Comfort Care Home

Type of visit: Case Management - Other

On 10/30/2023 at 12:05 PM Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to conduct a Case Management. LPA met with Leonora Maneja, Administrator. On 10/28/2023 LPA received a voicemail about a resident (R1) who passed away. On 10/30/2023 LPA received the death report for the same resident. In the report it lists the cause of death "Natural Death" and states that R1 condition prior to or contributing to Death was "vomit and pass out". LPA interviewed S1 and collected the following documents: physicians report 2022, physicians report 2023, Needs and services plan, and the MARS. No deficiencies issued during the visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 30, 2023

Type of visit: Required - 1 Year

On 02/23/23 at 01:11 pm Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to an annual inspection. LPA meet with Administrator Leonora Maneja and explained the purpose of the visit. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. The following deficiency was observed during the visit: LPA observed the Fire extinguishers was last serviced on 08/04/2018 LPA observed the drawer for the knifes was unlocked The Facility was cited, and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 23, 2023

Allegation investigated: Staff spoke inappropriately to resident while in care Staff did not adequately supervise resident in care resulting in resident’s head being covered by a blanket Staff are not ensuring that documentation regarding residents in care are maintained accurately

On 12/06/2022 starting at 11:40 am, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to to deliver findings on the above allegation. LPA met with Leonora Maneja, Administrator and explained the purpose of the visit. Based on LPAs interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. Exit interview conducted. Appeal Rights and a copy of this report provided. Substantiatedthe state’s words, verbatim · CDSS document, Dec 6, 2022 · control 15-AS-20221031085430

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87413(a)(2) · Plan of correction due date: Dec 20, 2022

In each facility: Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. This requirement is not met as evidenced by: Based on interviews & records reviews, Licensee did not comply with the regulation above, a staff member commenting on a reisdents physical appearance in a neagtive mannerthe state’s words, verbatim · CDSS document, Dec 6, 2022

Plan of correction: The facility will conduct an all staff training about a proper communication to the residents. The facility will submit a log of attendence for the training to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(10) · Plan of correction due date: Dec 20, 2022

Residents of residential care facilities for the elderly shall have all of the following rights: To be free from neglect...or abuse. This requirement is not met as evidenced by: Based on interviews & observations, Licensee did not comply with the regulation above, by allowing a resident to sit for a period of time with a banket covering their headthe state’s words, verbatim · CDSS document, Dec 6, 2022

Plan of correction: The Facility will conduct a staff training about Care and supervison of the residents. The facility will submit a log of attendence for the training to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Dec 20, 2022

The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff This requirement is not met as evidenced by: Based on interviews & records reviews, Licensee did not comply with the regulation above,by having the records taken home for updating.the state’s words, verbatim · CDSS document, Dec 6, 2022

Plan of correction: The facility will review the regulation and submit a letter of self certification to CCLD by POC date.

Allegation investigated: Staff are not following proper food safety procedures

On 12/06/2022 starting at 11:40 am, Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Leonora Maneja, Administrator and explained the purpose of the visit. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 6, 2022 · control 15-AS-20221031085430

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

While LPA J. Clancy-Czuleger conducted a complaint investigation (15-AS-20221031085430) on 12/06/2022, LPA observed that one of the staff members was not associated to the facility. The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 6, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Dec 13, 2022

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Based on interviews & records reviews, Licensee did not comply with the regulation above, by not having a staff member associated to the facility.the state’s words, verbatim · CDSS document, Dec 6, 2022

Plan of correction: The facility will associate the staff by submitting LIC 9182, and copy of the individual's Driver's license to CCLD by POC date. The individual will leave the facility and not return until associated. CCLDSCOaklandRO@dss.ca.gov

Type of visit: Required - 1 Year

On 11/01/22 at 3:14 pm Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to conduct infection control inspection LPA meet with Administrator Leonora Maneja and explained the purpose of the visit. During the Infection Control Inspection, LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen, and backyard. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. The facility has a mitigation plan. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. The following deficiency was observed during the visit: LPA observed that there was not a one week of one week non-perishable food supply LPA observed that there was a missing drawer in the kitchen The Facility was cited, and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided. Exit interview conducted.the state’s words, verbatim · CDSS document, Nov 1, 2022