Pleasant Hill Villa Home Care

Type of visit: Required - 1 Year

On 09/21/2023 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Myra Ecaruan and explained the purpose of the visit. Acting Administrator, Joy Dela Cueva, arrived shortly after. Joy's Administrator Certificate# 6016749740 Expires 06/25/2024. The facility’s fire clearance was approved for 6 non-ambulatory. LPA toured facility with Joy including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 6 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 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 106.3 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 06/11/2023. Emergency Disaster Plan was last posted on 09/10/23. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 09/10/23. LIC809-C Continued... LIC809 Continued.... LPA reviewed 4 residents records. LPA reviewed 7 staff records and 0 of 7 have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 11:24AM, LPA observed knives, scissors and matches unlocked in kitchen drawer. At 11:39 AM, LPA observed ladder, wood planks, garbage can located outside in the backyard At 11:43 AM, LPA observed screen door, more wood, broken wooded fence located behind storage shed in the backyard. At 11:45 AM, LPA observed wood planks in the front yard. At 11:48AM, LPA observed metal bed frames, walker, headboard, white door and dried up paint bucket located outside in front of the garage. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/28/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 21, 2023

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Staff does not have the required training to meet resident needs

On 5/23/2023 at 1:20PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to deliver findings in regards to the allegation above. LPA met with Licensee/Administrator, Gliceria Magat. During the course of investigation, LPA interviewed 1 resident, 5 staff, and complainant. LPA obtained and reviewed documents including physician's report, care plan, hospice records, medical records, MAR, list of medications, incident reports, and staff training. Training documents shows that staff did not complete annual 20 hours of training in 2021 and 2022. Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided. Substantiated Staff did not assist the resident as needed with ambulating which resulted in the resident becoming bruised. Physician's report dated 5/11/2022 does indicate that R3 is ambulatory. Pre-placement appraisal states that R3 is non-ambulatory and uses a walker. Interview with staff revealed staff assist residents in ambulating. Staff did not assist the resident as needed with medications. Interview with staff revealed there was a medication with instructions to hold if R3 will be laying down. Staff stated the medication was not given when R3 was laying down. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, May 23, 2023 · control 15-AS-20220830094419

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(2) · Plan of correction due date: Jun 9, 2023

Staff training; legislative findings; contents. In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training...This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not completing annual training for staff which poses a potential health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, May 23, 2023

Plan of correction: Administrator has agreed to conduct annual training to all staff and submit completion documents to CCLD by POC date.

Type of visit: Required - 1 Year

On 9/28/2022 at 2:30PM, Licensing Program Analysts (LPAs) L. Hall and Lori Alexander arrived unannounced to conduct an Infection Control Inspection. LPAs met with Christina Elazegui, Staff and Gliceria Magat, Administrator and explained the purpose of the visit. Upon entry, LPA's temperature was checked. LPA observed screening station. There were COVID signs posted on front door. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, back yard, kitchen, and garage. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap and paper towel, and hand washing poster. Hot water temperature in the shared clients’ bathroom was measured at 105.1 degrees Fahrenheit. Fire extinguisher last serviced on 6/29/2022. During record review, LPA observed visitors sign-in log. LPA observed facility has a copy of the mitigation plan on file. LPA observed PPE, food, and paper supplies are sufficient. No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 28, 2022

Type of visit: Case Management - Health Checks

On 8/31/2022 at 1:30PM, Licensing Program Analysts (LPAs) G. Luk and J. Sampair arrived unannounced to conduct a health and safety check as a result of a priority 1 complaint. LPAs met with Licensee, Gliceria Magat. Administrator, Christina Elazegui arrived an hour later. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, garage and outdoor area. Facility temperature was maintained at 76.6 degrees F. Hot water temperature was measured at 108 degrees F in kitchen sink. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Resident's medications were kept locked in the cabinet. Smoke and Carbon monoxide detectors observe. First-aid kit was complete. Fire extinguisher was observed to be full and last serviced on 6/29/2022. There are no accessible bodies of water observed. At 1:00PM, LPAs observed a bottle of furniture polish stored next to can goods in the garage storage. Licensee removed the furniture polish during inspection. At 1:03PM, LPAs observed unlocked garage door which had cleaning supplies and laundry detergent accessible. Cabinet under the sink was unlocked with cleaning supplies. LPAs also observed unlocked scissors in the drawer. Staff locked up disinfectant, cleaning supplies, and knives during inspection. At 1:05PM, LPAs observed air vent on the ceiling by the garage door and hallway bathroom appears to be loose and may be falling down. Ceiling vent in the hallway by the front door has cobwebs. Room #3 toilet seat is missing and floor of shower was dirty. Gate latch in the deck area is in disrepair and until to self-close. The 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. A copy of this report and appeal rights was provided.the state’s words, verbatim · CDSS document, Aug 31, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Sep 1, 2022

