Dysico Care Home, RCFE

Type of visit: Required - 1 Year

On 09/20/2023 at 11:41 AM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required Inspection. LPA met with Administrator/Caregiver, Evangeline Lekse, and explained the purpose of the visit. Evangeline's Administrator Certificate# 6024122740 Expired 03/08/2023. Evangeline is waiting for a renewal certificate to arrive. The facility’s fire clearance was approved for 6 non-ambulatory. Also the facility has a Hospice Waiver for 2 Residents. LPA toured facility with Evangeline including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 7 total bedrooms which 6 bedrooms are occupied by the residents and 1 bedroom is 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 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’ 2 shared bathrooms was measured at 109.0, 111.2/111.0 (double sink) degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. LIC809-C Continued... LIC809 Continued... 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 and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 09/14/2023. Emergency Disaster Plan was last posted on 07/20/2023. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 07/20/2023. At 12:30PM, LPA reviewed 6 Residents records. At 2:30 PM, LPA reviewed 7 staff records and 6 of 7 have current first aid training and associated to the facility. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/27/2023: 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 No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 20, 2023

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 09/20/2023 at 4:21PM, Licensing Program Analyst (LPA), L. Alexander conducted an unannounced Case Management in regard to a phone call from Staff (S1), regarding one of the Residents. S1 called LPA L. Alexander on 09/18/2023 with concerns for R1 because they have been drinking alcohol (Vodka) and not eating. S1 had concerns that R1 may have symptoms of alcohol withdrawal and that the Staff would not be able to handle that type of issue if it occurred. S1 says that R1 was admitted earlier to their facility under hospice care and that the Physician's Report (LIC602) did not say that there was any type of alcohol/substance abuse. The hospice agency (HA) was allowing R1 to consume alcohol. R1 was discharged from hospice on 07/21/2023. The updated LIC602 dated 09/13/2023 includes to question #13 and #14: (f) Substance Abuse Problem - yes, and (g) Use of Alcohol -yes (2.5L in 24hrs). Question#14 (c) Aggressive Behavior - yes (when intoxicated). S1 was concerned for compliance as well that R1 may be harming herself because she isn't eating much. There is a doctor's order with restrictions for R1, "R1 should not drink any alcohol." LPA spoke with R1 during "Client Interview" while conducting an Annual Inspection today. R1 says that she doesn't really go out in the main common area. R1 says that she doesn't eat much because she just doesn't eat. However, R1 says that she orders her own snacks (chips, salsa, water, seltzer drinks, etc) through Instacart and that's how she receives her delivered items. R1 has a instant ice maker and Keurig coffee maker in her private room. Today, R1 says that she ate a hotdog today for lunch but probably won't eat anything else. LPA requested and received documents for R1: Physician's Report LIC602; dated 06/05/2023 Physician's Report LIC602; dated 09/15/2023 Kaiser's Activity Status Report; dated 09/13/2023 (doctor's order with restrictions no alcohol) No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 20, 2023

Type of visit: Required - 1 Year

On 9/21/2022 at 3:25PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Administrator, Evangeline Lekse, and explained the purpose of the visit. Upon entry, LPA's temperature was checked. LPA observed screening station and COVID-19 signs posted near screening station. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage and back yard. All hand washing stations were equipped with soap and paper towel. Hot water temperature in the shared clients’ bathroom was measured at 119.9 degrees Fahrenheit. Fire extinguisher last serviced on 9/1/2022. There is a minimum of 7-day non-perishables and 2-day perishables foods. During record review, LPA observed facility has a copy of the mitigation plan on file. LPA observed PPE, food, and paper supplies are sufficient. The following deficiencies were observed: At 3:31PM, LPA observed knife drying in dish rack on kitchen counter. At 3:45PM, during observation and record review LPA observed R2, R3, and R6 does not have a doctor's order for their hospital bed. Continued on LIC809C. Continued from 809. The following 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 provided and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 21, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) James Sampair conducted an unannounced pre-licensing inspection and met with Administrator, Evangeline Lekse. LPA explained the reason for the visit. LPA observed 2 of the 2 staff wearing masks. LPA also observed 4 residents resting in their bedrooms during the visit. In this follow up of the initial 10/07/21 pre-licensing visit, the LPA again toured the facility inside and outside, including but not limited to resident's bedrooms, bathrooms, dining room, common living areas, kitchen, and outside patios. No reduction in the standard of care nor in the cleanliness and orderliness of the physical plant has occurred. The LPA also saw proof that the Applicant, Josephine Dysico, has completed all of the necessary changes identified on 10/07/21: adequate emergency lighting in easily accessible locations, updates to the Emergency and Disaster Plan, and an LIC 999 Facility Sketch of the Yard with a Resident Assembly Point on it. With those changes in place at the facility, this report is ready to be submitted to the central application unit (CAU), where a final review of the application will be conducted: This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 13, 2021

Type of visit: Prelicensing

Licensing Program Analyst (LPA) James Sampair conducted an unannounced pre-licensing inspection and met with Applicant, Josephine Dysico and Administrator, Evangeline Lekse. LPA explained the reason for the visit. LPA observed 4 staff wearing masks. LPA also observed 4 residents eating meals, resting in their bedrooms, and watching television during the visit. LPA toured the facility inside and outside including but not limited to resident's bedrooms, bathrooms, dining room, common living areas, kitchen, and outside patios. There is sufficient lighting around the facility. Resident's rooms were equipped with the proper furniture and lighting. Resident's rooms had proper bedding and linens. Bathrooms were equipped with grab bars, nonskid mats, and hygiene items. Living room is equipped with the proper furniture for the residents. All toxins and sharp objects were locked. Passageways and hallways were free of obstruction. Fire extinguisher is fully charged. Smoke and Carbon Monoxide detectors were operational. Medication cabinet was locked and first aid kit was complete. Exit doors are equipped with auditory signals. Hot water temperature was measured at 110 degrees F. Sufficient 2 day perishable and 1 week non-perishable food supplies were observed in the refrigerator, freezer, garage, and additional food supplies were observed in the garage freezer. Complaint poster, personal rights, Ombudsman and rights to council posters were observed displayed near the dining area. LPA did observe seven (7) Technical Violations during the inspection: one (1) Physical Plant/Environmental Safety, one (1) Residents with Special Health Needs, and one (1) Disaster Preparedness. The facility is not ready to be licensed. -------Continued on 809-C----------- The Licensee must complete the following before this report will be submitted to the central application unit (CAU), where a final review of the application will be conducted: 1. Provide proof that adequate emergency lighting has been placed in easily accessible locations for the residents of the facility at its maximum capacity. 2. Update the Emergency and Disaster Plan to include: (a) Methods for meeting the needs of residents with special needs, such as dementia and hospice services. (b) Proof that supplies and equipment mentioned in the plan have been purchased and included in "To Go Bags" and an "Emergency Kit" which includes but is not limited to: a generator able to supply the power necessary to care for all residents and staff when at maximum capacity with light, heat, cooling, refrigeration of medicines; and an adequate supply of bottled water. (c) Multiple transportation providers (d) Include procedures for confirming the location of residents during an emergency or disaster. 3. Complete LIC 999 Facility Sketch (Yard) and add the Resident Assembly Point to it. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 7, 2021

The state marks this report as 9 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.