Arveah's Care Homes 2

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to continue the Required Annual Inspection at Arveah's Care Homes 2, which was started on 07/28/2023. LPA returned to review resident and personnel files with Co-Administrator Leah Davis. LPA reviewed three resident files and three personnel files and found them to contain the required information. LPA did an inspection of the facility and found it to be clean and well-organized. All toxins and hazardous materials were inaccessible and locked. All plumbing fixtures were fully functional and bathrooms had been deep-cleaned, including shower curtains. There were no citations issued during this inspection. Exit interview conducted with Joseph Khofi, Caregiver.the state’s words, verbatim · CDSS document, Aug 11, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Annual Required – 1 yr. inspection of this facility. 2 care staff were present at the time of inspection. LPA had temperature taken and logged in as a visitor to the facility and access was granted. 5 residents were present at the facility and 2 residents were attending Day Program. LPA toured the facility on 7/28/2023 with staff; facility was found to be clean and at a comfortable temperature of 71 F with all exits free from obstruction. Residents' bedrooms, common areas, kitchen & food storage areas were inspected. Seven (7) smoke detectors and two (2) carbon monoxide detectors were found to be operational during the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator was properly stored as per regulations on this day at the time of the visit. However, LPA and Caregiver observed toxins were accessible to residents in care in a closet covered by a curtain rather than by a secured, locked door. (See LIC 809D and LIC 812-Observation/Photos). Staff did remove them immediately and placed them in a secured shed. Sharps and other items were stored inaccessible to residents in a locked drawer in kitchen. There was a supply of cleaners, hygiene products and paper products available for clients. All residents' bedrooms have lighting & appropriate furnishings. Medications are stored in a locked cabinet in the living room; beside that is a locked refrigerator for medications requiring refrigerated storage. Continued..... Continued... The following documents are requested: LIC500 Proof of Liability Insurance Resident Roster Employee Roster Signed LIC308 Infection Control Plan, Emergency Disaster Plan, Facility records, Staff records and Resident records will be reviewed at a later date and time. Staff and resident interviews will also be conducted at a later time. Annual Continuation required. The following deficiencies were observed (See LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with care staff and a copy of this report along with appeal rights .the state’s words, verbatim · CDSS document, Jul 28, 2023

The state marks this report as 6 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 Analyst (LPA) Jill Nakagawa conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility. 3 care staff were present at the time of inspection. LPA was screened for Covid-19 symptoms, vaccination records reviewed and temperature taken. Findings were documented. 4 residents were present at the facility. LPA toured the facility on 6/7/2022 with staff; facility was found to be clean and at a comfortable temperature of 75 F with all exits free from obstruction. Residents' bedrooms, common areas, kitchen & food storage areas were inspected. Eight (8) smoke detectors and two (2) carbon monoxide detectors was found to be operational during the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored in a locked cabinet in storage room. Dangerous items were stored inaccessible to residents. There was a supply of cleaners, hygiene products and paper products available for clients. All residents' bedrooms have lighting & appropriate furnishings. Medications are stored in a locked cabinet in the living room; beside that is a locked refrigerator for medications requiring refrigerated storage. Infection Control: Facility submitted a mitigation plan approved on 01/25/22. Posters have been placed at entrance, small table with hand sanitizer and other items designated for visitors are placed at entrance. Staff screen and do temperature checks prior to shift. Administrator was informed of the Infection Control Plan due by June 30, 2022. Exit interview conducted with Administrator Arvin Davis via phone, and report was signed by Client Care Concierge Sheaena Hocog. There were no deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Jun 7, 2022

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced at Arveah's Care Home 2 to perform a post licensing inspection on NOvember 16, 2021 at approximately 12:43 PM.. LPA was met at the front door where Covid-19 screening was done; a questionnaire was given and temperature taken and documented. Several residents were watching a movie in the living room, two (2) residents were taking a nap in their rooms, and another resident watching television in their room. There were 3 care staff on duty, and one care staff sleeping in staff room. Carestaff Ken Hashimoto toured LPA around the facility, which was 73 degrees. The water temperature in the kitchen was 109.4 F and one of the bathrooms was 114.6 F, which is within Title 22 acceptable regulation of 105 to 120 degrees F. The kitchen was stocked with several days of perishable foods and a week's worth of non-perishable food items. Sharps were stored and locked; inaccessible to residents. Cleaning supplies were also stored and locked; and inaccessible to residents. Medications are kept in a locked storage cabinet in the living room, along with the First Aid Kit. There was a supply of linens and blankets for the beds. The perimeter of the facility was surrounded by a fence, with latching gates at either entrance. The storage shed in the back yard was secured. Each exterior-exiting door had an auditory alarm. There were two (2) fire extinguishers that were charged with a date of June 3, 2021. There were 9 operational fire alarms, and a hard-wired operational fire alarm system. The facility has a supply of gloves, masks, face shields and gowns, as well as covered garbage cans. Signs were posted regarding Covid-19 and mask-wearing mandates. No citations issued at this time. Exit interview conducted with Ken V. Hashimoto, Care Staff.the state’s words, verbatim · CDSS document, Nov 16, 2021

