A Family of Care

Type of visit: Required - 1 Year

On 10/24/2023 at 9:10 AM, Licensing Program Analyst (LPA) P. Watson arrived unannounced to conduct Required 1 Year Annual inspection. Upon arrival LPA was greeted by caregiver, Simone Mladinich. LPA spoke with Administrator, Kathleen Taylor and explained the purpose of the visit. Administrator was unable to join the visit and allowed caregiver to sign report. The facility’s fire clearance was approved for 3 Ambulatory and 4 Non-Ambulatory. LPA toured facility with Simone 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. LPA observed a locked fence surrounding the pool area. A comfortable temperature is maintained at 77 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 and private bathrooms were measured within range of 105-120 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7 day supply of nonperishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last purchased in 02/2023. First aid kit was observed to be complete. Report continues on 809 C At 9:40 AM, LPA reviewed 6 of 6 residents records. At 10:23 AM, LPA reviewed 6 of 6 staff records and 6 of 6 have current first aid training and associated to the facility. At 11:06 AM, LPA reviewed a sample of 6 of 6 resident’s medications. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 11/14/2023: 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, Oct 24, 2023

Type of visit: Required - 1 Year

On 9/7/2022 at 3:30PM, Licensing Program Analyst (LPA) Leslie Ibo arrived unannounced to conduct an infection control inspection. LPA met with Administrator Kathleen Taylor. Facility has census of 7. LPA toured the facility inside and out including but not limited to common areas, resident rooms, bathrooms, kitchen and backyard. Pool was properly secured and locked. Facility has enough supplies of PPEs, paper supplies and hygiene supplies. Medications are centrally stored in a locked area that is inaccessible to clients and refilled every at least 30 days. Facility has enough 2-day perishable food and one week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Facility has a mitigation plan and updated infection control plan. Facility maintains record of routine screening for residents and staff. ...continued to LIC809C... Facility received an approval for capacity increase of 7 on 4/21/2022. License is being updated on the system. LPA observed the following: · S4 started working at the facility without fingerprint clearance, based on records review fingerprint clearance indicated still “in process” . Civil penalty was assessed during today’s visit. 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. Deficiency, plan and proof of correction and civil penalty were discussed with Kathleen Taylor. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report providedthe state’s words, verbatim · CDSS document, Sep 7, 2022

Allegation investigated: Staff member failed to fulfill mandated reporter responsibilities

On 12/22/2021 at 12:30PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to deliver complaint findings for the allegation above. LPA met with Administrator, Kathleen Taylor. During the course of the investigation, LPA Y. Flores-Larios obtained and reviewed documents, interviewed staff and witness. On the allegation staff member failed to fulfill mandated reporter responsibilities. Staff 1 (S1) was not able to obtain an updated physician’s report prior to Resident 1 (R1’s) admission on 02/25/2020. Witness 2 (W2) had tried to get an appointment for R1, but due to COVID restrictions no patients were being seen for non-emergencies. S1 did compose a preplacement appraisal on 2/25/2020 and an appraisal needs and services on 2/27/2020. Continued on LIC9099C. Unsubstantiated Continued from LIC9099. S1 had taken R1 to the emergency room on 2/26/2020. At the time of the emergency visit documentation from the physician did not suggest any suspicion of abuse or neglect. On 2/28/2020, Witness 3 (W3) examined R1 and there was not any mention of abuse or neglect. Based on interviews conducted and records reviewed, the preponderance of evidence standard has not been met, therefore the allegation is found to be UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove it did or did not occur. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 22, 2021 · control 15-AS-20200408090331

Type of visit: Required - 1 Year

On 10/6/2021 at 02:10 PM Licensing Program Analyst (LPA) Leslie Ibo arrived unannounced to conduct an infection control annual inspection. LPA met with Administrator Kathleen Taylor. Facility has census of 4. LPA toured the facility inside and out including but not limited to common areas, resident rooms, bathrooms, kitchen and backyard. Pool was properly secured and locked. Facility has enough supplies of PPEs, paper supplies and hygiene supplies. Medications are centrally stored in a locked area that is inaccessible to clients and refilled every at least 30 days. Facility has enough 2-day perishable food and one-week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Facility has a mitigation plan and maintains record of routine screening for residents and staff. No deficiency cited during the visit. Exit interview conducted. Copy of this report provided.the state’s words, verbatim · CDSS document, Oct 6, 2021