Stetson Court Living

Type of visit: Case Management - Incident

LPA Albert Johnson made an unannounced health and safety check. LPA met with Staff. LPA checked the medications, menu, food/snacks and staff /resident files. Staff confirmed that 1 resident has moved out which brings the census to 5. The residents appear to be in good health at this time and there are no immediate safety concerns. The facility does not have an activity calendar (not required for a six bed facility 87219(d)) and the residents confirmed that there are no coordinated activities, however, the residents have the option to listen to music, walk in the back yard, explore the internet on their tablets or watch television. The residents on-going or annual appraisals are written on the "Pre- appraisal form" the facility is using the wrong form to document the reappraisals. The following forms need updating and submitted to CCLD by 07/10/2023: LIC 308- Designation of Administrative Responsibility LIC 500 - Personnel Report with the Administrator hours included Exit interview conducted advisory given.the state’s words, verbatim · CDSS document, Jul 3, 2023

Type of visit: POC

LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of citations issued during the case management visit conducted on 2/21/2023 . LPA toured the facility, reviewed document submitted for plans of correction observed that the deficiency cited on 2/21/2023 has been cleared. Deficiency cited under Title 22 Regulations have been cleared. Licensee complied with the terms of the POC by POC due date. Facility was provided POC cleared letter. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 20, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Geline Artuz and explained the purpose of the visit. LPA and Staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, medication rooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in or around the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 128.5 degrees Fahrenheit in resident's bathroom sink, which is not within the required range of 105 to 120 degrees. Fire extinguishers is out of compliance (purchase date was 1/22/22) smoke detectors and carbon monoxide detector were in compliance with fire safety. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 4 resident and 2 staff files, including criminal record clearances. LPA observed during the file review 3 outdated service plans for (R1, R2 and R3) and R1 also had an outdated Physician's report. First aid kit was checked and is complete. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies were observed during this visit. Exit interview held with Administrator and a copy of report given at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 21, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202 · Plan of correction due date: Feb 22, 2023

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: This requirement is not met as evidenced by:Based on observation the licensee did not comply with the section cited above as the fire extinguisher were last purchased on Januaryof 2022 which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 21, 2023

Plan of correction: The facility will arrange for a company to service the extinguishers and will provide proof to CCL that the fire extinguishers have been serviced or a new one purchased and are in compliance.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87705(I)(8) · Plan of correction due date: Feb 22, 2023

Care of Persons with Dementia. Fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all direct care staff. LPA was able to determine the last disaster drill was conducted on 12/30/2021 this poses an immediate safety risk.the state’s words, verbatim · CDSS document, Feb 21, 2023

Plan of correction: The facility shall develop and implement a policy regarding fire drill and earthquake drill practices and procedures that include conducting fire drills at least once every three months on each shift and shall include, at a minimum, all direct care staff. Send copy of updated policy and fire drill log by POC date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5) · Plan of correction due date: Mar 9, 2023

Care of Persons with Dementia Licensees who accept and retain residents with dementia shall ensure that each resident with dementia has an annual medical assessment and a reappraisal done at least annually. LPA observed that R1 diagnosed with dementia didn't have an updated LIC 602.the state’s words, verbatim · CDSS document, Feb 21, 2023

Plan of correction: All residents diagnosed with dementia will be scheduled with their responsible physician and be assessed for any changes to their needs with an updated LIC 602. Statement of correction, with copy of updated LIC 602, to be completed and submitted into CCL by the due date.

Type of visit: Case Management - Health Checks

LPA Albert Johnson made an unannounced Safety check to the facility to verify correction of citation issued during the Annual inspection on 03/28/2022 and to follow-up on the health and safety checks. During the tour of the facility LPA observed debris on the side of the house and the files for all the residents including staff are not at the facility. LPA was able to confirm that Aida Fontanilla is not associated to this facility as of today's date. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies were observed during this visit. LPA will return to review files and complete the safety inspection/ plan of correction visit. Exit interview held with Staff. .the state’s words, verbatim · CDSS document, Jun 2, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80087(a) · Plan of correction due date: Jun 2, 2022

Buildings and Grounds - The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by: LPA observed debris on the side of the house. This poses a potential safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jun 2, 2022

