M & L South Bay Maxi Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon conducted a 1 year annual visit to the facility above. LPA met with Licensee/Administrator Lita Lazo and explained the purpose of the visit. LPA requested the following records from the Administrator: LIC, 500 Staff Roster, Register of Residents, Emergency & Disaster Plan, Documentation of Quarterly Emergency Drills, Copy of Liability Insurance, Copy of Admission Agreement with Addendums, Copy of Annual Fire Inspection/Certification of Fire System. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current infection Control Plan on file. The facility has a sign in and out note pad with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets need to tight fitting lids. Physical Plant & Environmental Safety: The facility is a 8 bedroom and 10 bathroom currently occupying 5 residents and employs 4 staff. The facility currently has 2 live-in staff. The facility is clean, safe and sanitary. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for residents comfort. The facility kitchen is clean, safe and sanitary. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Continued 809-C Disinfectant, cleaning solutions and poisons are inaccessible to residents in care and locked in garage and locked in cupboards. The facility has sufficient space inside and outside for activities and visiting. The facility has a pathway around the house and a sitting area in front yard for client use with shade. The facility has telephone and internet service for resident use. The facility provides resident with a shared computer with confidential internet access. Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 08/01/2024. The facility is approved for a capacity of 6 Non- Ambulatory, and Hospice approved for 3 residents. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas are kept clean and free from litter, rodents, vermin and insects. Kitchen staff are observed for personal hygiene and food sanitation practices. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers were charged and last inspected 10/22/2022. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. The facility has a generator for emergencies and for back up power outages. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not currently have any residents on oxygen. The facility does not currently have any hospice residents in care. Hospice care plans are kept on file and up to date for any residents on hospice services.. The facility currently has 1 resident on Home Health services. Home Health services records are kept on file. The facility has exiting door alarms for the safety of residents in care. Continued 809-C Staffing: The facility employes 4 staff and 1 Administrators Staff records are kept confidential. LPA will return at a later date to review staff records. Personnel Records & Training: The facility keeps confidential files for each staff member. LPA will return at a later date to review staff training records. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. LPA will return at a later date to review resident records. Incidental Medical & Dental: The facility has a locked medication cupboard in the dining room area. Facility provides transportation or assists in providing transportation to medical and dental appointments when needed. LPA will return at a later date to review medications and medication records. LPA will conduct interview with staff and residents upon return to complete the annual visit. Exit interview conducted, deficiency cited, copy of report and appeal rights printed for Administrator.the state’s words, verbatim · CDSS document, Oct 6, 2023

The state marks this report as 9 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon conducted a 1 year Infection Control Visit to the facility above. LPA met with Lita Lazo, Licensee/Administrator and explained the purpose of the visit. LPA reminded Licensee needs to submit a new LIC. 200 to CCL to remove deceased spouse from the record. Licensee provided certified mailing of renewal for Administrator Certificate. The back up Administrator certificate is valid till 2023. LPA took a physical plant tour of the facility with Licensee. The facility has submitted a mitigation plan to the department and it has been approved. The facility has an entry point at the front door where everyone entering completes sign-in, symptoms and temperature screening. All documentation is kept in binders. The entry station has hand sanitizer along with a thermometer. The facility has a living room to accommodate activities, a dining room for dining, all areas are spaced to accommodate as much space as possible for social distancing. The facility has a large covered patio for resident use. All equipment and PPE supplies are kept in the recreation room. Medications are kept in a locked medication filing cabinets in the family room. The staff screen residents for symptoms and temperature 1x's a day and documentation is kept on file. Increased monitoring is conducted if any change of condition are noted on any residents showing symptoms or has a temperature. Signs are posted on the front door, entry area and walls in common areas regarding Covid-19. Staff makes sure residents have a mask when leaving the facility on outings into the community. All staff wear face coverings in the facility and when on outings with residents. Facility have areas for visiting inside and outside. The facility also offers virtual and telephone communications to all residents in care. Staff, Residents and visitors are informed of the facilities infection control policies. New residents and staff will be tested and negative results received before residing or working in the facility. Cont. 809-C The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed. Emergency Disaster plan is posted and all agencies with telephone numbers are listed. Administrator is in charge of infection control and provides training and education to staff, residents and visitors. Administrator is in charge of staffing and works on any issues or additional coverage. If any suspected or confirmed cases of Covid-19 are found in the facility a staff will be assigned to only work with those quarantined/isolated individuals. Staff will use full PPE with N95 masks and face shields when dealing with any pending or confirmed cases of Covid-19. Facility is able to dedicate a single room for resident so isolation can be arranged when and if needed. The facility has 6 resident bedrooms and 6 resident bathrooms and 1 common area restroom. Restrooms are being disinfected. Precautionary Droplet signs will be posted on any room with quarantine or isolated individuals. PPE supplies will be located right outside those rooms when required. Facility has a 30 day supply of PPE on hand. Facility has plans for delivering medications and meals to any quarantined/isolation resident room. The facility has proper cleaning and disinfectant sprays. Facility Administrator has a plan in place for when and whom to notify in an outbreak or other emergencies. Administrator will keep a line list of all vaccinated and tested staff/residents in care with dates/results. Facility has conducted training on infection prevention, symptoms, transmission and PPE use. Facility has non-punitive sick leave polices for staff. Sick staff are requested to stay home and not report to work if ill. Activities have been modified to individuals or small groups with social distancing. Residents medication is delivered in 30 day supplies to the facility. The facility ensures proper cleaning is done on frequently touched surfaces and between any individuals sharing of space or items. Sinks were well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in locked cabinets in the family room. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. The most stringent orders should be followed by any of these agencies. Fire extinguishers are charged and last inspected on 10/27/2022. Smoke alarms are present in residents rooms and common areas. No deficiencies observed during the visit and all infection control protocols are implemented and are being followed. Exit interview completed and copy of report emailed to Administrator/Licensee.the state’s words, verbatim · CDSS document, Nov 18, 2022