A Heavenly Home

Type of visit: Required - 1 Year

At 9:15am on 06/01/2023, Licensing Program Analyst (LPA) Mark Jeffries arrived unannounced to the facility to conduct the annual inspection. LPA met with Administrator Jennifer Jimenez, Marco Jimenez, additional Administrators Karla Sanchez and Clementina Garcia. LPA announced who he was and the reason for the visit. Administrator, staff and LPA conducted a physical tour of the facility. This facility is 4 bedroom and 2 shared bathroom facility. There is a locked room which contains a medication cart that is locked, a small refrigerator that has a pad lock and the facilities first aide kit. LPA observed resident bedroom to all have appropriate linin, lighting and storage. LPA observed there to be at least 2 days of perishable foods and at least 7 days of non perishable foods on hand. LPA noted that all meals are stored cooked and prepared at adjacent facility on the campus property. LPA observed all required postings and emergency disaster plan. LPA observed that smoke detectors are also all carbon monoxide detectors as well and are all hardwired throughout the facility. LPA observed a working fire extinguisher currently tagged and in the green pressure range. LPA noted that the facility is clean and in good repair, all exits are clear and free of all hazards. LPA conducted a medication audit and found that Centrally Stored Medication Record (CSMR) to be missing entries. Facility Administrator assigned a staff to correct the entries during this inspection. Administrator will email a completed CSMR by 5pm on 06/02/2023. LPA did not find any other violations, technical or citations during the physical tour walk through. Administrator, staff and LPA conducted the read through of all the care tool modules. LPA noted that a technical violation was issued and corrected during the inspection for the CSMR. LPA noted that there were no other citations, violations, or technical issued during the control module. LPA conducted 4 of 4 staff interviews, however that staff interview tab was not functioning at time of inspection. Exit interview, Technical violation issued and corrected, report read, and report provided.the state’s words, verbatim · CDSS document, Jun 1, 2023

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At 10:40am on 07/26/2022, Licensing Program Analyst (LPA) Jeffries arrived at that facility to conduct and unannounced annual infection control inspection. LPA was met at the front door by staff and asked to screen for COVID-19 protocols. LPA met with Administrator Clementina Garcia and announced the reason for the visit. Administrator and LPA conducted a physical tour of the facility. The facility is a 4 bedroom, 2 bathroom, kitchen, living room and laundry room set up, medication cart is locked in the laundry room. LPA observed working fire/carbon-monoxide detectors in each room in working order. LPA observed at least two days of non perishable and seven days of perishable foods at this facility. LPA noted that there are 4 additional sister facilities on the same campus and all meals are prepared at facility 405802304 and brought to each of the five facilities for each meal. All staff have a single entry point at facility 405802302 and each facility has a single entry point of all residence and visitors at the front door. LPA observed an ample supply of PPE located in the garage of the facility and additional PPE is located on the campus in the other facilities. Administrator and LPA conducted the infection control module of the annual inspection tool. LPA did not find any violations or deficiencies during the infection control module. At this time there are no violations or deficiencies cited. Exit interview, report singed, and repot emailed.the state’s words, verbatim · CDSS document, Jul 26, 2022

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At 10:40am on 07/26/2022, Licensing Program Analyst (LPA) Jeffries arrived at that facility to conduct and unannounced annual infection control inspection. LPA was met at the front door by staff and asked to screen for COVID-19 protocols. LPA met with Administrator Clementina Garcia and announced the reason for the visit. Administrator and LPA conducted a physical tour of the facility. The facility is a 4 bedroom, 2 bathroom, kitchen, living room and laundry room set up, medication cart is locked in the laundry room. LPA observed working fire/carbon-monoxide detectors in each room in working order. LPA observed at least two days of non perishable and seven days of perishable foods at this facility. LPA noted that there are 4 additional sister facilities on the same campus and all meals are prepared at facility 405802304 and brought to each of the five facilities for each meal. All staff have a single entry point at facility 405802302 and each facility has a single entry point of all residence and visitors at the front door. LPA observed an ample supply of PPE located in the garage of the facility and additional PPE is located on the campus in the other facilities. Administrator and LPA conducted the infection control module of the annual inspection tool. LPA did not find any violations or deficiencies during the infection control module. At this time there are no violations or deficiencies cited. Exit interview, report singed, and repot emailed.the state’s words, verbatim · CDSS document, Jul 26, 2022

Allegation investigated: Masking protocols are not being followed.

Licensing Program Analyst (LPA) Olson conducted an unannounced 10-day complaint investigation visit to the facility above. LPA entered the facility at 12:15 PM and observed staff with mask not properly covering their nose. After opening the door staff pulled up their mask to properly cover their nose. A minute later a second staff entered through the back door with mask around their chin and waited to put it on properly until they stepped inside of the facility. LPA spoke with Administrator Jennifer Jimnez over the telephone and explained the purpose of the visit. Administrator sent Karla Sanchez who is a backup administor to the facility. LPA explained the purpose of the visit and toured the facility with Karla at 12:30PM. Continued on 9099-C Substantiated LPA interviewed staff regarding the allegation. Administrator interview revealed that staff always wear masks in the facility. Administrator stated over the phone that after the witness reported staff was not wearing a mask the staff was given a write up and masks were immediately brought over. Staff 1 (S1) stated that most staff have a mask on them but need reminders to wear it properly. S1 stated that there is proper PPE in multiple places throughout the facility. Staff 2 (S2) stated that they were aware of the masking policies and where masks were located. A credible witness (W1) stated on 3/30/2022, W1 observed a staff who was not wearing a mask and staff stated to them that there were no masks in the facility. LPA interviews revealed that in fact there were masks in the facility but in a location they were not aware of. Administrator Karla stated that when staff clock in there are always masks there in the office and they were in stock that day. Based on LPA observation, interviews, and the credible witness statement this allegation is deemed Substantiated at this time. The facility failed to protect the personal rights of residents in care to be able to receive safe and healthful accommodations, in that the facility staff failed to wear face coverings properly while providing care and supervision to residents in care. This is a violation of official government orders requiring the wearing of face coverings while working under specified conditions. Exit interview conducted, deficiency cited, copy of report and appeal rights emailed to Licensee/Administrator.the state’s words, verbatim · CDSS document, Apr 6, 2022 · control 29-AS-20220401105621

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: Apr 6, 2022

87468.1 Personal Rights of Residents in All Facilities ...To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on credible witness and LPA observation, the licensee did not ensure staff were wearing face masks in the facility, which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 6, 2022

Plan of correction: Administrator has agreed to immediately notify all staff to wear masks at all times in the facility. Administrator agreed to hold training with all staff about proper mask-wearing and COVID-19 prevention protocol, and provide training records to CCL by 4/7/2022.