Graceful Living at Oakdale

Type of visit: Required - 1 Year

On 05/04/23, at 10:00 AM, an unannounced annual inspection was conducted by Licensing Program Analyst, (LPA) Kimberly Viarella at Graceful Living at Oakdale. LPA identified herself and the purpose of her visit to staff who contacted the Designee, Rainilda Clavano, and she arrived within 20 minutes. Designee reported census was 6 with 2 hospice and the 2 hospice were bedridden. 4 Residents were ambulatory. The facility was licensed for 6 nonambulatory and approved for a hospice waiver of 2. They did not have a dementia program at this time. The facility was not licensed for bedridden. The Licensee/Designated Facility Administrator, Voica Matis, Certification 6008538740, expires 1/6/2023. The tour began in the kitchen/areas. LPAs checked the food supply and found that there were enough groceries for 2 days of perishable and 7 days of non-perishable items at this time. Knives were secured in a locked drawer and chemicals were stored in a locked cabinet and separate from the food supply. The fire extinguisher was last inspected on 06/17/22, by Stanislaus Fire. The LPA observed the furniture, furnishings and lighting in the kitchen/family room, dinning/living room, and four bedrooms. All were in compliance. Two of the residents required oxygen and both of their bedrooms displayed the appropriate warning signs. The hot water was measured in the hallway bathroom and found to be 113 degrees, within the range of 105-120 degrees required. LPA observed that the 2 bathrooms in the house had grab bars and bath mats along with paper towels. LPA inspected the linen supply and found it to be sufficient for the residents in care. The tour progressed to the garage. The Designee opened all of the locked cabinets. The LPA observed cleaning supplies and other toxins in one, the others contained PPE, holiday decorations and general household storage. The LPA also observed a small refrigerator for resident medications. It was not locked at this time. Continued on LIC 809C The Designee led the LPA to an area being modified into a staff room. The building permit was posted. Community Care Licensing was not notified of these physical plant changes. The inspection continued to the exterior of the house. There were no bodies of water or outbuildings present. At this time, the backyard was enclosed with a gate on one side. The area was free of debris and trip hazards. Adjacent to the front door was a small sitting area for residents to enjoy surrounded by a half-wall. All screens were intact and gutters were clear. At the time of the inspection, medications were centralized and stored in a locked cabinet next to the refrigerator. Policies and procedures were discussed with staff in terms of dispensing and documenting the administration of resident medications. First aid kit was observed to be present and contained all of the necessary components at this time. LPA completed a review of 5 resident files. LPA looked for the following: a signed and dated admissions agreement, a physician’s report, proof of a negative TB test, ambulatory/non-ambulatory status, ID and emergency information, an appraisal and needs service plan, a centrally stored medication destruction record, safeguards for cash resources, safeguards for property/valuables, statement of personal rights, and cash resources information. All were complete and in compliance LPA reviewed 6 staff files. LPA looked for the following: first aid certificate, fingerprint clearances/exemptions, personnel record/job application, health screening, proof of negative TB test, medical training verification, employee rights, and criminal record statement. 2 out of 6 were missing annual training and 2 out of 6 were missing First Aid Certification. The following forms and documents were requested to be updated and submitted to CCL via email to kimberly.viarella@dss.ca.gov by 05/19/23: LIC 308 LIC 400 LIC 500 LIC 610 Updated Liability Insurance. (Continued on the LIC 809 C) According to the California Code of Regulations (Title 22, Division 6), the LPA observed the following deficiencies listed on the LIC 809 D. Civil penalties were assessed during today's visit. An exit interview was conducted with staff member, Rainilda Clavano . Copies of the Facility Evaluation Report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, May 4, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 4/29/22 at 12:30PM to conduct an annual inspection visit. LPA met with the caregiver Carlo Ocampo and explained the purpose of the visit. Carlo Ocampo, Caregiver contacted the Administrator regarding the visit. At this time there are 3 residents receiving hospice services. Administrator certificate expires 12/16/23 for Voica Matias. The Licensing fees are current at this time. Rainilda Clavano arrived within 15 minutes to assist with todays visit. The facility is licensed for a capacity of 6 residents. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed residents during this visit. LPA observed 2-day perishables but not a supply of 7-day non-perishables during this visit. The temperature inside the facility was observed to be at 73*F which is within the required range of 68-85*F. The hot water temperature was measured at 129.3*F which is not within the required range of 105-120*F. LPA observed fire extinguisher(s), smoke and carbon monoxide detectors, pull alarm system, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. Upon a file review the following items were discussed to be submitted with any changes annually: A copy of the signed Hospice Waiver for 2, Control of Property, Designation of Facility Responsibility (LIC308), Personnel Report (LIC500), Theft and Loss Policy and Procedures, Transportation Procedures, Administrator Certificate-Updated, Liability Insurance, LIC 610E(3/19) Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Licensee was provided a copy of their rights (LIC9058 12/15) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was provided. See 809D for continuation...the state’s words, verbatim · CDSS document, Apr 29, 2022

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Apr 29, 2022

Maintenance and Operation Water supplies and plumbing fixtures shall be maintained as follows: 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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Hot water was measured by LPA to be 129.3*F. Based on the Licensee did not ensure the hot water temperature was between 105-120 degrees. This possess an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2022

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Apr 29, 2022

General Food Service Requirements The following food service requirements shall apply: Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: LPA observed 3 cans of vegetables and 6 cans of fruit. Based on observation and staff admitted there are no other nonperishable items in the facility. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 29, 2022

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA's) Sarah Hurt and Ruth Wallace conducted an unannounced visit today to complete an annual inspection. LPA's met with Assistant Administrator Leticia Cabangal. There are currently 4 residents who reside at this home and there is one resident on hospice at this time. LPA'S inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguishers expires 06/17/2022. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 108 F degrees. First Aid kit is on site and complete. Toxins are locked. This facility is operating within the scope of their license. LPA's reviewed four resident files. Resident's medical files and medications were reviewed. All resident files reviewed were in compliance. Four staff files were reviewed and each had the required criminal record clearances. First Aid and CPR training was current and staff has current training No deficiencies were identified on this inspection. The Administrator shall send in updated copies by July 13, 2021 of the LIC 500 Personnel Report, LIC 308, LIC 309, Liability Insurance, Designation of Administrative Responsibility, LIC 610-E, facility deed or lease agreement, the Emergency Disaster Plan if needed and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Assistant Administrator and copy of report left at facility.the state’s words, verbatim · CDSS document, Jun 29, 2021