Dago Residential Facility #2 Elderly

Type of visit: Required - 1 Year

On 09/09/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with administrator. LPA met with Romulo Manangan Caregiver. Caregiver Lourdes Davidson arrived shortly. Administrator Cristina Sanchez was called and arrived shortly and conduct tour with LPA. There are currently no residents were present during the inspection. Upon entry facility staff was observed with facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. Social distancing and cough etiquette postings observed. LPA checked residents’ locked medications. LPA observed 30 day PPE supplies. Food supply was checked and appeared to be an adequate supply. Cleaning supplies were stored and locked in cabinet in the garage. LPA observed fire extinguisher served date: 11/30/21. All resident’s room toured and observed to be adequately furnished and lit. LPA observed 2 shared residents’ bed to be at least 6 feet apart and 1 single occupant room. All bathrooms are observed with securely fastened grab bars and non-skid mat. All bathrooms observed trash bin with lid. Hand washing posting observed by bathroom sinks. The exterior tour was conducted. Side gate was self-closing and self-latching. Staff records were reviewed for good health and infection control training. All resident records reviewed to have updated emergency contact information. No deficiencies issued during this inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 9/16/22. The following updated forms were requested: Lic 308, Lic 400, Lic 402, Lic 500, Lic 610E, Lic 9282, and current liability insurance. LPA received a copy of facility sketch. Administrator was informed that as COVID-19 precautionary measure, this report will be provided via email. Report signed on-site.the state’s words, verbatim · CDSS document, Sep 9, 2022

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: A staff person is sleeping in a bed that the resident purchased.

Licensing Program Analyst (LPA) M. Yang conducted an initial complaint investigation and met with Administrtor. LPA stated the purpose of the visit and reviewed the allegations. During the course of the investigation, the Department conducted interviews and toured the facility. LPA interviewed staffs, clients, and spoke to regional center. It was confirmed that facility staff and C1 switched rooms and S1 slept on C1’s bed without informing Regional Center of the changes. S1 exhibit behaviors after the changed. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report and appeal rights will be provided via email. Report signed on-site. Substantiatedthe state’s words, verbatim · CDSS document, Nov 8, 2021 · control 24-AS-20211103141905

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80072(a)(2) · Plan of correction due date: Nov 8, 2021

80071 (a)(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not met: Based on interviews conducted, facility staff and C1 switched rooms and S1 slept on C1’s bed without informing Regional Center of the changes. S1 exhibit behaviors after the changed, this posses an immediately health and safety and personal rights risk to the client.the state’s words, verbatim · CDSS document, Nov 8, 2021

Plan of correction: Facility moved the client back into his room back to his bed. POC cleared during the inspection.

Type of visit: Case Management - Deficiencies

On this date, Licensing Program Analyst (LPA) M. Yang arrived to conduct an unannounced initial complaint investigation and met with Administrator Cristina Sanchez. LPA toured the facility, interviewed clients and staffs. During the course of the investigation, LPA observed the following deficiencies: 1. Chemicals and knife observed under unlocked resident’s bathroom sink 2. Client sleeping in a room designated for staff per the facility sketch. Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Administrator was informed that as a COVID-19 precautionary measure, this report and appeal rights will be provided via email. Report signed on-sitethe state’s words, verbatim · CDSS document, Nov 8, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80087(g) · Plan of correction due date: Nov 8, 2021

80087(g)Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement was not met: Based on observation, LPA observed chemicals and knife unlock under resident's bathroom, this posses an immediately health and safety and personal rights risk to the client.the state’s words, verbatim · CDSS document, Nov 8, 2021

Plan of correction: Administrator immediately removed chemicals and knife to a secured and locked garage cabinet. POC cleared during inspection.

From the deficiency page — Deficiency type: Type B · Section cited: CCR80022(b)(7) · Plan of correction due date: Nov 14, 2021

A sketch of the building(s) to be occupied, including a floor plan which describes the capacities of the buildings for the uses intended, room dimensions, and a designation of the rooms to be used for nonambulatory clients, if any. This requirement was not met: Based on observation and interviews conducted, resident was moved into a bedroom designated for staff which posses a potential health and safety and personal rights risk to the client.the state’s words, verbatim · CDSS document, Nov 8, 2021

Plan of correction: Administrator states that facility sketch will be updated to reflect correct designated rooms for resident. Updated facility sketch will be submitted to CCL by due date.

Type of visit: Required - 1 Year

On 09/03/2021, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, LPA was met by Direct Support Personnel (DSP) Veronica Noriega, and requested to meet with the Administrator. Administrator, Cristina Sanchez was called and arrived later. Four residents were present during the inspection. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. LPA conducted a complete tour of the facility with DSP and administrator. The facility was observed without any fire clearance issues or obstruction. Cough etiquette and COVID signs posted throughout facility. Common areas had furniture and was lit. LPA observed a hospital bed for one resident in the common area. LPA discussed with administrator regarding a physician order for the bed and relocating to the resident's room. LPA checked residents’ locked medications and observed a 30-day PPE supplies. LPA observed a 14- day supply of nonperishable food and a 2-day supplies of perishable food which were stored properly. Fire extinguisher observed to be last serviced 12/04/2020. The resident’s rooms were toured and were observed adequately furnished and lit. LPA toured resident bedrooms and bathrooms. LPA observe hand washing sign at all sinks. Cleaning supplies and chemicals were observed in the locked cabinet in the garage. The exterior tour was conducted. Side gate was self-closing and self-latching. Facility staff was observed with mask on. A sample of residents’ records reviewed to have updated emergency contact information. LPA, M. Yang follow-up on a case management on incident report that was received on 09/20/21. LPA interviewed staff regarding incident report. No follow-up needed. No deficiencies issued during this inspection. Exit Interview conducted. The following forms were requested: Administrator Certificate, updated Liability Insurance, LIC 308, LIC 309 LIC 400, and LIC 402, LIC 500, LIC 610D, LIC 9020. Please submit the above forms/information to Fresno CCL by: 10/07/21.Due to COVID-19 precautionary measures, a copy of this report will be provided via email and an electronic read receipt confirms receiving this email. Report signed on-site.the state’s words, verbatim · CDSS document, Sep 30, 2021