Casa Via Los Padres

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection at the facility. LPA met with Dorota Lositzki, Administrator. Entrance Interview Conducted: This is a one-story home licensed as a Residential Care Facility for the Elderly (RCFE) with a dementia diagnosis. The facility has been approved for a hospice waiver for 6 residents and has a fire clearance for 6 non-ambulatory residents, one of which can be bedridden. LPA explained the reason for the visit and toured facility with Administrator Lositzki. Upon arrival, there were 5 residents in care with two caregivers and one administrator on duty. Upon entrance into the residence, there is a walkway leading to the front door, garden areas, and a covered patio that surrounds the facility. The facility has a garage used for storage. There are no fountains or bodies of water. The facility consists of a living room, dining area, kitchen, and five bedrooms. The entrance into the residence leads into the living and dining area. The kitchen consists of a refrigerator, microwave, sink, stove, oven, dishwasher, an air fryer, a hot water dispenser, and a crock pot. Trash and recycling bins are kept in a pullout drawer. All required CCL posters and signage are posted near the entrance and in the hallway. Personnel files, Residents’ files, and medications are kept in locked cabinets in the dining area. All files and medications are inaccessible to residents in care. Sharps are kept in a locked kitchen drawer and inaccessible to residents in care. Perishable foods for 2 days and non-perishable foods for 7 days are kept on hand for the residents. The living room and dining area are furnished with adequate furnishings to sustain a capacity of six residents. There is an additional common area at the end of the hallway providing access into Bedrooms 4 and 5. The additional living room has built-in cabinets. First aid kits and a locked first aid supply drawer are kept in the built-in cabinets. Please continue to 809-C, Pg 2. Bedrooms 1 and 2 are private rooms and share a bathroom off the hallway. Bedrooms 3 and 4 are private bedrooms with a private bathroom. Bedroom 5 is a shared bedroom with a private bathroom for the occupants in Bedroom 5 only. Each bathroom has a sink, commode, and showers with grab bars. There is a half-bath off the hallway near the kitchen with a sink, commode, and grab bars. All grab bars are securely installed. Bedrooms 2, 3, 4, and 5 have exit/entrance doors leading to the outdoor areas. Each exit/entrance door has a functioning door alarm. Each resident’s bedroom has a bed, mattress, nightstand, chair, dresser, and closet. Overhead lighting and lamps on the nightstands provide sufficient lighting in each bedroom. Hallways have night lights and ample lighting. The laundry area and storage area for cleaning agents and chemicals is located off the hallway. The backyard consists of a covered, fenced, patio area with chairs and tables. The patio has built-in garden, planters and walkways. The trash, recycling, and green waste cans are standardized cans located outside the facility. Each side of the residence has locked gates that are inaccessible to residents in care. There is a hard-wired dual carbon monoxide detector and smoke alarm system located throughout the facility. There are three fire extinguishers that were serviced on 2/7/2023. The fire extinguishers are located near the common area close to the bedrooms, kitchen, laundry room, and hallway. LPA observed the facility’s comfortable room temperature. Residents will participate at will in various activities based on their individual interests and preferences, including reading, playing games (Dominoes, Bingo, and many others). Exercise classes on the premises are offered for the residents that include dancing, music, and singing. Outdoor activities, when permitted, include socializing, leisure walks, musical activities, dancing, visitors from community organizations, games, and seasonal celebrations. Per LPA's observation, physical plant is compliant to Title 22 Regulations. Exit interview conducted. No citations issued at this time. Copy of report issued at the time of the visit.the state’s words, verbatim · CDSS document, Aug 22, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Olson conducted an on-site 1 year infection control annual visit to the facility above on 09/16/2022 at 4:20 PM. LPA met with Administrator and Co-Administrator and explained the purpose of the visit. LPA took a physical plant tour of the facility with Administrators. The facility has an entry point at the front door where everyone entering completes sign-in, symptom questionnaire and temperature screening on all staff and visitors wanting to come into the facility. The entry station has hand sanitizer along with a thermometer. The facility has multiple areas spaced to accommodate as much space as possible for social distancing. The staff screen residents for symptoms and temperature at least once a day and documentation is kept on file. Increased monitoring is conducted if any change of condition are noted or any residents are showing any signs, symptoms or a temperature. Signs are posted on the front door, entry area regarding Covid-19. Staff makes sure residents have a mask when leaving the facility on outings into the community. All staff wear face coverings in the facility and when on outings with residents. Facility have areas for visiting inside and outside. The facility also offers virtual and telephone communications to all residents in care. Staff, Residents and visitors are informed of the facilities infection control policies. New residents and staff will be tested and negative results received before working or residing in the facility. The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed. Emergency Disaster plan is accessible and all agencies with telephone numbers are listed. Administrator is in charge of infection control and provides training and education to staff, residents and visitors. Continued on 9099-C Staff will use full PPE with N95 masks and face shields when dealing with any pending or confirmed cases of Covid-19. Facility is able to dedicate a single room for residents so isolation can be arranged when and if needed. The facility has single and double rooms with