Eben Haven

Type of visit: Required - 1 Year

On 10/3/2024, Licensing Program Analysts (LPAs) Janette Romero and Janira Arreola made an unannounced visit to the facility to conduct a required annual inspection. LPAs were greeted and granted entry by Caregiver, Angelica Alamillo who was informed of the purpose of the visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents. The facility also has an approved hospice waiver for four (4) residents and LPA was informed two (2) residents are currently receiving hospice services at the facility. During the visit, there was two (2) staff and five (5) residents present. Facility representative, Adeola Ayodele arrived during the visit. LPA toured the facility with Caregiver Alamillo, conducted interviews and reviewed records. During the tour, LPA observed indoor and outdoor pathways were free of obstructions. There were no bodies of water observed on the premises. Outdoor shaded seating is available for the residents in care. LPA toured the kitchen and observed the facility has a two-day supply of perishable foods and seven-day supply of non-perishable food items. Knives are secured in a locked kitchen cabinet next to the refrigerator. Cleaning solutions and disinfectants are secured in the locked garage. Caregiver Alamillo tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed charged fire extinguishers mounted throughout the facility, last serviced on 6/4/2024. Staff present have a criminal record clearance and are associated with the facility. Medications are secured in a locked hallway closet. LPAs reviewed the physical medications for Resident 1 (R1) and Resident 2 (R2) along with their Medication Administration Record for October 2024 and found facility staff documented administering a medication for R2 that is not listed in the latest medication list and was not found with their physical medications. Staff interviews conducted revealed facility staff are documenting administration of R1's routine medications for October 2024 on 10/3/2024 and not immediately after dispensing the medication from 10/1/2024 to 10/3/2024. During today's visit, the facility was issued one (1) deficiency. An exit interview was conducted and a copy of this report was reviewed and provided to facility representative, Adeola Ayodele along with an LIC 809-D, Confidential Names List (LIC 811) and Appeal Rights.the state’s words, verbatim · CDSS document, Oct 3, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cheryl Goodrich arrived at 8:48 am to conduct an unannounced annual visit. LPA met the Caregiver Angelica Alamillo Ochoa at the front door and was granted entry. The Administrator, Elizabeth Odunjo arrived at 9:07am. The purpose of today’s visit is to inspect the facility to ensure that the facility is following California Code of Regulations, Title 22, Division 6. The facility is a single-story home located in a residential area in Menifee, CA licensed to serve six (6) non-ambulatory and approved for 1 bedridden with 4 residents in care. The facility has a Hospice Waiver for 4 residents. Infection Control: The facility has an approved infection control plan and a surplus of supplies for infection control including but not limited to mask, gloves, gowns, first aid kit, and cleaning supplies. Physical Plant and Environmental Safety: The facility temperature read at 73 degrees. The facility consists of 4 resident bedrooms, and 3 bathrooms, living room, kitchen, and backyard. The bedrooms are furnished with lighting, closet space, tv and dresser. The beds are clean and have clean linens and the pathways are clean and clear of obstruction. The bathroom temperature read at 110 degrees which is within regulation requirements. The living room and kitchen clean and clear of obstruction. The medications are stored in a locked cabinet in the hallway and inaccessible to the resident. The facility has a current fire clearance, smoke and carbon monoxide detectors and fire extinguishers and are in working order. Personnel Records-Training: The staff records are completed with fingerprint clearance, Health screening for TB, CPR/First Aid training, and in-service trainings. Client Records-Incident Reports: The facility has identification and emergency information, physician’s report, resident appraisal, client rights, and admissions agreements. (Continued on LIC809-C) (Continued from LIC809) Client Rights-Information: The facility has client rights information posted in the facility. Food Service: 7-day non-perishable and 2 day of perishable food supply was observed, and all food was properly stored and available. Health- Related Services: The facility has a medication logbook; the facility documents the resident’s medication and in is compliance with physician’s orders and regulations. Disaster Preparedness: The facility has a disaster plan and has posted the evacuation plan, visible for staff and residents in care. The last fire drill was completed 09/23/23. The facility has emergency supply of food and water. Summary: No deficiencies were observed at the time of the visit. An exit interview was conducted and a copy of this report was provided to Administrator, Elizabeth Odunjo and her signature on this form confirms receipt of these rights.the state’s words, verbatim · CDSS document, Oct 20, 2023