The Norma J's Home for the Elderly III

Allegation investigated: Licensee/Administrator was not acting in good character with outside agency and interfered with their duties

Licensing Program Analyst (LPA), Elsie Campos conducted a subsequent visit to deliver the findings for the above allegation. Upon arrival, the LPA met with staff Robin Douglas and explained the reason for the visit. Administrator, Loretta Tiede arrived shortly thereafter. On 3/15/2023,the LPA conducted an initial 10 day complaint visit. The LPA observed the kitchen at 2:38 p.m.,conducted a facility tour at 2:56 p.m. to ensure there are no health and safety concerns. Interviewed staff at 2:43 p.m., and 2:52 p.m. and interviewed a resident at 3:35 p.m. **Continued on LIC 9099-C** Unsubstantiated Regarding allegation: Licensee/Administrator was not acting in good character with outside agency and interfered with their duties. The complainant alleged that the Administrator was speaking loudly and was not acting in good character with an outside agency and asking them to leave the facility which interfered with their duties. Interviews with residents denied claims that the Administrator was acting out of character. Residents confirmed that they were bothered by the outside agency representative who was disturbing their peace by not listening to the Administrator who wanted to take the representative outside to clarify the reason for their visit. Staff interviews confirmed that the Administrator was not acting out of character and was simply attempting to get clarification on the representative’s business at the facility. Interviews with staff confirmed that the Administrator is a naturally loud person with no negative tone or ill intentions. Interview with outside agency representative indicated that that they had informed staff of the reason for the visit and therefore did not find reason to explain their visit to the Administrator as they are not required too. Staff confirmed that the Administrator had been speaking loudly as they were helping a resident locate a phone when the representative arrived however, this is only the tone of their voice and there was nothing unusual about the Administrators character or behavior which is positively received by all staff and residents at the facility. Residents further expressed positive experiences at this facility and denied otherwise that the Administrator did not act in good character with an outside agency. Based on the information obtained, there is insufficient evidence to support the claim that Licensee/Administrator was not acting in good character with outside agency and interfered with their duties. While this allegation or may or may not have happened. This allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 6, 2023 · control 29-AS-20230314135749

Allegation investigated: Cleaning supplies are not properly stored

Licensing Program Analyst (LPA), Elsie Campos conducted an unannounced initial 10-day complaint visit for the above allegations. Upon arrival, the LPA met with staff Robin Douglas and explained the reason for the visit. Administrator, Loretta Tiede arrived shortly thereafter. During today's inspection, the LPA observed the kitchen at 2:38 p.m.,conducted a facility tour at 2:56 p.m. to ensure there are no health and safety concerns. Interviewed staff at 2:43 p.m., and 2:52 p.m. and interviewed a resident at 3:35 p.m. **Continued on LIC 9099-C** Unsubstantiated Regarding the allegation: Cleaning supplies are not properly stored It was alleged that a kitchen cabinet under the sink was observed to be open with cleaning supplies accessible. Interviews with staff revealed that at the time of the observation staff were actively in the kitchen cleaning, repairing a garbage disposal and preparing snacks, as residents were sitting at the table convening with one another. During today’s visit, the LPA conducted a physical plant tour of all the resident rooms and common spaces. Areas observed included the common areas, dining room, kitchen, garage, resident bedrooms, bathrooms, patio and exterior of the facility. During today's visit, areas were observed to be appropriately cleaned and all cleaning supplies were observed to be properly stored. The kitchen cabinet that is used to store cleaning supplies was locked and was not observed to be in disrepair. The LPA additionally attempted to open the cabinet and was unable to do so. Based on interviews, the Department does not have sufficient evidence to support the allegation that cleaning supplies are not properly stored, while this allegation may or may not have happened the allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 15, 2023 · control 29-AS-20230314135749

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA), Martha Arroyo conducted a pre-licensing visit to this property at 1:00pm on 1/20/2023 and met with applicant representative Loretta Tiede. The applicant has obtained fire clearance for a total capacity of five (5) non-ambulatory residents, and one (1) bedridden resident in bedroom #5 for a total capacity of six (6) residents. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. At 1:26pm, all hard-wired smoke alarms and carbon monoxide detectors were tested and function properly. LPA observed two (2) fire extinguishers to be fully charged on 10/11/2022. There are six (6) single occupancy bedrooms for resident use. Five (5) bedrooms are inside the house while bedroom #6 is located outside in the backhouse. There will be no-live in staff. Facility will have 24-hour wake staff. Each bedroom is equipped with clean mattresses, pillows, and bedding. There is sufficient supply of linens, including blankets, bath towels and wash cloths. Bedrooms have sufficient lighting. The facility has four (4) bathroom for resident use. Resident bathrooms contained appropriate non-skid mats and grab bars. Bathrooms has sufficient paper products. Night-lights were present in the main hallway. Hot water measured at 109.4 degrees Fahrenheit at 1:22pm. LPA toured the kitchen area at 1:29pm. The facility has at least seven (7) day supply of non-perishable food. Appliances and all equipment appear to be clean and in good repair. Kitchen knives are stored in a locked drawer next to the oven. The kitchen has a sufficient supply of plates, cups, cook ware and utensils. Kitchen hot water measured at 114.8 degrees Fahrenheit at 1:41pm. The living areas and dining areas are clean and properly furnished. All window screens and coverings are in good repair. Enough seating for six (6) residents at the same time in the dining room table. A working telephone is present. There are activity supplies for future residents. Report Continued on LIC 809C... Report Continued from LIC 809... Medications will be stored and locked in a file cabinet next to the kitchen. First aid kit was observed to have bandages, thermometer, scissors, tweezers and a current first aid manual. Facility records will be stored and locked in a cabinet adjacent to the kitchen. Cleaning and disinfectants are stored and inaccessibly locked under the kitchen sink. Garage: The garage is attached to the house and will be locked at all times. Laundry area is located in the garage. Laundry detergents and cleaning supplies are stored and inaccessible to residents. There is an adequate supply of emergency water, along with emergency nonperishable food items kept in the garage. There will be no firearms/ammunition stored on the property. The facility has required postings, including emergency exit plan, Licensing Complaint Poster, Resident Personal Rights, Theft and Loss Policy, Resident Council Rights, and CDSS PINs. Facility has one central entry point designated for universal screening. Alcohol-based hand sanitizer available upon entry. Signs are posted throughout the facility to promote handwashing, and cough/sneeze etiquette. Facility has an adequate 30-day supply of Personal Protection Equipment (PPE). The exterior passageways were clean and clear of any obstructions. There are no bodies of water on the premises at the time of the visit. The LPA observed the backyard, which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. Physical plant is consistent with the submitted facility sketch/floor plan. During today’s visit, LPA reviewed facility’s program plan, personnel policies, abuse reporting procedures, in-service training protocol, and medication procedures. The physical plant of this facility location is in compliance with Title 22 regulations at this time. Comp III conducted in Licensee Representative. 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 not allowed to begin 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. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Jan 20, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participant: Loretta Tiede, CEO/Administrator Interview Method: Telephone interview On 12/12/22, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. 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, Dec 12, 2022