Arveah's Care Homes 4

Type of visit: Post Licensing

On 10/4/23 at approximately 8:45am Licensing Program Analyst (LPA) Jennifer Fain and Licensing Program Manager (LPM) Liza King arrived at this facility unannounced to conduct a Post Licensing visit. LPA met with the administrator Rosa-Leah Martinez-Davis and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area and outside of the facility to ensure compliance with Title 22 regulations. Facility has 2 bedrooms and 2 bathrooms for resident use. Facility currently provides care for 2 non ambulatory residents. Facility Observation: Upon entry the residents were in their rooms. Resident 1 (R1) was resting. LPA observed children’s books to aid in stroke recovery in the room. R2 was watching a BB King concert on Youtube. R2 spoke about the music and was interested in LMP’s tattoos. R2 spoke of a desire to have a tattoo in the shape of a lightening bolt on the back. R2 was alert and conversational. During this inspection 2 resident files and 2 staffing files were reviewed for regulatory compliance. Staff files contained required contents including staff training requirements, with the exception of expired First aid and CPR training for 2 of 2 staff. Administrator will have staff complete training and email certifications. All staff noted on LIC 500 contained criminal background clearances. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Temperature on the heating and air unit read 74*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were tested and in working order. Fire extinguisher was checked 7/14/23. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and was accessible to staff. Facility does not contain any bodies of water. Facility has appropriate internet access available for resident use. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. The Care Tool was used during this visit. LPA requested an updated copy of LIC 308, LIC 500, Current Liability Insurance to be emailed to Jennifer.Fain@dss.ca.gov Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Rosa-Leah Martinez-Davis.the state’s words, verbatim · CDSS document, Oct 4, 2023

Type of visit: Case Management - Annual Continuation

On 10/4/23 at approximately 12:00pm Licensing Program Analyst (LPA) Jennifer Fain arrived at this facility unannounced to conduct a continuation of an annual inspection visit. LPA met with the administrator Rosa-Leah Martinez-Davis and explained the purpose of the visit. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms, resident bathrooms, laundry room, living area and outside of the facility to ensure compliance with Title 22 regulations. Facility has 2 bedrooms and 2 bathrooms for resident use. Facility currently provides care for 2 non ambulatory residents. During this inspection 2 resident files and 2 staffing files were reviewed for regulatory compliance. Staff files contained required contents including staff training requirements. All staff noted on LIC 500 contained criminal background clearances. Resident files reviewed contained all required contents including updated admission agreements, medical assessments, and updated appraisal forms as required. Smoke and carbon detectors were tested and in working order. Fire extinguisher was checked 7/14/23. LPA observed doors open to cleaning supplies. Medication storage area was observed to be locked and inaccessible to residents in care. First aid kit was observed to have adequate supplies and was accessible to staff. Facility does not contain any bodies of water. Facility has appropriate internet access available for resident use. LPA reviewed facility’s disaster plan to ensure regulatory compliance. Facility conducts quarterly fire drills. LPA provided Technical Assistance (TA) including, but not limited to, exceptions and waivers, change of administration, hospice and dementia care. The facility is not in compliance with Title 22 Regulations, and the deficiencies can be found on the LIC 809-D page. An exit interview was conducted with Rosa-Leah Martinez-Davis and a copy of the LIC 809 reports, LIC 809-D pages, and Appeals rights were provided.the state’s words, verbatim · CDSS document, Oct 4, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87309 · Plan of correction due date: Oct 11, 2023

Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not ensure the doors to storage rooms with cleaning supplies were locked, which poses a potential Health, Safety or, Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 4, 2023

Plan of correction: Licensee will review and provide an attestation that they understand and will follow the regulation. Proof of correction will be emailed to LPA at jennifer.fain@dss.ca.gov by 10/11/23.

