Blissful Grannies Home

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Teresa Camara conducted a case management - incident visit to the facility regarding a late death report for resident 1 (R1). LPA initially met with staff 1 (S1) and the administrator Johnna Udden arrived at the facility at 12:45 p.m. Interviews were conducted with S1 at 12:23 p.m. and staff 2 (S2) at 12:29 p.m. LPA requested records for R1 but they are no longer at the facility. The administrator brought the records to the facility and LPA reviewed the records at 12:48 p.m. Records show that R1 started their most recent admission to hospice on 4/6/2023. However, the administrator did not notify Community Care Licensing (CCL) of R1 starting hospice. Regulations require the licensee notify CCL within five working days of residents starting hospice or a hospice resident being admitted to the facility. Records show that R1 passed away on 5/7/2023, however the administrator did not report R1's death to CCL until 7/26/2023. Regulations require that the death of a resident is reported to CCL within seven days of the occurrence. Pursuant to Title 22, California Code of Regulations, the following deficiency will be cited (refer to LIC 809-D) Exit interview conducted, citations issued, appeal rights discussed, and a copy of this report sent via email.the state’s words, verbatim · CDSS document, Aug 9, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Aug 16, 2023

87211 Reporting Requirements. (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within 7 days of the occurrence...(A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility.the state’s words, verbatim · CDSS document, Aug 9, 2023

Plan of correction: Administrator will review Reporting Requirements and submit a letter of understanding of these regulations to CCL on or before 8/16/23. Based on interviews and record review, licensee failed to report R1's death within 7 days of the occurrence, which poses a potential health risk to resident in care.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87632(d)(2) · Plan of correction due date: Aug 16, 2023

87632 Hospice Care Waiver (d) If the Department grants a hospice care waiver it shall stipulate terms and conditions of the waiver as necessary to ensure the well-being of terminally ill residents and of all other facility residents, which shall include, but not be limited to, the following requirements: (2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services...the state’s words, verbatim · CDSS document, Aug 9, 2023

Plan of correction: Administrator will review Hospice Care Waiver requirements and submit a letter of understanding of these regulations to CCL on or before 8/16/23. Administrator will also submit any notices that have not previously been sent for current hospice residents. Based on interviews and record review, licensee failed to report R1 was admitted to hospice, which poses a potential health risk to resident in care.

Allegation investigated: Resident sustained questionable injury while in care.

Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced subsequent complaint visit to this facility. LPA initially met with staff who called the administrator Johnna Udden. LPA met with the administrator at 4:00 p.m. and explained the reason for the visit. On 12/14/2022, the Department received a complaint alleging resident 1 (R1) sustained a questionable injury while in care. Specifically, R1 was found to have brusing on their face reportedly due to a fall in the bathroom, however it was assumed that staff did not take R1 into the bathroom which made the injury seem questionable. (continued on 9099-C) Unsubstantiated On 12/21/2022, LPA Camara conduct an intial complaint investigation visit to the facility and conducted a brief tour of the facility at 2:45 p.m. LPA conducted records review at 2:55 p.m. and obtained copies of pertinent documents. LPA conducted interviews with staff and residents between 3:05 p.m. and 4:15 p.m. On 3/15/2023, LPA conducted a telephone interview with former staff. On 3/17/2023, LPA conducted a telephone interview with a witness. Facility records showed R1 was receiving hospice care. On 12/21/2022, LPA had attempted to speak with R1, however R1's condition prevented a successful interview. LPA observed R1 was on the couch watching television with other residents. R1 would frequently scream as if in distress and would frequently yell "ouch" although nobody was near them. Staff would sit with R1 to provide comfort. During an interview with another resident, resident 2 (R2), they indicated staff at the faciltiy provide excellent care and they are very caring and patient with R1. R2 had no concerns about the care provided at the facility. During interviews with staff, they stated on the date of the accident, 12/10/2022, R1 required incontinence care so two staff took R1 into the bathroom to get cleaned up. One staff left the bathroom to attend to another resident and during that time R1 fell forward off of the toilet and hit their forehead on the handrail directly across from the toilet. Staff was able to get R1 back on the toilet. Staff stated R1 had a bump on their head and bruising. The bruising eventually made its way down to R1's eyes and then down R1's face. The administrator and licensee stated they consulted with a hospice nurse regarding the bruising since it was concerning that the bruising traveled down R1's face but the hospice nurse told them it was normal for that type of injury. LPA interviewed a hospice nurse who confirmed the bruising process was normal for that type of injury. The nurse stated they did not realize facility staff cleaned R1 in the bathroom until after the incident and they understood the mechanism of injury. Based on the information obtained during interviews and document reviews, the Department does not have sufficient evidence to support the above allegation. Therefore, the allegation "Resident sustained questionable injury while in care" is deemed unsubstantiated at this time. Exit interview conducted. A copy of the report was provided to the administrator.the state’s words, verbatim · CDSS document, Mar 20, 2023 · control 29-AS-20221214083721

