Davis Guest Home #5

Type of visit: Required - 1 Year

Unannounced annual visit was conducted by Licensing Program Analysts (LPAs), Kimberly Viarella and Charlie Yang, on February 23, 2023. LPAs were met by staff member, Maria Bravo. Ms. Bravo was instructed to notify the designated facility administrator, Heather McCloskey, that Community Care Licensing was on the premises to conduct the annual review. The facility designated Administrator Heather McCloskey arrived shortly after. Brief interview was conducted with the facility staff and facility designated Administrator. The facility designated Administrator, Heather McCloskey, was observed to have the RCFE Certificate, # 6008133740, which was set to expire on 09/28/2023. Census at this time was 8 residents. There have been no new physical plant changes since the last annual conducted. Fire extinguishers were last inspected by Gateway on August 15, 2022. Bathrooms were sanitary and no toxic chemicals were present. The water temperature was measured in the hallway bathroom and was within the allowed range of 105 and 120 degrees. Resident bedrooms were observed to have sufficient furniture and lighting. LPAs interacted with residents who appeared to be content and going about their daily activities. The medication cart and logs were reviewed, including the medication disposal log. At this time all appeared to be in organized and in order. The First Aid kit was inspected and contained all of the required components at this time. All sharps and toxic chemicals in the kitchen were kept in locked cabinets and under the sink respectively. Additional dry goods and a second freezer was located in a locked storage. The food supply was inspected and there was a sufficient 2 day perishables, as well as a sufficient 7 day non-perishables food supply. The exterior grounds were inspected and found to be in good order and free of debris and tripping hazards. There were no bodies of water. There was a shed with a lock that contained holiday decorations, extra furniture and other items for storage. There were no deficiencies observed or cited at this time. The following documents were requested to be updated and submitted into CCL for review by the LPA: LIC 308 LIC 400 LIC 500 LIC 610 A copy of the updated Liability Insurance Exit interview.the state’s words, verbatim · CDSS document, Feb 23, 2023

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 03/07/2022 by Licensing Program Analyst (LPA) Charlie Yang and was met by the facility caregiver, Brittany Miller, and house manger, Maria Bravo, who were requested by this LPA to go ahead and contact the facility designated Administrator to inform her that CCL was present at this time. The facility designated Administrator, Heather McClosky, arrived shortly thereafter to this facility. Brief interview conducted with the facility designated Administrator. This facility accepts and retains up to 8 residents at any given time, of which only (2) can be non ambulatory, while the other (6) are ambulatory only. Current census was 6 residents. Tour of this facility was conducted. Kitchen area was toured. Food storage units were reviewed for 2-day perishable and 7-day nonperishable food quantities. Additional food supplies were observed to be present in the garage storage unit. Freezer unit and additional nonperishable food quantities were present and observed at this time. Dining area, living area, and all other areas intended for resident use were toured. Furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident bedrooms was conducted. Bedroom furniture and furnishings were observed to be sufficient and able to meet the needs of the residents at this time. A tour of the resident restrooms was conducted. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Fire extinguishers, located throughout this facility, were observed to have been annually inspected on 09/09/2021 by the local fire extinguisher company and in compliance at this time. Laundry area, located adjacent to family room, was toured. Medication cart, located in the dining area, was reviewed. It was observed to be locked and made inaccessible to the residents at this time. First aid kit was observed to be present and contained all of the required components at this time. Exterior grounds of this facility were toured. The facility perimeter fence, side gates, and exits were reviewed at this time. Linen closet was reviewed and observed to contain a sufficient supply of towels, sheets, and linens to be able to meet the needs of the residents at this time. The following forms and documents were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 There were no deficiencies observed or cited during today's annual visit. Exit Interviewthe state’s words, verbatim · CDSS document, Mar 7, 2022

Allegation investigated: Staff mishandled resident's funds Staff did not safeguard resident's belongings Staff did not assist resident with obtaining care Staff did not provide water to resident

Unannounced complaint visit made out to this facility on 12/23/2021 by LPA Charlie Yang. This LPA was met by the facility house manager, Maria Bravo, and facility caregiver, Brittany Miller, who was requested by this LPA to go ahead and contact the facility designated Administrator, Heather McClosky, who arrived shortly thereafter to this facility. Current census was 7 residents. Based on a review of the resident records, it was learned that all residents and their P&I funds were managed by this facility and its staff. Withdrawals and deposits were recorded and initialed by the corresponding resident after each transaction. Additional information revealed that R1 would also order items through Amazon, an online retail store, with the assistance of facility staff. Records revealed that items were ordered, paid for, and delivered to this facility address as ordered. Based on interviews, it was learned that adequate care and supervision was being provided to the residents by facility staff. It was learned that incontinent residents were properly cleaned and changed by staff from all shifts throughout the day and night as well. Unsubstantiated Based on interviews, it was learned that meals were served three times a day with two snacks in between meals. Along with the meals a variety of drinks were made available to facility residents upon request if water or juice was not wanted at that time. It was learned that milk and coffee were also made available if desired by facility residents at meal time. As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies observed or cited at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 23, 2021 · control 27-AS-20210920095837

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Johnson arrived unannounced to conduct an annual inspection. LPA met with Staff 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 131 degrees Fahrenheit in client's bathroom sink, which is not the required range of 105 to 120 degrees. Fire extinguishers and smoke detectors are operational. LPA observed centrally stored medications are kept locked and inaccessible to residents. LPA reviewed and compared resident medication vs. resident medication logs. During the medication review LPA and Med-tech observed expired medications without a back ordered replacement for R1 (photo taken). Also observed during the medication review was a bubble pack for R2 with medication pushed and re-taped, this is a medication error (Photo taken). Controlled medication count was not accurate for R3's Tramadol. LPA reviewed 4 resident and 2 staff files, including criminal record clearances. First aid kit was checked and is complete. Fire drill was conducted on 11/03/2021. Deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conductedthe state’s words, verbatim · CDSS document, Nov 20, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80088(e)(1) · Plan of correction due date: Nov 21, 2021

Fixtures, Furniture Equipment and Supplies. Faucets used by clients shall deliver hot water, and attain temperatures of not less than 105 degrees F and not more than 120 degrees F. LPA tested the hot water at 131 degrees F. Licensee failed to assure hot water meeting Title 22 regulation of 105-120 degree F. This poses a health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Nov 20, 2021

Plan of correction: The facility will test the hot water for 3 days. Test hot water in the hallway resident wash area for three days to meet Title 22 regulations. Send 3 days of hot water temperatures to LPA via email.

From the deficiency page — Deficiency type: Type A · Section cited: CCR80075(l)(1)A-D · Plan of correction due date: Nov 21, 2021

(l) Prescription medications which are not taken with the client upon termination of services, or which are not to be retained shall be destroyed by the facility administrator, or a designated substitute, and one other adult who is not a client. (1) Both shall sign a record, to be retained for at least one year, which lists the following: LPA and Med-tech observed expired medications without a back ordered replacement for R1. This poses a health and safety risk to resident.the state’s words, verbatim · CDSS document, Nov 20, 2021

Plan of correction: Licensee shall dispose of expired medications and maintain medications as per regulation cited. An inservice for all medication passers shall be conducted as a refresher to be completed by 11/30/2021 The facility will maintain for each client, records of centrally stored prescription medications destruction which shall be retained for at least one year.