Dignity Gardens Home

Type of visit: Required - 1 Year

On 6/9/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a subsequent Annual visit. LPA introduced self, stated the purpose of the visit, and was greeted by caregiver Pauline Simpson Cox. LPA was granted entry into the facility. Licensee (L1) Camalah Kopacz was called and arrived shortly. LPA toured facility with L1. All four clients were present upon LPA arrival. LPA conducted interviews with staff and resident.MARs was reviewed. All residents’ file reviewed to have update emergency contacts and Admission agreement, and Pre-Appraisal. Sample of staff's files were also reviewed. Staff files were observed to have current First Aid/CPR, Health screening, and Personnel record. Staff are fingerprinted clear and associated to the facility. The tour started in the kitchen into the common areas, to the resident's bedrooms, and bathrooms. LPA observed COVID-19 related signs. The facility was observed to be at a comfortable temperature of 77 degrees F, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Fire extinguisher was observed with a service date of: 06/02/23. Fire drill last completed: 04/14/23. Cleaning supplies and chemicals stored and locked in garage cabinet. LPA toured all resident’s bedrooms and observed 4 single occupant rooms. Residents’ room observed to be adequately furnished with bed, dresser, and adequate lighting. Bathrooms were properly equipped, and the hot water temperature was tested at 109.6 degrees F in bathroom 1 and 109.21 degrees F in bathroom 2. Medications are kept locked in hall closet. Outside of facility toured and observed to be free of debris. Carbon monoxide and smoke detectors were tested and observed to be operational. No deficiencies issued during this inspection Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 6/15/23. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, Lic 9282, current liability insurance, control of property, transportation procedure, theft and loss policy/procedure, and current Administrator certificate. A copy of this report was provided to Licensee.the state’s words, verbatim · CDSS document, Jun 9, 2023

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 05/25/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with administrator. LPA met with Marilyn Gregorio, Caregiver. Licensee Camalah Kopacz was called and arrived shortly and conduct tour with LPA. Four residents were present during the inspection. Upon entry facility staff was observed with no facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. LPA observed social distancing and cough etiquette postings.LPA and Licensee observed at 04:00 p.m. stove top knobs on stove top range. LPA checked residents’ locked medications. Food supply was checked and appeared to be an adequate supply. LPA observed 30 days PPE supplies. All resident’s room toured and observed to be adequately furnished and lit. LPA observed 2 shared residents’ bed to be at least 6 feet apart, one single occupant room and one vacant room. All bathrooms are observed with securely fastened grab bars and non-skid mat. All bathrooms observed trash bin with lid. LPA observed hand washing posting by bathroom sinks. The exterior tour was conducted. Side gate was self-closing and self-latching. Staff records were reviewed for good health and infection control training. All resident records reviewed to have updated emergency contact information. Cleaning supplies were stored and locked in cabinet in the garage. LPA observed fire extinguisher served date: 05/29/21. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 5/31/22. The following updated forms were requested: Lic 308, Lic 309, Lic 500, Lic 610E, Lic 808, Lic 9020, and current liability insurance. LPA received copy of current Administrator certificate. Licensee was provided a copy of this report and appeal rights.the state’s words, verbatim · CDSS document, May 25, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Darius Wiliams conducted an unannounced Annual Visit. LPA Williams met with Staff Lyn Geridoio, and discussed the purpose of the visit. LPA Williams toured the facility. LPA Williams observed a visitor log/temperature check and disinfection station at the front entrance. Facility has one entry and exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas. LPA Williams observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies were observed behind a locked door. LPA Williams observed the following personal protective equipment in the closet; gown, face shield, gloves, and masks. LPA Williams observed staff training records regarding Covid-19 mitigation and infection control. LPA Williams observed all facility staff wearing masks. Resident’s files have updated emergency contact information. No deficiency cited at this time. Administrator Camalah Kopacz, provided verbal approval for Staff to sign report. An exit interview was conducted a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 14, 2021

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Darius Williams conducted a Case Management facility visit. LPA Williams met with Licensee Camalah Kopacz and discussed the purpose of the visit. At approximately 10:45 a.m., LPA Williams observed locks on 2 out of 2 perimeter fence gates; on the east and west side of the facility. The lock can not be accessed from inside the fence perimeter which prevents exit from the backyard to the street. LPA Williams observed the facility sketch designating the West gate as Emergency Exit #2. Fire Clearance Inspection document reflects on 5/19/2021, Clovis Fire Department did not authorize a locked perimeter gate. Staff 1 reported the lock is on the gate to assist with residents wandering behavior. Based on observation, interview, and record review, a deficiency was cited on attached LIC 809-D according to Title 22, Division 6, Chapter 8, Article 12, Section 87705(l)(2). Additionally, a civil penalty is being assessed according to Section 1569.49(c)(2)(A) of the Health and Safety Code. Licensee immediately had the lock removed from the gate. An exit interview, a copy of the report, and appeals rights were provided.the state’s words, verbatim · CDSS document, Jul 14, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(l)(2) · Plan of correction due date: Jul 15, 2021

87705 Care of persons with Dementia, (l) The following initial and continuing requirements shall be met for the licensee to lock...perimeter fence gates:, (2) The licensee shall ensure that the fire clearance includes approval of...locked perimeter fence gates. This requirement was not met evident by: Based on LPA's observation, interview, and record review the Licensee did not receive a fire clearance to lock perimeter fence gate identified as Exit #2 on the facility sketch, which poses an immediate health and safety risk to 6 out of 6 persons in care.the state’s words, verbatim · CDSS document, Jul 14, 2021

Plan of correction: Licensee immediately removed the lock from the gate, Exit #2. POC was corrected on the spot. Licensee stated she will seek delayed egress for perimiter gate.