Emerald Home

Type of visit: Required - 1 Year

At approximately 09:15AM, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to conduct a Required 1 Year annual inspection and met with Staff Member, Magdalena Dixon and Jenifer Culili. Facility has an approved fire clearance for 5 non-ambulatory residents total capacity of 5 residents. Facility has an approved hospice waiver for 5 individuals. Administrator, Leonila Bunyi, arrived later during visit at approximately 09:45AM. LPA conducted a tour of the facility and observed the following: the facility was clean and at a comfortable temperature with all exits free from obstruction. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present. Toxins were secure and not accessible to residents. There is a sufficient supply of hygiene products, paper products, and linens available for resident use. Mattress pads were in place or available for resident use. Medication was centrally stored and secure. LPA reviewed 2 of 2 resident records. During review of resident records, Per facility's license, facility is approved for 5 hospice individuals at a time. LPA reviewed a sample of staff records. LPA reviewed 4 staff files. Staff files were found to be organized with proper documentation. Administrator's Certificate (606020104740) was current with an expiration date of 10/20/2024. Continued on LIC809C. Continue from LIC809 LPA and Administrator discussed facility's emergency and evacuation plan. The facility's last fire and evacuation drill will be conducted 08/25/2023. Facility's fire extinguishers were last inspected August 10,2023. Smoke detectors and carbon monoxide detectors were tested and operational. The amount of fresh and non-perishable foods are within regulation. Hot water temperatures for all sinks in facility were within Title 22 regulations of 105 to 120 degrees Fahrenheit. LPA conducted staff and resident interviews. LPA requested the following documents to update facility file: · Designation of Facility Responsibility (LIC 308) · Control of Property · Emergency Disaster Plan (LIC 610D) · Health Screening Report for Administrator (LIC 503) · Updated Personnel Report (LIC 500) · Updated Liability Insurance · Active and Current Administrator Certificate Facility Documents to be submitted to Community Care Licensing (CCL) by due date of Monday 09/04/2023 No deficiencies observed or cited during today's Required 1- Year inspection. Copy of this report provided.the state’s words, verbatim · CDSS document, Aug 25, 2023

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Walters arrived for the purpose of a Post-Licensing inspection. When LPA arrived there were no staff or clients at the present. LPA contacted Leonila Bunyi, Administrator (6020104740 exp 10/20/2022) and Cynthia Dinglasan, Licensee who met LPA at the facility and granted LPA entrance. The facility currently does not have clients in care. Per Administrator they submitted an application to recertify as an Administrator, however they have not received their updated certification. LPA was able to verify through the Administrator bureau that their application was pending. During today’s visit LPA observed the following items: · COVID-19 screening station with visitor log, thermometer, hand sanitizer · Lockable separate cabinets for medications, toxins/cleaners, and knives. · All exits were unobstructed · Smoke detectors and carbon monoxide detectors, which were tested & observed operational · Hand washing and supply of paper products available · Grab bars, ramps in the bathroom and non-slip mat in shower. · Auditory devices were observed · Fire Extinguisher charged 2/22/22 · Required postings (Personal Rights, Emergency plan/numbers, CCLD "Let Us Know" complaint poster, Emergency Disaster Plan, Rights of Individuals with disabilities and COVID-19 signs No deficiencies cited during today's inspectionthe state’s words, verbatim · CDSS document, Nov 4, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Katrina Walters conducted a pre-licensing inspection on 07/26/2022. LPA met with Applicants, Leonila Bunyi and Cynthia Dinglasan. Leonila Bunyi will be Administrator when the facility is approved for licensure. On 5/27/22 The facility was granted a fire clearance approval from the Suisun City Fire Department for a capacity of 5 non-ambulatory residents, with no bedridden residents. The facility is one level with 4 bedrooms that may be used for residents, 2 bathrooms, living room, dining room, kitchen, family room, medication cabinet, laundry room with shed and garage. The applicant has a dementia care plan that has been approved. During today’s visit LPA observed the following: The facility was clean and comfortable temperature. Upon entry there was an area in which staff will check in visitors with hand sanitizer and a temperature gun. LPA observed the following signs posted throughout the facility: Residents right's to counsel, Rights of Individuals with developmental disabilities, Let Us Know complaint poster, hand washing, masks required, personal rights and emergency disaster LIC 610. The Applicant will order the Ombudsman poster and will receive the poster after licensure. Continued on 809 C LPA toured the facility with applicants and found that the facility was clean and a comfortable temperature. All resident's rooms were furnished as required by regulation. A location has been designated for medication and sharps to be locked, and stored. Auditory alarms were on. Bathrooms were equipped with paper towels and hand soap. Grab bars and slip mats were present for residents safety. There was a supply of linens, paper products, and hygiene supplies available. There was at least a 30 day supply of personal protective equipment (PPE). Kitchen was spacious and clean, adequate supply of dishes and utensils. There were non-perishable foods. The facility has a phone line designated for residents use. Facility has lighting in hallways. LPA confirmed that contents of the facility First Aid Kit were sufficient and that facility has emergency lighting in case of a power outage. Facility has a emergency supply of bottled water. Fire extinguisher was charged and current. Smoke detectors and carbon monoxide detectors were present they were last tested by the fire department on 5/27/22. Exits were observed to be unobstructed. The hot water temperature measured at 118 & 119, in faucets used by residents, which is within regulation. LPA observed that there was sufficient equipment and supplies to meet the requirements of the activity program including access to reading materials, bingo, painting and other activities. The backyard had a shaded area for visiting and activities. Applicant will provide LPA with a copy of the liability insurance. LPA conducted a COMP III with applicants some of the following items were discussed: Administrator Qualifications, Reporting Requirements, Maintenance and Operation, Personal Accommodations, Criminal Background clearance, Acceptance and Retention, Restricted and Prohibited Health Care Conditions. This pre-licensing is complete. LPA will submit the pre-licensing reports to the Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status. A copy of the report was given to the Applicant.the state’s words, verbatim · CDSS document, Jul 26, 2022