Golden Seasons

Type of visit: Required - 1 Year

On 8/4/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. Upon arrival at the facility, LPA Montoya called, spoke with Caregiver David Bandola and conducted a risk assessment. Based on the assessment, the facility is clear of Covid-19 infection. LPA met with Caregiver David Bandola and spoke with Staff Bienvenido Cadungog on the phone. LPA explained to Staff Cadungog the purpose of the visit. Shortly after, Staff Cadungog arrived and assisted LPA with the visit. The facility is licensed to serve six (6) elderly residents ages 60 and older. All bedrooms are cleared for bedridden residents. Facility is approved for one (1) hospice resident. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) resident bedrooms, one (1) staff bedroom, two (2) bathrooms, living area, dining area, kitchen, and outside covered patio area. LPA Montoya toured and inside and outside grounds of the facility with Staff Cadungog. There were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured 149.4 degrees Fahrenheit. A comfortable temperature was maintained in the facility. LPA observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. The facility has one (1) fire extinguisher that was last serviced on 3/7/2022; smoke detectors, and carbon monoxide were operable. The facility conducted a Fire/Safety Drill on 4/20/2022. A working telephone number 310-320-7178 remains available. Evaluation Report Continues on LIC 809- During the visit, LPA observed the facility's infection control practices. LPA observed sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report on file with CCLD. LPA did not observe screening protocols for residents, staff, and visitors. Advisory Note - Technical Assistance was issued, please see LIC9102-AN. Deficiencies are being cited based on LPA's observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. Civil penalty assessed. An exit interview was conducted, Plans of Corrections were reviewed and developed with Staff Cadungog. A copy of this report and appeal rights were discussed and emailed to Staff Bienvenido Cadungog due to a technical difficulty.the state’s words, verbatim · CDSS document, Aug 4, 2022

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Aug 5, 2022

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above. LPA Montoya observed the water temperature in a residents' common bathroom between resident bedrooms #2 and #3 measured at 149.4 degree Fahrenheit. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 4, 2022

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Aug 5, 2022

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above. LPA observed Caregiver (Staff #1) providing care and supervision to two residents during the visit. Based on interview with Staff #2, Staff #1 does not have criminal record clearance and not associated to the facility. Staff #2 stated Staff #1 does not have personnel records. Staff #1 admitted he commenced working for the facility on June 4 as a caregiver reliever. Staff #1 admitted he is working by himself supervising and providing care for two residents during LPA's visit. Staff #2 stated Staff #1 worked on 6/4/22, 6/25/22, 7/9/22 and 8/4/22. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 4, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Aug 15, 2022

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above. LPA Montoya observed the kitchen cabinets, bathroom cabinets, garage, and underneath the outdoor patio have plenty of clutters. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 4, 2022

Allegation investigated: Facility has several wasp nests under the eaves of the home. The eaves of the home are deteriorating. Part of the brick wall outside the home is falling down. There is garbage in the yard of the facility.

On 09/10/21 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced visit regarding The allegations above. LPA was met by Care giver Delia and the purpose of the visit was explained. The investigation Consisted of Tour of Physical plant, Interviews with Residents, and staff. Regarding Allegation: Facility has several Wasp Nest under the eaves of the home. LPA Observed a total of 3 wasp nest, at 1:45pm. Two of which had wasps, and wasp eggs present. One Large, and Medium size wasp nest were located in eaves of the back de- attached Garage used for storage, on the Right hand side, and one small one in the front overhang of the home. Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) us found to be SUBSTANTIATED. California Code Of Regulations, are being cited on the attached LIC 9099 D. Substantiated Regarding Allegation: Facility Eaves of the home are deteriorating LPA observed that the eaves around the perimeter of the entire home, including the back garage Are cracked and deteriorating. LPA observed Dicoloration, surface cracks on the wood, and chipped paint on the outside, and underneath the eaves of the facility. Therefore; Based on LPAs observations the preponderance of evidence standard has been met, therefore the above allegation(s) us found to be SUBSTANTIATED. California Code Of Regulations, are being cited on the attached LIC 9099 D. Regarding Allegation: Part of the brick wall outside the home is falling down. Lpa Observed a Brick wall that divides the property to be incomplete and missing bricks. There has been another wall that was built to separate the neighbor and facility property line. Based on interviews, the neighbor offered to go 50/50 on the wall that divides the property, but the owner of the home did not Comply, therefore the neighbor had their own contractor build a new wall on their property line. Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) us found to be SUBSTANTIATED. California Code Of Regulations, are being cited on the attached LIC 9099 D. Regarding Allegation: There is garbage in the yard of the facility LPA Observed an Old hospital Bedframe outside in the back yard. Facility staff stated that someone was coming to get the bed. Windows were also being replaced, and old shutters were observed outside towards the walls of the facility. Based on LPA Observation the preponderance of evidence standard has been met, therefore the above allegation(s) us found to be SUBSTANTIATED. California Code Of Regulations, are being cited on the attached LIC 9099 D. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 10, 2021 · control 11-AS-20210907092149

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 1, 2021

87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and Visitors. This requirement was not met as evidenced by: Based on LPA observation there was a 3 wasp nest underneath the eaves of the home/garage, there was a broken/unfinished brickwall there cracked wood, chipped paint and discolorarion of eaves around perimeters of the home,a broken/unfinished brickwall, and trash in the form of unusued bed and shutter that had not been disguarded. This poses a potential health,safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 10, 2021

Plan of correction: Administrator will submit a photograph and pest control plan of wasp nest being disguarded. Will submit either contract plan for eaves, or photograph to show they have been fixed around the home, and will send picture of backyard free of debris. To LPA by POC due date 10/01/21.