Margaret's Care Home

Type of visit: Required - 1 Year

On 10/09/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an annual visit. LPA was greeted by staff member, Antoinette Garcia, and explained the purpose of the visit. LPA Pascua asked that SM Garcia call the Facility Designated Administrator, Margaret Feril, to inform them that CCL was present. It was learned at this time that FDA Feril was unable to come to the facility at this time. Shortly after, LPA met with Facility Designated Representative, Ralph Feril and explained the purpose of this visit. There were no other staff members present at this time. Current census was 6. A brief interview with FDR Feril was conducted. This facility is licensed to serve 6 residents, 5 of which are ambulatory and 1 non-ambulatory. This facility has a dementia plan on file and has a hospice waiver for 3. It was learned that only the administrator and the representative have access to the facility files. LPA explained that facility records must be made available at all times to CCL staff. LPA reviewed 3 resident files and 3 staff files. Administrator has a current administrator certificate #6054358740 and expires on 12/05/2023. A medication cabinet was identified in the kitchen. Along with the FDR Feril, LPA observed, reviewed, and compared medication to medication dispensing logs. First Aid Kit was present and contained all of the required components. Fire Extinguisher was in compliance and has been services by Hayden Fire Protection on 07/13/2023. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. A tour of the garage was conducted. Additional non-perishable food supplies were identified. All cleaning supplies were locked and made inaccessible to residents at this time. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. 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 . Exit Interview.the state’s words, verbatim · CDSS document, Oct 9, 2023

Type of visit: Case Management - Incident

On 10/09/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a case management visit. LPA met with Facility Designated Representative (FDR), Ralph Feril and explained the purpose of this visit. The purpose of this visit was in response to the annual visit conducted on 10/09/2023. It was learned during this visit that on 10/08/2023, R1 left the facility and walked down the street with Modesto Police Department at approximately 6:00pm. LPA obtained R1's physicians report and learned that R1 is allowed out of the facility without assistance. It was learned that the facility has not provided a Special Incident Report to the department as of this date. Based on interview and records review there were the following deficiencies that were cited during this case management visit. A copy of this report was provided to the facility and an exit interview was conducted.the state’s words, verbatim · CDSS document, Oct 9, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Oct 30, 2023

(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This is not met as evidenced by: Based on interview and record review, the Licensee did not ensure that they have provided an incident report to the department after an incident that occured on 10/08/2023. This poses an potential health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 9, 2023

Plan of correction: Facility Administrator stated that a review of the section, 87211(a)(1)(D), will be conducted. A statement of correction, along with proof of staff training for no less than (1) hour in duration, for the cited section will be completed and submitted to the LPA's email at arielle.pascua@dss.ca.gov. by the due date of 10/30/2023 COB. Information submitted must include attendees, trainers, and information discussed.

Type of visit: Required - 1 Year

On 09/21/2022 at 1:30pm, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a infection control visit. LPA Pascua met with staff member, Ralph Feril and explained the purpose of this visit. LPA Pascua asked staff member, Feril to call the Administrator, Margaret Feril, to let her know that CCL is present at this time. This facility is licensed to hold 6 residents with a hospice waiver for 3. At 1:40pm, LPA Pascua initiated a tour of the facility with staff member, Ralph Feril. Current Census is 6. Administrator has a current certificate and expires on 12/05/2023. Fire extinguishers located in the kitchen and hallway have been inspected by Hayden Fire Protection on 07/15/2022. This facility has a central screening point and have a sufficient amount of PPE supply. The kitchen area was toured. LPA identified non-perishable and 2 days perishable food supply. Knives were observed to be locked in the kitchen cabinet and made inaccessible to the residents at this time. A medication cabinet was identified in the kitchen. LPA observed medication to be pre-poured from designed resident bottles to another medication dispenser. Staff member stated that this is easier for them to disperse medication. LPA Pascua advised staff member, Feril what the regulations are about pre-pouring medication. Along with the staff member, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. A tour of the garage was conducted. Additional non-perishable food supplies were identified. All cleaning supplies were locked and made inaccessible to residents at this time. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. 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 . Exit Interview.the state’s words, verbatim · CDSS document, Sep 21, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arlene Garcia conducted an unannounced annual / Infection Control visit on this date. LPA met with Margaret Feril, Administrator LPA and AD, inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, and dining/ living room areas. LPA observed sufficient 7 days non-perishable and 2 days perishable food supplies.. Hot water temperature at 114.4 degrees in residents bathroom and room temp at 79 degrees. Fire Drill conduced. Fire extinguisher maintained 7/1//2021. Fire alarm and carbon monoxide functional. LPA observed sharps and toxins locked. LPA reviewed 3 staff and resident files. Resident emergency contact complete. LPA observed all staff files complete. Administrator Certificate valid until 12/5/21. All persons in facility fully vaccinated. LPA observed 30 days PPE supply. LPA and AD observed centrally stored medications. LPA and AD observed the lock on one of the medication cabinets not functioning. Upon entry, AD did not conduct symptom check until requested by LPA. Sanitizer/ thermometer were observed. Sign in sheets were observed to document date and visitors name. Sign in sheets did not include symptom screening for reporting requirements to public health officer and contact tracing. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited today in violation of California Code of Regulations. Exit interview held with AD and a copy of report given via email.the state’s words, verbatim · CDSS document, Oct 4, 2021

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Oct 5, 2021

87465 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 regulation was not met by evidence by: Based on observation: Licensee did not ensure cabinet that holds medications was locking properly making the medications accessible to the residents in care. This poses an immediate risk to the residents.the state’s words, verbatim · CDSS document, Oct 4, 2021

Plan of correction: Licensee will send a letter acknowledging the undestanding of the regulation and a picture showing the lock has been repaired by POC date.

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Oct 15, 2021

87464 (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).This regulation was not met by evidence by: Based on observation, Licensee did not have a sign-in policy available upon entry to ensure compliance with symptom screening and to record contact information (for reporting requirements to public health officer and contact tracing).the state’s words, verbatim · CDSS document, Oct 4, 2021