Storage Space. Disinfectants, cleaning solutions...and other items which could pose a danger...shall be stored where inaccessible to clients. This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by having unlocked cleaning supplies and scissors in the kitchen and garage which poses an immediate health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Aug 31, 2022

Plan of correction: Staff locked up the cleaning supplies and scissors during inspection. Deficiency cleared. Civil penalty of $250 is being assessed for repeat violation.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(25) · Plan of correction due date: Sep 1, 2022

General Food Service Requirements. The following...shall apply: Soaps, detergents, cleaning compounds...shall be stored in areas separate from food supplies. This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by having furniture polish stored next to food supplies which poses a potential health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Aug 31, 2022

Plan of correction: Staff removed the furniture polish next to the food supplies during inspection. Deficiency cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 16, 2022

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by having vent and gate latch in disrepair, vents and shower not clean, and missing toilet seat which poses a potential health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Aug 31, 2022

Plan of correction: Licensee has agreed to repair the vent and gate latch, clean vents and shower, and install toilet seat in room 3. Licensee will send pictures and LIC9098 to CCLD by POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) James Sampair conducted an infection control annual inspection and explained the purpose of the visit with Administrators Gliceria Magat and Maria Christina Elazegui. LPA observed all staff wearing face masks during the visit. Maria Christina Elazegui is the designated Infection control leader. LPA discussed the mitigation plan with them, as well as their current COVID-19 infection control practices. They have conducted staff training on infection prevention, symptoms, transmission, as well as the proper donning and doffing of PPE. All of the staff and residents were fully vaccinated. LPA inspected the facility inside and outside. LPA observed screening station located near the front entrance with a digital visitor's log, hand sanitizer, face masks, and a no-touch temperature probe. Routine symptom screening (+/-) temperature and symptom check is done at entry for all staff, residents, and visitors. LPA observed COVID-19 signs posted in common areas to promote hand washing, cough/sneeze etiquette and physical distancing. Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Pathways were observed to be free of obstruction and fire hazards. There were sufficient food and water supplies in the kitchen refrigerators/freezers. Emergency paper and PPE supplies were observed. Facility room temperature was maintained at a comfortable temperature and the water temperature was in the acceptable range. A certified administrator is on site at all times to oversee proper business operation and compliance with COVID-19 infection control practices. Fire extinguishers were observed fully charged and last inspected in June 2021 and the Smoke and Carbon monoxide detectors were fully operational. LPA observed two citations that have been written up on the LIC809-D for 1 Type A and 1 Type B deficiencies that were both corrected before the LPA left the facility. Exit interview conducted and a copy of this report and copies of the Appeal Rights were provided.the state’s words, verbatim · CDSS document, Oct 4, 2021

Allegation investigated: Residents sustain falls while in care

On 09/17/2021 at 09:45AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct complaint investigation and deliver complaint findings for the above allegation. LPA met with Gliceria Magat, Administrator and explained the reason for the visit. During the course of the investigation LPA interviewed three (3) staff, reviewed residents files, obtained resident and staff roster. Interview with staff indicated that an alarm is placed on fall risk residents and there is only one (1) fall risk resident at this time. Facility has protocol in place to assist residents if resident fall. LPA observed caregiver assisting resident while walking. Continued on LIC9099C. Unsubstantiated Continued from LIC9099. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of report provided.the state’s words, verbatim · CDSS document, Sep 17, 2021 · control 15-AS-20201028095918

Type of visit: Case Management - Other

On 09/17/2021 at 11:15AM Licensing Program Analyst (LPA) L. Hall conducted an unannounced Case Management visit. LPA met with Gliceria Magat, Administrator and explained the purpose of the visit When LPA L. Hall arrived to deliver complaint findings (15-AS-20201028095918) on 09/17/2021, LPA observed four (4) monitors on dining room table monitoring residents in their bedrooms. LPA inquired with staff about monitors and was advised used for fall risk residents. Record review indicated one (1) of five (5) residents as fall risk. The deficiencies was 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, Sep 17, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Sep 24, 2021

87468.1 Personal Rights of Residents in All Facilities (a) Residents... shall have all of the following personal rights:(3)To be free from... ...other actions..., such as... or interfering with daily living functions... This requiremnent was not met as evidence by: Based on LPA's observation Licensee did not comply with the section cited above, which poses a potentitial health and safety risk for persons in care.the state’s words, verbatim · CDSS document, Sep 17, 2021

Plan of correction: Administrator agreed to remove monitors. Monitors were removed during visit. Deifciency cleared during visit.