Immaculate Home at Walnut

Type of visit: Case Management - Annual Continuation

On 09/18/2023 at 02:00 PM, Licensing Program Analyst J. Sampair arrived unannounced as a continuation of the annual inspection began on 07/19/2023. Upon entry, LPA informed Caregiver Elizabeth Joy Fernandez of the purpose of the visit. Caregiver informed Licensee Norberto Geronimo of the LPA's arrival at the facility. Licensees Norberto Geronimo and Eileen Carreon were present during the inspection. During this visit, the LPA inspected the facility inside and outside and reviewed personnel and resident files. Facility is safe and well maintained. Residents are safe and clean. The staff are caring and well trained. The annual inspection is complete. No citations issued during visit. LPA conducted an exit interview with Administrator Norberto Geronimo and sent a copy of this report via email.the state’s words, verbatim · CDSS document, Sep 18, 2023

Type of visit: Case Management - Licensee Initiated

On 08/04/2023 at 10:15 AM, Licensing Program Analyst J. Sampair arrived unannounced as a continuation of the annual inspection began on 07/19/2023. Upon entry, LPA informed Caregiver Elizabeth Joy Fernandez of the purpose of the visit. Caregiver called Licensee Eileen Carreon and informed her of the LPA's arrival at the facility. LPA and Licensee subsequently spoke over the phone. Initially, the conversation was about the annual inspection. At approximately 10:30 AM, the Licensee shared a report from witness W1 alleging that staff member S1's had behaved in an abusive manner toward residents R1 and R2. After that report, the LPA interviewed Licensee, W1, and W2 about S1's alleged behavior toward R1 and R2. LPA found no evidence that the behavior of S1 rose to the level of abuse and filing a complaint. Instead, S1's behavior was better handled internally, through coaching on speaking at a volume and in a manner better suited to a professional environment since this was not S1's home but rather the home of the residents living in the facility. LPA conducted an exit interview with Caregiver Elizabeth Joy Fernandez and sent a copy of this report to Licensee via email.the state’s words, verbatim · CDSS document, Aug 4, 2023

Type of visit: Case Management - Annual Continuation

On 08/04/2023 at 10:15 AM, Licensing Program Analyst J. Sampair arrived unannounced as a continuation of the annual inspection began on 07/19/2023. Upon entry, LPA informed Caregiver Elizabeth Joy Fernandez of the purpose of the visit. Caregiver called Licensee Eileen Carreon and informed her of the LPA's arrival at the facility. During this visit, the LPA inspected the facility's physical plant. The annual inspection is not complete. 1 Type-B citation was issued during visit (for details refer to LIC809-D). LPA conducted an exit interview with Caregiver Elizabeth Joy Fernandez and sent a copy of this report to Licensee via email.the state’s words, verbatim · CDSS document, Aug 4, 2023

Type of visit: Required - 1 Year

On 07/19/2023 at 11:15 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at facility for required annual inspection. LPA was greeted by staff members Joy Fernandez and Efren Fernandez. At approximately 12:30 PM, Administrator (ADM) Norberto Geronimo arrived. During the Inspection, LPA observed that the facility has a sufficient supply of food: 2 days for perishable and 7 days for nonperishable. A comfortable inside temperature was maintained. The facility is clean, comfortable, and odor-free. LPA interviewed 2 residents and 2 staff members, and reviewed the records for 5 residents and 5 staff members. Exit interview conducted with Administrator Norberto Geronimo. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Jul 19, 2023

Allegation investigated: Resident was physically abused while in care Staff physically restrained resident

At 11:00 AM on 04/24/2023, Licensing Program Analyst (LPA) J Sampair arrived unannounced for a complaint visit and explained purpose of the visit to staff member Estrella Tiangsing, who called Administrator Norberto Geronimo, who arrived at approximately 11:45 AM. During the investigation, the LPA conducted a health and safety inspection of the facility inside and outside and collected resident R1 and facility documentation. The Investigation Bureau (IB) conducted interviews of the Complainant and R1. The LPA then reviewed IB interviews, reviewed the documentation collected, and interviewed the Administrator and 2 staff members. Resident was physically abused while in care No evidence was collected from the IB interviews, LPA interviews, nor facility or R1 records provided any proof that R1 was physically abused while in care. (Continued on LIC9099-C...) Unsubstantiated (...Continued from 9099-C) Staff physically restrained resident No evidence was collected from the IB interviews, LPA interviews, nor facility or R1 records provided any proof that R1 was physically restrained while in care. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur; therefore, the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Apr 24, 2023 · control 15-AS-20221220091645