Plan of correction: Administrator shall submit pictures of the removed debris on the side of the house in the fire lane. The pictures shall be sent by POC 6/15/22.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to continue the annual inspection from 3/28/22. LPA met with Geline Artuz and later joined byGAOIRAN, CHRISTIAN LPA was able to open document sent to the email address provided to verify staff information as well as the residents information for R1 and R2. During the inspection today the facility sent over information for R1 that is not dated or signed. The information for R2 is not complete and is missing the signature for the physician on the LIC 602 Physician's report. This information was cleared by Administrator. S1 is not associated to this facility. This was verified by the department's Office tech on 3/29/2022. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies were observed during this inspection. Civil penalties assessed. The 809 D page is attached to the report dated 3/28/2022 as this is a continued inspection from that date. Exit interview held with Staff.the state’s words, verbatim · CDSS document, Mar 29, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Geline Artuz and explained the purpose of the visit. LPA and Staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, medication rooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in or around the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 107.5 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA was not able to review 2 resident and 2 staff files. First aid kit was checked and is complete. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies were observed during this visit. LPA will return to review files and complete the inspection and write citations. Exit interview held with Staff.the state’s words, verbatim · CDSS document, Mar 28, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Mar 29, 2022

87355(e)(2) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline. This requirement is not met as evidenced by: Based on LPA observation and record review licensee failed to ensure S1 obtained a criminal record clearance transfer prior to starting.the state’s words, verbatim · CDSS document, Mar 28, 2022

Plan of correction: Licensee will obtain the criminal record clearance transferfor S1. Licensee has agreed to not allow said staff member or potential new hire to be present in the facility without first obtaining a criminal record clearance transfer. Licensee to review the cited regulation to ensure continued compliance. *****Immediate Civil Penalty Assessed******

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Geline Artuz and explained the purpose of the visit. LPA and Staff inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, medication rooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. There are no bodies of water present in or around the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 107.5 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. LPA reviewed 4 resident and 3 staff files, including criminal record clearances. S1 left the facility during the inspection. There is no documents for S1 and LPA was unable to identify S1. The staff on-site did not have a contact number or any other information for S1.There were other staff with limited or no information in the staff files. First aid kit was checked and is complete. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies were observed during this visit. Exit interview held with Administrator and a copy of report given at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jul 14, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87606(f)(1) · Plan of correction due date: Jul 15, 2021

Care of Bedridden Residents. To accept or retain a bedridden person, a facility shall ensure the following: The facility's Plan of Operation includes a statement of how the facility intends to meet the overall health, safety and care needs of bedridden persons. This requirement is not met as evidenced by: Record review, interviews, and observation. Facility failed to obtain proper fire clearance for (R1). R1 is unable to turn or assist with ADLs This poses and immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 14, 2021

Plan of correction: Facility shall immediately notify the fire district that they have a bedridden resident. Facility shall ensure there is staffing sufficient to accommodate transfer residents. Facility shall update the facility's Plan of Operation to address how the facility intends to meet the needs of bedridden residents in the home. R1 will have his LIC602 updated to reflect his current ambulatory status.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87463(c) · Plan of correction due date: Jul 15, 2021

87463 Reappraisals. (c) The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first This requirement is not met as evidenced by: Based on record review, the licensee failed to ensure that annual reappraisals were done for R1 last assessment was done in 2015, which poses a health risk to residents in care.the state’s words, verbatim · CDSS document, Jul 14, 2021

Plan of correction: Licensee agrees to complete updated Reappraisal and Needs and Service plan for Residents R1 and provide to CCL by FAX by 7/15/21. The facility will also provide a schedule for R1 to have has finger nails and toe nails trimmed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(b)(2) · Plan of correction due date: Jul 21, 2021

87412(b)(2) Personnel Records Health screening documents as specified in Section 87411(e). This requirement is not met as evidenced by: oberservation and records review LPA obtained information that the health screening for staff S1 was not done.the state’s words, verbatim · CDSS document, Jul 14, 2021

Plan of correction: Licensee shall submit proof of correction by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80075(f) · Plan of correction due date: Jul 21, 2021

80075(f) Health Related Services. Staff providing care and supervision shall receive first aid training from qualified agencies including but not limited to the American Red Cross. Expired First Aid and CPR for S3 proof in file.the state’s words, verbatim · CDSS document, Jul 14, 2021

Plan of correction: Administrator shall call a First AID vendor and requested a New Card or send by email proof. Administrator will send a copy of First Aid card to LPA. FAX (916) 263-4744

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c) · Plan of correction due date: Jul 21, 2021

Personnel Requirements – General. All staff who assist residents with personal activities of daily living shall receive at least ten hours of initial training within the first four weeks of employment and at least four hours annually thereafter. S1 and S2 file is missing orientation documentationthe state’s words, verbatim · CDSS document, Jul 14, 2021

Plan of correction: Licensee shall submit a written plan on how she is going to ensure all staff will have the required training before and during employment. Submitted into CCL by the due date.