Six Rose's Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced 1-Year Required inspection at Six Roses Senior Care, on July 6, 2023 at 2:40 PM. LPA met with Administrator/Licensee Salvador Ivan Hernandez. The facility currently has 3 clients in care. Administrator conducted a walk through of facility and LPA observed client rooms were furnished per regulations. LPA observed all walkways and exits to be unobstructed. The facility was decorated for the recent Fourth of July holiday. Facility has at least two days of perishable and one week of nonperishable foods. Facility has space indoors and outdoors for client activities. Administrator has a current and complete file for clients, observed by LPA. Disinfectants/toxins are kept locked in a closet and inaccessible to clients in care. Extra linens and paper supplies are available for clients. Medications are kept locked and documented on a Centrally Stored Medication Log. LPA observed fire extinguisher in kitchen which was charged and purchased on 05/01/2023. The facility has 1 operational carbon monoxide detector, and 7 interactive smoke detectors which were tested and operational. All exterior doors had operational auditory alarms. House temperature was 73 F. Facility has 30 days supply of PPE and Resident has 30 days supply of medication and incontinence supplies. No deficiencies cited at today's inspection.the state’s words, verbatim · CDSS document, Jul 6, 2023

Type of visit: Case Management - Other

LIcensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to do an inspection and check on the submittal of the Infection Control Plan and the request by the Licensee for a change in . LPA arrived and was screened for Covid-19 symptoms, and results and temperature were documented in log. There was one caregiver and 3 residents at the facility at the time of inspection; two were up enjoying television and one resident was in bed resting. The facility was clean and a comfortable temperature. The facility was decorated for Fall, with garlands of leaves and pumpkins. The residents expressed they liked the homelike atmosphere. The kitchen was clean and well-stocked with at least a two-day supply of perishables and a 7-day supply of non-perishables. There was soap and paper towels in the restrooms and signage posted reminding residents, staff and visitors to wash their hands for at least 20 seconds. A sign requiring masks upon entry was posted at the front door. LPA discussed the submittal of the Infection Control Plan, the Monkey Pox Control Plan. Licensee is requesting to change staff room to resident room. LPA will contact Fire Department. No citations were given.the state’s words, verbatim · CDSS document, Sep 20, 2022

Type of visit: Case Management - Other

LIcensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to do an inspection and check on the submittal of the Infection Control Plan. LPA arrived and was screened for Covid-19 symptoms, and results and temperature were documented in log. There was one caregiver and 2 residents at the facility at the time of inspection; and a visit from hospice agency. The facility was clean and a comfortable temperature. Both residents had just had lunch and were resting in bed. There were soap and paper towels in the restrooms and signage posted reminding residents, staff and visitors to wash their hands for at least 20 seconds. The kitchen was clean and well-stocked with fresh fruit. The facility was decorated with seasonal decor, which made the setting homelike. Via phone, LPA discussed with Administrator the submittal of Infection Control Plan and the move-in of a new resident at the end of July. No deficiencies were found at the time of inspection. No citations were given.the state’s words, verbatim · CDSS document, Jul 27, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Annual Required – 1 yr. Infection Control inspection of this facility and met with Administrator Salvador Hernandez. 3 clients were present at the facility. LPA arrived at the facility and was screened for possible Covid-19 exposure and had temperature checked and logged into visitor’s binder, which is kept at a small table at entrance, along with thermometer, hand sanitizer and masks. The facility was found to be clean and at a comfortable temperature of 75 F with all exits free from obstruction, and equipped with door alarms. Client’s bedrooms, common areas, kitchen & food storage areas were inspected. Smoke detectors and carbon monoxide detector 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. Toxins are stored and locked in laundry room. Dangerous items were stored inaccessible to clients. There was a supply of cleaners, hygiene products and paper products available for clients. All client’s bedrooms have lighting & appropriate furnishings. The backyard was well equipped for visitors during the Summer months to allow for social distancing. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE supply stored. Facility is in the process of being N95 Fit tested. No deficiencies were observed or cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was left with Salvador Hernandez, Administrator.the state’s words, verbatim · CDSS document, May 17, 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.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Jill Nakagawa conducted an unannounced Post Licensing inspection at Six Roses Senior Care, on November 5, 2021 at 2:35 PM. LPA met with Administrator/Licensee Salvador Ivan Hernandez. The facility currently has 1 client in care. Administrator conducted a walk through of facility and LPA observed client rooms were furnished per regulations. LPA observed all walkways and exits to be unobstructed. LPA reminded Licensee about required postings . LPA observed staff wearing masks as a COVID-19 precaution. Facility has at least two days of perishable and one week of nonperishable foods. Facility has space indoors and outdoors for client activities. Administrator has a current and complete file for client, observed by LPA. Disinfectants/toxins are kept locked in a closet and inaccessible to clients in care. Extra linens and paper supplies are available for clients. Medications are kept locked and documented on a Centrally Stored Medication Log. LPA observed fire extinguisher in kitchen which was charged and purchased on 12/21/2021. The facility has 2 operational carbon monoxide detectors, and 7 interactive smoke detectors which were tested and operational. All exterior doors had operational auditory alarms. House temperature was 73 F. Facility has 30 days supply of PPE and Resident has 30 days supply of medication and incontinence supplies No deficiencies cited at today's inspection.the state’s words, verbatim · CDSS document, Nov 5, 2021

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Karina Canela and Jill Nakagawa conducted a pre-licensing inspection on 07/12/2021. LPAs met with Applicant Salvador Ivan Hernandez, who will be the Administrator when the facility is approved for licensure. The facility has a fire clearance approval from the Woodland Fire Department for 3 non-ambulatory residents and 1 bedridden for a total capacity of 4. Facility will operate with live-in staffing and Licensee will ensure sufficient staffing at all times. During today’s visit LPAs observed the following items: · Lockable separate cabinets for medications, toxin, and knives. · All exits were unobstructed · 7 hardwired smoke detectors, 2 carbon monoxide detectors which were tested and observed to be operational · First Aid kit, night-lights, and flashlights for emergency lighting · Supply of linens, paper products, and hygiene supplies available · Grab bars and non-slip mats in 2 of 2 bathrooms. · Fire Extinguisher charged · Administrator Certification Report continued on LIC 809-C. LPAs Karina Canela and Jill Nakagawa notified the applicant that the following corrections must be made in order to proceed with licensure: · Chest of drawers needed in 2 out 3 bedrooms (bedrooms 2 and 3 on facility sketch) · Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, Client personal rights, Administrator certificate posted, and visitor policy). The Component III Orientation was completed during today's inspection. Pre-Licensing is incomplete with above items to be resolved by 7/19/2021. Applicant to submit pictures as proof of correction to Community Care Licensing Department (CCLD) for review. Once corrections are submitted and reviewed by CCLD, LPA will submit the pre-licensing report with proof of corrections to Application Unit Analyst in Sacramento; Application Unit Analyst will notify applicant of application status.the state’s words, verbatim · CDSS document, Jul 12, 2021