Daybreak Villa East

Type of visit: Required - 1 Year

On June 23, 2023, at 6:50pm, Licensing Program Analyst (LPA) Jacqueline Shaw Ross arrived at the facility unannounced to conduct a annual inspection. LPA was greeted by Caregiver, Remedios Semon and the purpose of the visit was explained. Administrator Rolando Corpuz joined shortly. The facility is a one story five (5) bedroom, four (4) bathroom home. There is one bedroom shared by two (2) clients. A tour of the facility was conducted inside and out. The alarm system was tested. Hot water temperature was tested at 110.9 degrees Fahrenheit. Due to time constraints, LPA advised Administrator the inspection would have to be continued at another date. On June 24, 2023 at 10:30am, LPA Shaw Ross returned back to the facility to complete the inspection, and was greeted by Administrator, Rolando Corpuz. Present at the facility were two (2) staff members and six (6) clients. LPA conducted staff and client interviews. LPA reviewed staff and client records. Review of staff records indicate all staff have criminal record clearances and are appropriately associated to the facility. Staff files had the required documentation including First Aid Certifications and training documents that included recent trainings on June 16, 2023. Review of the facility training binder showed the following refresher trainings completed include: Alzheimer's, Emergency Disaster, Postural Supports, Restricted Conditions, Hospice, Reporting Abuse, Food Handling, Dementia, Fall Prevention and Medication training. LPA inspected medications and medications appear to be dispensed appropriately according to physician's orders. The outdoor space is free of hazard. Emergency drills are conducted quarterly. Fire extinguishers are charged. During the inspection, no deficiencies were observed. An exit interview was conducted and a copy of the report and LIC 811 was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 24, 2023

Type of visit: POC

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility in order to conduct a plan of correction visit. Deficiency were cited on 5/31/2023 during an informal office visit. The LPA met with Administrator, Rolando "Bobby" Corpuz who was informed of the purpose of the visit. The following deficiency was corrected during today's POC visit: Deficiency cited under Title 22 Regulation 87707(a) Advertising Dementia Special Care, Programming, and Environments. The POC made with the licensee was to hold an in-service with staff and themselves in attendance and send proof of this to the LPA by the POC due date 6/6/2023. The topics shall include: dementia care and fall risk prevention. On today's visit LPA spoke with administrator and look at training material received. LPA also received the POC by the due date to their email. POC was cleared and clearance letter was provided to administrator. The following deficiencies were not corrected by the POC due date nor at the time of the visit. Civil Penalties are being assessed and will continue to accrue until correction has been submitted: Deficiency cited under Title 22 Regulation 87405(a) Administrator- Qualifications and Duties. The POC made with the administrator was to spend 20 hours a week at the facility and to oversee Daybreak Villa East and West and remove themselves as administrator from the other (3) facilities. Proof of removal from facilities as administrator, LIC500 showing the 20 hours allotted per week. This was due by POC date 6/6/2023. On today's visit LPA spoke to administrator who stated they had sent the LPA LIC308 to designate their house managers in their place for other (3) facilities but had not disassociated themselves. POC documented has still not been received. Civil penalties are being assessed for the dates of 6/7/2023 to 6/14/2023 in the amount of $100 per day for 8 days. Civil penalties will continue to accrue at the rate of $100 corrections are made and sent to LPA. An exit interview was conducted with administrator, Rolando "Bobby" Corpuz where this report and civil penalties were reviewed and provided.the state’s words, verbatim · CDSS document, Jun 14, 2023