restrooms and they are disinfected and wiped down daily. Precautionary Droplet signs will be posted on any room with quarantine or isolated individuals. PPE supplies will be located right outside those rooms when required. Facility has a 30 day supply of PPE on hand. Facility has plans for delivering medications and meals to any quarantined/isolation resident rooms. The facility has proper cleaning and disinfectant supplies. Facility Administrator has a plan in place for when and whom to notify in an outbreak or other emergencies. Administrator will keep a line list of all vaccinated and tested staff/residents in care with dates/results. Facility has conducted training on infection prevention, symptoms, transmission and PPE use. Facility has non-punitive sick leave polices for staff. Sick staff are requested to stay home and not report to work if ill. Residents medication is delivered in 30 day supplies to the facility. The facility ensures proper cleaning is done on frequently touched surfaces and between any individuals sharing of space or items. Sinks were well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in locked cabinet. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. The most stringent orders should be followed by any of these agencies. Administrator Certificates are valid. Fire extinguishers were charged and inspected annually. The facility has hard wired carbon monoxide and smoke detectors thorough the facility. At approximately 5:10 pm, LPA reviewed Department of Social Services, Community Care Licensing Division, Licensing Information System (LIS), Facility Personnel and facility staff roster and determined that all staff are fingerprint cleared and associated to the facility No deficiencies observed during the visit and all infection control protocols are implemented and are being followed. Exit interview completed and copy of report emailed to Administrator/Licensee.the state’s words, verbatim · CDSS document, Sep 16, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kristin Kontilis conducted an announced pre-licensing visit to the facility. LPA met with Dorota Lositzki, Administrator and Anton Zamyatin, Co-Administrator. LPA arrived at 12:45 pm. Entrance Interview Conducted: This is a one-story home which will be licensed as a Residential Care Facility for the Elderly (RCFE). LPA toured facility with Administrators Lositzki and Zamyatin. There are currently 6 residents residing in the facility. Upon arrival, there were two caregivers and two administrators on duty. The facility has a fire clearance for one bedridden resident and six (6) non-ambulatory residents and consists of a living room, dining area, kitchen, and five bedrooms. Upon entrance of the residence, there is a walkway leading to the front door, garden areas, and a large covered patio that surrounds the facility. The facility has a locked garage used for storage including the facility’s commercial generator. There are no fountains or bodies of water. The entrance into the residence leads into the living and dining area. The kitchen consists of a refrigerator, microwave, sink, stove, oven, dishwasher, an air fryer, a panini grill, a hot water dispenser, and a crock pot. Trash and recycling bins are kept in a pullout drawer. All required CCL posters and signage are posted near the entrance and in the hallway. Personnel files, Residents’ files, and medications are kept in locked cabinets in the dining area. All files and medications are inaccessible to residents in care. Sharps are kept in a locked kitchen drawer and inaccessible to residents in care. Perishable foods for 2 days and non-perishable foods for 7 days are kept on hand for the residents. The living room and dining area are furnished with adequate furnishings to sustain a capacity of six residents. There is an additional common area at the end of the hallway providing access into Bedrooms 4 and 5. The additional living room has built-in cabinets. First aid kits and a locked first aid supply drawer are kept in the built-in cabinets. Please continue to 809-C, Pg 2. Bedrooms 1 and 2 share a bathroom off the hallway. Bedrooms 3 and 4 have private full bathrooms. Each bathroom has a sink, commode, and showers with grab bars. There is a half-bath off the hallway near the kitchen with a sink, commode and grab bars. Bedrooms 2, 3, 4, and 5 have exit/entrance doors leading to the outdoor areas. Each exit/entrance door has a functioning door alarm. Each resident’s bedroom has a bed, mattress, nightstand, chair, dresser, and closet. Overhead lighting and lamps on the nightstands provide sufficient lighting in each bedroom. Hallways have night lights and ample lighting. The laundry area and storage area for cleaning agents and chemicals is located off the hallway. The backyard consists of a covered, fenced, patio area with chairs and tables. The patio has built-in garden planters and walkways. The trash, recycling, and green waste cans are standardized cans located outside the facility. Each side of the residence has locked gates that are inaccessible to residents in care. There is a hard-wired dual carbon monoxide detector and smoke alarm system in every room and every hallway. There are three fire extinguishers that were serviced on 1/8/2021. The fire extinguishers are located near the common area close to the bedrooms, kitchen, and hallway. LPA observed the facility’s comfortable room temperature upon arrival at 12:45 pm. Residents’ records, personnel documents and records of confidentiality are kept in a locked closet located in the kitchen area. Residents will participate in various activities based on their individual interests and preferences, including reading, playing games (Dominoes, Bingo, and many others). Exercise classes on the premises are provided for the residents that include dancing, music, and singing. Outdoor activities, when permitted, include socializing, leisure walks, musical activities, dancing, visitors from community organizations, arts and crafts, games, and seasonal celebrations. Per LPA's observation, physical plant is compliant to Title 22 Regulations at this time. Exit interview conducted. Copy of report issued. LPA concluded the inspection. A copy of this report will be issued via email.the state’s words, verbatim · CDSS document, Aug 23, 2021