Casa Blanca Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual inspection at 8:15 a.m. The last annual conducted at this facility was on 11/22/2022. When the LPA arrived, there were two staff and four residents present. Upon arrival, the LPA was scanned and greeted at the door by staff Kat Walker and Administrator Monica Vigil, at this time the reason for the visit was explained. Entrance interview conducted. The LPA along with the 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. KITCHEN: The LPA began the inspection in the kitchen/food service area at 8:20 a.m. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Food labels were inspected and checked for dates and expiration dates. Knives and sharps stored inside a box in a locked cabinet in the kitchen. Cleaning supplies and disinfectants are stored under the kitchen sink inaccessible to residents. At 8:31 a.m., the hot water temperature was measured in the kitchen at 113.5 degrees Fahrenheit. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is adequately screened and inaccessible. The facility maintained a comfortable temperature. At 9:00 a.m., the smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. The fire extinguisher was fully charged and last serviced on 11/15/2022. The LPA observed required postings throughout the common space. GARAGE: The garage is kept locked and inaccessible at all times. The washer and dryer were observed inside the garage. The LPA observed a sufficient supply of emergency water. At 8:50 a.m., the LPA observed a few food items that were expired; these included canned fruit (09/2023) and canned soup (08/2023). Items were immediately discarded. Cleaning supplies, detergents, and disinfectants were observed locked and inaccessible at the time of the visit. (Report Continued on LIC 809C...) (Report Continued from LIC 809...) BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. At 8:35 a.m., the LPA observed two self-latching gates; however, both passageways had items obstructing the passageways. The Administrator had passageways cleared at the time of the visit. There were no bodies of water noted 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 four (4) designated private bedrooms and one (1) staff room. Each bedroom has its own supply of clean towels and linens; however, there is a linen cabinet in the hallway with extra towels, blankets, and linens. RESTROOMS: The two (2) resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with supplies and paper towels; towels and washcloths are not shared. The hot water temperature was measured in both bathrooms; the first bathroom measured 112.1 degrees Fahrenheit at 8:43 a.m.; and the second bathroom measured 106.8 degrees Fahrenheit at 8:48 a.m. RECORDS: Records review began at 9:07 a.m.; four (4) resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. All records were in order. Four (4) Personnel records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. Although the facility has a designated training binder, the LPA was unable to determine the number of hours completed per regulation for the past 12 months. The facility has not conducted an emergency drill in the last 12 months. Administrator stated the facility will schedule one soon. MEDICATIONS: Medications review began at approximately 12:15 p.m. The medications are centrally stored and locked in a cabinet by the kitchen. PRNs were labeled, stored, and inaccessible to residents. PRNs have physicians order on file. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. (Report Continued on LIC 809C...) (Report Continued from LIC 809C...) INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. At this time, the staff will continue to keep up signs that promotes good hand hygiene and symptoms of COVID. The facility has an adequate supply of Personal Protection 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 a communicable disease. The facility’s policies and procedures as it pertains to infection control are adequate. At approximately 1:00 p.m., the LPA interviewed one (1) staff member and two (2) residents. During today’s visit, the LPA obtained copies of the following: LIC 500 Personnel Report, LIC 9020 Client Roster, Emergency Disaster Plan, and limited liability insurance. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Nov 3, 2023

The state marks this report as 8 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Resident care needs not met

Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent visit to deliver investigation finding. LPA met with Licensee/Administrator Monica Vigil and reason for visit was explained. On 05/19/2022, information was provided that a welfare check for resident #1 (R1) was requested by facility staff on 05/18/2022 at approximately 5:23PM due to resident #1 allegedly making suicidal statements. Staff claimed they overheard R1 say on the phone they wanted to kill self, but no means or specifics were given. R1 denied wanting to harm or kill self. R1 reported being held at the facility against own will. R1 claimed staff refused to take resident on a walk which upset resident. At approximately 7:26PM, law enforcement was dispatched back to facility as a result of R1 leaving the facility. R1 was located at the neighbor’s front yard (5679 Eunice St.). R1 was returned to the facility without incident. Reporting party believes facility is unable to meet R1’s needs with only one staff present. On May 26, 2022, LPA Martha Guzman-Chavez conducted the initial complaint visit. (continue to LIC9099c) Unsubstantiated LPA toured the facility, interviewed the Administrator, staff, and R1 between 10:03AM - 10:50AM. LPA also obtained copies of pertinent documents. Records reviewed revealed that R1 was admitted to facility on 04/02/2022 and moved out on 06/01/2022. Physician report dated 03/02/2022 and Resident Appraisal dated 03/30/2022 did not indicate any special needs for supervision as there was no indication of R1 having any wandering or exiting behavior. According to staff and Administrator at the time of the incident (05/18/2022) involving R1, the facility census was two (2) and one staff on duty at the time was sufficient. Administrator and her husband live and work at the facility as well. Interview with Staff, Administrator, and resident revealed the staff provided the care, and supervision to meet the need of both residents in care at the time. Administrator explained that R1 was living at home in a bad environment which resulted in R1 being hospitalized. Administrator stated R1 was fine upon admission to her facility. According to Administrator R1 began exhibiting unusual behavior and they did everything to meet R1’s needs by communicating with R1’s conservator to arranging doctor appointments; R1 was assisted with dressing/grooming, bathing and toileting needs every day. Administrator stated that one staff on duty was sufficient since R2 was self-sufficient in perform all activities of daily living but bathing. Following this one incident which happened on 05/18/2022 Administrator ensured two (2) staff were available at the facility at all times for the safety of R1 and R2 until things subside and/or new placement was found for R1. During todays visit, three out of three resident observed/interviewed at approximately 1pm observed in good spirits; reported that they are happy and well taken care; feel safe at the facility. Based on the interviews conducted and records reviewed there is insufficient evidence to support allegation. Therefore, allegation "Resident care needs not met" is deemed unsubstantiated at this time. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Mar 22, 2023 · control 29-AS-20220519144248