Type of visit: Office

Licensing Program Analyst (LPA) Janira Arreola conducted an informal office meeting with managing member of Twet LLC, Bin Shen. The meeting was accorded to speak about topics of concern with Daybreak Villa East and Daybreak Villa West (374603760). Provide updated Articles of Incoproration and LIC309 for managing LLC's of the facility: Twet LLC, GODM Investmentsa, Shnaghai Nushi LPA provided consultation to Shen, as they expressed they are looking at a potential buyer for Daybreak Villa West and Daybreak Villa East. Shen was informed of liability of the licensee, and proper notification that is needed to the resident responsible parties and to the department Administration of the facility, and Administrator hours to 20 hours per week at each facility, Daybreak Villa West and Daybreak Villa East Use of restraints on residents in care, Shen agreed would cease immediately and facility would provide the requested documentation by the POC due dates. The facility is to provide the requested Licensee documentation by June 6, 2023 close of business 5 p.m. An exit interview was conduced where this report was reviewed and provided to the Licensee representative, Bin Shen through email for signature.the state’s words, verbatim · CDSS document, Jun 1, 2023

Type of visit: Office

Licensing Program Analyst (LPA) Janira Arreola and Licensing Program Manger (LPM) Joel Esquivel conducted an informal office meeting virtually with Administrator, Roland Corpuz on 5/31/2023 at 9:00 a.m. The meeting was accorded to discuss the following points: Deficiency cited by LPA Arreola on 5/30/2023 concerning Resident #1 (R1) at facility Daybreak Villa East 374603760, and the use of restraints. Fall prevention training for administrator and staff Dementia care training for administrator and staff Administrator increasing hours present at the facility to 20 hours per week. These items were discussed with the administrator, where they agreed to have the items corrected by June 6,2023 and present corrections to LPA. Citations were recorded on LIC809-D page along with plans of correction. The administrator agreed to contact the licensee, as both the LPA and LPM were unable to gain contact for the informal meeting. The administrator agreed to inform the LPA by June 1, 2023 availability for June 2,2023. An exit interview was conducted where plans of correction for these issues were reviewed and discussed with Administrator, Roland Corpuz. The report was sent to Rolando Corpuz via email for signature.the state’s words, verbatim · CDSS document, May 31, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 97707(a) · Plan of correction due date: Jun 6, 2023

(a) Licensees who...hold themselves out as providing special care...for residents with dementia...shall ensure that all direct care staff... who provide care to residents with dementia, meet...training requirements This requirment was not met as evidenced by: Based on record review and interview with administrator, the staff at the facility have not received dementia care training as outlined in the facility's dementia care plan. This poses a potential personal, health or safety risk.the state’s words, verbatim · CDSS document, May 31, 2023

Plan of correction: The licensee agreed to hold an inservice with staff and themselves in attendance and send proof of this to the LPA by the POC due date. The topics shall include: dementia care and fall risk prevention.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Jun 6, 2023

(a) ...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours...The Department may require that the administrator devote additional hours in the facility to fulfill his...responsibilities...This requirment was not met as evidenced by: During the informal meeting, the Administrator stated they oversaw (5) facilities and that they were unware fo the extent of the use of the retraints with R1, and medication that was stored unlocked. This poses a potential health, saftey, personal rights risk to residents.the state’s words, verbatim · CDSS document, May 31, 2023

Plan of correction: The administrator agreed to spend 20 hours a week at the facility and to oversee Daybreak Villa East and West and remove themselves as adminsitrator from the other (3) facilities. Proof of removal from facilities as administrator, LIC500 showing the 20 hours alotted per week, and signed statement of understanding of the regualtion cited by the administrator must be submitted by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct an annual inspection with emphasis on infection control. LPA met with Caregivers Arnel Reclusado and Imelda Palecpec and explained the purpose of today's visit. Arnel phoned Administrator Bobby Corpuz and notified him of LPA's presence and he arrived shortly thereafter. During today's visit, LPA inspected the facility for regulatory compliance for the mitigation of COVID-19. LPA observed appropriate postings in the facility which were in accordance with the Department's guidelines. LPA observed that the facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). The facility has an approved COVID-19 Mitigation Plan Report (Report) on file which identifies a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases and ensures that staff are trained in the facility's infection control measures. The Report also indicates the facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolation, and properly caring for residents with COVID-19 positive results and/or exposures. Also detailed in the Report is a plan to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms. No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 16, 2022