C-H #4 Residential Care for Elderly

Type of visit: Required - 1 Year

On 10/30/2023 Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Betty Woods /staff and the purpose of today’s visit was explained. The facility is licensed to operate for (4) developmentally disabled or Mentally Ill adults ages 60 and above, of which (3) can be ambulatory and (1) non-ambulatory. Currently, the home has (3) clients. The clients are from: Westside Regional Center. (0) clients have Restricted Health Care Conditions, and (2) are utilizing postural supports or protective devices. The one-story residential house consisted of (3) client bedrooms, (2) bathroom, living room, dining room, kitchen, and enclosed patio area. LPA Iniguez and administrator toured the inside and outside of the facility. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting was observed, plenty of dresser and closet space was observed. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, there is adequate lighting, and sufficient toiletries accessible to clients. The water temperature properly measured between 105F°-120F° degrees (Kitchen 116.5F°, Bathroom #1 108.5°F). Evaluation Report continues LIC 809-C Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide/Smoke detectors were observed and operational (See technical advice). Fire extinguishers were fully charged, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and fully stocked. Last facility disaster drill was:9/5/2023. Licensee will email a copy of liability insurance to LPA. LPA conducted a records review of (3) client records, (3) staff records and reviewed the facility disaster plan. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (3) Client Medication Administration Records (MAR) and did not observe any discrepancies at the time of visit. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. (See D pages) An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to the Staff/ Betty Woods.the state’s words, verbatim · CDSS document, Oct 30, 2023

Type of visit: Required - 1 Year

On 08/31/22 LPA Perry Scott conducted an unannounced 1-year Required Annual Inspection at the C-H #4 Residential Care for Elderly facility, with an emphasis on infection control. LPA Scott met with facility representatives Christina Fuentes and Robin Perez and the purpose of the visit was explained. Upon entry, my temperature was taken, I was given hand sanitizer, and I was presented with a visitor’s log to sign in. Both staff were wearing masks. The facility has a capacity for four (4) residents. Three (3) ambulatory and one (1) non-ambulatory. Currently the home has (3) ambulatory client and (0) non-ambulatory. The facility serves residents 60 and over. As part of the inspection, my primary focus was on infection control. LPA observed the facility’s infection control practices: LPA observed a sanitizing station at the facility entrance. PPE supplies are readily available to staff, and additional supplies are stored. Sufficient paper, cleaning, and disinfecting supplies were observed. The facility has the mandated COVID infection control posters as well as facility license, floor plan, administrators’ certificate, and emergency evacuation plan etc. Report continued form LIC 809-C. LPA Scott, Fuentes and Perez toured the entire facilities inside and outside grounds. The one-story residential house consisted of (3) client bedrooms, (2) bathrooms, living room, dining room, kitchen, and enclosed patio area. All facility rooms are clean and in good repair. LPA Scott observed the following during inspection of client rooms: mattresses and box springs in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. LPA Scott also observed that there were sufficient bedding, linens, and toiletries accessible to clients. Further, LPA Scott observed bathrooms were found to be within Title 22 regulation. Bathroom fixtures are clean, in good repair, and working properly. Water temperature properly measured at 106.2 degrees F for the facility. Perishable (7 day) and non-perishable (2 day) food supply were checked and are adequately stocked. Facilities Carbon Monoxide/ Smoke Detectors (combined) were tested. All alert systems are working properly. The facilities (2) Fire Extinguisher were fully charged and accessible; and last serviced on 02/2022. Fire drill was conducted on 02/19/2022. All toxins and knives are locked/secured and inaccessible to clients. Medications are centrally stored and in a locked storage box. Facility first aid kit was checked and in order. Outside grounds were toured and no bodies of water were observed. Outside patio accessible to clients. All Exits/ Walkways around the home were free of debris and hazards. The facility is in good repair. During the visit, LPA observed the following to be complying: the facility's infection control practices; screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms; every staff was wearing a face covering; the facility has a 90-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has a Mitigation Plan Report approved by CCLD. According to the California Code of Regulations (Title 22, Division 6, Chapter 1), there were no deficiencies cited at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to facility representatives Christina Fuentes and Robin Perez.the state’s words, verbatim · CDSS document, Aug 31, 2022

Allegation investigated: Facility license is not posted in a location that is accessible to public view.

Licensing Program Analyst (LPA) Jey Cardenas conducted an unannounced 10 day initial complaint visit to the above facility to initiate complaint investigation. Upon arrival at the facility, LPA met with staff#1 and explained the purpose of today’s visit. LPA conducted a risk assessment, based on the assessment, the facility is clear of Covid-19 infection. The investigation consisted of the following: LPA interviewed staff#1 (S1), and attempted to interview three (3) residents who were present at the time of visit, LPA toured physical plant. Regarding allegation: Facility license is not posted in a location that is accessible to public view. On 11/23/21 LPA asked to see facility license, LPA asked S1 if staff knew where the license was located; S1 was unsure and contacted Miss Woods via telephone. Miss Woods guided S1 to the license. LPA was lead to the laundry space, which is located towards the middle of the property; the laundry has a door to close behind. LPA observed that license was posted on a bulletin mounted on the wall in the laundry area. Unless one went into the laundry area, public wouldn’t be able to see it; therefore the license is not Substantiated accessible to public view. Based on LPA’s observations the preponderance of evidence standard has been met. Therefore, the above allegation is found to be substantiated. California Code of Regulations, Title 22, are being cited on the attached LIC 9099D. Exit interview conducted copy of this report and copy of appeal rights provided to facility representativethe state’s words, verbatim · CDSS document, Nov 23, 2021 · control 11-AS-20211117134340

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87113 · Plan of correction due date: Nov 24, 2021

Posting of License -The license shall be posted in a prominent location in the licensed facility accessible to public view. This requirement not met as evidenced by: On 11/23/21 LPA Cardenas observed license posted behind closed door in the laudry area, License is not accessible to public view. This poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 23, 2021

Plan of correction: LIcense shall be posted in a prominet location inside the facility, accessible to view.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Jey Cardenas conducted a case management visit to the above facility; during a complaint investigation visit made on 11/23/21, LPA observed deficiencies that is non-related to the complaint investigation conducted on today. On 11/23/21 LPA observed a smoke detector located in resident bedroom that was wrapped in tape. S1 indicated that the smoke detector chirps at different times of day. LPA indicated that the smoke detector may have to be replaced. The following was discussed with the staff: smoke detectors shall be in working condition at all times. Per California Code of Regulations, Title 22, deficiency is being cited on the attached LIC 809D. Exit interview conducted copy of this report and copy of appeal rights provided to facility representativethe state’s words, verbatim · CDSS document, Nov 23, 2021