Loving Hearts Care Home II

Type of visit: Required - 1 Year

On 11/7/2023, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection visit for this facility and was greeted by Administrator, Rose Devera. The facility is licensed for six non-ambulatory residents and a hospice waiver for three. The facility currently provides care for five residents, none of which are receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with Administrator, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility exits were equipped with auditory alarms for residents with dementia tested and found to be in working order. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 6/12/2023. Both smoke detectors and carbon monoxide detectors throughout the facility were interconnected, tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Water at faucets accessible to residents was measured between 109.9 and 110.3 degrees which is within regulation. Toxins, sharps and other items that could pose threat if readily available to residents were kept locked under the kitchen and bathroom sinks and within cabinets in the laundry room all of which were found to be secured. During inspection, LPA observed three storage sheds located in the side yard to also be locked and secured. Residents were observed engaging in discussion with staff, watching television shows or resting in their bedrooms. Residents appear to have a positive relationship with staff based on LPA observations. LPA found that the facility is utilizing pest traps in the garage. LPA confirmed with the Administrator and Pest Control company that the services are currently being implemented. Administrator contacted the Pest Control company confirming the services for precautionary measures. The facility conducts emergency disaster drills quarterly with updated logs on record and has a current emergency disaster plan. Continued onto LIC809-C There was a supply of hygiene products, continence products, paper products and clean linens available for residents. All resident bedrooms have lighting & appropriate furnishings. Medications are stored in a designated medication cabinet located in the dinning area were found to be secured. LPA conducted spot medication count and although LPA found Medication Administration Records in order, it was also found that three prescription medications were not properly recorded on the Centrally Stored Medication Record. Administrator will be conducting medication review to properly reconcile prescription information. LPA also conducted a file review for all residents and found residents to have updated Physician's Reports and Needs & Service Plans. Individual Program Plans for residents under North Bay Regional Center were also found to be current. During a review of staff files, LPA found all staff to have current 1st aid & CPR certification along with adequate annual training on file. Upon review of staff association on Caregiver Background Check roster LPA found that staff S1 was not properly associated to Loving Hearts Care Home II. LPA confirmed with the Regional Office and Guardian search that S1 is currently associated and cleared for two other residential care facilities. Administrator has previously submitted a transfer request for S1 but was not completed. Administrator re-submitted S1's transfer request to the Regional Office during the visit. LPA will follow through confirming the proper association. Technical Violation issued. Administrator, Rose Devera's Administrator Certificate 6008400740 is currently active through of 11/1/2024. LPA requested the following documents be sent to CCL by COB 12/7/2023: 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 Control of Property 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, Nov 7, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Canela arrived unannounced, to conduct a Case Management visit and review resident R1's room #3 that was recently approved to be used for bedridden by the Vallejo Fire department. LPA will update the facility license to reflect changes. This facility is vendor by North Bay Regional Center. Licensee Rose Devera arrived towards the end of the visit and LPA went over visit observations. LPA consulted with facility and reminded them to not put any items near any doors, so that doors can open to their full potential for fire safety reasons. During the visit, the small box was removed and facility was advised of the regulation and citations that may be issued, along with civil penalty fines if noncompliance continues. During todays visit LPA reviewed food in the refrigerator and confirmed the dishwasher and oven were not properly working. LPA was notified of facility issues and LPA arrived to the facility to go over the concerns. LPA observed staff bedroom not locked and there were prescription medication accessible and a bottle of cleaner in master bedroom bathroom and citations were issued. LPA requested facility to send in all hospital discharge records for resident R1. LPA went over facility requirements regarding R1 and R2's care. Facility to send in care plans for both R1 and R2. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights were provided. Exit interview conducted with Rose Devera, Licensee/Administrator. This report was emailed to facility.the state’s words, verbatim · CDSS document, Jan 26, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Jan 27, 2023

Care of Persons with Dementia 87705(f)(2) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met. During todays inspection, LPA observed the staff bedroom open, staff do not lock it- and LPA observed a bottle of staff prescription medication accessible. Bathroom in master bedroom also had a bottle of cleaner accessible. This is an immediate risk o the health & Safety of residents in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: Facility to send in written plan and staff training to ensure they are following regulation. Plan to include how they will make these items inaccessible to residents. POC due date: 1/28/2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Feb 20, 2023

87303(a) Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met. During todays visit. LPA observed the facilities dishwasher and oven are not operationalthe state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: Facility to send in written plan they understand the facility and all appliances needed for the day to day operation are operational. Proof of items corrected to LPA By POC date 2/20/2023 Attention : LPA Araceli Canela

