Alleviate Care

Type of visit: Required - 1 Year

At 2:55 p.m. on 11/16/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with staff and later Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility was last visited on 11/23/2021 for an annual visit. It is a single story building with 5 bedrooms, 3 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 5 may be non-ambulatory. The facility serves residents with dementia. Approved hospice waivers for 5. Upon entry, LPA observed a sign at the front door for the facility’s visitation policy. Once inside, LPA observed additional postings for COVID precautions, ombudsman contacts, confidential complaint contacts, personal rights, rights of resident councils, emergency disaster plan, facility license, and Administrator certificate. LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer, N95 masks, gloves, sanitizing wipes, and hand sanitizer. The facility had 5 private bedrooms. All bedrooms contained a chair, nightstand, storage, and bed with adequate bedding. All furnishings were clean and in good condition. One resident was observed watching television in the living room, and LPA spoke with another resident in their room. Both residents reported enjoying the facility and staff. The facility had 3 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 3:21 p.m. LPA measured the water temperature in the bathroom adjacent to Bedroom #4 to be 119.7 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. Kitchen surfaces were sanitary, and all appliances were functional. Sharps were locked below the counter, and cleaning solutions were locked below the sink. LPA observed an operable washer and dryer in the garage. The garage was locked, and detergents were stored inside. Walls, floors, ceilings, windows, and screens were clean and in good repair. At 3:55 p.m. LPA measured the room temperature to be 73 degrees Fahrenheit. All emergency exit paths were free from obstructions. Exit gates were unlocked. At 3:50 p.m. LPA observed a fully charged fire extinguisher in the kitchen. It was last inspected on 11/10/2020. At 4:06 p.m. LPA tested the dual-function smoke and carbon monoxide detector to be operational. When tested, 3 out of 3 detectors functioned simultaneously, and the fire door closed. 2 out of 2 auditory alarms were on and functioning. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Nov 16, 2022

Type of visit: Case Management - Deficiencies

lOn 11/23/2021 at 12:20 PM, Licensing Program Analyst (LPA) Nicholas Reed noted deficiencies from an unannounced annual visit earlier in the day. LPA met with Administrator to discuss the deficiencies LPA observed. The census of residents was 7 During a facility tour at approximately 10:15 AM, LPA observed two residents in Bedroom #6, one resident in Bedroom #3, one resident in the living room, one resident in Bedroom #2, and two residents in Bedroom #1. The facility currently provides service to 7 residents. Additionally, one of the two residents in Bedroom #1 was non-ambulatory. From records review and discussion with Administrator, LPA learned Bedroom #1 is designated for ambulatory use only. Administrator noted the reasons for operating beyond the facility’s fire clearance. Administrator accepted Emergency Placements recently, and due to additional, necessary medical procedures and family requests, Administrator retained an extra resident. Two residents were expected to leave by December 1st, so Administrator did not initiate the 30-day eviction process. Pursuant to Title 22 Division 6 Chapter 8 Article 4 of the CA Code of Regulations, deficiencies were cited (refer to LIC 809-D). Exit Interview conducted, appeal rights discussed and issued, and copy of report emailed to Administrator.the state’s words, verbatim · CDSS document, Nov 23, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(a) · Plan of correction due date: Nov 24, 2021

****This document was amended to include necessary language**** 87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the limitations specified on the license, including specification of the maximum number of persons who may receive services at any time. This requirement was not met as evidenced by: Based on LPA observation, interview, and record review, it was determined the Licensee operated beyond the faciilty's maximum approved fire clearance for 6 residents. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 23, 2021

Plan of correction: Administrator will seek outside placement for the extra resident today and verify the resident's move by 11/24/2021 to LPA in person.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87204(b) · Plan of correction due date: Nov 24, 2021

87204 Limitations - Capacity and Ambulatory Status (b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. This requirement is not met as evidenced by: Based on LPA observation and interview, it was determined the Licensee placed a non-ambulatory resident in a room with fire clearance designated for ambulatory residents only. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 23, 2021

Plan of correction: Administrator will seek outside placement for the resident today and verify the resident's move by 11/24/2021 with LPA in person.