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jill Nakagawa performed an unannounced subsequent visit on 08/10/2021 to assure that Applicant Arvin Davis has resolved all Pre-Licensing deficiencies: ~Water temperature was tested at 111.3 degrees F. Applicant understands the water temperature shall be within 105-120 degrees F. ~Applicant has provided a locking drawer in the kitchen for sharps to ensure all sharps are locked and inaccessible to individuals with dementia. ~Applicant has demonstrated to LPA that all smoke detectors are operable. ~LPA observed that auditory alarms are on all doors leading to exterior. ~ LPA observed salmon-colored bedroom closet doors are properly secured. ~Required postings were observed. ~Applicant received physician’s orders for all residents using ½ bed rails. Component III was completed with applicant Arvin Davis on 7/27/2021. Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete. LPA will submit pre-licensing reports to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.the state’s words, verbatim · CDSS document, Aug 10, 2021

Type of visit: Prelicensing

Licensing Program Analyst (LPAs) K. Walters and J. Nakagawa arrived unannounced and met with applicant, Arvin Davis for the purpose of conducting a Pre-Licensing inspection. Facility is currently licensed and new facility will be a Change of Ownership. LPAs conducted a risk assessment with Applicant, Arvin Davis, who will be the Administrator once the license is approved. Upon entry, LPA's were screened for COVID-19 symptoms, which was then logged into facility I PAD. Alcohol based sanitizer was available. LPA observed a 30 day supply of Personal Protective Equipment. (PPE) The facility has designated indoor/outdoor visitation areas. The applicant has a mitigation plan for COVID-19, which has been submitted to Community Care Licensing. LPAs toured the facility with AD at 10:00 AM. LPAs observed that auditory alarms were not present in three bedrooms and that the auditory alarm was turned off in the living room. LPAs observed that carbon monoxide alarms and smoke detectors were operational. The fire extinguisher was last inspected on 06/03/2021. Woodland Fire Department granted the facility a clearance on 7/7/2021 for 8 non-ambulatory residents. The facility is one story with 6 bedrooms, 3 bathrooms, office room, staff room, and a fenced back yard. The outside grounds were free of any apparent hazards, and fire exits were clear. No accessible bodies of water. No firearms. The interior living room, dining room and kitchen were adequately furnished. Continued 809 C Continued from 809 LPAs observed locked cabinets for resident and staff records observed in the office. Medications were locked in the office cabinet. Kitchen was spacious and clean, adequate supply of dishes and utensils. Refrigerators were clean, with perishable and non-perishable foods. Kitchen cabinets and several shelves were supplied with can/dry goods, paper products and emergency water. LPAs observed sharps in unlocked kitchen drawers. Sharps were accessible to residents with dementia. (pictures taken). Applicant immediately removed and locked all sharps. Bathrooms were supplied with slip mats. Bedrooms were observed to be clean with adequate dressers and closet space for belongings. Hot water temperature measured at 136.2, 136.7 and 142.3, which is not within requirements of 105 to 120 degrees. The Component III Orientation was completed during today's visit. A subsequent Pre-Licensing inspection is needed to ensure the following items are corrected and reviewed: · Applicant will ensure water temperature measures between 105-120 degrees. · Applicant will ensure all sharps are locked and inaccessible to individuals with dementia. · Applicant will ensure that all smoke detectors are operable and alarms are on. · Applicant will install auditory alarms on all doors leading to exterior. · All required postings will be posted. (Let us know, Resident Rights, and Theft and loss) · B3's closet door will be repaired by 8/3/21.(pictures taken) · Obtain prescription for all residents 1/2 bed rails. This pre-licensing is incomplete. The above items are to be resolved by 08/03/21. A follow up Pre-licensure LIC809 will be generated upon resolution of listed items above. LPA will submit the pre-licensing reports to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status. A copy of the report was given to the Applicant.the state’s words, verbatim · CDSS document, Jul 27, 2021