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Canela arrived unannounced, to conduct an Annual Required 1 YR inspection and was greeted by care staff, Linda Ramos. Administrator/Licensee Rose Devera arrived a few minutes later. The inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. Upon arrival, LPA observed that facility has Covid posters on the front door. LPA discussed visitation procedures with administrator, documenting & screening questions. Once inside the facility, LPA observed that facility has a sign-in for visitors, screening area with PPE . Staff wear masks inside the facility. LPA conducted a walk-through of the facility and observed Covid-19 posters that included hand washing signs in restrooms, but no paper towels. Facility was a comfortable temperature. Residents are encouraged to wear masks when in the community. Commonly touched surfaces are disinfected throughout the day. Facility staff have been trained on PPE. Facility has submitted their Covid-19 Mitigation Plan and it was approved. Facility has more than a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, face shields, gowns and hand sanitizer. PPE is in a location that is stored and accessible to staff. Facility maintains a 30 day supply of medication. LPA observed the, "if you see something say something" complaint poster, but the poster is not the required size 20"x26". Facility will need to get and post the correct size, failure to correct will result in citation being issued. Continue report See LIC809-C LPA requested the following updated records to be submitted to Community Care Licensing by 12/15/2022: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500), LIC 9020 Register of Facility ResidentsLiability Insurance Certificate and Emergency Disaster Plan (LIC610E). In addition, facility to send in the following information to LPA Araceli Canela by 11/21/2022: current facility sketch , correcting size of rooms, use of room by staff or residents, ambulatory, non -ambulatory or bedridden use. Facility to identify all rooms on sketch and use of room in garage. Facility to also provide current Administrator information and copy of Administrator certificate. During today's visit staff S1 had a fingerprint clearance, but was not associated to the facility as required. Staff S1 did not have a current health screeing and proof of negative TB test. LPA consulted regarding all the items that are being placed behind doors that may prevent exit doors to open properly and requested facility to move items during the inspection. Facility understands that this may be a fire safety violation and result in citations and civil penalties. LPA also consulted regarding a front door deck piece of wood that felt loose and will need to be secured, firm and in good condition. LPA also requested facility to review right side of yard where a couple of bricks are sticking a little higher than the others and could be a tripping hazard or will not allow a wheel chair to go through easily. Facility to notify LPA of corrected status. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights were provided. A civil penalty was assessed during todays visit for $100.00 for S1 not being associated to this facility. Exit interview conducted with Rose Devera, Licensee/Administrator. This report was emailed to facility during this visit.the state’s words, verbatim · CDSS document, Nov 17, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) A. Canela conducted thisLoving Hearts Care Home II pre-licensing inspection on 10/21/2021, for this change of ownership application. LPA met with applicant Rose Devera, and Luisa Datuin, who will be the Administrator for LOVING HEARTS CARE HOME II. The facility received a fire clearance approval from the Vallejo Fire Department on 7/13/2021 for a total of 6 Non-ambulatory residents. Applicant will ensure sufficient staffing at all times. The facility is one level home with 5 bedrooms , of which 4 bedrooms may be used for residents and 1 bedroom used for staff. There are 2 full bathrooms, living room, dining room, kitchen, laundry room and garage. The garage has a room that is used as an office and two sofas that facility states is used for staff to take a break and facility understands the garage is not approved for sleeping. The staffs bedroom has two beds and will be used for sleeping. During today’s visit LPA observed the following items: · COVID-19 postings and screening station at entrance · Lockable separate cabinets for medications, toxin, and knives. · All exits were unobstructed · 6 smoke and 2 carbon monoxide detectors, which were all operational. · First Aid kit and flashlights for emergency lighting. · Supply of linens, paper products, and hygiene supplies available. · Non-slip mat and grab bars in bathrooms. · Fire Extinguisher charged and serviced 07/1/2021 · Required facility postings were observed · The water temperature was tested during inspection and within regulation of 105-120 Degrees F. · LPA observed at least a minimum of a 2 day supply of perishable and 7 day supply of non-perishable food necessary for 5 residents. Component III Orientation was completed with Applicant Rose Devera. Pre-Licensing is complete, LPA will notify Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.the state’s words, verbatim · CDSS document, Oct 21, 2021

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 0 Census (if any clients in care): 3 COVID Mitigation Plan discussed? Yes Method: Telephone call with CAB COMP II Participants: Administrator Luisa Datuin & Licensee Rose Marie DeVer Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Oct 4, 2021