Providence Home of Aragon

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management-Legal/Non-compliance Inspection and met with Renato "June" Yamat, Administrator. LPA conducted a walk-through of the facility, that was found at a comfortable temperature with all exits free from obstruction. This facility was placed on non-compliance on May 1, 2023 for a one-year term. The refrigerator was observed with plenty of food that was stored properly and in good condition. LPA went over compliance plan and reminded facility of the below agreement of 5/1/2023 between Community Care Licensing (CCL) and Facility, Providence Home of Aragon. Facility agrees to provide quarterly financial documents for the month of August/September/October 2023 by November 17,2023. Records for November/December 2023 and January of 2024 by February 16, 2024, and February/March/April 2024 by May 17, 2024. Facility agrees to ensure proper bookkeeping and having adequate Finance staff and not commingle funds between all five (5) licensed facilities. Facility to ensure food costs are related to the resident census per facility. LPA consulted with facility regarding the side yard gates requiring to self close and latch. Facility will notify LPA once completed. No citations issuedthe state’s words, verbatim · CDSS document, Nov 3, 2023

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management-Legal/Non-compliance Inspection and met with Renato "June" Yamat, Administrator and Michelle Janger, co-administrator. LPA conducted a walk-through of the entire facility, that was found at a comfortable temperature with all exits free from obstruction. This facility was placed on non-compliance on May 1, 2023 for a one-year term. The refrigerator was observed with plenty of food that was stored properly and in good condition. LPA went over compliance plan and reminded facility of the below agreement of 5/1/2023 between Community Care Licensing (CCL) and Facility, Providence Home of Aragon. Facility agrees to provide quarterly financial documents for the month of May/June/July 2023; by August 18,2023. Records for the month of August/September/October 2023 by November 17,2023. Records for November/December 2023 and January of 2024 by February 16, 2024, and February/March/April 2024 by May 17, 2024. Facility agrees to ensure proper bookkeeping and having adequate Finance staff and not commingle funds between all five (5) licensed facilities. Facility to ensure food costs are related to the resident census per facility. No citations issuedthe state’s words, verbatim · CDSS document, Aug 7, 2023

Type of visit: Office

A Non-Compliance office meeting was conducted today in the Santa Rosa Regional Office via Microsoft Teams. Present in the meeting were acting Regional Manager Stephenie Doub, Licensing Program Manager Kimberley Mota, Licensing Program Manager Liza King, Auditor Diana Chapman, Audit Manager Jacqueline Juarez, Licensing Program Analyst Araceli Canela, Licensee Warren Delfin, Facility Administrator Michelle Jangar, Facility Administrator Renato Yamat, and Facility finance staff Maximina "Ami" Landicho. This Non-Compliance Plan Conference is being conducted to discuss concerns identified by the Licensing Agency in regard to the findings of a recent solvency Audit that was conducted for the following facilities Providence Home of Aragon #486803945; Providence Home of Fairfield #486803888; Providence Home of Hillview #486803890; Providence Home of Vallejo #486803850 and Providence Home of Modesto #50270093 owned and/or operated by Warren Delfin. The financial audit documents showed the licensee does not have a sound financial plan and has negative equity. The facility is generating enough income to meet its expenses; However, expenses are not being paid; the amount of money being sent out of the facility account is negatively affecting the licensee’s solvency. Licensee is not managing finances of the facility in a manner that ensures solvency and there is a lack of control over the finances. Operating expenses were reviewed for Bank statements and cash reserves; Utilities; Rent; and Food. The licensee did not pay operational expenses timely. In Addition, there are tax liens against the facility. Continue report see LIC809-C Facility was placed on a compliance plan for 1 year. Licensee has been advised that failure to complete the agreed upon actions by the dates given, will result in this Department taking the following action(s): Facility agrees to provide quarterly financial documents for the month of May/June/July 2023; by August 18,2023. Records for the month of August/September/October 2023 by November 17,2023. Records for November/December 2023 and January of 2024 by February 16, 2024, and February/March/April 2024 by May 17, 2024. Facility agrees to ensure proper bookkeeping and having adequate Finance staff and not commingle funds between all five (5) licensed facilities. Facility agrees to submit copies of proper 60-day resident eviction notices regarding Providence Home of Modesto #50270093 by May 5, 2023. Facility to ensure food costs are related to the resident census per facility. Failure to comply with the terms and conditions of the one-year compliance plan may result in administrative action. Facility is subject to increased quarterly monitoring to ensure compliance. Licensee was provided the following regulations: CCR, Title 22, Division 6, Chapter 8, Section 87213, Finances CCR, Title 22, Division 6, Chapter 8, Section 87205, Accountability CCR, Title 22, Division 6, Chapter 8, Section 87555, General Food Service Requirement CCR, Title 22, Division 6, Chapter 8, Section 87405, Administrator Qualifications and Duties No citations were issued at this time. LPA will review and issue citations that may be warranted. A copy of this report was emailed to Administrator/Licensee, signature in file.the state’s words, verbatim · CDSS document, May 1, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Co-Administrator, Michelle Jangar. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. There are currently 4 residents in care, one receiving Hospice services. This facility is licensed for a total of 6 residents, with a hospice waiver to allow all 6 residents on Hospice services and no approval for bedridden residents/rooms. LPA toured facility and grounds and observed COVID-19 precaution signs posted in common areas to promote hand washing. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms upon arrival to the facility. Infection control practices are present: entry procedures, face coverings, daily monitoring and temperatures checked for residents and staff, and 30-day PPE supply. Facility states staff clean and disinfect the facility daily. Bathrooms are equipped with liquid soap and paper towels. Covid-19 Mitigation and Infection Control plan was submitted to the department. Caregivers have completed PPE training. In addition, facility was found to be at a comfortable temperature with all exits free from obstruction. Facility has at least two days of perishable and one week of non-perishable foods. Fire Extinguisher was found to be charged and serviced on 2/16/2023. LPA went over daily activities being available for residents. Facility understands they will need to continue to provide any updates or changes regarding the ownership status of this facility or anything that may affect the Health & Safety and well being of all the residents living at this facility. LPA went over the following updated forms to be submitted to LPA A Canela by 3/12/2023. · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan · LIC 9020 Register of Facility Residents · Copy of Liability Insurance · Copy of current Lease/Rental Agreement Exit interview conducted with, co-Administrator, Michelle Jangar. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Feb 27, 2023

