Kind Care Home II

Type of visit: Required - 1 Year

Unannounced annual licensing visit made out to this facility on 08/16/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Davina Bratton, who was briefly interviewed. This LPA requested that the facility caregiver go ahead and contact the facility designated Administrator, Kashmindar Kaur, to inform her that CCL was present at this time. The facility designated Administrator, Kashmindar Kaur, arrived shortly thereafter to this facility. A brief interview was conducted with the facility designated Administrator at this time. This facility is licensed to serve and accept up to 6 residents who are deemed to be ambulatory and non ambulatory. This facility is not vendorized to accept and retain any Regional Center residents at this time. Current census was 4 residents. It was learned that there were (2) residents currently on hospice. There were (2) dementia diagnosed residents and (3) residents with bowel/bladder incontinence. Tour of this facility was conducted. Kitchen area was toured. Cabinets and drawers were reviewed. Drawers and cabinets housing cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Drawers containing knives and other cutlery were observed to be locked and made inaccessible to the residents at this time. Food supply was reviewed for 2-day perishable and 7-day nonperishable food quantities at this time. Additional nonperishable food items were observed to be stored in the garage area along with an additional refrigerator unit. Dining room, living area, and all other areas designated for resident use were observed to be maintained and observed to be in compliance at this time. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be present and maintained in compliance at this time. A tour of the resident restrooms was conducted. Shower areas, toilets, and wash basins were reviewed and observed to be functional and in good repair at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Medication for resident use, located in kitchen cabinet, was reviewed. Policies and procedures for dispensing, handling, and overall documentation of the resident medications were discussed with the facility designated Administrator at this time. Fire extinguishers were observed to be placed throughout this facility and were annually inspected on 05/02/2023 from the local fire extinguisher company, Jorgensen Co, and in compliance at this time. First aid kit was observed to be present and contained all of the required components at this time. Linen closet, located in facility hallway, was observed to contain a sufficient supply of blankets, sheets, and towels for resident use. Laundry area, located adjacent to kitchen area, was observed to be made inaccessible to the residents at this time. Laundry detergents, bleach, and all other cleaning supplies were observed to be stored in cabinets where they were locked and made inaccessible to the residents at this time. Exterior grounds of this facility was toured. Facility perimeter fence, side gates, and emergency exits were reviewed. Additional garage space was reviewed and observed to be contain materials and items intended for upkeep and maintenance of this facility. A review of (5) facility personnel files was conducted. A review of (4) facility resident files was conducted. The following forms were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Aug 16, 2023

Type of visit: POC

Unannounced Plan of Correction visit was conducted on 08/16/2023 by Licensing Program Analyst (LPA) Charlie Yang to review and clear the deficiencies that were previously cited on 08/29/2022. This LPA was met by the facility designated Administrator, Kashmindar Kaur, and a brief interview was conducted with her at this time. Current census was 4 residents. The following items were reviewed to make sure that they had been corrected and brought into compliance at this time: Based on observation, the licensee did not comply with the section cited above in that the hot water temperatures measured in the facility restrooms were at 121.2 degrees which posed an immediate health, safety or personal rights risk to persons in care. Based on observation, the licensee did not comply with the section cited above since it was discovered that cleaning supplies were accessible to residents and care under the kitchen sink and resident restroom which posed an immediate health, safety or personal rights risk to persons in care. Based on observation, the licensee did not comply with the section cited above in that the facility kitchen refrigerator was observed to be locked with a metal cord that would not allow access to the residents which posed an immediate health, safety or personal rights risk to persons in care. Based on observation, the licensee did not comply with the section cited above in that one of the resident bedrooms had been converted into a retreat style room for employees and board members visiting out of town or serving as an office space which poses/posed a potential health, safety or personal rights risk to persons in care. Based on observation, the licensee did not comply with the section cited above since facility exits were equipped with high locking mechanisms and cord locks on the facility driveway fence which posed an immediate health, safety or personal rights risk to persons in care. There were no deficiencies observed or cited at this time. All of the above deficiencies, with Plan of Correction, were reviewed and cleared at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Aug 16, 2023

