Adriana Elderly Care Home IV

Type of visit: POC

Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 10/14/2022. LPA De Perio explained reason for visit and was greeted by staff on duty, who contacted facility administrator (AD) Richard Mendoza about visit. For today's visit, LPA De Perio verified that there are currently 4 residents in care, and 2 staff on duty. On 10/14/2022, licensee failed to lock disinfectants, cleaning solutions, poisons, and other items which could post a danger. LPA De Perio observed cleaning supplies and disinfectants stored in an unlocked cabinet located in the laundry room, of which the laundry room is unlocked at all times. This poses an immediate health, safety or personal rights risk to persons in care. *Deficiency cited under Title 22 Regulation 87309(a) pertaining to Storage Space has been CLEARED. Licensee has secured noted items and now has a designated locked location for disinfectants, cleaning solutions, poisons, and other items. Licensee has complied with the terms of the POC. For this visit, no deficiencies were issued at this time. No citations issued at this time. LPA De Perio conducted an exit interview with AD Mendoza and a copy of this report and Letter of Cleared Deficiency has been provided to the facility.the state’s words, verbatim · CDSS document, Nov 4, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, 2 staff were on duty, who contacted facility administrator (AD) Richard Mendoza about visit. AD Mendoza arrived to facility at 2:22 PM. As of 10/14/22, there are no active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted in the entrance of the facility and in the kitchen hallway. The PUB475 "See Something, Say Something" poster was also observed at the entrance and in the facility hallway. AD R. Mendoza has not received the renewed certificate, however stated to LPA De Perio that the renewal fee has been paid. NOTE: Per AD R. Mendoza, renewal fee was submitted to bank via business check. AD R. Mendoza stated that he would obtain a copy of the renewal fee from bank and submit it to LPA De Perio on or by 10/21/22. LPA De Perio observed the Administrator's Certificate for Adriana Mendoza, which expires on 4/6/2023. LPA De Perio toured the interior and exterior portions of the facility with staff on duty (S1). The facility is a single level structure and is licensed for for six residents, of which 6 may be bedridden and a hospice waiver for 6. For this visit, there are a total of 5 residents in care, of which 0 are bedridden and 0 on hospice. There are a total of 5 bedrooms, of which 5 are private, and 1 is shared and no room is designated for staff use. LPA De Perio toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 5 restrooms in the facility. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 107.9 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care and located in a kitchen drawer. Fire extinguisher was charged, mounted and located in the kitchen. LPA De Perio observed the emergency disaster and evacuation plan, which is posted at the main entrance of the facility. Facility had back-up emergency food and water supply, located in a kitchen pantry. LPA De Perio observed that First Aid Kit had all the required components. The facility had an adequate supply of PPE that was located in a hallway cabinet. Medications were locked in a cabinet and inaccessible to residents in care. There is a laundry room of which does not have a lock, and has two cabinets that store disinfectants and toxins. The bottom part of the cabinet is locked, however, the top portion of the cabinet does not have a lock. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There is 1 gate in the backyard, which is self-closing and self-latching. No bodies of water were observed. LPA De Perio verified the Coronavirus 2019 (COVID 19) mitigation plan of the facility with AD Mendoza. LPA De Perio discussed Assembly Bill 665 requires that a licensee of any adult or senior care residential facility that has internet service 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. LPA De Perio discussed with AD Mendoza to review, and subscribe for emails regarding the Provider Information Notices (PINs) as well as to attend the CCLD Informational Calls to ensure that facility and staff are up to date. The PINs can be accessed at: www.ccld.ca.gov. LPA De Perio discussed the California Code of Regulations Section 87466 Observation of the Resident and Section 87211 Reporting Requirements with AD Mendoza. For today's visit deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. LPA De Perio advised AD Mendoza to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA. LPA De Perio conducted an exit interview with AD Mendoza and a copy of this report, regulations discussed and Appeal Rights were provided to the facility.the state’s words, verbatim · CDSS document, Oct 14, 2022

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

Licensing Program Analyst (LPA) Albert Marin conducted an unannounced required annual inspection in this facility. LPA met with Administrator (ADs) Richard Mendoza Sr. and Adriana Mendoza; and stated the purpose of this visit. The facility is a single level structure and licensed for six bedridden and with hospice waiver for six. For this visit, there were two residents under hospice care. About 3:23 PM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. LPA observed six residents in care and two staff members on the floor. LPA toured the interior and exterior portions of the facility. There were six private rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Hardwired smoke, carbon monoxide and auditory exit alarms were tested to be operational. Bathrooms were observed to be in good repair, provided with grab bars and nonskid floor mats. Hot water was measured at 116 degrees Fahrenheit. 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. Side exit door was self-closing and self-latching. LPA Marin reviewed the COVID 19 mitigation plan of the facility; and assisted AD Mendoza with the Guardian System. For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. LPA Marin conducted an exit interview with AD R. Mendoza; and copy of this report was left in the facility.the state’s words, verbatim · CDSS document, Dec 6, 2021