New Rivershore Care Home

Type of visit: Required - 1 Year

On 5/22/2023 at 2:10PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced 1-Year Required inspection. LPA met with Aurora Blancio, Administrator, and explained the purpose of the visit. The Administrator certificate is pending and expired 3/26/2023. The facility’s fire clearance was approved for six (6) non-ambulatory residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, garage and backyard. The facility consists of three (3) bedrooms and one and one-half (1-1/2) bathrooms. No bodies of water was observed. A comfortable temperature is maintained at 76 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 113.0 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. There is a minimum of 7-day supply of non-perishable and 2-day of perishable foods. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 06/20/2022. Emergency Disaster Plan was last posted on 06/22/2022. First aid kit was observed to be complete. Fire drill was last conducted on 01/5/2023. Continued on LIC809. Continued from LIC809. LPAs reviewed three (3) staff files. All three (3) staff did not have first aid or CPR. All four (4) residents' file were reviewed. LPA observed the following deficiencies: At 2:22PM, LPAs observed refrigerator/freezer and freezer in garage is unsanitary. At 2:25PM, LPAs observed a pair os scissors, allergy medication, a lighter, a bottle of Tylenol, and mucous medication in unlocked kitchen drawer. At 2:30PM, LPAs observed 4 cans of propane, a mattress, a bed frame, a shovel, and a drawer plastic bin in backyard passageway. At 2:45PM, LPAs observed during record review R2 and R4 do not have an current medical assessment. At 2:45PM, LPAs observed during record review none of the residents have a current appraisal needs and services plan. At 3:05PM, LPAs observed during record review none of the staff have first-aid or CPR training. LPA requested the following documents to be submitted to CCLD by 5/30/2023. Resident Roster LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (9 pages) Liability Insurance Continued on LIC809C. Continued from LIC809C. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.the state’s words, verbatim · CDSS document, May 22, 2023

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: POC

On 6/22/2022, at 2:40PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct proof of correction (POC) visit. LPA met with Administrator, Aurora Balancio, and explained the purpose of the visit. Facility has the following deficiencies that was not cleared: 87455(b) LPA have not received documents to request a hospice waiver from Administrator after case management visit 6/15/2022 87211(a) LPA had not received documents as requested to report incidents from the Administrator after case management visit on 6/15/2022. Administrator gave LPA both incident reports during today's visit. Civil Penalties for 87455(b) assessed immediately. Civil Penalties in the total amount of $600.00 is assessed today for the period of 6/16/2022 to 6/22/2022 for failure to meet POC date for deficiency 87455(b). Facility is subject to ongoing civil penalties until deficiency is corrected. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 22, 2022

Type of visit: Case Management - Other

On 6/22/2022 at 3:55PM, Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding care of dementia residents LPA met with Aurora Balancio, Administrator, and explained the purpose of the visit. While conducting an annual inspection on 6/15/2022, LPA reviewed six (6) of six (6) residents’ files and observed two (2) residents had a diagnosis of dementia. LPA reviewed the facility’s file at Community Care Licensing (CCL) and observed the plan of operation, which has not been updated since 1996, did not include a plan to take care of dementia residents. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.the state’s words, verbatim · CDSS document, Jun 22, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(b) · Plan of correction due date: Jun 29, 2022

87208 (b) A licensee who advertises... dementia special care... or environments shall include additional information in the plan of operation as specified in Section 87706(a)(2). This requirement was not met as evidence by: Based on LPAs record review the Licensee did not comply with the section cited above in having a plan for dementia care, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 22, 2022

Plan of correction: Administrator agreed to make an amendment to the facility’s plan of operation to include dementia care and submit it to CCLD by POC date.

Type of visit: Required - 1 Year

On 6/15//2022 at 3:35PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Aurora Balancio, Administrator, and explained the purpose of the visit. Upon entry, LPA temperature was not checked. LPA observed screening station that contained hand sanitizer and COVID signage. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage, and back yard. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap, paper towel, and hand washing poster. Hot water temperature in the shared residents' bathroom was measured at 105.1 .degrees Fahrenheit. Fire extinguisher was serviced on 3/20/2021. During record review, LPA observed facility has a copy of Mitigation Plan on file. LPA observed food, PPE and paper supplies are sufficient. The following forms are to be updated and submitted to CCLD by 6/22/2022: -LIC9020 Register of facility Clients/Residents -LIC308 Designation of Administrative Responsibility Continued on LIC809C Continued from LIC809. -LIC610E Emergency Disaster Plan The following deficiencies were observed. -At 3:57PM, LPA observed a knife sitting on kitchen counter. -At 3:59PM, LPA observed a pile of dirty clothing sitting on a shower chair located in the shower stall in shared bathroom. -At 4:05PM, LPA observed a shovel, pruner, bags of clothing, 3 mattresses, 2 boxes of garbage, a wheelchair with clothing in seat, 2 ladders, bed railing, and a plastic 5-drawer bin in back yard. -At 4:50PM, LPA reviewed R1's file and did not observe an order for bed rails, incomplete physician's report, missing consent form, Identification and Emergency information, TB information, theft and loss, appraisal needs and services plan, and safeguard. -At 5:00PM, LPA reviewed R2's file. The file is missing consent form, theft and loss, appraisal needs and services plan 11/14/2018, physician's report 12/11/18, and safeguard. -At 5:10PM, LPA reviewed R3's file. The is missing Identification and emergency form, consent, physician's report 9/2018, and appraisal needs and services 9/26/18. -At 5:15PM, LPA reviewed R4's file physician's report 10/20/16 and appraisal needs and services 10/1/16. -At 5:20PM, LPA reviewed R5's file physician's report 10/13/2016 and appraisal needs and services 10/1/2016. Continued on LIC809C. Continued from LIC809C. -At 5:25PM, LPA reviewed R6's file appraisal needs and services 6/7/2017, physician's report had no signature and file is missing safeguard and consent. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 15, 2022

The state marks this report as 17 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 6/15/2022 at 6:30PM Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit regarding a request of hospice services to CCLD on 6/10/2022. LPA met with Administrator, Aurora Balancio and explained the purpose of the visit. An email was received via email to LPA L. Hall on 6/10/2022, requesting a hospice waiver for one (1). LPA telephoned Staff 1 (S1) to request more documents and inquire on the resident that will be receiving hospice services. S1 stated that the resident has been receiving hospice services for two (2) weeks and the facility has another resident that has been receiving hospice services for two (2) months. S1 did not obtain a hospice care waiver for R1 or R2 from the Department before retaining residents at the facility. While LPA was conducting the annual inspection on 6/15/2022, LPA was informed that two (2) residents R3 and R4 had tested positive for COVID. S1 stated she did not report incident to CCLD. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 15, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(2) · Plan of correction due date: Jun 16, 2022

87211 (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (2) Occurrences, such as epidemic outbreaks...which threaten the welfare, safety or health of residents...This requirement was not met as evidence by: Based on LPAs record review and interview, licensee did not comply with the section cited above in reporting to COVID residents to CCLD, which poses a health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 15, 2022

Plan of correction: Administrator agreed to submit LIC624 for both residents to CCLD by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87455(b)(8) · Plan of correction due date: Jun 16, 2022

87455 (b) The following persons may be accepted or retained in the facility: (8)Persons who have been diagnosed as terminally ill and who have obtained the services of hospice... This requirement was not met as evidence by: Based on LPAs interview and record review, Licensee did not comply with the section cited above in requesting a hospice waiver for R3 and R4, which poses a health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 15, 2022

Plan of correction: Administrator agreed to submit a request for a hospice waiver for 2 residents from CCLD by POC date.