Casa Cambria Way

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection at the facility. LPA met with Asel Dzheentaeva. Entrance Interview Conducted: The facility is a one-story Residential Care Facility for the Elderly (RCFE). The facility has been approved for six non-ambulatory residents of which two may be bedridden and maintains a hospice waiver for six residents. There are currently 6 residents residing in the facility. Upon arrival, there were five residents in care with two caregivers and one administrator on duty. Four residents are currently on hospice. The facility consists of a living room, dining area, kitchen, and five bedrooms. Upon entrance, there is a walkway leading to the front door and garden areas. The front porch has a covered patio with available seating. The facility has a locked garage used for storage including the facility’s commercial generator. There are no fountains or bodies of water. The entrance into the residence leads into the common living area from a hallway. The kitchen consists of a refrigerator, microwave, sink, stove, oven, dishwasher, and a toaster. Trash and recycling bins are kept in a pullout drawer. All required CCL posters and signage are posted near the entrance and in the hallway. Personnel files, Residents’ files, and medications are kept in locked cabinets in the kitchen area. All files and medications are inaccessible to residents in care. Sharps are kept in a locked kitchen drawer and inaccessible to residents in care. Perishable foods for 2 days and non-perishable foods for 7 days are kept on hand for the residents. The living room and dining area are furnished with adequate furnishings to sustain a capacity of six residents. First aid kits and a locked first aid supply cabinet are kept in the built-in locked cabinets located in the hallway. Bedroom 1 is a shared bedroom with a shared private bath. Bedrooms 2 and 3 are private bedrooms with private bathrooms. Bedrooms 4 and 5 are private bedrooms and share a bathroom off the hallway. Each bathroom has a sink, commode, and showers with grab bars. Please continue to 809-C, Pg 2. Bedroom 1 is a shared bedroom with a shared private bath. Bedrooms 2 and 3 are private bedrooms with private bathrooms. Bedrooms 4 and 5 are private bedrooms and share a bathroom off the hallway. Each bathroom has a sink, commode, and showers with grab bars. Bedrooms 1 and 5 have been designated as bedridden bedrooms. Each bedridden bedroom has an exit/entrance door leading to the outdoor areas. Each exit/entrance door has a functioning door alarm. Each resident’s bedroom has a bed, mattress, night stand, chair, dresser, closet, and a motion detector for movement. Overhead lighting and lamps on the night stands provide sufficient lighting in each bedroom. Hallways have night lights and ample lighting. The laundry area and storage area for cleaning agents and chemicals is located in the locked garage. The backyard consists of an umbrella, fenced, patio area with chairs and tables. The patio has built-in garden planters and walkways. The trash, recycling, and green waste cans are standardized cans located outside the facility. There is a hard-wired dual carbon monoxide detector and smoke alarm system in every room and every hallway. There are three fire extinguishers that were serviced on 2/22/2023.The fire extinguishers are located near the common area close to the bedrooms, kitchen, hallway, and in the garage. LPA observed the facility’s comfortable room temperature at 12:45 pm. Residents’ records, personnel documents and records of confidentiality are kept in a locked closet located in the kitchen area. Residents participate at will in various activities based on their individual interests and preferences, including bird watching, musical activities, games (Dominoes, Bingo, and many others). Exercise classes on the premises are provided for the residents that include physical therapy, music, and singing. Outdoor activities, when permitted, include bird watching, socializing, leisure drives and walks, and outside exercise. Volunteers from community organizations will assist residents in reading, arts and crafts activities, games, and seasonal celebrations. Administrator’s certificate is current. All staff have received a criminal background clearance and are associated to the facility. Exit interview conducted. No deficiencies noted; no citations issued. Report issued at the time of the visit.the state’s words, verbatim · CDSS document, Oct 20, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cortez conducted an on-site 1-year infection control annual visit to the facility above on 10/14/2022 around 11:10 AM. LPA met with Armando, Staff who notified Administrator. Administrator, Asel Telman, arrived 11:15 AM and explained the purpose of the visit. LPA then took a physical plant tour of the facility with Administrator. The facility has an entry point at the front door where everyone entering completes sign-in, symptom questionnaire and temperature screening on all staff and visitors wanting to come into the facility. The entry station has hand sanitizer along with a thermometer. The staff screen residents for symptoms and temperature at least once a day and documentation is kept on file. Increased monitoring is conducted if any change of condition is noted or any residents are showing any signs, symptoms, or a temperature. Signs are posted on the front door, entry area 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 has 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. The Administrator is in charge of infection control and provides training and education to staff, residents and visitors. Continued on 809-C Staff will use full PPE with N95 masks and face shields when around with any pending or confirmed cases of Covid-19. Facility is able to dedicate a single room for residents so isolation can be arranged when and if needed. The facility contains 4 single rooms and 1 shared room. Restrooms that are shared and in private rooms are disinfected and wiped down daily. 