Baywood Manor RCFE II

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst's (LPA's) De Leon and Chavez conducted a Case Management Annual Continuation to the facility above. LPA met with Wildfred Pacaoan, Licensee and explained the purpose of the visit. LPA's reviewed 4 staff files all required forms were present, Personnel Record, 1st Aid & CPR, Fingerprint clearance and associations, Criminal Records Clearance, and Health screening with TB results. LPA's reviewed Staff Training Records, all training records were present with a total of 18 hours completed and missing 2 hours annually covering hospice care and psycho-tropic medication which is required. LPA's reviewed 4 residents medications, medication reviewed were current on the CSMDR and MAR for 3 residents in care. One resident had a wrong expiration date on the CSMDR and 1 medication was not written on the MAR as prescribed by the physician. Staff corrected both CSMDR and MAR errors on visit. Exit interview conducted, Deficiency cited, Technical Violations issued, copy of report and appeal rights issued to Administrator.the state’s words, verbatim · CDSS document, Mar 29, 2023

The state marks this report as 36 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst’s (LPA’s) De Leon and Chavez arrived at 9:45 am and made an unannounced 1-year required annual visit to the facility above. LPA’s met with Wilfred Pacaoan, Licensee and explained the purpose of the visit. LPA’s requested a staff roster, a resident roster, emergency disaster plan, documentation of quarterly emergency drills. LPA’s provided administrator the entrance checklist and asked for a physical plant tour. A tour of the physical plant was assessed, and the following was noted: LPA observed the license posted, personal rights, LTCO poster, CCL Complaint poster and covid signs. The facility has 3 bedrooms with 2 bathrooms, kitchen, living room, dining room, laundry room, medications locked in files in living room, covered patio with chairs for resident outside use. Physical plant was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked, and all were in good condition. The facility maintains a comfortable temperature. The facility provides working telephones and on-line communication for resident use. The smoke detectors are hard wired, tested and working properly. The carbon monoxide detector was tested and operational. Fire extinguishers were last inspected 08/19/2022 and all show charged in the green. There are no issues with Fire Clearance. Living and dining rooms furniture were also checked for functionality and condition. The living rooms was clean, safe and sanitary along with the dining rooms. There are no bodies of water on the premises. The facility had buckets of water that LPA requested to be emptied. There is plenty of lighting available for the safety of the residents. The kitchen area was sufficiently stocked with two-day perishable and seven-day non-perishables. The following needed cleaning kitchen oven, stove, cupboards. The facility did not have a sample menu to review. Snacks and beverages are available for residents in the facility when they want. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers. The kitchen has two unlocked gates making the stove in accessible to dementia residents in care. The Resident rooms have beds with sheets, pillowcase, mattress pad, and blankets which are in good condition. There is at least one chair, nightstand and enough lighting for each resident. Residents arranged the rooms the way they want them. There is enough linen available to change weekly or more if need. The bathrooms were checked for cleanliness and proper operation. The hot water temperature measured at 116.3 F in bathroom #1 and bathroom #2 at 120.0 F. Towels and washcloths are not shared. Residents have a sufficient amount of supplies for personal hygiene. Soap and Toilet paper are provided by the Licensee. Grab bars are secured in toilet and shower areas. Showers have non-slip mats. Resident records were reviewed for requirements and legibility: LPA reviewed 4 resident’s files for current Medical Assessments with TB results, Current Appraisal Needs and Service plans which were not updated, signed Admission Agreements, consent forms, and immunization records. Planned activities are offered to residents in care. Infection control was evaluated and facility is in compliance. The facility needs to fix outside gates to be self- closing and self latching, a gate needs to be added between the deck and fence on the side of the home to make the very back yard inaccessible to residents s it is used for storage. Facility sketch will need to be updated for legibility of licensed areas, staff office is no longer used for that purpose and has been designated for staff area. Hall closet and garage door needs to be kept locked inaccessible to dementia residents as cleaning supplies are stored in it. The facility has recently painted and new vents need to be hung back up. The outside yards need to be cleaned up and tools moved to storage area inaccessible to dementia residents. LPA's will return at a later date to review staff files, medications, staff training and interviews of staff and residents to complete the annual. Exit interview conducted, Technical Violations issued, and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Mar 8, 2023

The state marks this report as 36 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon conducted an on site 1 year infection control annual visit to the facility above on 05/05/2022 at 10:12 AM. LPA met with Licensee Eddie Pacaoan and explained the purpose of the visit. LPA took a physical plant tour of the facility with Licensee. The facility has submitted a mitigation plan to the department and it has been approved. The facility has an entry point at the front door where everyone entering completes sign-in, temperature and symptom check. All documentation is kept in binders. The entry station has hand sanitizer along with a thermometer. The facility has a living room to accommodate activities, a dining room for dining, all areas are spaced to accommodate as much space as possible for social distancing. All equipment and PPE supplies are kept in closet. Medications are kept in a locked medication filing cabinets in the living area. The staff screen residents for symptoms and temperature 1x's a day and documentation is kept on file. Increased monitoring is conducted if any change of condition are noted or any residents are showing any signs, symptoms or has a temperature. Signs are posted on the front door, entry area and walls in common areas regarding Covid-19. Staff makes sure residents have a mask when leaving the facility on outings into the community. All staff wear face coverings in the facility and when on outings with residents. Facility have areas for visiting inside and outside. The facility also offers virtual and telephone communications to all residents in care. Staff, residents and visitors are informed of the facilities infection control policies. New residents and staff will be tested and negative results received before working or residing in the facility. The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed. Continued 809-C Emergency Disaster plan is posted and all agencies with telephone numbers are listed. Administrator is in charge of infection control and provides training and education to staff, residents and visitors. Administrator is in charge of staffing and works on any issues or additional coverage when needed. If any suspected or confirmed cases of Covid-19 are found in the facility a staff will be assigned, Staff will use full PPE with N95 masks and face shields when dealing with any pending or confirmed cases of Covid-19. Facility is able to dedicate a single room for resident so isolation can be arranged when and if needed. The facility has one shared room. The facility has 3 resident bedrooms and 2 resident bathrooms and they are disinfected after use. Precautionary Droplet signs will be posted on any room with quarantine or isolated individuals. PPE supplies will be located right outside those rooms when required. Facility has a 30 day supply of PPE on hand. Facility has plans for delivering medications and meals to any quarantined/isolation resident room. The facility has proper cleaning and disinfectant sprays. Facility Administrator has a plan in place for when and whom to notify in an outbreak or other emergencies. Administrator will keep a line list of all vaccinated and tested staff/residents in care with dates/results. Facility has conducted training on infection prevention, symptoms, transmission and PPE use. Facility has non-punitive sick leave polices for staff. Sick staff are requested to stay home and not report to work if ill. Activities have been modified to individuals or small groups with social distancing. Residents medication is delivered in 30 day supplies to the facility. The facility ensures proper cleaning is done on frequently touched surfaces and between any individuals sharing of space or items. Sinks were stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in locked filing cabinets in living area. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. The most stringent orders should be followed by any of these agencies. Administrator Certificates is valid. Fire extinguishers are charged and inspected annually. Smoke alarms are hard wired throughout the facility. Carbon Monoxide monitor is present in the hallway. No deficiencies observed during the visit and all infection control protocols are implemented and are being followed. Exit interview completed and copy of report emailed to Administrator/Licensee.the state’s words, verbatim · CDSS document, May 5, 2022