Victorpaz Farmhouse

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Required 1-Year Annual Inspection and met with Administrator, Annalee Gomez. This facility submitted a mitigation plan, which was approved by community care licensing on 02/26/21, as well as the Infection Control Plan When LPA arrived at the facility they were greeted by 2 carestaff. There were 5 residents in care. At the entrance, there was a sign in sheet with a symptom check list and hand sanitizer. LPA toured the facility with staff and found the facility to be clean and comfortable and providing a cheery, homey atmosphere. Signs were posted appropriately informing the use of oxygen. Bathrooms were equipped with grab bars and non-skid rugs. Paper towels and antibacterial soap were also available in bathrooms used by residents and staff. All residents' rooms were furnished per regulation. Facility is able to isolate resident in an isolation room in the event of an outbreak. Medications are securely stored in a locked medication cart and each resident has a 30-day supply of medications. Facility is disinfected daily. Cleaning products were not accessible to residents in care. Kitchen was clean and orderly and there were perishable and non-perishable food stores as required per Title 22. Sharps were locked and inaccessible to residents. The living room had reclining chairs for the comfort of each resident while watching television, listening to music or partaking in activities together. The backyard includes a lovely covered patio for residents to enjoy the warm weather under shelter from the sun. Staff and resident records were complete and within regulation. Fire clearance is for three (3) non-ambulatory and three (3) bedbound. There were 3 fire extinguishers, last charged and inspected on June 16, 2022; fully charged. There were two (2) carbon monoxide detectors, which were tested and operational. There were seven (7) smoke detectors, which were tested and operational. There were no deficiencies found at the time of inspection. No citations cited during today's visit.the state’s words, verbatim · CDSS document, Apr 20, 2023

Allegation investigated: Resident's rates were raised without proper notice. Admission's Agreement is not being adhered to.

On 2/16/22 Licensing Program Analyst (LPA) Walters arrived unannounced to deliver findings for the above complaint allegations that Licensee, did not adhere to the admission agreement and that Licensee did not give proper notice for rate increase. LPA was greeted by staff, the Administrator, Annalee Gomez arrived later. The department received this complaint on 02/01/2022. On 02/02/2022, LPA conducted a facility visit to tour the facility and gather information. During the course of this investigation, LPA gathered resident R1’s Admission Agreement, Physician’s Report (LIC 602), Power of Attorney, Needs and Service Appraisal, Staff charting notes, hospice records, and interviewed staff. Continued on 9099 C Substantiated The investigation revealed that during a resident care meeting, Licensee, Melissa Gomez issued a verbal 30 day notice rate increase notification to the responsible party of R1, however R1’s admission agreement revealed that the facility is to issue rate increases in writing and give 60 days’ notice, unless there is an increase in the level of care that results in a rate increase. The notice must itemize the charges. R1’s records did not indicate a change of condition. Based on the information obtained during the course of the investigation through interviews, and record review a preponderance was established to SUBSTANTIATE this complaint. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and Health and Safety Code (cited on 9099-D). Appeal rights given to the Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 16, 2022 · control 21-AS-20220201133243

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Feb 21, 2022

1569.655(a) If a licensee.. increases the rates of fees for residents the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. Based on record review, the licensee did not comply with the section cited above in one of six residents which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 16, 2022

Plan of correction: Administrator to send LPA Walters a copy of the rate incerase in writing prior to issuing rate increase to residents. Administrator to submit copy by POC due date (2/21/22), attention LPA Walters.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katrina Walters arrived unannounced to conduct a Required 1-Year Annual inspection and met with Administrator, Annalee Gomez and Licensee, Melissa Gomez. This facility submitted a mitigation plan, which was approved by community care licensing on 02/26/21. This inspection will focus on the infection control of this facility. When LPA arrived at the facility they were greeted by staff. At the entrance, there was a sign in sheet with a symptom check list, disposable mask and hand sanitizer. After visitors check in they are able to visit with residents in their bedroom or designated area. LPA toured the facility with staff and observed signs posted throughout the facility to promote droplet precautions. Signs were also posted in the bathrooms on the proper hand washing technique. Paper towels and antibacterial soap were also available in bathrooms used by residents and staff. All resident's room were furnished per regulation. Facility is able to isolate resident in an isolation room in the event of an outbreak. Isolation carts are stocked with PPE and placed outside of isolation room. Facility has a 30 day supply of Personal Protective Equipment and incontinence products. Facility is disinfected daily. Cleaning products were not accessible to residents in care. Facility has a 100% vaccination rate of staff and residents. Vaccination records are stored in appropriate folders. Residents do not typically wear a mask while in the facility, but they do wear masks when in the community. Per Administrator, all staff have received infection control training, but it has not yet been documented. LPA is requesting that all staff are re-trained on infection control, and facility staff document, the hours of training. Administrator to send proof of training to CCL attention LPA Katrina Walters by 2/16/22. No citations cited during todays visit.the state’s words, verbatim · CDSS document, Feb 2, 2022