Home Sweet Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced annual required inspection and met with Administrator Codruta Paula Valeanu (Carol) who allowed the entry of the facility and explained the reason of the visit and assisted with the visit.. The facility is licensed to serve elderly residents age 60 and above. Fire clearance granted four (4) non-ambulatory and 1 bedridden. Facility may retain 3 hospice residents. The following twelve (12) tool domains were observed and reviewed: Infection Control, Operational Requirements, Physical Plant/Environmental Safety, Staffing, Personal Records-Training, Resident Rights/Information, Resident Records/Incident Reports, Planned Activities, Food Service, Incidental Medical and Dental, Disaster Preparedness and Resident with Special Health Needs. 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. Facility still practice hand washing constantly. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: The facility is cleared for four (4) non-ambulatory and one (1) bedridden. Currently all the residents are non-ambulatory but no bed-ridden. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 3. Physical Plant and Environmental Safety: The facility is a two story house and located in a residential neighborhood area. First floor, its included living room, dining area, kitchen, three residents bedrooms and one resident bathrooms and attached garage. On the second floor, the administrator and families are living upstairs. LPA inspected all three residents bedrooms: Bedroom#1 and #2 has one bed, one closet, one drawer, one night stand, required furniture and beddings, sufficient lighting and closet space. Bedroom#3 has two beds, two night stands, two drawers, required furniture and beddings and sufficient closet space and lighting. The resident bathroom is clean, sanitary and in a good working condition. The bathroom also has required grab bar and non-skid mat. The hot water temperature tested in resident bathroom is 114.6 degrees F which is within the Title 22 regulation. The appliances in the living room and kitchen are working well. The sharp knives and utensils are stored in the kitchen drawer and its locked and inaccessible to residents. The cleaning supplies are stored and locked in a cabinet on top of the washer and dryer in the garage The facility has a land line telephone system. LPA inspected the carbon monoxide detectors and its located in bedroom#3 and its working well. The walkway, passageway and patio are free of obstruction. 4. Staffing: The facility has sufficient staffing in the facility. All staff has updated CPR training. The administrator is living in the facility too, therefore she's always in the facility and she has a designated person when she's absent from the facility. 5. Personnel Record Training: All the staff files are stored and locked in the kitchen cabinet. The facility staff are all over 18 years old, associated with the facility and criminal background clearance. All staff does have the required training hours yearly. The facility administrator is Codruta Valeanu and her administrator certificate expiration date on 01/21/25. 6. Resident Records-Incident Reports: The resident files are stored and locked in the kitchen cabinet. LPA reviewed all three (3) resident files and they all have the required documents which included: face sheet, pre-placement appraisal information, appraisal/needs and service plan, admission agreement, updated physician report and TB test, ambulatory status and medication list. 7.Residents' Right : The facility has all the required posts including : Resident's right , non-discrimination notice, Licensing and Long Term Care Poster ..etc. The facility also has internet service shall provide at least one internet access device for resident use to face time with their families or entertainment. 8. Planned Activities: The facility does have sufficient space to accommodate both indoor and outdoor activities 9. Food Service: The facility has sufficient food supply for two days perishable and seven days non-perishable. All the food are stored probably. No residents are on modified diet that prescribed by the doctor. 10. Incident Medical and Dental: The resident medication are centrally stored and locked in the kitchen cabinet. LPA inspected all three (3) residents medication and they all seemed accurate and updated. Each resident has the 30 day supply mediation. Administrator will also provide medical and dental transportation if needed. 11. Disaster Preparedness: The facility has an updated disaster plan dated on 09/22/23. The facility has two alternative temporary shelter location. The last fire/emergency drill was conducted on August 21, 2023. 12. Residents with Special Health Needs: Currently one (1) resident is on home health services for once a week. No resident is on hospice. No resident is under restricted health condition or prohibited health condition. Individual Service Plans and Appraisals are on file. No deficiencies were observed during the visit Exit Interview conducted and A copy of the report was provided to Administratorthe state’s words, verbatim · CDSS document, Sep 22, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kruz Long conducted a site visit for the annual inspection. Upon arriving at the facility, LPA met with Codruta Paula Valenau (Administrator) and explained the purpose of the visit. FACILITY LICENSED TO SERVE ELDERLY RESIDENTS AGE 60 AND ABOVE. FIRE CLEARANCE GRANTED 4 NON-AMBULATORY AND 1 BEDRIDDEN. FACILITY IS 87724 COMPLIANT. FACILITY MAY RETAIN 3 HOSPICE RESIDENTS. During today’s visit, LPA observed the following: Physical Plant and Environmental Safety: Sufficient lighting, non-skid maps in bathroom, comfortable temperature, hot water temperature measured between 105 degree F to 120 degree F in the bathroom, all bathing facilities in operable condition, no bodies of water on the premises, no firearms on the premises, toxins stored inaccessible to residents. Operational Requirements: Facility has an approved fire clearance for non-ambulatory persons and plan for dementia care. Staffing: There is sufficient staff, the administrator is on the premises during normal business hours. Personnel Records - Training: Staff has criminal record clearance, staff have sufficient hours of training. Resident Records/Incident Reports: Admission agreement, medical assessment and appraisal observed. Resident Rights/Information: Complaint poster (PUB 475) posted on wall next to the garage entrance, resident's personal rights in file. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities, furnished areas is provided for relaxation of residents and entertaining friends and relatives. Food Services: Perishable foods are stored in covered containers, toxins are stored separate from foods, kitchen is kept clean. Resident with Special Health Needs: Hospice care plan is current, items that can constitute a danger is inaccessible to residents. Incidental Medical and Dental: Licensee provide assistance in meeting medical and dental needs for residents, all centrally stored medications is labeled and maintained in compliance with state and federal law. Disaster Preparedness: Fire safety plan and emergency exiting plan was observed. Resident roster, appraisal, contact information is readily available during emergencies. No deficiencies were observed during today's visit. Exit interview conducted with Codruta Paula Valenau and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 3, 2022