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 rooms. 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. 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 well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in locked cabinets. 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. Administrator Certificate is valid. Fire extinguishers were charged and inspected annually. At approximately 11:45 AM, LPA reviewed Department of Social Services, Community Care Licensing Division, Licensing Information System (LIS), Facility Personnel and facility staff roster and determined that all staff are fingerprint cleared and associated to the facility All infection control protocols are implemented and are being followed. Exit interview completed and copy of report emailed to Administratorthe state’s words, verbatim · CDSS document, Oct 14, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kristin Kontilis conducted an announced pre-licensing visit to the facility. LPA met with Asel Dzheentaeva and Anton Zamyatin, Co-Administrators. LPA arrived at 1:35 pm. Entrance Interview Conducted: This is a one-story home which will be licensed as a Residential Care Facility for the Elderly (RCFE). LPA toured facility with Co-Administrators. There are currently 6 residents residing in the facility. Three residents are on hospice. Upon arrival, there were two caregivers and three administrators on duty. The facility has a fire clearance for 2 bedridden residents and four (4) non-ambulatory residents and consists of a living room, dining area, kitchen, and five bedrooms. A hospice waiver for 5 residents has been requested. Upon entrance of the residence, there is a walkway leading to the front door and garden areas. The front part of the house has a covered patio with available seating. The facility has a locked garage used for storage including the facility’s commercial generator. There are no fountains or bodies of water. The entrance into the residence leads into the common living area from a hallway. The kitchen consists of a refrigerator, microwave, sink, stove, oven, dishwasher, and a toaster. Trash and recycling bins are kept in a pullout drawer. All required CCL posters and signage are posted near the entrance and in the hallway. Personnel files, Residents’ files, and medications are kept in locked cabinets in the kitchen area. All files and medications are inaccessible to residents in care. Sharps are kept in a locked kitchen drawer and inaccessible to residents in care. Perishable foods for 2 days and non-perishable foods for 7 days are kept on hand for the residents. The living room and dining area are furnished with adequate furnishings to sustain a capacity of six residents. First aid kits and a locked first aid supply cabinet are kept in the built-in locked cabinets located in the hallway. Please continue to 809-C, Pg 2. Bedroom 1 is a shared bedroom with a shared private bath. Bedrooms 2 and 3 are private bedrooms with private bathrooms. Bedrooms 4 and 5 are private bedrooms and share a bathroom off the hallway. Each bathroom has a sink, commode, and showers with grab bars. Bedrooms 1 and 5 have exit/entrance doors leading to the outdoor areas. Each exit/entrance door has a functioning door alarm. Each resident’s bedroom has a bed, mattress, night stand, chair, dresser, and closet. Overhead lighting and lamps on the night stands provide sufficient lighting in each bedroom. Hallways have night lights and ample lighting. The laundry area and storage area for cleaning agents and chemicals is located off the second hallway. The backyard consists of a covered, fenced, patio area with chairs and tables. The patio has built-in garden planters and walkways. The trash, recycling, and green waste cans are standardized cans located outside the facility. Each side of the residence has locked gates that are inaccessible to residents in care. There is a hard-wired dual carbon monoxide detector and smoke alarm system in every room and every hallway. There are three fire extinguishers that were serviced on 2/3/2021.The fire extinguishers are located near the common area close to the bedrooms, kitchen, hallway, and in the garage. LPA observed the facility’s comfortable room temperature at 12:45 pm. Residents’ records, personnel documents and records of confidentiality are kept in a locked closet located in the kitchen area. Residents will participate in various activities based on their individual interests and preferences, including reading, playing games (Dominoes, Bingo, and many others). Exercise classes on the premises are provided for the residents that include “Gentle Movement” (dancing with exercise), music, and singing. Outdoor activities, when permitted, include socializing, leisure walks, outside exercise, musical activities, and dancing. Visitors from community organizations will assist residents in arts and crafts activities, games, and seasonal celebrations. Per LPA's observation, physical plant is compliant to Title 22 Regulations at this time. Exit interview conducted. Copy of report issued via email.the state’s words, verbatim · CDSS document, Oct 11, 2021