Graceful Living at Oakdale 2

Type of visit: Required - 1 Year

On 11/7/23 at approximately 10:30am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a required 1 year annual inspection. LPA Jensen met with Licensee Voica Matis and explained the purpose of today's visit. The Licensee holds a current Administrator certificate good through 12/16/2023. The annual fees were verified to be current. LPA Jensen toured the grounds and determined all paths to be free of obstruction. The grounds were observed to be maintained. There is outdoor seating available with shaded areas for client engagement. All screens were in good repair. LPA Jensen toured the interior. The facility was observed to sanitary and was free of odor. There was adequate lighting and furniture throughout. There are night lights available in the hallway. The facility maintains adequate linens and hygiene supplies. All appliances are in good working order. LPA Jensen toured the kitchen and observed in excess of a two day supply of perishable food and a 7 day supply of non-perishable food. There was a variety of fresh fruit and vegetables available. LPA Jensen observed the meal service preparation for lunch which consisted of chicken noodle soup and sandwich. All medications were locked and inaccessible. All toxins and sharp objects were locked and inaccessible. The fire extinguisher and carbon monoxide detector were observed to be in compliance. The first aid kit was observed to be complete and in compliance. The facility maintains and an adequate supply of emergency food. The emergency disaster plan has recently been updated and is in compliance. LPA Jensen reviewed 6 of 6 resident files and determined them to be complete. LPA Jensen reviewed 3 of 4 staff files and determined them to be complete. LPA Jensen observed 1 staff member to be present in the facility that did not have a criminal background clearance. Continued on LIC 809C.... LPA Jensen provided technical assistance in relation to the facility Infection Control Plan. Deficiencies are being cited pursuant to the California Code of Regulations (CCR) Title 22, Division 6. Civil penalties are also being assessed for criminal background clearance. The inspection tool was used during the course of this inspection. An exit interview was conducted and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 7, 2023

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with facility staff Rainileo Clavana Continual Administrator's Certification for Voica Matis expires 12/16/2023. There are currently 5 residents who reside at this home and there is 0 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 119 degrees. First Aid kit is on site and complete. LPA confirmed staff present has a COVID 19 vaccine card or exemption card on file. LPA confirmed all staff present to be background cleared. LPA observed cleaning solutions such as glass cleaner, and Fabuloso not secured or locked in the facility garage area. LPA observed a closet used to store facility medications unlocked and accessible to residents. There following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with facility staff Rainileo Clavana and copy of report left at facilitythe state’s words, verbatim · CDSS document, Sep 29, 2022

Allegation investigated: Facility staff gave resident wrong medications Facility did not report medication error to licensing

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to investigate the above mentioned allegations on 4/29/22 at 2:20pm. LPA was met by Linda Aguilar and stated the purpose of the visit. The Administrator Voica Matias was made aware of the complaint as well. LPA observed the locked medication cabinet and the containers for each resident. LPA observed the Medication Administration Record (MAR), and the Tablets-Capsules-Ampules Log. LPA interviewed staff #1 (S1-S3) during this visit. LPA did not observe the use of 7-day pill box during this visit. Based on interviews, observation and lack of evidence the preponderance of evidence standards has not been met; therefore, the above allegation(s) is found to be UNSUBSTANTIATED. A finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, nothe state’s words, verbatim · CDSS document, Apr 29, 2022 · control 27-AS-20220419085726

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced 4/29/22 at 2:20pm on a subsequent complaint visit. 27-AS-20220419085726 LPA was met by Rainilda Clavano, Caregiver and stated the purpose of todays visit. During the complaint investigation, LPA observed the Medication Administration Record (MAR) which indicated the medications for 8am and 8pm were given for the dates of 4/29/22, 4/30/22, and 5/1/22. LPA also observed the Tablets-Capsules-Ampules Log was missing signatures and/or initials for 4/29/22 which should indicate that medications were passed. Staff # 1 (S1) stated that it was busy and it is usually completed at night. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Licensee was provided a copy of their rights (LIC9058 12/15) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 29, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(5) · Plan of correction due date: Apr 30, 2022

Incidental Medical and Dental Care The following requirements shall apply to medications which are centrally stored:Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: LPA obtained information that the medications were transferred from the original container. Based on the Licensee did not ensure the medication was provided to the person it was prescribed for. This possess an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2022

Plan of correction: Licensee shall submit a plan to conduct an in-service for staff regarding medication processes. The in-service shall be completed by 5/6/22 with proof faxed to CCL.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(d)(3) · Plan of correction due date: Apr 30, 2022

Incidental Medical and Dental Care If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to 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:The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: LPA observed that the medication records were completed days in advance. Based on the Licensee did not ensure the medication record is maintained appropriately This possess an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2022

Plan of correction: Licensee shall submit a plan to conduct an in-service for staff regarding medication and procedures. The in-service shall be completed by 5/6/22 with proof faxed to CCL.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facilities annual inspection. LPA met with Wellness Coordinator Ging Clavano. There are currently 5 residents who reside at this home and there are no residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period (June 17, 2021.) Smoke alarms were tested and are operational. Water temperature was tested at 118 F degrees. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Wellness Coordinator Ging Clavano and copy of report left at facilitythe state’s words, verbatim · CDSS document, Nov 3, 2021