Gabriel's House 2

Type of visit: Required - 1 Year

On 08/15/2023 at 12:55 pm Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with Licensee Jane Bernardino, and explained the purpose of the visit. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. At 1:20 pm LPA reviewed 6 residents records. At 2:05 pm, LPA reviewed 3 staff records and 3 of 3 were fingerprint cleared and associated to the facility. No deficiencies cited during visit. Exit interview conducted and a copy of this report providedthe state’s words, verbatim · CDSS document, Aug 15, 2023

Type of visit: Required - 1 Year

On 08/11/2022 at 1:25 pm Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to conduct infection control inspection LPA meet with Administrator Gladys Enriquez and explained the purpose of the visit. During the Infection Control Inspection, LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen, and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. The facility has a mitigation plan. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Fire extinguishers were observed fully charge and tags showed serviced 11/04/2021. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 11, 2022

Type of visit: Case Management - Other

On 04/04/2022 at 12:22 pm LPA J. CLancy-Czuleger arrived unannounced to conduct a case management visit regarding a report that was submitted on 3/21/2022. LPA met with Administrator, Jane Bernadino and explained the purpose of the visit. During the visit LPA spoke and reviewed incident with Administrator. The Administrator stated that the Resident (R1) had been experiencing weakness and chills prior to the facility calling 911. R1 passed away while at the hospital and the family did not disclose the cause of death to the facility. AM125 Death Report CM30.pdf Exit interview conducted.the state’s words, verbatim · CDSS document, Apr 4, 2022

Type of visit: Required - 1 Year

On 8/17/2021 at 8:35AM, Licensing Program Analysts (LPAs) G. Luk and J. Clancy-Czuleger arrived unannounced to conduct an Infection Control Inspection. LPAs met with staff, Maricel David and explained the purpose of the visit. Administrator, Alberto Bernardino arrived an hour later. Upon entry, LPA's temperatures were checked and asked to fill out COVID-19 questionnaire. LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, living room, and outdoor areas. LPAs observed sign & symptoms, cough etiquette, and social distancing were posted in the common areas. Hand washing posters were posted at bathrooms and sinks. During record review, LPAs observed visitors log and temperature logs for both residents and staff. LPAs observed facility has a copy of Mitigation Plan on file. LPAs observed food and paper supplies are sufficient. The following deficiencies were observed during the visit: -At 9:00AM, LPAs observed unlocked scissors in the kitchen and unlocked cleaning supplies. Staff locked up scissors and cleaning supplies during inspection. -At 9:10AM, LPAs observed the medication cabinet was unlocked. Staff locked the medication cabinet during inspection. -At 9:20AM, LPAs observed that resident had full bed rail and was not on hospice care. Staff removed the full bed rails during inspection. -At 9:45AM, LPAs observed that staff was not associated to the facility. Administrator provided LIC9182 and a copy of ID to LPAs during inspection. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct 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, Aug 17, 2021

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.