New Alamo Residence Home

Type of visit: Required - 1 Year

On 3/15/2023 at 9:30 AM, Licensing Program Analysts (LPAs) L. Francisco and C. Fowler arrived unannounced to conduct 1-Year Annual Required inspection. LPAs met with Administrator, Meeran Saxena and explained the purpose of the visit. The facility’s fire clearance was approved for five (5) non-ambulatory and one (1) bedridden residents. There are 6 residents and 4 staff present during inspection. LPAs toured facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 8 total bedrooms which 6 bedrooms are occupied by the residents and 2 bedrooms are occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. 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 and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was serviced on 1/9/2022 Emergency Disaster Plan was last posted on 3/15/2023. First aid kit was observed to be complete. At 11:15 AM, LPAs reviewed 3 staff records and 2 of 3 have current first aid training and at least 1 staff have CPR training per shift. At 1:40 PM, LPA reviewed a sample of resident's medications. REPORT CONTINUES 809C THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: -at 9:58am, LPAs observed Tylenol stored inside medication cabinet in R2's bedroom -at 10:07am, LPAs observed unlocked clorox, drain cleaner, and oxyclean underneath bathroom sink -at 10:28am, LPA observed R3's sliding screen door is off track and in disrepair. -at 11:50am, LPA observed S1's first aid training expired December of 2020 -at 12:15pm, LPA observed quarterly drill was last completed in 2019. -at 12:25pm, LPA observed residents records are not maintained and available to LPAs. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 3/31/2023 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 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. LPA will return for annual continuation at a later time.the state’s words, verbatim · CDSS document, Mar 15, 2023

The state marks this report as 10 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 6/24/2022 at 12:25 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct a Case Management visit. Upon arrival, LPA was greeted by Care Staff, Irene Joseph. Administrator, Meeran Saxena later arrived at 12:40 PM The Department conducted interviews and record during the course of investigation for complaint (#15-AS-20211222084738), the following deficiency was observed. Based on record review, S1 is not fingerprint cleared. S1 stated S1 has been living and employed with the facility since 11/05/2022. According to S2, S1 was employed on 11/15/2021. Although dates of employment are conflicting, record review shows that S1 is not cleared and The Department observed S1 working at the facility on 12/21/2021. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. A $500 Civil Penalty is being observed Administrator authorized Care Staff, Irene Joseph to sign report. Exit interview conducted with Care Staff. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 24, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jun 25, 2022

CRIMINAL RECORD CLEARANCE (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing.. (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: Based on the Deparments record review and observation, Licensee did not comply with the regulation above. S1 has been employed at the facility without fingerprint clearance since November 2021. S1 was observed by the Department on 12/21/2021 which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 24, 2022

Plan of correction: Deficiency cleared. S1 was removed from facility on 12/22/2021. On 12/27/2021, LPA confirmed S1 is no longer at the facility. A $500 Civil Penalty is assessed.

Type of visit: Required - 1 Year

On 6/24/2022 at 12:25 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPA was greeted by Care Staff, Irene Joseph. Administrator, Meeran Saxena later arrived at 12:40 PM. During the Infection Control Inspection, LPA toured facility with Administrator 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. Visitors policy is posted on the front entrance. 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 Social distancing and hand washing posters were observed. Common touched surfaces are disinfected at least once daily. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. During record review, LPA reviewed 3 staff records and 3 of 3 have health screening and TB test results on file. Facility has a mitigation plan on file. THE FOLLOWING DEFICIENCY HAS BEEN OBSERVED At 1:15 PM, during record review and interview, S1 has been employed since March 2022, and no vaccination exemption on file is maintained in accordance to Public Health Order and PIN 22-05.1-ASC At 1:20 PM, during record review, weekly COVID-19 testing is not being conducted for S1 according to Public Health Order on September 28, 2021 and PIN 21-32.1-ASC REPORT CONTINUES ON 809C Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 7/1/2022: 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 deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency by POC date may result in additional Civil Penalties. Administrator authorized Care Staff, Irene Joseph to sign report. Exit interview conducted with Care Staff. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 24, 2022