Allegation investigated: Facility not following Covid-19 protocol.

Licensing Program Analyst (LPA)Christine Wong conducted an initial 10 days investigation to address the above allegation. LPA met with administrator/licensee Codruta Valeanu and explained the reason of the visit. The investigation consisted of the following: LPA interviewed the administrator, three residents (R1-R3) and reviewed residents files. The investigation revealed of the following: In regards to the allegation "Facility not following Covid-19 protocol." LPA interviewed residents and all reported they do not wear mask in the facility as this is their home and they do not need to wear mask. And for the administrator, she does not need to wear mask too as she is the live in staff and she is like their family memebrs. Residents reported all the visitors would wear mask while in the facility and facility does follow the Covid-19 protocol and they all feel comfortable and safe living here. (See LIC 9099C for continuation) Substantiated Administrator also reported that she lives in the home with the residents and they are all like family members, therefore she does not wear mask in the facility. For all visitors, they are all required to have face covering in the facility even they are fully vaccinated. However, when LPA arrived the facility, there's no sign in policy to ensure compliance with entry point for symptom screening and to record contact information. Administrator admitted she did not do it because most of the visitors are the immediate family members for the residents. Based on LPA observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8 are being cited on the attached LIC9099D) Exit interview conducted with Administrator Codrute Valeanu and a copy of this report is being provided. In addition Appeal Rights were given.the state’s words, verbatim · CDSS document, Sep 14, 2022 · control 28-AS-20220909155151

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(c)(1)(F) · Plan of correction due date: Sep 22, 2022

87470 Infection Control Requirements (c)(c) An Infection Control Plan shall be ....shall be included in the Plan of Operation required by Section 87208.(1)(1) The Infection Control Plan shall include all of the following:(F)Staff shall demonstrate knowledge of and skill in infection control, as appropriate to the job assigned and as evidenced by safe and effective job performance The requirement is not met as evidenced by: LPA's observation. LPA observed there was no sign in policy to ensure compliance with entry point for symptom screening and to record contact information which posed a potential risk for residents in care.the state’s words, verbatim · CDSS document, Sep 14, 2022

Plan of correction: The administrator will ensure to follow the infection control plan. The administrator will put the visitors sign in log book by the front door and start checking temperature and symptoms upon entering the facility. The administrator will send the picture to LPA by POC due date. *POC was cleared during the time of the visit."