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management - Health and Safety check of this facility. LPA and Licensee are in communication regarding the facility ownership status. LPA toured the home and all resident rooms. There are currently 5 residents living in the home with two staff providing care and supervision. The home was observed clean and at a comfortable temperature. LPA observed the refrigerator has plenty of food, and the pantry is well stocked. LPA met with Administrator, Michelle Jangar and requested an update and records for resident R2, plan of care and medical records. LPA also went over resident R1 who had recently sustained a fall while R1 was getting up from their commode. Facility notified LPA by phone and with an incident report within the required time and sent R1 to the hospital. R1 returned the same day. LPA observed and talked to R1, who said he is doing well. Facility understands they will need to continue to provide any updates or changes regarding the ownership status of this facility or anything that may affect the Health & Safety and well being of all the residents living at this facility. No citations issued during this visit.the state’s words, verbatim · CDSS document, Jan 26, 2023

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management - Health and Safety check of this facility. LPA has been reaching out to the facility for an update regarding the facilities foreclosure status. LPA toured the home and all resident rooms. There are currently 5 residents living in the home with two staff providing care and supervision. The home was observed clean and at a comfortable temperature. LPA observed the refrigerator has plenty of food, and the pantry is well stocked. LPA met with Administrator, Michelle Jangar and requested an update to be provided to LPA by 12/28/2022, regarding the facility status or any information received that may affect the residents living at this facility. Facility understands they will need to continue to provide any updates or changes regarding the financial status of this facility or anything that may affect the Health & Safety and well being of all the residents living at this facility. No citations issued during this visit.the state’s words, verbatim · CDSS document, Dec 27, 2022

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management - Health and Safety check of this facility. LPA and facility are in communication regarding the facilities foreclosure status. LPA toured the home and all resident rooms. There are currently 5 residents living in the home with two staff providing care and supervision. The home was observed clean and at a comfortable temperature. LPA observed the refrigerator has plenty of food, and the pantry is well stocked. LPA met with Administrator, Michelle Jangar and went over requirements for facility to have control of the property. Facility previously notified LPA and provided copies of letter sent to all facility residents/responsible parties and the Ombudsman notifying them of the foreclosure status of this property, 124 Aragon Court. Facility understands they will need to continue to provide any updates or changes regarding the financial status of this facility or anything that may affect the Health & Safety and well being of all the residents living at this facility. No citations issued during this visit.the state’s words, verbatim · CDSS document, Dec 2, 2022

Type of visit: Office

An informal meeting was conducted today, by the Santa Rosa Regional Office via Microsoft . Present in the meeting were, Regional Manager, Carla Martinez- Nutti, Licensing Program Manager, Kimberley Mota, Licensing Program Manager, Bethany Moellers, Licensing Program Analyst, Araceli Canela and Licensee, Warren Delfin. The purpose of the informal office meeting was to discuss concerns that have been identified by the Licensing Agency regarding information received of this facility being in Foreclosure status. The following was discussed during the office meeting: Facility to notify all residents and/or their responsible parties and the local Ombudsman regarding the foreclosure of this property by 11/22/2022. Community Care Licensing (CCL) requested copy of letter issued by the licensees attorney to the lender of this home. Licensee to also include a copy of the financial plan for this licensee and records discussed during this meeting. The department will conduct a Solvency Audit on all five (5) of the licensee's facilities. Health & Safety Code 1569.686 was cited today. Licensee must notify within 2 business days the Department, the state long term ombudsman, all residents, and their representatives of financial distress. Licensee to ensure the services of residents in their facility are not affected by home owner/Licensee default. Civil Penalty assessed for $100 per day, maximum of 20 days. Total assessed during todays office meeting is $2,000. Deficiencies 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. This report was emailed to licensee to obtain signatures.the state’s words, verbatim · CDSS document, Nov 21, 2022

