A Family Affair Care II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit on 3/29/23. LPA met with Co-Administrator Patrick Cain and explained the purpose of the visit. Administrator holds current certification #6020161740 and expires on 9/5/2024. The facility is licensed for 6 non-ambulatory residents. Approved hospice waiver for 1. There are 5 residents present during today’s visit. LPA inspected the physical plant including but not limited to the common area, kitchen, pantry, dining area, resident bedrooms, resident bathrooms, laundry area and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. The hot water temperature was observed to be 112.6 degrees Fahrenheit. Facility thermostat observed at 73 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed knives and toxins to be locked away and inaccessible to residents. Smoke and carbon detectors were in good repair. Fire extinguisher and first aid kit was up to date. LPA checked medication cabinet and found medication to be locked away and inaccessible to residents. Proof of current liability insurance was observed. Report continued on 809-C LPA requested resident and staff files for review. LPA reviewed (5) resident files and (4) staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. LPA verified staff training for staff file reviews. The following documents was obtained during today's visit: LIC 500 Personnel Report, LIC 610 Emergency Disaster Plan, Copy of Administrator Certificate, LIC308 Designation of Administrative Responsibility, Proof of Current Liability Insurance and resident roster. As a result of this visit, there were no deficiencies cited, per California Code of Regulations, Title 22 and Health and Safety Code. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 29, 2023

Type of visit: Required - 1 Year

On 3/8/2022 at 10:15 AM, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct an annual inspection visit. Prior to entering the facility, LPA Truong called the facility and spoke to staff, who confirmed no residents or staff have had any symptoms of COVID-19 in the last 10 days. Upon LPAs arrival, Caregiver Rhonda Hood was present at facility and contacted Administrator Kassia Mitchell who arrived a bit later. LPA met with Administrator Kassia Mitchell and explained the purpose of the visit. Administrator Kassia Mitchell holds current certification #6020161740 and expires on 9/5/2022. The facility is licensed for 6 non-ambulatory residents. Approved hospice waiver for 1. There are currently 6 residents who reside in the facility. LPA toured the facility with Administrator Kassia Mitchell on 3/8/2022 at 10:30 AM. LPA inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry area, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. The hot water temperature was observed to be 117.3 degrees Fahrenheit, which is within the required regulation of 105 to 120 degrees Fahrenheit. Facility thermostat observed at 70 degrees Fahrenheit. Food supply is adequate for 2-day perishable and 7-day nonperishable. Report continued on 809-C LPA observed knives and toxins to be locked away and inaccessible to clients. Smoke and carbon detectors were in good repair. Fire extinguisher and first aid kit was up to date. LPA checked medication storage and found medication to be locked away and inaccessible to clients. LPA also conducted the infection control domain tool. The facility mitigation plan was submitted to CCLD, and it was approved on 4/5/2021. Facility has routine symptom screening checks for clients, staff, and visitors. The facility has a symptom check binder for staff, clients, and care staff. Hand Hygiene procedures have been implemented. Facility had Covid-19 posters throughout the facility, and the facility has implemented Covid-19 mitigation plan. Administrator was informed to send updated copies of the following documents to CCL within 15 days: (1) LIC308 Designation of Administrative Responsibility (2) LIC500 Personnel Report (3) LIC610 Emergency Disaster Plan (4) Proof of Current Liability Insurance (5) Copy of Administrator Certificate Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 8, 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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced on 07/22/2021 at 11:20 AM to conduct an annual inspection visit. LPA met with Assistant Administrator Patrick Cain and explained the purpose of the visit. Administrator Kassia Mitchell holds current certification #6020161740 and expires on 9/5/2022. The facility is licensed for 6 non-ambulatory residents. Approved hospice waiver for 1. There are currently 6 residents. LPA toured the facility with Assistant Administrator Patrick Cain on 07/22/2021 at 11:40 AM. LPA inspected the physical plant including but not limited to the common areas, kitchen, dining area, resident bedrooms; resident bathrooms, staff room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. The hot water temperature was observed to be 115.9 degrees Fahrenheit. LPA observed there to be a sufficient amount of perishable and non-perishable food supply on hand. LPA observed knives and toxins to be locked away and inaccessible to residents. Smoke and carbon detectors were in good repair. Fire extinguisher and first aid kit was up to date. LPA checked medication storage and found medication to be locked away and inaccessible to clients. LPA also conducted the infection control domain tool. Continued on 809-C The facility mitigation plan was submitted to CCLD, and it was approved on 4/5/2021. Facility has routine symptom screening checks for residents, staff, and visitors. The facility has a symptom check binder for staff, residents, and care staff. Hand Hygiene procedures have been implemented. Facility had Covid-19 posters throughout the facility, and the facility has implemented Covid-19 mitigation plan. The following forms and documents were requested to be submitted within 15 days: (1) LIC308 Designation of Administrative Responsibility (2) LIC500 Personnel Report (3) Copy of Administrator Certificate (4) LIC610 Emergency Disaster Plan (5) Proof of Current Liability Insurance (6) Administrative Organization (LIC309) (7) Control of Property Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Jul 22, 2021

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: Suspected physical abuse of resident in care.

Licensing Program Analyst (LPA) Tung Truong conducted an unannounced visit to this facility to deliver investigation findings on 7/9/2021. LPA identified himself and discussed the purpose of the visit and the elements of the allegation(s) with administrator Kassia Mitchell. The investigation was conducted by the Department which consisted of reviews of the facility records and interviews with facility management and staff. The resident (R1) and other witnesses were contacted and interviewed. The complaint alleges that resident R1 sustained a fibula tibia fracture to the right lower leg as a result of abuse. Continued on 9099-C Unsubstantiated During the investigation, it was revealed that R1 had two falls while at a Skilled Nursing Facility (SNF). After discharged from SNF on 2/17/2021, R1 had ongoing issues with a sore to the right toe and swelling of lower right leg. Resident R1 was diagnosed with a tibia fracture on 3/10/2021. When interview R1, R1 was not able to speak to the cause of injury. Administrator Kassia Mitchell reported that R1 is non-verbal at baseline. Administrator Kassia Mitchell stated she was not aware of how R1’s leg was injured. Administrator Kassia stated she had no idea as to what could have caused the fracture and denied any time that R1 fell while in her care. Staff (S1) denied anything occurred that would have caused R1's leg to got injured. Staff (S2) did not know how R1’s injury occurred. Other residents in care that were interviewed did not know how R1’s leg got injured. The investigation revealed the lack of evidence to substantiate that resident R1 was being physically abused while in care. Investigation revealed the cause of R1’s leg injury was unknown. This Department has investigated the complaint alleging the above allegation to be UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted with Administrator Kassia Mitchell and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 9, 2021 · control 27-AS-20210329120627