Type of visit: Required - 1 Year

On 8/31/23 at approximately 10am, Licensing Program Analysts (LPAs) Maja Jensen and Jennifer Fain arrived at facility unannounced to conduct a required one year annual visit. LPAs met with Licensee Arvin Davis and explained the purpose of today's visit. The facility is a single story building with an additional building on the property for staff quarters and laundry. The facility is licensed for 4 residents and has 2 bedrooms for double occupancy. LPAs had their temperatures taken and were asked about covid symptoms on entry. Facility had one resident in care. Resident was resting in room. During the visit Home Health arrived to see resident. LPA Fain toured the facility including but not limited to living room, dining room, kitchen, laundry room, bedrooms and bathrooms. The facility had adequate lighting and furniture for the comfort of residents in care. The temperature in the facility was 77 degrees which falls within the required range of 68-85 degrees. The first aid kit was observed to be complete including but not limited to scissors, thermometer, tweezers, gauze, bandages and 1st aid manual. Toxins, medications and sharp objects were observed to be locked and inaccessible to residents. The kitchen was observed to be clean and sanitary. There was a 7 day supply of non-perishable food and 2 day supply of perishable food. The fire extinguisher was last serviced on 7/14/23 and is in compliance. The resident bathroom water temperature was measured at 107.2 degrees. Continued on 809C Continued from 809 LPA Fain observed laundry room door propped open and pesticide and detergents accessible to residents in care. The grounds were observed to be maintained and clear of debris with easily accessible fire escape routes. LPA Fain requested resident’s admission agreement, 602 and needs and service plan be emailed to LPA by end of business today. Staff files will be reviewed at a future visit when the annual is completed. Pursuant to the California Code of Regulations, Title 22, and California Health and Safety Code deficiencies were observed and will be cited at the completion of the annual. An exit interview was conducted and a copy of this report was provided to Arvin Davis.the state’s words, verbatim · CDSS document, Aug 31, 2023

Type of visit: Case Management - Other

On 8/31/23 at approximately 10am Licensing Program Analysts (LPAs) Maja Jensen and Jennifer Fain arrived at facility unannounced to conduct a case management visit related to acceptance and retention limitations. LPAs Jensen and Fain met with Co-Administrator Arvin Davis and explained the purpose of today's visit. On July 14, 2023 the facility submitted an exception request to accept a resident with a gastronomy tube, a prohibited health condition. The Department reviewed the documentation submitted and determined that the resident in fact had multiple prohibited conditions and expressed those concerns to the Licensee. Based on an interview with co-administrator Arvin Davis, the resident was admitted on 7/30/23 despite not having received an approval from the Department. LPAs requested the resident file for review and observed that under section 8, the care home has "a sound monitoring device in the home to monitor residents during times that staff may be outside of the home or in separate laundry room." Furthermore, during the course of the visit LPAs Jensen and Fain observed a staff member on duty who, according to Arvin Davis is not associated to the facility. Technical assistance was provided on prohibited health conditions. Deficiencies are being cited from the California Code of Regulations (CCR). Civil Penalties are also being assessed. An exit interview was conducted and a copy of this report, an LIC 811, and appeal rights were given.the state’s words, verbatim · CDSS document, Aug 31, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615 · Plan of correction due date: Sep 1, 2023

Prohibited Health Conditions Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. (2) Gastrostomy tubes. (3) Naso-gastric tubes. (4) Staphylococcus aureus ("staph") infection or other serious infection. (5) Residents who depend on others to perform all activities of daily living for them as set forth in Section 87459, Functional Capabilities. This requirement was not as evidenced by: (6) Tracheostomies. Based on LPA Fains observation of R1 and a file review for R1 and the Co-Administrators own admission that a resident with prohibited health conditions was accepted. This poses an immediate risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Aug 31, 2023

Plan of correction: The Licensee agrees to submit a plan to come in to compliance within 24 hours and will email the plan to maja.jensen@dss.ca.gov for review and approval.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80072(a)(1) · Plan of correction due date: Sep 1, 2023

Personal Rights ...each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other person. This requirement was not met as evidenced by: Based on a review of the admission agreement for R1, section 8 states the facility uses audio monitoring when staff are not present in the facility. This poses a potential risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Aug 31, 2023