Type of visit: Case Management - Deficiencies

At 11:00 AM on 04/24/2023, Licensing Program Analyst (LPA) J Sampair arrived unannounced for a complaint visit. While conducting the complaint inspection, LPA observed 2 deficiencies, 1 Type-A and 1 Type-B (refer to LIC809-D for details). Exit interview conducted with Caregiver Estrella Tiangsing. LPA sent copy of this report provided via email to Administrator Norberto Geronimo.the state’s words, verbatim · CDSS document, Apr 24, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(1) · Plan of correction due date: Apr 25, 2023

87705 CARE OF PERSONS WITH DEMENTIA(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Based on observation at 2:35 PM, the licensee did not comply with the section cited above at the kitchen knife drawer that was unlocked, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 24, 2023

Plan of correction: Caregiver locked drawer during inspection

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(h) · Plan of correction due date: May 8, 2023

87705 CARE OF PERSONS WITH DEMENTIA: (h) Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. This requirement is not met as evidenced by: Based on observation at 2:45 PM, the licensee did not comply with the section cited above for 2 of the 2 gates, which pose a potential risk to the health, safety or personal rights to persons in care.the state’s words, verbatim · CDSS document, Apr 24, 2023

Plan of correction: On or before due date, Licensee shall notify LPA that ALL non-working gates (self-closing and not self-closing) in the exterior of the facility have been repaired.

Type of visit: Case Management - Health Checks

On 12/22/2022, Licensing Program Analysts (LPAs) J. Sampair and G. Luk arrived unannounced to conduct a health and safety check as a result of a Priority 2 complaint. LPAs met with Licensees, Norberto Geronimo and Eileen Carreon. LPAs toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, garage and outdoor area. Facility temperature was maintained at 70.9 degrees F. Hot water temperature was measured at 118 degrees F in kitchen sink. 7-days of non-perishable and 2-days of perishable food supplies were sufficient. Resident medications were kept locked in the cabinet. Smoke and Carbon monoxide detectors tested and were functional. First-aid kit was complete. Fire extinguisher was observed to be full and last serviced on 12/22/2021. There are no accessible bodies of water observed.. No citations issued. Exit interview conducted. A copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 22, 2022

Type of visit: Required - 1 Year

On 07/18/22 at 11:00AM, Licensing Program Analyst (LPA) James Sampair conducted an infection control annual inspection. LPA explained the purpose of the visit with staff member Estrella Tiangsing and spoke briefly over the phone with Administrator Norberto Geronimo upon entry. LPA toured the facility inside and out. Facility has a COVID-19 mitigation plan 4/1/22 in place that they are following, as well as the infection control plan from PIN 22-13-ASC that has been implemented. The designated infection control leader is the administrator. They have one central entry point that has been designated for universal entry screening with the station located near the front entrance with visitor's log, hand sanitizer, face masks, and no touch thermometer. Facility follows daily cleaning, sanitation of frequently touched common surfaces with disinfectants. COVID-19 signs were posted throughout the facility to promote hand washing, cough/sneeze etiquette and physical distancing. All staff and clients have been fully vaccinated. A written Emergency/Disaster plan was posted on the bulletin board for staff, clients and visitors to read. Centrally stored medications were in locked cabinets. The temperature inside of the facility was 78.8 degrees, which was in the safe range. The hot water was 110 degrees, which is in the safe range of 105 to 120 degrees Fahrenheit. Toxic chemicals were stored in locked closets and cabinets, as were sharp objects. Administrator is on site a minimum of 20 hours a week to oversee proper business operation. LPA observed fire extinguisher was fully charged and had been recharged October of 2021. Continued on next page LIC 809-C Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 07/25/22: · LIC500 - Personnel Report · LIC308 - Designation of Facility Responsibility · LIC610E - Emergency/Disaster Plan · Evidence of Liability Insurance & Surety Bond No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Jul 18, 2022