Type of visit: Required - 1 Year

On 11/23/2021 at 09:58 AM, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with Staff, and Administrator joined later. LPA disclosed the reason for the visit. LPA conducted the visit under the Infection Control Domain of Licensing’s Compliance and Regulatory Enforcement (CARE) Tools. The census of residents was 7 Facility has a Mitigation Plan, approved by the Regional Office, to mitigate the spread of COVID-19 in the facility. At approximately 10:07AM, LPA inspected the inside of the facility. ENTRY: LPA noted the entrance ramp and stairs to be in good condition. Outside of the front door, LPA observed two COVID-related signs: No Visitors Allowed and instructions for Special Visitors. Upon entry to the facility, staff took LPA’s temperature and directed LPA to sign Visitor's Log. Staff was wearing a mask to prevent spread of COVID-19. LPA observed one central entry point designated for the screening. LPA saw a screening station which contained hand sanitizer, 2 digital thermometers N95 masks, surgical masks, and disinfecting bleach wipes. Once inside, LPA observed Emergency Evacuation route posted, as well as Personal Rights poster and a Confidential Complaint hotline poster. Administrator showed LPA the facility’s designated visitation area at the front. Kitchen: As staff sanitized the area, LPA observed two handwashing signs posted by the kitchen sink, along with liquid soap and a metal paper towel dispenser. Below the sink was a locked cabinet containing cleaning supplies. Bathrooms: LPA observed liquid soap, metal paper towel dispensers, and two handwashing signs in 3 out of 3 bathrooms. 2 out of 3 bathrooms had trash cans with tight-fitting lids. LPA measured water temperature in the bathroom directly across from the kitchen to be 105.1 degrees Fahrenheit. Bedrooms: LPA observed bedrooms to be in good condition. LPA detected no odors or signs of vermin. LPA tested room temperature. Thermometer read 78.3 degrees Fahrenheit. Shared bedrooms #1 and #6 contained beds which were 6 feet apart allowing appropriate social distancing for residents. Common Areas: LPA observed a resident watching television. Seating accommodations in the living room are spaced so residents remain 6 feet apart. Administrator noted high traffic common areas and high touch surfaces are cleaned and disinfected at least once a day. Walls, floors, furniture, windows, and curtains were all clean and in good repair. Outside and Garage: At approximately 11:15 AM, LPA and Administrator toured outside and the garage. LPA heard and saw 2 audio alarms attached to the front door and side exit of the facility. In the garage, LPA observed sufficient supplies of gloves, N95 masks, surgical masks, face shields, and gowns. LPA also observed hazardous chemicals locked away in garage as well. Mitigation Plan: At approximately 10:38 AM, Administrator and LPA reviewed the facility’s Mitigation Plan. Administrator assured all residents have been notified about facility infection control policies. Administrator also noted the facility has procedures for when to test staff and residents to monitor the spread of the virus and mitigate outbreaks, and the facility tests staff during hiring process and residents before admission for COVID-19. The Facility checks supplies daily to make sure that all resident rooms and common areas have tissues and hand sanitizer, and all sinks have liquid soap, and paper towels. The Facility also has 2 phones for residents’ use. In the event of a staffing shortage, Administrator provides assistance, and he has access to a staffing agency. Administrator is also the infection control lead in charge of preparedness planning and integrating local Department of Public Health, California Department of Public Health and Center for Disease Control guidance to all residents and staff. At approximately 10:55 AM, LPA and Administrator discussed facility procedures in the event of a COVID positive resident. Administrator stated the facility is able to designate a single-person room with a closed door to isolate symptomatic and/or asymptomatic exposed residents. Staff are able to serve all meals and deliver medications to residents in isolation. Facility developed plan to ensure appropriate cleaning of isolation rooms. Mitigation Plan Review: Facility follows many aspects of the Mitigation Plan LPA reminded Administrator to maintain a symptom screening log (+/- temperature and symptom check) for all staff, residents, and visitors, in which the facility has documented daily temperature and COVID-19 symptom checks, and any changes in condition for staff and residents. LPA also reminded Administrator to obtain Fit testing for staff working with COVID positive residents. Exit interview conducted and copy of report emailed to Administrator.the state’s words, verbatim · CDSS document, Nov 23, 2021