Summerfield Home Care

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Hansen conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was welcome by staff Edmond. Licensee/Administrator Victoria Wainaina and Kennedy Wainaina arrived shortly after and conducted the visit. Facility has 5 residents, 2 with dementia, without any on hospice care at the time of visit. During facility tour of facility on 10/11/2022 with Licensee & Administrator, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. LPA observed auditory devices functioning on the front door and on the doors exiting to the backyard. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 3/1/2022 at the time of the visit. Smoke Detectors & Carbon monoxide detector was found to be operational during the visit. 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 secured and inaccessible in locked garage cabinets. Dangerous items were stored inaccessible to residents in locked kitchen drawer. There was a supply of cleaners, hygiene products and paper products available for residents. Residents' bedrooms have lighting & appropriate furnishings. Water temperature in resident's bathrooms measured 105.6 degrees F and 105.8 degrees F which are within acceptable range of 105 to 120 degrees F. Medications are locked and centrally located in a kitchen cabinet. Facility has a 30-day supply of medication for residents. All staff had masks on during this visit. Facility has activities for residents such as group working exercises, reading word games, and outside offsite activities as well as live music. Disaster Drills have been conducted quarterly with the last one being a fire drill conducted 8/2022. Infection Control: Facility has submitted a mitigation program plan and infection control plan that has been approved. Posters have been placed at facility and entrance has hand sanitizer and other items designated for visitors and staff before coming into work. Facility has PPE supply stored in garage. Continue LIC 809-C In addition, facility has a designated area for visitors which are being allowed for scheduled visits. Residents also have available Zoom, Facetime, and telephone calls when contacting with family members and others. Staff had all PPE training required on file and have obtained N-95 fit testing. LPA Hansen reviewed Licensing Information System (LIS) with Licensee who stated that is corrected and updated at this time other then email address which needs to be changed. LPA advised facility to contact Local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. LPA was presented with proof of current CPR & 1st Aid certification for staff. Administrator Certificate is for Kennedy Wainaina 6059978740 Exp. 6/7/2023 All staff have received COVID booster vaccinations. No deficiencies cited during todays inspection LPA Hansen is requesting Licensee to update and submit the following documents by 10/27/2022: LIC 308 Designated LIC 309 Administrative Organization LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Oct 11, 2022

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced on 3/3/2022 to conduct a post licensing inspection. LPA was initially greeted by staff who screened LPA for COVID symptoms. LPA met with licensees/administrator Kennedy and Victoria Wainaina. Currently there are 5 residents in care none of which are on hospice and some who have a diagnosis of dementia. LPA observed auditory devices functioning on the front door and on the doors exiting to the backyard. The amount of fresh and nonperishable foods appeared to be within regulation. LPA observed non perishable food in garage cabinets. Toxins are secured and inaccessible in locked garage cabinets. Medications are locked and centrally located in a kitchen cabinet. LPA reviewed medication record which was current. LPA recorded a water temperature of 107.6 degrees which is within regulation of of 105 and 120 degrees F at faucets accessible to residents. Food is available for residents any time of the day. Bathrooms were equipped with necessary grab bars and non-slip floors/mats and appeared to have sufficient hygiene products. Fire extinguisher inspected was charged and dated 4/2/2021. Smoke detectors and carbon monoxide detector were operational, devices had fresh batteries per administrator. LPA observed required postings (LTCO, CCL Complaint poster) in addition to COVID-19 postings. Facility is screening visitors at the front door which includes taking temperatures and requiring visitors to wear masks. LPA reviewed 5 out of 5 resident files. LPA observed current need/services plans and appraisals. 4 out of 5 resident files had admission agreements listing the information for the previous license. LPA provided guidance to obtain updated admission agreements with current license information. Continued on 809-C LPA reviewed 3 staff record and found that staff had current first aid and CPR training. LPA and administrator discussed annual training requirements for staff. LPA provided outline of necessary training. Licensee stated disaster drills were conducted last month. Kennedy Wainaina's Administrator Certificate 6059978740 expires 6/7/2023. No deficiencies cited during today's inspection. Exit interview conducted with licensee and a copy of this report emailed to the facility.the state’s words, verbatim · CDSS document, Mar 3, 2022

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Erik Gonzalez-Campos arrived announced, to conduct a Pre-Licensing Inspection and met with applicants, Victoria and Kennedy Wainaina. LPA and Applicants toured the inside of the facility and grounds. Facility is a one-story residence with five single occupancy bedrooms, 5 private half bathrooms and one common bathroom, an office and common areas. Resident bedrooms have required furnishings, such as a dresser, night stand, lamp and bed linens. Bathroom shower has non-skid shower floor and grab bars for safety. LPA confirmed that contents of the facility First Aid Kit were sufficient. Water temperature in resident bathroom read at 107.6 degrees F which is within regulation of 105 & 120 degrees F. Facility has sufficient items used for cooking and eating. Facility locks centrally stored medications in a kitchen cabinet. Resident and staff files are stored in the office. Cleaning supplies and toxins are locked in a cabinet under the kitchen sink and in the garage. Perishable and non-perishable foods observed per regulation. Facility received an approved fire clearance dated July 12, 2021 that allows for six non-ambulatory residents. Facility has space indoors and outdoors for client activities. Component III reviewed with applicants. LPA will notify Application Unit so application process may proceed.the state’s words, verbatim · CDSS document, Oct 21, 2021

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 Method: Telephone call with CAB COMP II Participants: Wainaina, Victoria, licensee/administrator Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. Identification of the applicant and administrator was verified by photo ID. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant has been advised to transmit signed LIC 809 with copy of photo ID to CAB.the state’s words, verbatim · CDSS document, Oct 8, 2021