Dignity Senior Living

Type of visit: Required - 1 Year

On 08/28/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by Licensee, Cosmina Stancu and explained the purpose of the visit. This facility is licensed to serve and accept up to 6 residents who are deemed to be non-ambulatory only. This facility has a dementia plan on file and a hospice waiver for 2. LPA reviewed 4 resident files. It was learned that 1 out 4 residents were receiving hospice services at this time. 4 out 4 resident files were current and up to date. LPA reviewed 4 staff files. 4 out 4 staff files were current and up to date. A tour of the facility was conducted. Fire extinguisher located in the kitchen was inspected by a located Fire company, Assured, and was inspected on 08/15/2023. Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. Food storage units were reviewed for adequate 2-day perishable and 7-day non perishable quantities at this time. Knives were locked and made inaccessible to the residents at this time. LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, 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 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. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet resident needs at this time. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. The exterior of the physical plant was in good repair with no hazards present. 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 -Liability Insurance Technical Assistance was provided for the Section, 87465(h)(5). As a result of this visit, no deficiencies were observed or cited during this annual visit. An exit interview was conducted and copy of the 809 and 809-C was provided to Licensee, Cosmina Stancu.the state’s words, verbatim · CDSS document, Aug 28, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arielle Pascua conducted an unannounced visit on this day for the purpose of conducting a 1-Year Annual Visit. LPA Pascua arrived and was greeted by Caregiver, Cynthia Miller. LPA Pascua asked Caregiver, Miller to contact the Facility Designated Administrator (FDA) to let them know that CCL was present at this time. FDA Cosmina Stancu arrived shortly after LPA Pascua's arrival. This facility is licensed to serve and accept up to 6 residents who are deemed to be non-ambulatory only. . Administrator holds a current certificate and expires on, 01/25/2023. Current Census was 2. Tour of the facility was conducted. Fire extinguisher located in the kitchen was purchased on 02/07/2022. Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. Food storage units were reviewed for adequate 2-day perishable and 7-day non perishable quantities at this time. Knives were locked and made inaccessible to the residents at this time. LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, 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 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. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet resident needs at this time. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. The exterior of the physical plant was in good repair with no hazards present. 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 designated Administrator. Exit Interviewthe state’s words, verbatim · CDSS document, Aug 17, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Aug 18, 2022

Criminal Record Clearance Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by having a caregiver working at the facility who has not had proper criminal background clearance prior to working at the facility which poses an immediate health, safety or personal rightsthe state’s words, verbatim · CDSS document, Aug 17, 2022

Plan of correction: Effective immediately, but no later than 08/18/2022; The administrator shall remove staff from the facility and have employee fingerprinted prior to returning to work. Written certification is required to show administrator has read regulation an ensure that all staff are fingerprinted and cleared prior to working.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Arielle Pascua conducted an unannounced visit on this day for the purpose of conducting a Post Licensing Evaluation. LPA Pascua arrived and was greeted by Caregiver, Cynthia Miller. LPA Pascua asked Caregiver, Miller to contact the Facility Designated Administrator (FDA) to let them know that CCL was present at this time. FDA Cosmina Stancu arrived shortly after LPA Pascua's arrival. This facility is licensed to serve and accept up to 6 residents who are deemed to be non-abulatory only. . Administrator holds a current certificate and expires on, 01/25/2023. Current Census was 2. Tour of the facility was conducted. Fire extinguisher located in the kitchen was purchased on 02/07/2022. Dining areas, living areas, and all other areas intended for resident use were toured. It was observed that furniture and furnishings were sufficient and able to meet the needs of the residents at this time. Kitchen area was toured. Food storage units were reviewed for adequate 2-day perishable and 7-day non perishable quantities at this time. Knives were locked and made inaccessible to the residents at this time. LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, 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 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. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet resident needs at this time. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. The exterior of the physical plant was in good repair with no hazards present. Perimeter fence was observed to be stable and gates were in good repair. A copy of this report was provided to the Facility Designated Administrator. Exit Interview.the state’s words, verbatim · CDSS document, Aug 17, 2022

Type of visit: Prelicensing

On 8/27/2021 Licensing Program Analyst LPA Ashley Boothe arrived announced to conduct a Prelicensing Inspection. LPA arrived at 9:00am and met with Administrator Cosmina Stancu with and stated the purpose of today’s visit. This facility has received a fire clearance on 7/19/2021 for 5 non ambulatory and 1 bedridden residents. Current Census 0. Current Administrator Certificate expires 9/30/2021. The physical plant was toured inside and outside to ensure the safety of the residents. LPA's observed common area, kitchen, dining room, bedrooms, restrooms, garage, and backyard. The facility was found to be clean and in good repair in all areas. LPA observed the areas to store centrally stored medications, knives, cleaning supplies, and staff office to be locked and inaccessible to residents. The temperature inside the facility was measured at 74*F which is within the required range of 68 *F and 85 *F, or in areas of extreme heat the maximum shall be 30*F less than the outside temperature. The hot water was measured at 111.7*F which is not less than 105 *F and not more than 120 *F. The first aid kit was found in compliance containing at least the following: a current edition of an approved first aid manual, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA observed newly purchased fire extinguisher, smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA completed Comp III with during visit. The facility is ready for licensure and the applications unit will be notified of this visit and report. Exit interview and copy of report provided.the state’s words, verbatim · CDSS document, Aug 27, 2021

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.