A&M Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Edward Tapia made an unannounced required annual inspection at this facility. LPA met with staff and stated the purpose of this visit. Administrator was not able to make the inspection. The facility is a single-level structure and licensed for five non-ambulatory with a hospice waiver for three. One may be bedridden. This facility is a Residential Care Facility for the Elderly. At about 9:25 am, LPA Tapia was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, LPA observed 5 residents in care and staff members on duty. LPA toured the interior and exterior portions of the facility. There were 5 resident rooms 1 of which was a shared room. There was also a staff room which inaccessible to residents. Resident rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Manual smoke detectors, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair and provided with grab bars and hot water was measured at 111.3 degrees Fahrenheit. Facility met the minimum two-day supply of perishable and seven-day supply of non-perishable food stock requirements. Facility had adequate supplies of personal protective equipment in place. Fire extinguisher was observed. For the exterior portion, facility had outside furniture in good repair; and grounds were free of tripping hazards. Backyard also had different fruit trees in good condition. Facility offers a 2-car garage which is kept locked and used for storage, contained emergency food, refrigerator and a car. Laundry room was locked and inaccessible to residents and contained an operational washer/dryer. Kitchen was in good repair. LPA noticed a knife in an open drawer. LPA interviewed staff and they stated, “I use it to cut saran wrap.” Staff immediately removed it from residents in care. Medications were kept locked separately. LPA spoke with Administrator over the phone and informed them of annual late fee. Administrator paid annual fee and was provided with a confirmation number. LPA Tapia reviewed the COVID 19 mitigation plan and the Emergency Disaster Plan of the facility. LPA discussed Assembly Bill 665 that requires a licensee of any adult care residential facility that has internet service to provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. For this visit, no deficiency was noted in areas observed. One advisory was issued today. LPA Tapia conducted an exit interview with staff and a copy of this report was explained and left at the facility.the state’s words, verbatim · CDSS document, Oct 11, 2022

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.

Allegation investigated: Uncleared adults living at the facility.

Licensing Program Analysts(LPAs), Kathrina Chin and Jessica Cho made an unannounced visit to investigate a complaint. LPA also met with the caregiver (staff 1) and Kevin Surgent Administrator and discussed the above allegation. The investigation into the allegation that uncleared adults living at the facility revealed the following: LPAs conducted an interview with the caregiver and Administrator. Mr. Surgent reported that staff 1 and her adult son (staff 2) are both live-in caregivers. LPAs observed that both employees have fingerprint clearances and have complete staff records on file. LPA's interviewed two residents and both indicated only staff 1 and staff 2 are live-in caregivers. Both reported that they have not seen other adults reside at the facility. Staff 3 is a live-out caregiver but was not working at the time of the visit. (Continued on LIC 9099C). Unfounded Based on the above findings, this allegation is determined to be UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted, appeal rights explained, and a copy of this report was given to Kevin Surgent, Administrator.the state’s words, verbatim · CDSS document, Mar 2, 2022 · control 22-AS-20220225094508

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Kathrina Chin conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into the facility by Kevin Surgent, Administrator and explained the reason for the visit. LPA Chin toured the facility. There are five residents residing in the facility and no active COVID-19 cases. All residents appeared clean and well taken care of. LPA observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed had ample soap/ sanitizer and appeared clean. Resident bedrooms appeared clean and sanitary and had all required components. LPA observed the emergency disaster and evacuation plans. Facility has back-up emergency food and water supply as well as PPE supplies. LPA reviewed the COVID 19 mitigation plan of the facility. Smoke detectors, carbon monoxide and auditory exit alarms were tested and were operational. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Hot water was measured at 120 degrees Fahrenheit and has adjusted the temperature. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had patio furniture in good repair, and grounds were free of tripping hazards. No deficiencies cited this review as per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 11, 2021