Lincoln & Pine, Willow Glen

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Administrator Ligaya Semana. LPA toured the facility inside out which included; the Living room, kitchen, dinning area, backyard patio, 2 restrooms and 5 residents bedrooms. The staff area of the facility was also inspected. Front yard and backyard were inspected. There was no obstruction to block the walkways. Two day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the locked medication cabinet, knives storage closet, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 75 degree F, and hot water temperature was measured to range from 115 to 118 degrees F in both bathrooms. Fire extinguisher was serviced in June 19th 2023. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors was tested by ADM, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on September 4,2023. LPA reviewed facility records for 3 staff and 3 residents. LPA reviewed 3 resident medications and centrally stored medication records. LPA conducted interviews with 3 staff and 3 residents. No deficiencies cited during today's visit. This report was reviewed with Administrator Ligaya Semana and a copy of the signed report was provided.the state’s words, verbatim · CDSS document, Sep 27, 2023

Allegation investigated: Resident left the facility unsupervised and sustained injuries

Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced complaint investigation to deliver findings on the above allegtaion. LPA met with facility Administrator Gladys Smart (Admin). During interview conducted with Admin on 10/15/2020, S1 confirmed that a resident (R1) had eloped from the facility on 09/27/2020. Admin stated that they believed that staff member on duty was asleep at the time of R1's elopement. Review of incident report indicated that the elopement occurred at an underermined time on 09/27/2020, but was discovered at 12:00am. R1 was found by staff 45 minutes later and returned to the facility. In review of R1's physician's report, it was determined that R1 was not permitted to leave the facility unassisted. Substantiated During tour of the facility on 10/15/2020, facility door alarms were determined to be functioning properly. LPA toured the facility and tested all the door alarms once more. All alarms were observed to be functioning properly. In review of staff training documents, it was determined that staff have received additional training regarding care for residents with dementia and wandering tendencies. In review of photographic evidence submitted by a witness and facility incident report written regarding the elopement, it is confirmed that R1 sustained a bump on their head as well as bruising around the eye during the period in which R1 was not on the premises. The Department has conducted an investigation of the above allegation. Based on interviews conducted and records review, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED. Deficiency is being cited. Civil penalty Assessed. See LIC 9099-D and LIC421IM. Exit interview conducted with Administrator Gladys Smart. A copy of this report, along with the facility's appeals rights were provided electronically due to printer error.the state’s words, verbatim · CDSS document, Feb 23, 2023 · control 26-AS-20201008163105

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4)(A) · Plan of correction due date: Feb 24, 2023

87705 - Care for Persons with Dementia - (c)(4)(A) a facility... shall have at least one night staff person awake and on duty if any resident with dementia is determined... to require awake night supervision. This requirement was not met as evidenced by: Based on interviews and records reviewed, the facility did not prevent resident elopement due to night shift staff member sleeping during his/her shift. This posed an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Feb 23, 2023

Plan of correction: POC has already been received

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Required 1 Year visit and met with Administrator Erene Bautista. During visit, LPA Marrufo toured the facility inside and out. LPA Marrufo observed there to be a perishable food supply of 2 days and a non-perishable food supply of 7 days. LPA Marrufo observed a PPE supply of 30 days. LPA Marrufo observed a visitor screening area at the entrance. LPA Marrufo toured the outside area of the facility and found the exits to be free of obstructions. No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Administrator Erene Bautista and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 10, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Nguyen conducted an unannounced Annual Required 1 Year Infection Control site visit and met with Rose Abcede, Administrator. LPA toured the facility inside and out to include but not limited to: kitchen, dining room, living room, bedrooms, bathrooms and exterior. All fire exit routes were free and clear of obstructions. Medications are stored in a locked cabinet. Toxins, cleaning supplies, knives and sharp objects are secured. Interior temperature 75 degrees Fahrenheit. In the kitchen LPA observed a minimum of 3 day perishable food supply and 7 day non perishable food supply. Facility observed to have designated entry point for universal symptom screening. Administrator will conduct in house staff training on visitor screening protocols. All restrooms observed to be supplied with hygiene products. Hand washing signs were posted in bathrooms. Hand sanitizer available to residents. Facility observed to have adequate supply of Personal Protective Equipment (PPE). Staff observed wearing masks. LPA reviewed the facility policies and procedures to include screening, isolation, disinfecting, staffing, training, supplies, PPE usage and social distancing. No citations were issued per the California Code of Regulations, Title 22. LPA reviewed report with Rose Abcede, Administrator and a copy provided,the state’s words, verbatim · CDSS document, Nov 15, 2021