laundry detergent and other supplies to be in locked cabinets located in the garage and made inaccessible to the residents in care. At 1:30pm, LPA Pascua toured the kitchen. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food supply. Kitchen cabinets, appliances, and sink were observed to be in good repair. LPA observed knives to be located in a closet located in the hallway next to the kitchen. A fire extinguisher located in the kitchen was observed to be purchased on 03/07/2022. At 1:35pm, LPA Pascua toured the dining room and living room. Windows, blinds, and screens were in good repair. Furniture and furnishings intended for resident use were observed to be in maintained and in good repair. At 1:40pm-1:55pm, LPA Pascua toured 4 shared resident bedrooms. Resident furniture was observed to be sufficient to meet their needs at this time. At 2:00pm, LPA toured two resident bathrooms. Hot water temperature was measured to be 112 degrees. Grab bars were observed to be stable and in good repair at this time. At 2:05pm, LPA Pascua toured the exterior of the physical plant. Perimeter fence was observed to be stable and gates were in good repair. At 2:10-2:25pm, LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with the Administrator Suzara, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. The following forms and documents were requested to be updated and submitted into CCL -LIC 308 -LIC 400 -LIC 500 -LIC 610 As a result of this visit, no deficiencies were observed or cited during this annual visit. An exit interview was conducted and copy of the 809 and 809-C was provided to Administrator Suzara.the state’s words, verbatim · CDSS document, Oct 17, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arlene Garcia conducted an unannounced annual / Infection Control visit on this date. LPA met with Sarah Suzara, Administrator. LPA and AD, inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, and dining/ living room areas. LPA observed front yard and back yard free and clear of debris. LPA observed sufficient 7 days non-perishable and 2 days perishable food supplies.. Hot water temperature measured 114.6 degrees in residents bathroom. Last Fire Drill conduced dated 6/16/21. Fire extinguisher maintained 2/22//2021. Fire alarm and carbon monoxide functional. LPA observed sharps and toxins locked. LPA and AD observed centrally stored medications. LPA reviewed 3 staff and 4 resident files. Resident emergency contact complete. LPA observed all staff files complete. Administrator Certificate valid until 11/15/2021. All persons in facility fully vaccinated. LPA observed 30 days PPE supply. Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies are being cited today in violation of California Code of Regulations. Exit interview held with AD and a copy of report given .the state’s words, verbatim · CDSS document, Nov 9, 2021