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.686(a) · Plan of correction due date: Nov 22, 2022

1569.6869a) Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception. (a) A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days, and shall notify all applicants for potential residence, and, if applicable, their legal representatives, prior to admission, of any of the following events, or knowledge of the event: This requirement was not met as evidenced BY: Based on today's meeting with licensee, the facility failed to notify CCL, Local Ombudsman & resident or their responsible parties as required. This is an immediate risk to the Health and Safety of residents in care.the state’s words, verbatim · CDSS document, Nov 21, 2022

Plan of correction: Licensee agrees to issue letters and notify all residents and/Ombudsman by 11/22/2022. Licensee to provide copies of letters to CCL by 1or their responsible parties, Local 1/22/2022 Attention LPA: Araceli Canela A civil Penalty was assessed today for a total of $2,000. for HSC1569.686 violation

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Case Management - Health and Safety check of this facility. LPA received information the facility home, may be in foreclosure status. LPA toured the home and all resident rooms. There are currently 5 residents living in the home with two staff providing care and supervision. The home was observed clean and at a comfortable temperature. LPA met with Administrator, Michelle Jangar (MJ) who explained the facility home is in good standing and is not in foreclosure status. Community Care Licensing (CCL) verified with the County assessor and Tax Treasury office and there are no current Liens on this property. This facility has a current lease agreement in file from the property owner. MJ reported they are always in communication with the property owner and expressed the information CCL received regarding the foreclosure is incorrect and will provide proof to LPA A. Canela by tomorrow 11/18/2022. LPA observed the refrigerator has plenty of food, and the pantry is well stocked. LPA will follow up on 11/18/2022 with facility, regarding the information that was requested. No citations issued or observed.the state’s words, verbatim · CDSS document, Nov 17, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator, Renato Yamat Jr. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. The facility currently has 5 residents in care, 2 of which are on Hospice Services. This facility is licensed for 6 non ambulatory residents, with hospice waiver approved for all 6 of the residents and 1 of the residents may be bedridden in room #2. LPA toured facility and grounds and observed COVID-19 precaution signs posted in common areas to promote hand washing. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms upon arrival to the facility. Infection control practices are present: entry procedures, face coverings, daily monitoring and temperatures checked for residents and staff, and 30-day PPE supply. Facility to follow indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test. Facility states staff clean and disinfect the facility daily. Bathrooms are equipped with liquid soap and paper towels. Covid-19 Mitigation plan was submitted to the department on 8/17/2021. Caregivers have completed PPE training but have not been N-95 Fit tested. In addition, facility was found to be at a comfortable temperature with all exits free from obstruction. Facility has at least two days of perishable and one week of non-perishable foods and items are stored properly. Fire Extinguisher was found to be charged and serviced 2/16/2022. Administrator, Renato Yamat's Administrator certificate #6054180740 expires 8/16/2023. Facility staff to get N95 fit tested. Exit interview conducted with Renato Yamat. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Feb 25, 2022

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct a Post Licensing Inspection and met with Michelle Jangar, Administrator. The Post Licensing Inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. LPA observed a screening station at the entrance of facility which had hand sanitizer, a thermometer, and a sign-in station for visitors. Visitors are screened for COVID-19 symptoms (including temperature check) upon arrival to the facility. Staff and clients' temperatures are taken at least once a day and are documented. LPA conducted a walk-through of the facility with Administrator and observed COVID-19 precaution postings at the entrance to building, in common areas and bathrooms and kitchen. LPA observed facility was a comfortable temperature. Staff clean and disinfect the facility daily. High touched surface areas are disinfected after each use. The facility allows visitation in the private rooms or outside with masks, provides virtual visits and has a house phone for family to stay in contact with residents. Administrator reported that new residents and new hires will be Covid -19 tested prior to admittance or hire, and 25% of staff and residence are surveillance-tested every two weeks. LPA observed 4 residents in care, 1 in hospital. Facility staff have completed training on infection prevention, symptoms, transmission and PPE use. N-95 respirator Fit testing is in process.LPA observed a supply of PPE including: gloves, face shields, N-95 respirators, surgical masks and gowns. All staff wore a face mask during this visit. The facility has submitted a COVID-19 Mitigation Plan Report on Epidemic Outbreaks specific to COVID-19 to the California Department of Social Services. 2 Fire Extinguishers were up to date and easily accessible. All exits were unobstructed and had auditory alarms. LPA observed that 3 staff were up to date with CPR and First Aid certification. Exit interview conducted with Administrator Jangar, whose signature on this document confirms receipt. No deficiencies cited during this inspection. Inspection Tool Notes: Infection Control Practices - No Deficiency: 130 - Staff is in process of fit testing.the state’s words, verbatim · CDSS document, Aug 26, 2021