Type of visit: Required - 1 Year

On 02/19/2023, Licensing Program Analyst (LPA) Sandra Urena, arrived at the facility unannounced to conduct a required annual inspection. LPA Urena arrived at the facility at 10:15 a.m. This annual inspection had a specific emphasis on infection control practices, and procedures. The purpose of the inspection was discussed with the Licensee Helen Rose Busch. Infection Control: Upon entry, the facility has a sign in book and sanitizing gel. Infection Control signage was visible at entrance. Temperature was checked, and recorded. From 10:30 a.m. to 11:15 a.m. LPA Urena and licensee conducted a tour inside and outside of the physical plant to ensure there are no health, and safety hazards, and facility is in compliance with Title 22 Regulations. Common Areas: Common seating area and dining room furniture were observed to be in good condition. Fire extinguishers were observed to be serviced within the last year. Kitchen: Knives are stored in a locked cabinet drawer. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. Emergency food supply is adequate for six residents, and two staff. Continues on LIC 809C... Bedrooms: Bedrooms were furnished appropriately with appropriate furnishings and sufficient lighting. Linens are clean, and in good condition. Bathrooms: Bathrooms were clean, shower area was in clean condition with grab bars and a non-skid mat available. Paper towels were available for drying hands. Hand washing signs were displayed, and sufficient amounts of soap, and paper products in each bathroom. Outdoor Space: Backyard has a covered outdoor area equipped with furniture in good repair for residents’ use. There were no bodies of water noted. Side gate is unlocked. LPA Urena observed an adequate supply of Personal Protection 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 No citations were issued. Exit interview was conducted, the report was reviewed with the Licensee, and a copy of the report was provided. Signatures were obtained.the state’s words, verbatim · CDSS document, Feb 19, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Angel Ascencio conducted a Pre-Licensing Inspection with Applicant Representative Helen Busch and Administrator Johnna Udden. Reason for pre-licensing is Change of Operations. An Application to operate a Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) on 2/9/2022. A Fire Clearance was approved for a maximum capacity of six( 6) non-ambulatory and two (2) bedridden residents on 1/4/2022. The physical plant is a single story facility located in a residential neighborhood of Oxnard, CA. The current location is licensed under JN Care Home (#565801334), operated by Nelia Gascon. A tour of the physical plant was conducted for completeness and the following observed: KITCHEN: Appliances and fixtures appeared clean and functional. There was sufficient non-perishable food to accommodate a maximum capacity of 6 residents for 7 (seven) days. There was sufficient dining and cook ware to accommodate a maximum capacity of 6 residents. Cleaning supplies were stored and locked under-sink cabinet and locked closet in the garage. Knives and other sharps were stored in a locked cabinet during tour. Water temperature was measured and was within range of 105 degree F to 120 degrees F at the time of visit. There were no visible immediate hazards observed. BEDROOMS: There are four (4) bedrooms, all of which are designated for resident use. Two (2) bedrooms are furnished for double occupancy, two (2) are furnished for single use. All bedrooms were equipped and supplied with appropriate furniture, bedding and linens. There were no visible hazards or discrepancies observed. BATHROOMS: There are two (2) bathrooms for resident use. The resident bathrooms are full bathrooms with overhead shower head, non-skid tile and shower bench. All bathrooms were supplied with appropriate paper and hygiene products. COVID-19 signs are required inside all bathrooms and were observed during the visit. Water temperatures were measured in all bathrooms and measured within the required range of 105 degrees F to 120 degrees F at the time of the visit. Continued on LIC-809-C COMMON AREAS: These include the Common Area Room and Dining Room. The common areas were furnished to accommodate a maximum capacity of six (6) residents. The Fire safety inspection clearance was approved on 1/4/2022. Fire extinguishers and carbon monoxide detectors were observed throughout the facility. There were no immediate hazards observed. A COVID-19 Screening & Hand Sanitizing Station was observed at the entrance to the facility. COVID-19 signs were observed throughout the facility common areas. GARAGE & OFFICE AREAS: There is a Garage and an office room at the premise. Medications are stored in a locked cabinet and refrigerator in the garage. The 1st Aid Kit is stored in the locked cabinet and locked storage area. The garage was observed to be locked and contained Emergency food supplies, resident supplies and Personal Protective Equipment (PPE). LAUNDRY: Laundry room was observed to be locked and contained laundry supplies in a locked cabinet. BACKYARD: The backyard has a patio with furniture appropriate for outdoor use and shade for the residents. There were no visible immediate hazards or deficiencies. COMPONENT III ORIENTATION: A Component III Orientation was completed with the Licensee and Administrator on 2/23/2022 during pre-licensing visit for Blissful Grannies Home, #565850237. COVID-19 MITIGATION PLAN REPORT: During today’s visit, LPAs reviewed the facility’s Plan for Epidemic Outbreak specific to COVID-19 Mitigation Plan Report. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are allowed to continue operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Pre-licensing is complete and this facilities has no deficiencies. Exit interview conducted. A copy of the Licensing Report was provided via email.the state’s words, verbatim · CDSS document, Feb 23, 2022

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 5 Census (if any clients in care): 6 COMP II Participants: Johnna Udden - applicant/licensee, administrator; Helen Busch - applicant/licensee Interview Method: Telephone interview On [DATE], applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Feb 8, 2022