Delta Home Care III

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Assistant Administrator Danielle Maximo. Administrator Rose Maximo arrived later. There are currently 4 developmentally disabled residents 60 years and older residing in the facility. None of the residents are receiving hospice care, home health, or have Dementia. The inspection was completed using the CARE tools. Twelve (12) CARE tools domains were reviewed. Infection Control: Visitors are no longer being screened for COVID-19, but are still required to sign in. The facility has an Infection Control Plan and Covid-19 Mitigation Plan. Infection control practices and Personal Protective Equipment (PPEs) were observed. Operational Requirements: A current Plan of Operation was reviewed. The facility has a Dementia Waiver in place. A Hospice Waiver for 4 is approved. A fire clearance for 6 non-ambulatory adults 60 and over is in place. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is current. Facility handles resident's P & I monies. A Surety Bond of $2,000 is current. ***See next page for report narrative.*** Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood consisting of 4 private resident bedrooms, 2 bathrooms, living room, dining room/kitchen, outdoor patio area with patio furniture, and 2 car detached garage with laundry area. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Kitchen drawers containing knives/sharp objects were locked. The facility has one (1) fully charged fire extinguisher and a fire pull alarm. Auditory alarms in bedrooms with exterior exit doors are operable. Water temperature readings did not measure within the required 105 - 120 degrees Fahrenheit. Bathrooms hot water measured 123.1 & 122.6 Degrees Fahrenheit. Citation was issued. Staffing: A total of 7 staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificate expired 7/10/2022. Licensee/Administrator provided proof that training was submitted to certification unit and is awaiting receipt of current certificate. Personnel files were reviewed. Criminal Background Clearance, staff training, 1st Aid/CPR, and health screening/TB clearance was checked. Resident Records/Incident Reports: A total of four (4) resident files were reviewed. All required documents were observed. RCFE complaint poster and Personal rights were observed posted in the facility. ***narrative continues next page*** Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed, as well as community outings. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician orders for modified diets are in place. One (1) resident has a puree diet. Incident Medical and Dental: Medication Administration Records (MARs) and resident medications were reviewed. PRN medications were not listed on the MAR, but MD orders are in place. Administrator was advised to contact pharmacy so they can add the PRN medications to the MAR. Medical and dental transportation is provided by facility staff. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. The last emergency disaster drill was conducted on 9/22/2023. Residents with Special Health Needs: No residents currently receive hospice or home health care. No resident beds have bed rails.. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator Rose Maximo. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Oct 3, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Galarza conducted a follow-up Prelicensing visit to verify corrections. The purpose of the visit was explained to Administrator Marie Kunkel. An initial Prelicensing visit was conducted on 8/31/2022. The facility presently has four (4) non-ambulatory developmentally disabled adults. The items listed below have been corrected: The hot water temperature in kitchen and bathrooms measured within normal limits 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). The side iron gates locking mechanisms have been removed. The facility purchased a new stove and all burners are operational. An exit interview was conducted, and a copy of this report has been furnished to Administrator Marie Kunkel. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, Sep 23, 2022

Type of visit: Prelicensing

Licensing Program Analysts (LPA) Galarza & Yang made an announced visit and met with Administrator Marie Kunke to conduct a pre-Licensing evaluation. The facility presently has four (4) non-ambulatory developmentally disabled adults. It is serviced by San Gabriel/Pomona Regional Center as a level 4C home. The facility has a Dementia plan and hospice waiver for four (4) residents. An application was submitted to Community Care Licensing Department (CCLD) for a change of ownership of an RCFE (Residential Care For the Elderly) for developmentally disabled adults. The requested capacity is for four (4) non-ambulatory residents; of which one (1) may be bedridden. Structure: Facility is a single-story home consisting of four (4) bedrooms [room #4 is bedridden], two (2) full bathrooms, kitchen, dining room, living room, laundry room, medication room/storage, office, and a 2-car detached garage.The front and backyard have grassy areas. The backyard has shaded patio furniture. Bedroom Clients: All bedrooms are private. Bedrooms # 1-3 have exit doors leading to the side yard. Bedroom #4 is designated as bedridden. Bedrooms are equipped with one bed, night-stand, chair, lamp, and overhead lightning. Bathrooms: Have a working toilet, wash basin, and bathtub. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens is stored in bedroom closets. Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. One (1) fully charged fire extinguisher is in place. Facility has a land line telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Smoke Detectors: There are electrical & inter-connected smoke detectors located in all bedrooms, common areas, and hallways. Appliances: Refrigerator, oven, microwave, dishwasher and washer/dryer were observed. The stove's left back burner was not working. The residence is equipped with central heating and air conditioning. Toxins: Cleaning supplies, and toxins are locked only accessible to staff. See LIC 809C for continuation of report. Water Temperature: Hot water was tested in all bathrooms, and kitchen sink. Water temperature was not within normal limits 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). Medication, First-Aid Kit & Book: Designated centrally stored medications are stored in the medication room/storage room, and the first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. Clients & Staff Files: Designated area for files will be in the dining room. Pools/Jacuzzi & Pets: No bodies of water and no pets on these premises. Fire Clearance: Fire clearance was approved on 6/2/2022 for four (4) [3 non-ambulatory & 1 bedridden] residents. The facility has no delayed egress. The facility has a fire pull alarm. Component III: Component III PowerPoint presentation was conducted. The following items must be corrected, and proof of correction shall be submitted to the CCLD office to the attention of LPA Galarza by September 28, 2022. If additional time is required to complete noted items to correct, then the applicant will request an extension in writing prior to the due date. Some items may require a follow up inspection for verification of correction. 1. The hot water temperature in all kitchen and bathrooms was not within normal limits 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). Submit a 3-day log of water temperature measured during each shift. 2. The side iron gates had locking mechanisms on the outside of the door; which prevents staff and residents from exiting from the interior of the property. Remove and/or replace the doors and ensure persons can exit without requiring a key to unlock. 3. The stove left back burner does not work. Repair and/or replace. Submit picture proof and an invoice. An exit interview was conducted, and a copy of this report has been furnished to Administrator Marie Kunkel. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their applicationthe state’s words, verbatim · CDSS document, Aug 31, 2022