The state marks this report as 9 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Registered Sex Offender(RSO) is allegedly associated or present at the facility

On 12/27/2021 at 3:15 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to deliver findings for the above allegation. LPA was greeted by Rosalina Bermudas. LPA later met with Administrator, Meeran Saxena at 3:30 PM. During course of the investigation, the Department conducted interviews with Administrator, RSO and Witness. Documents including but not limited to: Signed 10-day Notification, RSO’s Driver’s License, Department of Justice Fingerprint Response, and Facility Safety Plan were obtained. **REPORT CONTINUES ON 9099C** Substantiated On 12/21/2021, The Department observed Registered Sex Offender (RSO), Pedro Omar at the facility. Based on interview with Administrator, RSO has been residing and employed at the facility since 11/15/2021. RSO reported to the Department that he has been living and working at the facility since 11/05/2021. Administrator submitted live scan for RSO. However, status of RSO was pending. According to RSO, he informed Administrator that he is a registered sex offender. However, Administrator denied she had knowledge, but was aware he had criminal background. A safety plan was provided to the Department by Administrator on 12/21/2021. On 12/22/2021, the Department was informed by Administrator that RSO has left the facility. LPA L. Francisco confirmed RSO is not present at facility during today’s visit on 12/27/2021. Based on evidence obtained during the course of this investigation, the Department has substantiated Registered Sex Offender(RSO) is allegedly associated or present at the facility licensed by the Department. This is a factual determination based on all the facts and circumstances of the case. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Health and Safety Code is being cited on the attached LIC 9099D. An immediate $500 Civil Penalties is being assessed. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 27, 2021 · control 15-AS-20211222084738

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.17(c)(3) · Plan of correction due date: Dec 28, 2021

1569.17(c)(3) Fingerprints and criminal records.. (3)…If the State Department of Social Services determines, on the basis of the fingerprint images submitted to the Department of Justice, that the person has been convicted of a sex offense against a minor…. the receipt of the notification from the Department of Justice to act immediately to terminate the person’s employment, remove the person from the residential care facility for the elderly….” This requirement is not met as evidenced by: Based on evidence obtained during the course of this investigation, Licensee did not comply with the regulation cited above. The Department observed RSO present at the facility on 12/21/2021 which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 27, 2021

Plan of correction: Administrator will review regulation and submit a self certification letter of understanding to CCL by POC date. AN IMMEDIATE $500 CIVIL PENALTY IS BEING ASSESSED.

Type of visit: Case Management - Health Checks

On 12/27/2021 starting at 3:30 PM, Licensing Program Analyst (LPA) L. Francisco conducted a Health and Safety Inspection as a result of the Deparment receiving a Priority 1 complaint (#15-AS-20211222084738). LPA met with Administrator, Meeran Saxena. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and outdoor area. There is a minimum of 2-day perishable and one week non-perishable food supply. LPA observed smoke detectors and carbon monoxide throughout facility. Fire extinguishers were observed to be fully charged. LPA reviewed LIC 500 and observed facility has sufficient staffing to meet resident's needs. -At 3:25 PM during record review, LPA observed S1 is fingerprint cleared. However, is not associated to the facility. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. 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, Dec 27, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(c)(1) · Plan of correction due date: Dec 29, 2021

87355(c)(1)CRIMINAL RECORD CLEARANCE (c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another,..providing the following documents to the Department: (1) A signed Criminal Background Clearance Transfer Request, LIC 9182 (Rev. 4/02). This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the regulation cited above. LPA observed S1 is fingerprint cleared. However, not associated to the facility which poses a potential health and safety risk to resdients in care.the state’s words, verbatim · CDSS document, Dec 27, 2021

Plan of correction: POC cleared during visit. Administrator faxed LIC 9182 and a copy of identifcation and provided LPA a copy. DEFICIENCY CLEARED DURING VISIT.