Ocean Breeze at Blue Oak

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 08:40AM. LPA initially met with facility staff. Administrator Evelyn Rayas was contacted and arrived shortly after the visit began. Entrance interview conducted. Beginning at 09:10AM, the LPA, along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed: Fire extinguishers are fully charged and last serviced on 05/19/2023. Hardwired combination smoke detectors and fire doors were tested at 11:03AM, separate carbon monoxide detector was tested at 11:05AM and all were functional at the time of the visit. No fire clearance concerns were observed. KITCHEN: The LPA observed the kitchen to be clean. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of seven (7) days non-perishable and two (2) days perishable food. Cleaning supplies are located in a locked cabinet under the kitchen sink. Medications and sharps are locked in a separate kitchen cabinet. Water was tested in the kitchen sink and measured in the appropriate range. COMMON AREAS: This includes the living room, family room, and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. An adequately screened fireplace was noted in the living room. BATHROOMS: There are three (3) bathrooms for resident use. One (1) shared half bathroom was observed Report Continued on LIC 809-C in the hallway, one (1) full bathroom is designated for resident use, one (1) private bathroom was observed attached to the shared resident bedroom with an adjoining door to a private resident bedroom. It was observed that the facility staff are currently using the walk-in shower for all residents, not just the residents with direct access to the private restroom. Restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. The water temperature was measured in both shared resident bathrooms and measured in compliance with regulation. BEDROOMS: There are six (6) total bedrooms in the facility; five (5) bedrooms are designated for resident use and one (1) staff room. The staff room is kept locked. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. GARAGE: Garage was observed locked and contained laundry area, extra food, PPE and incontinence supplies, and emergency food and water. OUTDOOR SPACE: The backyard has a covered patio area with patio furniture including a table and chairs for resident use. Facility has one gate, which was observed at 09:25AM to be difficult to open, not self-closing or self-latching. All passageways were observed to be clear. There were no bodies of water on the premises. RECORD REVIEW: Began at 09:30AM. Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. All five (5) staff files and five (5) resident files observed were observed to be in compliance with regulation. Administrator Certificate was observed to be expired 03/22/2023, however LPA reviewed the Administrator Certification website, which indicated all documents were received 02/21/2023 and the Administrator's Certificate is still pending at this time. All trainings were observed to be complete. MEDICATION REVIEW: Began at 01:00PM. Medications for five (5) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit. Report Continued on LIC 809-C INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster drills are conducted quarterly, with the last drill conducted on 07/14/2023. Emergency disaster plan was observed to be complete and updated annually, as required. INTERVIEWS: During today's visit, LPA interviewed two (2) staff and attempted to interview three (3) residents. Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D.) Administrator was informed that failure to correct the deficiencies may result in civil penalties. Exit interview conducted, appeal rights discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 6, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 04:28 PM. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Evelyn Rayas, who is authorized to sign and receive reports for this facility, and discussed the reason for the visit. The LPA, along with facility designee, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, family room, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. The garage was observed and contained the laundry area, as well as emergency food supply, and storage. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 6 (six) total bedrooms; 5 (five) are for resident use and 1 (one) is designated as a staff room. RESTROOMS: The LPA observed 3 restrooms in the facility. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. LPA measured hot water in resident Report continued on LIC 809-C restrooms, which measured within the required range. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator designee regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff and visitors to be wearing masks. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. The following recommendations were made: - N95 fit testing for all staff No deficiencies cited. Exit interview conducted. A copy of the report was provided via emailthe state’s words, verbatim · CDSS document, Sep 29, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 10:48AM. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Evelyn Rayas, who is authorized to sign and receive reports for this facility, and discussed the reason for the visit. At 11:07AM, the LPA, along with facility designee, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, family room, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. The garage was observed locked and contained the laundry area, as well as emergency food supply, and storage. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 6 (six) total bedrooms; 5 (five) are for resident use and 1 (one) is designated as a staff room. RESTROOMS: The LPA observed 3 restrooms in the facility. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Report continued on LIC 809-C INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff and visitors to be wearing masks, however residents are not consistently encouraged to wear face coverings in common areas. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. The following recommendations were made: - N95 fit testing for all staff - Post PINs and educate staff, residents, and families on changing policies and procedures from the Department No deficiencies cited. Exit interview conducted. A copy of the report was provided via email.the state’s words, verbatim · CDSS document, Oct 22, 2021