Benicia Angel's Home 1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator/Licensee, Evelyn Bayon. There are currently 4 residents in care. This facility is licensed for 6 non ambulatory residents, with hospice waiver approved for 2 of the residents and none of the residents are approved for bedridden. LPA initiated a tour of the facility and made the following observations: Facility was clean, organized and at a comfortable temperature, with passageways free from obstructions. Residents rooms were furnished per regulation. Water temperature in bathrooms used by residents measured at 110 degrees F which is within the required range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinet containing cleaning supplies was observed locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Facility maintains emergency food and water supplies. Fire extinguishers were fully charged and last serviced March 18, 2023. Smoke and Carbon Monoxide detectors located throughout the facility were operational. Most recent disaster drill was conducted June 2023. Administrator Certificate for Evelyn Bayon, #6018780740 expires on 10/5/2024. Staff have First Aid and CPR certificates. LPA reviewed 4 resident files that contained all records. Three staff files were reviewed and had the required training and employee records. Medication records were reviewed and in order. Required postings were observed. Continued Report see LIC809C LPA consulted regarding information needed to be submitted if the facility wants to request a locked perimeter. Licensee/Administrator to submit updates of the following documents by 9/28/2023: LIC 500 Personnel Summary- LIC308 Designation of Facility Responsibility LIC 610 Emergency Disaster Plan (If changes) Infection Control Plan (If changes) Copy of Liability Insurance Copy of Administrators Certificate No Citations issued during todays inspectionthe state’s words, verbatim · CDSS document, Aug 30, 2023

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: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator/Licensee, Evelyn Bayon. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. There are currently 5 residents in care. This facility is licensed for 6 non ambulatory residents, with hospice waiver approved for 2 of the residents and none of the residents are approved for bedridden. LPA toured facility and grounds and observed COVID-19 precaution signs posted in common. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms upon arrival to the facility. Infection control practices are present: entry procedures, face coverings, daily monitoring and temperatures checked for residents and staff, and 30-day PPE supply. Facility follows indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test. Facility states staff clean and disinfect the facility daily. Bathrooms are equipped with liquid soap and paper towels and required hand washing postings. Covid-19 Mitigation plan was reviewed by Community Care Licensing department on 1/4/2022. Caregivers have completed PPE training but have not been N-95 Fit tested. In addition, facility was found to be at a comfortable temperature with all exits free from obstruction. Facility has at least two days of perishable and one week of non-perishable foods and items are stored properly. Fire Extinguisher was found to be charged and serviced May 16, 2022. Continue report see LIC809-C LPA went over reporting requirements for incident reports to be submitted to CCL within 7 days. Report any Covid positive cases of staff and residents immediately to CCL. Went over Provider Information Notice (PIN) 21-40-ASC. LPA reminded facility to continue following Covid precautions. Masks must be worn at all times by staff in the facility and any staff not fully vaccinated must be tested weekly for Covid-19. LPA requested the following updated records to be submitted to Community Care Licensing (CCL) 9/19/2022. · LIC 308 Designation of Facility Responsibility · LIC 500 Personnel Report · LIC 610 Emergency Disaster Plan · LIC 9020 Register of Facility Residents Copy of administrator certificate Copy of liability insurance Copy of current Lease/Rental Agreement Exit interview conducted with Evelyn Bayon. No deficiencies cited during this inspectionthe state’s words, verbatim · CDSS document, Aug 19, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Farhaan Sarangi arrived at Benicia Angel's Home 1, Inc. for the purpose of conducting a Required-1 year inspection. LPA was greeted at the door by Caregiver, Zaneida Alve. Administrator, Evelyn Bayon arrived at 01:58 PM. LPA toured the facility with Caregiver, Zaneida Alve. The facility was a comfortable temperature of 75 degrees, free from obstructions, and was well lit. Extra hygiene products and linens were available and required bath mats and grab bars were observed. Water temperature in resident's bathrooms measured at 128.3 degrees F which is not an acceptable range of 105 to 120 degrees F (See LIC 9102-Technical Violation). Water temperature was corrected on site by Administrator. Water temperature is now at 110 degrees. Cleaning products and other toxins are located in the locked garage and locked under sink cabinet. Knives are located in a locked drawer in the kitchen. Perishable and non-perishable foods were sufficient, with a 2 day supply of perishable foods, and a 7 day supply of non-perishable foods, as required. Medications were centrally stored and locked. Residents handle their own cash resources. Fire extinguisher located in the kitchen was last inspected July 2021. Smoke detectors located throughout the facility and carbon monoxide detectors were tested and functional. Exit doors have auditory alert system. LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Facility has PPE supply stored in the storage room. Staff have had all PPE training required and will be in the process of obtaining N95 Fit testing for employees. No deficiencies were observed or cited during today's Required 1- Year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator, Evelyn Bayon.the state’s words, verbatim · CDSS document, Aug 3, 2021

The state marks this report as 5 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.