Camarillo Haven

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a continuation of the required annual visit at 01:45PM. LPA met with Licensee Representative Teddy Catabay. Additional Licensee Representative Grace Catabay arrived shortly after the visit began. Administrator arrived at the facility during medication review. Entrance interview conducted. During today's visit, LPA reviewed and observed the following: INTERVIEWS: Beginning at 01:47PM, LPA interviewed 3 (three) staff and two (2) residents. EMERGENCY DISASTER PLAN: LPA reviewed the facility's emergency disaster plan, which was recently updated. Emergency drills are conducted quarterly, with the last completed drill documented on 08/18/2023. INFECTION CONTROL PLAN: During today's visit, LPA reviewed the facility's infection control plan. The facility's policies and procedures related to infection control are adequate. MEDICATION REVIEW: Began at 02:50PM. Medications for 5 (five) residents were observed. All 5 (five) of 5 (five) residents' medications were observed to be maintained and administered in compliance with regulation. No citations issued. Exit interview conducted. A copy of today's report was provided.the state’s words, verbatim · CDSS document, Sep 22, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 01:38PM. LPA met with facility Administrator Erika Catabay and discussed the reason for today's visit. Entrance interview conducted. At 01:53PM, LPA, along with Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Fire Extinguisher was observed to be fully charged and purchased on 04/22/2023. Hardwired combination smoke detectors and carbon monoxide detector were tested at 03:58PM and were functional at the time of the visit. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. LPA observed the fireplace in the living room, which was adequately screened. The facility laundry room and garage were observed to be locked. Garage contains emergency water supply, extra food, and storage. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. Outdoor shed was observed locked. Two (2) gates were observed to be locked, one on each side of the facility. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency supply. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. Report Continued on LIC 809-C BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are for resident use and 1 (one) is designated as a staff room. RESTROOMS: The LPA observed 3 restrooms in the facility; 2 (two) are designated for resident use and one is a staff restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in resident restrooms and measured within the required range. RECORD REVIEW: Began at 02:12PM, staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 5 (five) resident records reviewed were complete and contained all required documents. 4 (four) staff files reviewed. 3 (three) of 4 (four) staff files reviewed did not contain proof of first aid training. MEDICATION REVIEW: Not reviewed during today's visit. EMERGENCY DISASTER PLAN: Not reviewed during today's visit. INFECTION CONTROL PLAN: Not reviewed during today’s visit. INTERVIEWS: Not completed during today's visit. Due to time constraints, LPA will return at a later date to continue the inspection. Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted with Erika Catabay. Today’s reports and appeal rights were reviewed and provided.the state’s words, verbatim · CDSS document, Aug 30, 2023

Allegation investigated: Resident sustained unstageable pressure injury while in care

Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation with the purpose of delivering findings for the allegation listed above. LPA arrived at the facility at 10:14 AM and initially met with facility staff. Licensees Grace and Teddy Catabay arrived at 10:35AM. Entrance interview conducted. During today’s visit, LPA toured the facility at 10:39AM with Licensee Grace Catabay. No immediate health and safety hazards were identified. During an initial complaint visit on 08/31/2022, LPA toured the facility with Licensee at 12:19PM, interviewed licensees at 10:36AM and 11:06AM, interviewed staff at 12:23PM, and LPA gathered copies of pertinent documents. LPA reviewed documents related to Resident #1 (R1) throughout the course of the investigation. The following was then determined: Report Continued on LIC 9099-C Unsubstantiated Record review revealed that R1 had been hospitalized four (4) different times between 07/07/2022 and 08/26/2022. Hospital records reviewed for the initial 07/07/2022 hospitalization did not indicate a pressure injury at the time of hospitalization or discharge from the hospital. Incident report sent to the Regional Office indicates on 08/02/2022, facility staff noticed a pressure injury on R1’s sacral area. Interviews revealed that as soon as staff noticed the pressure injury, Licensee was notified, and R1’s conservator and primary care physician (PCP) were notified. When R1’s PCP was unable to schedule a visit to observe and care for the wound timely, the Licensee sent R1 to the hospital. R1 returned from the hospital with orders for Home Health to provide pressure injury care at the facility. Home Health began to treat R1’s wound beginning on 08/13/2022, but record review revealed the wound was not staged at that time, nor was it indicated as unstageable. Wound care was conducted every other day until 08/17/2022, when facility staff again sent R1 to the hospital. Hospital records reviewed make no mention of the wound, it’s care or staging at that time. Home Health again visited R1 at the facility beginning on 08/22/2022, when every other day wound care visits resumed. R1 was hospitalized on 08/26/2022 and had yet to be discharged at the time of LPA’s initial complaint visit. On 08/29/2022, a wound consult was conducted at the hospital, where R1 had remained since their 08/26/2022 hospitalization. At the time of the wound consult, it was noted R1’s sacral wound is unstageable and measured 2cm x 2cm larger than home health indicated during their last facility visit on 08/24/2022. Wound consult notes also revealed additional wounds on both of R1’s heels that had not been previously identified during wound care prior to R1’s hospitalization. Home Health records reviewed indicate the sacral wound was getting larger in size during the time period 08/13/2022 – 08/26/2022, while Home Health was providing wound care. Additionally, hospital records reviewed for the first three (3) hospitalizations, did not indicate there was a pressure injury, and therefore did not indicate size or staging. As thus, it is unclear whether R1 sustained the pressure injury while hospitalized or while in the facility. Also, since staging was not completed during the initial Home Health consult or subsequent wound care, there is no way to ascertain whether the wound became unstageable during the course of Home Health care, at the facility, or during a hospitalization. Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that “Resident sustained unstageable pressure injury while in care” is deemed UNSUBSTANTIATED at this time. No deficiencies cited. Exit interview was conducted with Licensee. Report was provided via email.the state’s words, verbatim · CDSS document, Oct 5, 2022 · control 29-AS-20220830110458