Type of visit: Prelicensing

Licensing Program Analyst (LPAs) K. Walters and J. Nakagawa arrived unannounced and met with applicant, Arvin Davis for the purpose of conducting a Pre-Licensing inspection. Facility is currently licensed and new facility will be a Change of Ownership. LPAs conducted a risk assessment with Applicant, Arvin Davis, who will be the Administrator once the license is approved. Upon entry, LPA's were screened for COVID-19 symptoms, which was then logged into facility I PAD. Alcohol based sanitizer was available. LPA observed a 30 day supply of Personal Protective Equipment. (PPE) The facility has designated indoor/outdoor visitation areas. The applicant has a mitigation plan for COVID-19, which has been submitted to Community Care Licensing. LPAs toured the facility with AD at 10:00 AM. LPAs observed that auditory alarms were not present in three bedrooms and that the auditory alarm was turned off in the living room. LPAs observed that carbon monoxide alarms and smoke detectors were operational. The fire extinguisher was last inspected on 06/03/2021. Woodland Fire Department granted the facility a clearance on 7/7/2021 for 8 non-ambulatory residents. The facility is one story with 6 bedrooms, 3 bathrooms, office room, staff room, and a fenced back yard. The outside grounds were free of any apparent hazards, and fire exits were clear. No accessible bodies of water. No firearms. The interior living room, dining room and kitchen were adequately furnished. Continued 809 C Continued from 809 LPAs observed locked cabinets for resident and staff records observed in the office. Medications were locked in the office cabinet. Kitchen was spacious and clean, adequate supply of dishes and utensils. Refrigerators were clean, with perishable and non-perishable foods. Kitchen cabinets and several shelves were supplied with can/dry goods, paper products and emergency water. LPAs observed sharps in unlocked kitchen drawers. Sharps were accessible to residents with dementia. (pictures taken). Applicant immediately removed and locked all sharps. Bathrooms were supplied with slip mats. Bedrooms were observed to be clean with adequate dressers and closet space for belongings. Hot water temperature measured at 136.2, 136.7 and 142.3, which is not within requirements of 105 to 120 degrees. The Component III Orientation was completed during today's visit. A subsequent Pre-Licensing inspection is needed to ensure the following items are corrected and reviewed: · Applicant will ensure water temperature measures between 105-120 degrees. · Applicant will ensure all sharps are locked and inaccessible to individuals with dementia. · Applicant will ensure that all smoke detectors are operable and alarms are on. · Applicant will install auditory alarms on all doors leading to exterior. · All required postings will be posted. (Let us know, Resident Rights, and Theft and loss) · B3's closet door will be repaired by 8/3/21.(pictures taken) · Obtain prescription for all residents 1/2 bed rails. This pre-licensing is incomplete. The above items are to be resolved by 08/03/21. A follow up Pre-licensure LIC809 will be generated upon resolution of listed items above. LPA will submit the pre-licensing reports to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status. A copy of the report was given to the Applicant. No deficiencies were cited at todays visit. Continued from 809 LPAs observed locked cabinets for resident and staff records observed in the office. Medications were locked in the office cabinet. Kitchen was spacious and clean, adequate supply of dishes and utensils. Refrigerators were clean, with perishable and non-perishable foods. Kitchen cabinets and several shelves were supplied with can/dry goods, paper products and emergency water. LPAs observed sharps in unlocked kitchen drawers. Sharps were accessible to residents with dementia. (pictures taken). Applicant immediately removed and locked all sharps. Bathrooms were supplied with slip mats. Bedrooms were observed to be clean with adequate dressers and closet space for belongings. Hot water temperature measured at 136.2, 136.7 and 142.3, which is not within requirements of 105 to 120 degrees. The Component III Orientation was completed during today's visit. A subsequent Pre-Licensing inspection is needed to ensure the following items are corrected and reviewed: · Applicant will ensure water temperature measures between 105-120 degrees. · Applicant will ensure all sharps are locked and inaccessible to individuals with dementia. · Applicant will ensure that all smoke detectors are operable and alarms are on. · Applicant will install auditory alarms on all doors leading to exterior. · All required postings will be posted. (Let us know, Resident Rights, and Theft and loss) · B3's closet door will be repaired by 8/3/21.(pictures taken) · Obtain prescription for all residents 1/2 bed rails. This pre-licensing is incomplete. The above items are to be resolved by 08/03/21. A follow up Pre-licensure LIC809 will be generated upon resolution of listed items above. LPA will submit the pre-licensing reports to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status. A copy of the report was given to the Applicant. No deficiencies were cited at todays visit.the state’s words, verbatim · CDSS document, Jul 27, 2021

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 8 Census: 6 COMP II Participant: Arvin Davis, Managing Member/Administrator Interview Method: Telephone interview On 7/14/21, 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, Jul 14, 2021