Plan of correction: The Licensee agrees to immediately remove audio recording equipment from the interior of the facility and to revise the admission agreements and submit the revision to maja.jensen@dss.ca.gov by 9/7/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(d)(2) · Plan of correction due date: Sep 29, 2023

Administrator - Qualifications and Duties The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)... Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: Based on the facility accepting a resident with a prohibited health condition without an exception by the Department. This poses a potential risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Aug 31, 2023

Plan of correction: The Licensee agrees that the Administrator and the co-administrator will complete an additional 4 hours of training specific to regulations relating to Residential Care Facilities for the Elderly and will submit proof of completion to maja.jensen@dss.ca.gov by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g)(2) · Plan of correction due date: Sep 1, 2023

Personnel Requirements - General Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall:... Request a transfer of a criminal record clearance as specified in Section 87355(c) Based on Co-Administrator Arvin Davis' own admission that the staff present during the course of the visit was not associated to the facility. This poses an immediate risk to the health, safety and personal rights of residents in care.the state’s words, verbatim · CDSS document, Aug 31, 2023

Plan of correction: The Licensee agrees to have all staff associated by POC due date.

Type of visit: Case Management - Other

On 3-7-23 at 11:00am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding an exception request. LPA met with Administrator Rosa-Leah Martinez-Davis, and explained the purpose of the visit. LPA discussed with Administrator the conditions of resident1 (R1) and conditions for the exception request. At this time, Administrator is discussing additional options with R1's responsible party. An exit interview was conducted with Rosa Leah-Martinez-Davis and a copy of this report was provided to Rosa.the state’s words, verbatim · CDSS document, Mar 7, 2023

Type of visit: Prelicensing

On 10/26/22 at 9:30am Licensing Program Analyst (LPA) Maja Jensen arrived at facility to conduct a pre-licensing inspection. LPA Jensen met with Licensee Rosa-Leah Martinez-Davis and explained the purpose of today's visit. The licensee will also act as the administrator and holds current administrator certificate #6055110740. The facility will serve a maximum capacity of 4 non-ambulatory residents. The facility consists of a main building and an adjacent structure with garage, staff quarters and laundry room. The main entrance has COVID signs posted and a thermometer to screen visitors and staff. All visitors are logged in through a digital application, SmartCare. The application is installed on staff cell phones and there is an Ipad available for sign in as well. The facility has a 30 day supply of PPE available. The main structure consists of a living room, kitchen, two bathrooms and two double occupancy bedrooms. The facility was observed to be sanitary and free of odor. The facility was also observed to be equipped with adequate lighting and furnishings for the comfort of the residents. Night lights were present in the hallways and emergency lighting was available. Activities were observed to be available for the residents. LPA Jensen reviewed the disaster plan and found it to be in compliance. The fire extinguisher was last serviced in March of 2022 and is in compliance. The carbon monoxide and fire alarm were tested and found to be in good working order. A first aid kit was available and observed to be complete. The thermostat was set at 70 degrees and is in the required range of 68-85 degrees. The water temperature was measured in the kitchen at 105.4 degrees and is within the required regulatory range of 105-120 degrees. The kitchen contains a locked cabinet for resident medications. There is a separate locked cabinet for cleaning supplies. Personnel files and resident files will be maintained electronically on the SmartCare application which will be accessible to licensing upon request. The laundry room is separate from the main facility and is adjacent to staff quarters. Cleaning supplies in the laundry room are locked. An adequate supply of linen was observed on hand. The grounds were well maintained and had adequate furniture for outdoor activities. All window screens were observed to be maintained in good repair. There are no bodies of water on the property . The facility was found to be in substantial compliance and has passed pre-licensing. A Component III presentation was completed. An exit interview was conducted and a copy of this report was handed to the licensee.the state’s words, verbatim · CDSS document, Oct 26, 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: Office

Facility Type: RCFE Application Type: Initial Capacity: 4 COMP II Participants: Arvin Davis, Managing Member; Rosa-Leah Martinez-Davis, Administrator Interview Method: Telephone interview On 6/15/22, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jun 15, 2022