Aging in the Bay

Type of visit: Required - 1 Year

On 09/14/23 at 3PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with staff (S1) and spoke with administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with staff (S1, ADM). LPA toured the facility including but not limited to the front entrance, screening station, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs, paper, medications locked in cabinets. Comfortable temperature is maintained at 74 deg F. Hot water temperature was measured at 117 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Fire extinguisher was observed fully charged. LPA reviewed 3 staff and 4 resident files. LPA also conducted 2 staff and 2 resident interviews during visit. The following deficiencies were observed during visit: Two expired fire extinguishers (purchase date 10/02/19) 4 open trash bins in bathrooms & bedrooms Continued on next page, LIC 809-C Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proofs of correction (POCs) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 14, 2023

Allegation investigated: Facility staff yelled at resident Facility staff restricted resident inside the room

On 12/07/22 at 3:46PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent complaint visit, met with administrator and delivered investigation findings of above allegations. LPA explained the purpose of the visit with administrator. Allegation: Facility staff yelled at resident Investigation Finding: Unsubstantiated During investigation, LPA conducted interviews with residents (R1, R2, R3). All residents denied being yelled at or being maltreated by staff (S1). Witness (W1) also stated she has visited the facility several times unannounced and did not observe staff (S1) yell at residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. Continued on next page, LIC 9099-C Unsubstantiated Allegation: Facility staff restricted resident inside the room Investigation Finding: Unsubstantiated Based on interviews and record reviews which were conducted, residents (R1, R2, R3) stated they were never restricted inside their bedrooms by staff (S1). On 12/01/22, R1 denied to LPA being restricted inside her bedroom by S1. W1 stated she did not observe any resident being restricted inside their bedrooms. Residents state they are able to move around the facility as often as they want without restriction. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. No deficiency cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Dec 7, 2022 · control 15-AS-20221128113357

Type of visit: Required - 1 Year

On 9/21/22 at 3:42 PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct infection control inspection. LPA met with administrator and explained the purpose of the visit. LPA observed 2 staff wearing face masks and eyeglasses. LPA observed the 2 residents resting inside their bedrooms. LPA toured the facility including but not limited to common areas, kitchen, bedroom, and shared bathrooms. to front entrance, screening station, hand washing stations, common areas. There is one central entry point for universal screening for staff, clients and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Cough/sneeze etiquette, social distancing signs were posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs maintained at a central location and easily accessible for staff. Comfortable temperature is maintained at 76 deg F. Facility has a mitigation plan in place and maintains records of routine screening for residents and staff. The infection control leader is the administrator. Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 09/22/22: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan including infection control plans · Evidence of Liability insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 21, 2022

Type of visit: Required - 1 Year

On 11/16/21 at 3PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with administrator (ADM). Facility has a mitigation plan in place dated 03/04/21 to mitigate the spread of COVID-19. LPA discussed the completed mitigation plan (LIC 808) with ADM as well as COVID-19 infection control practices. LPA inspected the facility inside and outside. One central entry point has been designated for universal entry screening with the station located near the front entrance with visitor's log, hand sanitizer, face masks and no touch temperature probe. COVID-19 signs were observed posted in the front entrance and common hallways to promote handwashing, cough/sneeze etiquette and physical distancing. Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Pathways were observed to be free of obstruction and fire hazards. A written Emergency/Disaster plan dated 10/19/2020 was posted on a bulletin board near the front entrance. Centrally stored medications were locked in the kitchen cabinets. Sharp objects were locked in the kitchen drawer. Continued on next page LIC 809-C Toxic chemicals were locked in the laundry room and garage. underneath the kitchen sink.Infection control designated leader is the administrator. All staff and residents have been fully vaccinated since March 2021. There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the garage. Facility room temperature was maintained at 72 degrees Fahrenheit. Resident's bedrooms and bathrooms have COVID-19 signages. Fire extinguisher was observed fully charged. Smoke and Carbon monoxide detectors were operational. Adequate supplies of PPE were also observed stored in the garage and hallway closet. Facility follows daily cleaning, sanitation of frequently touched common surfaces using Clorox and Lysol disinfectants. The facility has auditory signals on each exit door. Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 11/17/2021: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan · Evidence of Liability Insurance No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Nov 16, 2021