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 08/29/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Kashmindar Kaur, who was briefly interviewed. It was learned that there was (1) resident under the care of hospice at this time while (3) other residents were receiving services through home health. This facility does have a hospice waiver for (6) residents and fire cleared for (1) bedridden resident at any given time. Current census was 5 residents. A tour of this facility was conducted alongside the facility designated Administrator Kashmindar Kaur. Administrator certificate was observed to be present and in compliance at this time for facility designated Administrator Kashmindar Kaur. Kitchen area was toured. Cabinets and drawers were reviewed. Food supply was reviewed for adequate 2-day perishable and 7-day nonperishable quantities at this time. This LPA did observe additional food storage units which were present and functional at this time in the garage area. A tour of the dining area, living area, and all other areas intended for resident use was conducted. Medication cabinet, located in the kitchen area, was reviewed. Policies and procedures involving dispensing, documenting, and overall administration of resident medications was discussed with the facility designated Administrator. This medication cabinet was observed to be locked and made inaccessible to the residents at this time. A tour of the resident bedrooms and restroom was conducted. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. Hot water temperature was taken and measured to make sure that it was within the allowed range of 105-120 degrees. Linen closet, located in the entry way, was observed to contain a sufficient supply of towels, blankets, and linens to meet the needs of the residents at this time. Garage area was toured. This area was used to house additional furniture and supplies for the facility residents. Wheelchairs and additional beds were observed to be present. Laundry area was toured. Cabinets storing detergents and bleach were observed to be locked and made inaccessible to the residents at this time. Fire extinguisher, located in dining area, was observed to have been annually inspected on 05/23/2022 by the local fire extinguisher company, Jorgensen, and in compliance at this time. Exterior grounds of this facility were toured. A review of the facility perimeter fence, side gate, and exits was conducted. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Code. Appeal rights were printed and a copy was given to the facility designated Administrator Sandra Jackson at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Aug 29, 2022

Type of visit: POC

LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of citations issued during the case management visit conducted on 08/17/2021 . LPA toured the facility, reviewed document submitted for plans of correction observed that the deficiencies cited on 08/17/2021 have been cleared. Deficiency cited under Title 22 Regulations have been cleared. Licensee complied with the terms of the POC by POC due date. Facility was provided POC cleared letter. Exit interview conducted and a copy of this report emailed.the state’s words, verbatim · CDSS document, Sep 13, 2021

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Maninderdeep Kahlon and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards. LPA observed sufficient furniture and lighting throughout the facility. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Hot water temperature was measured at 108.5 degrees Fahrenheit in resident bathroom sink, which is within the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA observed centrally stored medications. LPA reviewed and compared resident medication vs. resident medication logs. During the inspection in the kitchen LPA and Administrator observed medications (comfort packs for three residents on hospice) unlocked in the refrigerator. LPA also observed medication errors in the medication administration record for 2 of 2 records reviewed. The facility did not have discontinued medication documentation for R1 from the doctor. LPA reviewed 3 resident and 2 staff files, including criminal record clearances. All staff are fingerprint cleared, however, S1 was not associated to the facility. Fire drill was completed on 8/2/2021. Deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes.the state’s words, verbatim · CDSS document, Aug 17, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(1-3) · Plan of correction due date: Aug 18, 2021

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication when the physician should be contacted for a medication re-evaluation. (2) Once ordered by the physician the medication is given according to the physician's directions. (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. LPA observed medication errors in the medication administration record for 2 of 2 records reviewed. The facility did not have discontinued medication documentation for R1 from the doctor.the state’s words, verbatim · CDSS document, Aug 17, 2021

Plan of correction: Licensee/Administrator will provide training for all staff that provide medication administration from an outside vendor. The training will cover 87465 Incidental Medical and Dental Care (a thru j) The facility will also update the appraisal/needs and service plan for R1 and R2. Please provide this information to CCL by 8/18/2021. If you need additional time please request by email or by a phone call.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Aug 18, 2021

Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: LPA and Administrator observed medications (comfort packs for three residents on hospice) unlocked in the refrigerator that were accessible to the residents in care. This poses an immediate health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2021

Plan of correction: Administrator will include this as a highlighted training topic for all attending the training for medication administration.