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 10:14AM. This annual had a specific emphasis on infection control practices and procedures. The LPA initially met with facility staff and discussed the reason for the visit. Licensee Representatives/Administrators Grace and Teddy Catabay arrived at 10:35AM. Entrance interview conducted. The LPA, along with facility Licensee Representative Grace Catabay, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: Fire Extinguisher was observed to be fully charged and purchased on 11/24/2021. Hardwired smoke detectors and separate carbon monoxide detector were tested at 10:49AM and were functional at the time of the visit. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. LPA observed the fireplace in the living room, which was adequately screened. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. The facility laundry room and garage were observed to be locked. The outdoor shed was locked and contained the emergency water, PPE supply, and storage. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency supply. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. Report Continued on LIC 809-C (Continued from LIC 809) BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are for resident use and 1 (one) is designated as a staff room. RESTROOMS: The LPA observed 3 restrooms in the facility; 2 (two) are designated for resident use and one is a staff restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Water temperature was measured in both resident restrooms and measured at 139.0 degrees Fahrenheit at 10:44AM in the shared resident restroom and after adjusting the water heater, measured at 131.8 degrees Fahrenheit at 12:03PM in the same restroom and 122.6 degrees Fahrenheit at 12:08PM in the private resident restroom. INFECTION CONTROL: During today’s visit, the LPA spoke with the Licensee Representative/Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff and visitors to be wearing masks. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. The following recommendations were made: - N95 fit testing for all staff Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted with Grace Catabay. Today’s reports and appeal rights were reviewed and provided via email.the state’s words, verbatim · CDSS document, Oct 5, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 2:45PM. This annual had a specific emphasis on infection control practices and procedures. The LPA initially met with facility staff discussed the reason for the visit. Administrator Erika Catabay arrived at 3:20PM. Entrance interview conducted. The LPA, along with facility Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed: COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common area. LPA observed the fireplace in the living room, which did not have a screen. Administrator stated the fireplace is not being used, but will obtain a screen for the fireplace. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. The facility laundry room was observed to be locked. The outdoor shed was locked and contained the emergency water, PPE supply, and storage. KITCHEN: Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food, as well as emergency supply. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 5 (five) total bedrooms; 4 (four) are for resident use and 1 (one) is designated as a staff room. Report Continued on LIC 809-C (Continued from LIC 809) RESTROOMS: The LPA observed 3 restrooms in the facility; 2 (two) are designated for resident use and one is a staff restroom. Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening. LPA observed all staff and visitors to be wearing masks, however residents are not consistently encouraged to wear face coverings in common areas. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. The following recommendations were made: - N95 fit testing for all staff No deficiencies cited. Exit interview conducted. A copy of the report was provided via email.the state’s words, verbatim · CDSS document, Oct 12, 2021

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.