Golden Home RCFE

Type of visit: Required - 1 Year

On 9/6/2023 at 10:10am, Licensing Program Analysts (LPAs) L. Hall and A. Gomez, conducted an unannounced 1-Year Required inspection. LPA met with Amankai Pormee, Caregiver, and explained the purpose of the visit. The Administrator, Liwayway Mendoza, arrived at 11:15am. The Administrator holds a certificate 6053359740 which expires on 11/11/2023. The facility’s fire clearance is 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 five (5) bedrooms and three (3) bathrooms. One (1) bedroom is used by staff. No bodies of water was 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. The hot water temperature in the residents’ shared bathroom was measured at 115.4 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 06/09/2023. Emergency Disaster Plan was last posted on 01/23/2023. First aid kit was observed to be complete. Fire drill was last conducted on 04/11/2023. Continued on LIC809. Continued from LIC809. LPAs reviewed four (4) staff files. LPAs also reviewed all five (5) residents' files which did not contain an appraisal needs and services plan. LPA observed the following deficiencies: At 10:45am, LPAs observed during record review all residents' files did not contain an appraisal needs and services plan. At 11:10am, LPAs observed an unlocked kitchen drawer containing several knives and pairs of scissors. Lock on drawer was broken. At 11:20am, LPAs observed shed in back yard unlocked. Broken lock was on shed. LPA requested the following documents to be submitted to CCLD by 09/13/2023. 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 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, Sep 6, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 9/8/2022 at 4:05PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Reymund Tulabot, Caregiver, and explained the purpose of the visit. Administrator Liwayway Mendoza arrived at 1:00PM. Upon entry, LPA's temperature was not checked. LPA observed screening station and COVID-19 signs were posted on the front door. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, back yard, and kitchen. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at hand washing stations. Hot water temperature in the shared clients’ bathroom was measured at 114.4 degrees Fahrenheit. Fire extinguisher last serviced on 6/9/2022. There is a minimum of 2-day perishables foods and 7-day non-perishables foods. During record review, LPA observed visitors sign-in log. LPA observed facility has a copy of the mitigation plan on file. LPA observed food, PPE, and paper supplies are sufficient. The following deficiency was observed: Continued on LIC809C. Continued from LIC809. The following deficiency was observed: At 12:40PM, LPA observed R1 in bedroom #1 and R2 in bedroom #4 have a hospital bed without a doctor's order and neither are on hospice care. The following 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. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 9, 2022

Type of visit: Required - 1 Year

On 09/22/21 at 2:15PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with administrator. LPA observed 2 staff wearing face masks during visit with one resident watching TV while the other 4 residents were resting in their bedrooms. Facility has a completed mitigation plan in place dated 03/05/2021 to mitigate the spread of COVID-19. LPA discussed the completed mitigation plan (LIC 808) with administrator as well as COVID-19 infection control practices. LPA inspected the facility inside and outside. LPA observed screening station located near the front entrance with visitor's log, hand sanitizer, gloves, face masks and 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 signages 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. Continued on next page LIC 809-C A written Emergency/Disaster plan dated 05/15/2020 was posted in a common hallway next to the office. Centrally stored medications were locked in laundry room cabinets. Sharp objects were locked in the kitchen drawers. Toxic chemicals were locked in the laundry room. LPA observed sufficient supply of PPE and incontinence products stored in the office. Facility has conducted staff training on infection prevention, symptoms, transmission and proper donning & doffing of PPE. Trash bins with lid operated with foot pedal were located inside bedrooms, bathrooms and kitchen. Infection control designated leader is the administrator. All staff and residents have been fully vaccinated since February 2021. There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the hallway closet. Facility room temperature was maintained at 78 degrees Fahrenheit. A certified administrator is on site a minimum of 20 hours a week to oversee proper business operation and compliance with COVID-19 infection control practices. Fire extinguisher was observed fully charged. Smoke and Carbon monoxide detectors were operational. Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 09/23/2021: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan · Evidence of Liability Insurance No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided to administrator.the state’s words, verbatim · CDSS document, Sep 22, 2021