Heavenly Angels

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 7/25/23 to conduct a Required-1 Year Inspection utilizing the CARE inspection tool. LPA met with Caregiver and explained the purpose of the visit . Administrator arrived to assist. LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. Residents appear to have all identified care needs met. LPA reviewed 5 resident files and 2 staff files. LPA found staff to be complete with the exception of required medication training for S1. Resident files were found to be complete with the advisories noted below. LPA and Admin discussed the following topics: Resident needs and services plans reviewed and signed by residents, PRN administration records complete and thorough, an activity plan to engage residents to their needs and interests, having a designee present when Admin is absent and maintaining staff training for restricted health conditions. Infection control plan is on file. Licensee was provided a copy of liability insurance. As a result of this inspection, a deficiency is noted. Report reviewed with licensee . Copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 26, 2023

Type of visit: Case Management - Other

On 12/29/22, Licensing Program Analyst (LPA) Kevin Mknelly, met with licensee, Larisa Romanova. Prior to the inspection, LPA followed department Covid precautions. LPA was screened upon entering the home. The purpose of this inspection was to conduct a health and safety check related to licensee's increased monitoring during probation. LPA confirmed that licensee met all current training requirements. LPA toured the home. The home is well maintained and residents appeared to have needs met. LPA conducted a file review for one resident. Files are in order. Licensee and LPA discussed newly admitted R1 and options for physician contact for issues to be resolved. LPA discussed PIN 22-24 and 22-13 and provided copy. As a result of this inspection, no deficiencies were found. Report reviewed and copy provided.the state’s words, verbatim · CDSS document, Dec 29, 2022

Type of visit: Case Management - Other

On 6/13/22, Licensing Program Analyst (LPA) Kevin Mknelly, met with licensee, Larisa Romanova. Prior to the inspection, LPA followed department Covid precautions. LPA was screened upon entering the home. The purpose of this inspection was to conduct a health and safety check related to licensee's increased monitoring during probation. LPA confirmed that licensee met all current training requirements. LPA toured the home. The home is well maintained and residents appeared to have needs met. LPA conducted a file review for one resident and one staff. Files are in order. LPA advised part-time staff be aware of all Covid-19 mitigation measures. LPA discussed PIN 22-24 and provided copy. As a result of this inspection, no deficiencies were found. Report reviewed and copy provided.the state’s words, verbatim · CDSS document, Oct 6, 2022

Type of visit: Case Management - Other

An office meeting was held on August 26,2022 at 12:30 PM on a Microsoft Teams Meeting video conferencing system review the stipulation adopted on April 7, 2022 and the next steps. This Stipulation shall be posted in a conspicuous place at the facility for the duration of the probationary period. The following were in attendance: Regional Manager Alycia Berryman, Licensing Program Manager Maribeth Senty, Licensing Program Analyst Kevin Mknelly and Licensees for Heavenly Angels, Larisa Romanova. Alycia Berryman discussed the purpose and elements of this type of meeting. The Stipulation was reviewed with the Licensee who expressed their understanding. Items discussed at the meeting included, but not limited to: Stipulation contents · Findings · Revocation of License- Stayed with Probation conditions · Exclusion- stayed with probation · Future Application for a license, registration, certification or approval · Tolling of probationary period · Violation of Stipulation Term · Completion of probation · Violation of stipulation terms · Completion of probation and future applications Report continued... · Department’s Authority · Monitoring Fee · Waiver of Hearing Rights · Waiver of Appeal/Modification Rights · Waiver of Claims · Public Record · Signatures · Counterparts · Effective Date April 7, 2022 · No Oral modification The Licensee/Respondent/Representative stated they would abide by the following: ꞏ Abide by the contents/terms of the Stipulation (submit all documents timely) ꞏ Operate the facility in strict compliance with the regulations and statutes governing the operation of a residential care facility for the elderly. CCLD will do the following: ꞏ Increase monitoring Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations cited during this visit. A virtual exit interview was conducted, and a copy of this report was provided via email for a signature. Administrator agreed to return a signed copy to CCLD by COB 8/26/22.the state’s words, verbatim · CDSS document, Aug 26, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 08/10/22 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator, Larisa Romanova, and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility. LPA toured the interior and exterior of the facility together with Administrator to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathrooms, kitchen, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. LPA reviewed the conditions of probation. Licensee continues to be significantly compliant. LPA advised that licensee discuss best practices with medication independent resident for securing medications. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Aug 10, 2022

Type of visit: Case Management - Other

On 6/13/22, Licensing Program Analyst (LPA) Kevin Mknelly, met with licensee, Larisa Romanova. Prior to the inspection, LPA followed department Covid precautions. LPA was screened upon entering the home. The purpose of this inspection was to conduct a health and safety check related to licensee's increased monitoring during probation. LPA confirmed that licensee met all current training requirements. LPA toured the home. The home is well maintained and residents appeared to have needs met. LPA conducted a file review. Files are in order. LPA advised more detail to resident incontinence care plans and diabetic diets. As a result of this inspection, no deficiencies were found. Report reviewed and copy provided.the state’s words, verbatim · CDSS document, Jun 13, 2022

Allegation investigated: Resident not receiving well-balanced meals. Resident is not being encouraged to participate as fully as their conditions permit in daily living activities.

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 09/22//2021 to deliver investigation findings for complaint received on 09/14/21. Prior to visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; upon entry LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. LPA reviewed resident records, facility records, and conducted interviews. LPA finds that facility met Tittle 22 requirements.Records from R1's physician confirmed that R1 was receiving the proper diet and level of activity for their current condition. Immediate family who visit the facility often express being very satisfied with R1's care. This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted, copy of report provided. Unfoundedthe state’s words, verbatim · CDSS document, Sep 22, 2021 · control 25-AS-20210914145308

The state marks this report as 2 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

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 07/01/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator, Larisa Romanova, and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility. LPA toured the interior and exterior of the facility together with Administrator to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, five (5) resident bedrooms, three (3) bathrooms, kitchen, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. LPA requested for documents such as LIC 500 Personnel Summary, LIC 308 Designation of Facility Responsibility, and Administrator Certificate. LPA received copies of requested documents from Administrator at the facility. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Jul 1, 2021