Rodelou Care Home

Type of visit: Required - 1 Year

On 7/20/2023, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Licensee, Delia Ulbata. The facility is licensed for 10 non-ambulatory residents and a hospice waiver capacity of 2. The facility currently provides care for 7 residents. In addition, there is 1 resident that is receiving hospice services and none of which with a diagnosis of dementia. LPA arrived at the facility and observed appropriate signage for COVID protocols and client personal rights posted. LPA continued with a tour of the facility with Licensee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be last charged on 2/7/2023 at the time of visit. The facility has installed new interconnected smoke detectors which were tested and found to be in working order. Carbon monoxide detector located in the hallway was also tested and found to be functioning. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in the facility laundry room. Sharps and other kitchen supplies that could pose danger if available to residents were found secured in the kitchen cabinet. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Water was measured at faucets accessible to residents and measured between 112.8 and 116.9 degrees F which is within regulation. LPA reviewed facility files and found liability insurance updated. LPA observed appropriate evacuation map located in the front room of the facility. Fire drills are also conducted every 3 months, are recorded and signed off by staff and residents. Continued onto LIC809-C Medications located in designated cabinet and were found to be secured. LPA also observed refrigerated mediation to be locked in a separate refrigerator. LPA conducted a review of medication records and found all administering records to be in order. Facility receives medication deliveries direct from pharmacy or picked up by Licensee. During the review, LPA observed medications for residents (R6 & R7) that receive multiple prescriptions to be prepared under a 24 hour period but for the upcoming shifts. LPA explained to Licensee that prescriptions are not to be transferred between containers. Licensee will be reaching out to R6 & R7's physicians to request for guidance and an order on preparing medications prior to administering. Licensee to provide update to CCLD and will be administering medications directly until physician's orders are granted. LPA provided Technical Advisory. Residents were observed interacting with staff in the common area, watching television, interacting with staff or meeting with visitors for leisure. The exit located in the backyard was found to be unobstructed. All auditory alarms leading out of the facility were tested and found to be in working order. LPA conducted a sample file review for staff and found all staff to have appropriate 1st Aid & CPR certification on file. Upon review of records, LPA found that all staff are in need of their annual training to be updated. LPA also conducted a file review for all residents. Upon review, LPA found that residents (R2, R3, R5, R6 & R7) require an updated Needs & Service Plan completed. There have not been any major changes of condition. Technical Violation Issued. Administrator prepared forms during the visit and will be working with residents and conservators to update. Delia Ulbata 6035695740 Administrator Certification application and payment was received by the Department and confirmed on 5/16/2023. LPA requested the following documents be sent to CCL by COB 8/20/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Liability Insurance Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Jul 20, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tobola conducted an unannounced Required 1 year inspection to Rodelou Care Home and met with Administrator, Delia Ulbata. Staff and Administrator were observed to be wearing masks during facility tour. Facility provides care for 9 residents some of which with a diagnosis of dementia. LPA continued with a tour of the facility with the Administrator. The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Client’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on January, 26 2022 at the time of the visit. Facility smoke detectors and carbon monoxide were found to be functioning properly. There was a ample supply of both perishable and nonperishable foods as required by Title 22 Regulations. LPA observed outdoor storage unlocked containing cleaning supplies and a pair of gardening sheers located outside of the shed accessible to residents in care. Gardening sheers were immediately removed and placed in the outdoor shed and new padlock was put in place. There was a supply of cleaners, hygiene products and paper products available for clients. The bathroom designated for clients at the facility were supplied with individual paper towels; hand soap dispenser was available. LPA also observed spider webs along the corner of the ceilings in the resident restroom and in resident bedrooms. Upon review of staff records LPA found that 2 out of 3 staff do not have 1st Aid & CPR training. Facility has submitted infection control plan for review. Posters have been placed at entrance, and facility entrance area has a designated area to screen visitors, thermometer and other items designated for visitors and staff before coming into work. Staff and residents are being monitored daily for symptoms and temperature. Facility has PPE supplies stored in a designated location. Facility has a 30-day supply of medication for residents. Continued onto LIC809-C LPA requested the following documents be sent to CCL by COB 9/1/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate(s) Copy of Certificate of Liability Insurance Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Due to printer technical issues LPA provided copy of electronic report to Administrator. Appeal Rights Given.the state’s words, verbatim · CDSS document, Jul 22, 2022

Type of visit: Case Management - Other

On 5/5/2022 LPA Tobola conducted an unannounced Case Management visit and was greeted by Licensee, Delia Ulbata. The purpose of the visit is to follow up on a self reported AWOL for resident (R1). The Licensee stated that on 4/23/2022 R1 contacted an outside party to be picked up and taken to R1's home in American Canyon. Licensee contacted Vallejo Police Department who located R1 at the American Canyon home. R1 refused to return to the facility from Licensee and Vallejo Police Department request. R1's Power of Attorney had also been notified since 4/23/2022. LPA conducted interview with Licensee and provided technical assistance regarding the case. In addition LPA gathered resident R1 documents for review. Licensee will be contacting Adult Protective Services. Licensee submitted Unusual Incident Report to CCL Regional Office and provided LPA with a copy of the report. No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, May 5, 2022

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Lopez and Tobola conducted an unannounced Required 1 year inspection to Rodelou Care Home and met with Administrator Delia Ulbata. LPAs called the facility to conduct a risk assessment call prior to visit. Staff and Administrator were observed to be wearing masks during facility tour. Facility provides care for 6 residents some of which with a diagnosis of dementia. LPAs toured the facility on July 26th, 2021. The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Client’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on February 16, 2021 at the time of the visit. Facility smoke detectors and carbon monoxide were found to be functioning properly. There was a ample supply of both perishable and nonperishable foods as required by Title 22 Regulations. LPAs observed Resident R1's blood test kit sharps container in R1's bedroom and two gardening sheers located in the backyard accessible to residents in care. The blood test kit sharps were removed from R1's bedroom and placed in the medicine cabinet. Gardening sheers were immediately removed and placed in locked closet located in the laundry room. There was a supply of cleaners, hygiene products and paper products available for clients. The bathroom designated for clients at the facility were supplied with individual paper towels; hand soap dispenser was available. LPAs observed razor blades in an unsecured shower room accessible to clients with dementia. Shower room was immediately locked. In addition, LPA's observed a box of over the counter medications located in Resident R2's bedroom accessible to residents with dementia which were immediately removed. LPA's also observed 3 disarmed auditory alarms located in R2's bedroom, backyard and front doors. Facility has submitted a mitigation program plan and LPAs reviewed at the time of visit. Posters have been placed at entrance, and facility entrance area has a designated area to screen visitors, thermometer and other items designated for visitors and staff before coming into work. Staff and residents are being monitored 1x/day and results are documented in a binder for each month. Facility has PPE supplies stored in a designated location. Facility has a 30-day supply of medication for residents. Residents do not typically wear masks inside the facility but have them available. Facility has conducted staff training on infection control. No deficiencies observed or cited during today's Required 1- Year inspection.the state’s words, verbatim · CDSS document, Jul 26, 2021

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.