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian arrived unannounced to conduct a required annual visit. This annual had a specific emphasis on infection control practices. The LPA met with Administrator Monica Vigil and explained the reason for the visit. The LPA and Administrator toured the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Knives and chemicals are locked inaccessible. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: four out of five rooms are for resident use; one bedroom is a staff room. Bedrooms had appropriate furnishings, clean linens and sufficient lighting. RESTROOMS: Resident restrooms were clean and sanitary with grab bars and non-skid surfaces. The LPA observed hand hygiene signs in all restrooms. COMMON SPACES: Living room and dining furniture were observed to be in good condition. Exits have functioning auditory devices. Fire extinguisher charged and serviced in the last twelve months. BACKYARD: There were no bodies of water noted at the time of the visit. INFECTION CONTROL: There is a central entry point for universal screening and temperature checks. Staff were observed wearing appropriate face masks. There is a centralized location for COVID-19 signs to promote hand hygiene, physical distancing, and cough/sneeze etiquette. There is sanitizer available for use throughout the facility. There is an adequate supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol is sufficient. The facility can designate a single-person room to isolate persons if there is a confirmed case of COVID-19 (all private rooms). The policies and procedures pertaining to infection control observed adequate at the time of visit. No deficiencies observed at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 22, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Brian Balisi conducted a Pre-licensing visit to the above facility. LPA met with Administrator Monica Vigil and explained the reason for the visit. At 10:00am LPA conducted physical plant along with Administrator. LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. Smoke detectors and Carbon Monoxide detectors appeared to function properly during time of visit. Facility is a single-story residence and consists of a total of five (5) bedrooms and two (2) bathrooms with (1) bedroom is designated for staff use at this time. Fire clearance was approved for (6) non-ambulatory residents, but licensee stated since they are residing in bedroom #2 at this time they will be updating facility capacity from (6) to (4). Fire extinguishers were observed to be fully charged and purchased this year . During physical plant tour LPA observed the required postings throughout the facility. Kitchen: The kitchen appeared to be clean at this time and the appliances and fixtures functional during the time of visit. LPs observed a sufficient amount of perishable and non-perishable food at the facility; properly stored. Sharp objects are to be stored in a locked cabinet in the kitchen next to the hallway. Medications are planned to be kept in this cabinet in individual medication lock boxes. LPA observed PPE supplies stored in this cabinet and appeared sufficient at this time. Cleaning supplies and toxins will be kept in a locked cabinet to the right of the sink. To the right of the kitchen was in office area. Dining furniture in kitchen and dining room area appeared to be clean and sufficient at this time. Continued on 809-C Continued from 809 Bedrooms: The resident bedrooms were properly furnished with a bed, night stand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a sufficient supply of linen and personal hygiene supplies in the hallway closet between bedrooms one and two, Bathrooms: LPA observed all bathrooms were clean, properly supplied and had functional fixtures. LPA observed all resident bathrooms to have grab bars and non-skid mats. The hot water was measured in each bathroom between 112 - 113 degrees Fahrenheit. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Planned activities and games were on display on a shelf in the living room. Outdoor Area: There was a shaded area with sufficient room for activities. LPA observed sufficient furniture designated for outdoor use. There are no bodies of water on the premises. Garage was accessible from the exterior. LPA observed laundry area in the garage. LPA also observed (2) locked storage cabinets which stored extra cleaning supplies and garden supplies. Comp III was completed in conjunction with the visit. Pursuant to Title 22, Division 6, facility observed to be compliant with regulation. No corrections needed at this time. A copy of this report will be forwarded to the application specialist with LPA's recommendation for licensure. Licensee agreed to follow up with LPA to follow up on their capacity status once it has been changed. An exit interview was conducted with Administrator, and a hard copy was provided via email.the state’s words, verbatim · CDSS document, Nov 5, 2021

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with applicant COMP II Participants: Monica Vigil Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. Identification of the applicant and administrator was verified by photo ID. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant has been advised to transmit signed LIC 809 with copy of photo ID to CAB.the state’s words, verbatim · CDSS document, Aug 6, 2021