Camino Hills Care Home 1

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on deficiency cited on 09/30/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit. Deficiency cited under Title 22 Regulation 87303(e) pertaining to Maintenance and Operation, Water Temperature has been cleared. During the visit, LPA tested water temperature to be between 109.4 and 113.9 degrees F. Licensee has complied with the POC. Licensee has been advised to maintain compliance in all items previously cited. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 28, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Camino Hills Care Home 1. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 bedridden residents. Facility has an approved hospice waiver for 6 residents and the home currently has 4 residents on hospice. Administrators Mercy Ang and Maria Cecelia Domingo arrived during the visit. Administrator Mercy Ang has an administrator certificate valid until 11/25/2024. LPA Lyman along with Administrator Ang toured the facility at 8:01 AM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. Facility appears to be clean, safe, and sanitary. The home consists of six resident bedrooms, 1 common restroom, 4 resident restrooms, living room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident rooms are single occupancy. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. Water temperature measured between 74.6 and 143 degrees F in all facility bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. Auditory exit alarms were operational during today's visit. First aid kit had all the elements including thermometer, tweezers and scissors. LPA observed toxins are secured during today's visit. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Smoke detectors and carbon monoxide detectors tested operational during today's visit. Fire extinguishers are fully charged. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gates are unlocked and operational. LPA observed ample emergency food and water supply. LPA reviewed the emergency disaster plan and infection control and plans are thorough and complete. CONT ON LIC809-C DATED 09/30/2024 Facility provided documentation of last fire drill conducted in July 2024. Facility provides activities in the form of exercise, and music therapy. LPA reviewed six resident files and three staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Staff files reviewed contained required documentation of medical clearance/ TB, CPR training and criminal record clearance as well as required training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. Based on the observations made during today's visit, the following violation is being cited per California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a copy of this report as well as appeal rights were discussed and provided with facility representative.the state’s words, verbatim · CDSS document, Sep 30, 2024

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Sean Haddad conducted this announced inspection for the purpose of conducting a pre-licensing inspection. LPA met with Applicant (AP) Maricris Lafiguera, discussed the purpose of the inspection, and toured the facility. Facility is to operate a Residential Care Facility for the Elderly. Application was submitted to Community Care Licensing on 09/01/2022. This is a change of ownership with persons in care. This is the second pre-licensing inspection. Please see LIC809 dated 06/20/2023. During the initial inspection, the LPA and AP observed the following: the fire clearance granted on 01/17/2023 allowed for 2 Non-Ambulatory, 2 Ambulatory, and 2 Bedridden residents. However, all residents residing at the facility were Non-Ambulatory. AP stated they would obtain a new fire clearance to resolve the issue. Since the initial pre-licensing inspection, AP obtained a new fire clearance from Orange County Fire Authority dated 09/12/2023 which allows for 6 Bedridden residents. During today’s inspection, LPA toured the facility with AP and confirmed the facility is following the new fire clearance. The issue noted during the initial pre-licensing inspection has been addressed. AP has requested a hospice waiver for 3 and LPA confirmed there are 3 residents currently on hospice at the facility. AP stated they would like to increase the hospice waiver either before or after licensure. LPA advised AP to follow the current hospice waiver until a new one is approved. AP stated they understood and agreed. LPA explained the process of this application and about the post licensing inspection once the facility is licensed. AP was informed today that the facility is ready for licensure and final approval will be processed by the CAB supervisor in Sacramento. Component III was waived during the initial pre-licensing inspection. An exit interview was conducted and a copy of this report was discussed with and provided to AP.the state’s words, verbatim · CDSS document, Oct 18, 2023