Delta Meadows Care Home

Type of visit: Required - 1 Year

On 2/10/2023, Licensing Program Analyst (LPA) D. Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and was greeted by Lead Staff Janet Cancino. Licensee, Cecilia Ganzon was contacted and arrived later in the visit. The facility currently provides care for 4 residents all of which were present at the time of visit, none of which are receiving hospice services and some of which with a of diagnosis of dementia. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Lead Staff. Facility was at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 10/26/2022 at the time of the visit. Smoke and carbon monoxide detectors were tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations with food stored properly. Residents are provided various alternative food options per meal with the facility ensuring well balanced and nutritious foods. Residents were observed to be participating in their individual activities including watching television, conversing or with visitors. All resident bedrooms have appropriate lighting and furniture with a supply of extra blankets and linens. There was a supply of hygiene products and paper products available for resident use. LPA conducted a sample review of staff training and found that all staff have current CPR and 1st Aid training on file. Toxins are stored in a locked cabinet in the facility garage and found to be secured. LPA observed prescription medications unsecured in the office area. LPA was informed that the medications were in process of being recorded and put away. No residents were present. LPA discussed with Licensee and staff and issued Technical Violation. Medication was immediately secured in designated cabinet. Continued onto LIC809-C LPA measured water at faucets accessible to residents and measured at 117.4 degrees F which is within Title 22 Regulations. All exit doors were inspected with auditory alarms fully functioning for residents with dementia. Licensee, Cecilia Ganzon's Administrator Certification is expired as of 7/28/2022, however documents have been submitted for re-certification. Licensee was notified by the Department of current delay on processing. Licensee will submit renewed Administrator Certification to CCLD once received. Infection Control: Facility has submitted an infection control plan for review. Posters have been placed at the front door, and facility has a station near facility entrance with a sign in sheet, hand sanitizer and other items designated for visitors and staff. There is a sufficient amount of PPE supplies available. All staff and visitors were observed to have appropriate face coverings and following facility COVID protocols. Residents and staff are also screened for symptoms on daily and based on observation. LPA requested the following documents be sent to CCL by COB 2/24/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility client’s/client’s Copy of Administrator Certificate(s) Copy of Liability Insurance No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, Feb 10, 2023

Allegation investigated: Resident asked to pay more money for services already covered in admission agreement

On 7/29/2022 Licensing Program Analyst (LPA) Tobola conducted a facility visit for the purpose of delivering complaint findings. LPA Tobola toured the facility, gathered facility documents, conducted interviews with staff, residents and outside parties and made observations. LPA A. Canela also conducted initial investigation on 4/8/2022. Complaint alleges resident (R1) was asked to pay more money for services already covered in admission agreement. Upon review of R1’s admission agreement, it was observed the admission agreement had contradicting information and/or did not specify a fee for transportation to medical appointments. In addition investigation revealed facility care staff (S1) was found providing transportation to R1 at a flat rate fee of $30.00. R1 issued a check to S1 for the $30.00 for services on 2/28/2022 and S1 was notified of an input error when submitting the check to their bank as a deposit for $38.00. S1 received a letter explaining they owed the bank $8.00 as the check cashed was for $30.00 and not $38.00. Continued onto LIC9099-C Substantiated S1 failed to read the statement/letter correctly and informed R1 that they owed them and additional $8.00 because the bank was charging S1. LPA Canela interviewed staff S2 on 4/8/2022 who corroborated to LPA, S1 requested and told R1 they owed them the $8.00 the bank was charging them. S2 also disclosed to LPA they too asked R1, if they would be paying S1 the $8.00. It was also disclosed R1 eventually gave S1 an additional $10.00 but S1 returned the money to R1. On facility visit of 4/8/2022, LPA Canela confirmed with facility Administrator, Cecilia Ganzon, residents pay a flat rate fee of $30.00 for transportation. Based on incomplete information in the admission agreement, the above allegation is found to be SUBSTANTIATED. The preponderance of evidence standard has been met, therefore the above allegation, resident asked to pay more money for services already covered in admission agreement is SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D. Appeal Rights Given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Jul 29, 2022 · control 21-NP-20220330092030

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(3)(B) · Plan of correction due date: Aug 10, 2022

87507(g)(3)(B) Admissions Agreement - (g) - Admission agreements shall specify the following: (B) - A comprehensive description of and the corresponding fee schedule for all additional items and services not included in the fees for basic services shall be listed. **This requirement was not met as evidence by: Based on a review of facility and resident records LPA found that facility was charging a flat rate to resident R1 for transportation services which was not clearly indicated in R1's admissions agreement. In addition, upon interviews with staff LPA found that staff S1 had requested for additional money from R1 to compensate for a bank error notification.the state’s words, verbatim · CDSS document, Jul 29, 2022

Plan of correction: Licensee has immediately stopped receiving additional payments from all residents for transportation services. Licensee agrees to update the admissions agreements for any incoming residents clearly indicating any additional charges to residents if resident choos receive facility transportation services. Deficiency cleared at time of visit.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, Administrator, Cecilia Ganzon. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. The facility currently has 4 residents in care. This facility is licensed for a total of 5 residents. 3 bedrooms may be used for non-ambulatory residents and bedroom #1 may only be used for ambulatory residents. This facility has a Hospice waiver approved for 2 residents and does not have approval for bedridden residents. LPA toured facility and grounds and observed COVID-19 precaution signs posted in common areas to promote hand washing. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms upon arrival to the facility. Infection control practices that are present are: entry procedures, face coverings and 30-day PPE supply. Facility does not have proof of daily monitoring and temperatures checked for residents and staff. Facility to follow indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test. Facility states staff clean and disinfect the facility daily. Bathrooms are equipped with liquid soap and paper towels. Covid-19 Mitigation plan was submitted to the department on 8/20/2021. Caregivers have completed PPE training but have not been N-95 Fit tested. In addition, facility was found to be at a comfortable temperature with all exits free from obstruction. Facility has at least two days of perishable and one week of non-perishable foods and items are stored properly. Fire Extinguisher was found to be charged and serviced 11/29/2021. Facility has 2 resident room doors that are getting stuck and will need to be corrected for easy opening and closing. Continue report see LIC809-C and LIC809-D for citations issued during todays inspection. During todays visit, LPA discovered resident R1 was hospitalized from 2/10-2/13/2022, was also sent to the ER on other occasions, and the Vallejo police department made a health & safety check to this facility on 1-2 occasions and facility failed to notify CCL and submit the required incident reports within 7 days. Facility staff to get N95 fit tested. Exit interview conducted with Cecilia Ganzon See LIC809-D for citations issued Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 8 and the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Appeal rights and report emailed to facility.the state’s words, verbatim · CDSS document, Apr 8, 2022