M&M Board & Care

Type of visit: Required - 1 Year

On 07/27/23, Licensing Program Analyst (LPA) Michelle Echeverria arrived unannounced to conduct the required annual visit to the facility. LPA met with Administrator, Victor Mercado and introduced self and stated the purpose of the visit. LPA was informed that there are currently 3 residents in care who will be leaving shortly to senior program. The facility has 4 resident bedrooms, 2 resident bathrooms, 2 staff bedrooms, 1 staff bathroom, living room, kitchen, dining area, laundry room, backyard and 2 storage sheds. LPA completed a walk through of the facility and review of records. Physical Plant: The facility is maintained at a comfortable temperature of 78 degrees farenheit. LPA inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, chairs and sufficient lighting. LPA inspected resident bathrooms; bathrooms were clean and appliances were found functional. LPA observed a trash can in resident's bathroom without a tight-fitting cover. Deficiency issued. Water temperature tested at 116.9 degrees farenheit. The facility is equipped with operational smoke detectors, carbon monoxide alarms and 3 fire extinguishers. Posters such as; the personal rights, CCL complaint poster and ombudsman were posted in a common area. LPA observed the emergency and disaster plan missing. Deficiency issued. LPA also observed an old facility license with the incorrect capacity number posted. Technical violation issued. LPA observed chemicals left unlocked underneath kitchen sink, knives and medication unlocked inside kitchen drawers. Deficiency issued. There was a designated storage space for residents/staff files. First aid kit was observed in a locked closet inaccessible to residents. There are no pools, bodies of water, firearms or ammunition. There are no obstructions to indoor and outdoor passageways. The facility is not clean, in good repair, and operating in safe conditions for residents in care. LPA observed counters with food crumbs, refrigerator with moldy liquid and stains inside, greasy stove with fan, dirty floors, and dead flies by windows. Deficiency issued. Food Service: There is a 7 day supply of non-perishable food. LPA observed that there is not a 2 day supply of perishable food for number of residents in care. Deficiency issued. Dishes, cups, and utensils were stored properly. Yards/Outside: One shaded patio, two sheds, and a side gate with self-latching handle on the right side of the house that leads into the backyard. Record Review: LPA reviewed residents files for admission agreements, updated physician reports, and needs and services plans. LPA observed a missing and incomplete record for 2 residents. Deficiency issued. LPA reviewed the Administrator's record for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. LPA observed that the Administrator's CPR and First Aid certification expired on April of 2017. Deficiency issued. LPA also observed the Administrator's certificate expired on 04/10/2017. Deficiency issued. Per interview, observation and record review, Administrator stated that his mother and aunt sleep over during some weekends. Mother and aunt do not have criminal record clearance. Deficiency with civil penalty issued. One technical violation, deficiencies and civil penalties were cited during this visit. An exit interview was conducted where this report LIC809, LIC809C, LIC809D, LIC9102TV, LIC421BG and appeal rights were discussed and copies were provided to the Administrator, Victor Mercado.the state’s words, verbatim · CDSS document, Jul 27, 2023

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 05/24/2023 at 09:59 a.m., Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to obtain signatures on amended LIC 9099. LPA met with Licensee/Administrator Victor Mercado and explained the purpose of the visit. An exit interview was conducted and a copy of this report and amended LIC 9099 were provided to Mercadothe state’s words, verbatim · CDSS document, May 24, 2023

Allegation investigated: Facility staff did not follow reporting requirements.

Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegation. LPA met with Victor Mercado and explained the purpose of the visit. The investigation consisted of file reviews and interviews with relevant parties. The allegation alleged that resident # 1 (R1) fell in the community on March 29, 2023. The allegation alleged that both the administrator and R1 stated that R1 received medical treatment for the fall; however, the administrator failed to report the incident to Community Care Licensing Division (CCLD) and other agencies. Title 22 of the California Code of Regulations (CCR), Section 87211 Reporting Requirements (a)(1) states, “A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence…”. The Licensee did not violate regulation because CCLD received this allegation from the reporting party (RP) on April 3, 2023, five (5) days after the incident. The Licensee had until April 5, 2023, to report the incident. Unfounded This agency has investigated the complaint allegations. We have found that the complaint was unfounded meaning that the allegations were false, could not have happened and/or are without a reasonable basis. We have therefore dismissed the complaint.the state’s words, verbatim · CDSS document, Apr 5, 2023 · control 56-AS-20230403100950

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rayshaun Nickolas conducted a case management deficiency visit. The case management visit is in response to a deficiency cited at the facility. LPA met with Licensee Victor Mercado and explained the purpose of the visit. During a facility file review, LPA discovered that the facility had not reported any unusual incident or injury to Community Care Licensing Division (CCLD) since November 2020. LPA also observed a bedroom window covered with window film installation and card board. LPA interview with the Licensee revealed that the window is broken. The Licensee also stated that they are in the process of getting the window repaired. However, the Licensee was unable to prove that they are in the process of repairing the window. Based on observations made during today, two (2) deficiencies was cited per Title 22, Division 6, of the California Code of Regulations (CCR), Sections 87211 Reporting Requirements and Section 87303 Maintenance and Operation (a). . An exit interview was conducted and a copy of this report, LIC 809D, and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Apr 5, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211 · Plan of correction due date: Apr 17, 2023

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following... This requirement was not met as evidenced by. Based on file review, the licensee did not ensure to report any unusual incidents or injuries since November 2020, which poses a health, safety, personal rights violation to clients in care.the state’s words, verbatim · CDSS document, Apr 5, 2023

Plan of correction: The licensee shall provide training in the section cited to all staff. Licensee shall submit a letter of understanding to the Regional Office (RO) with training records by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: May 5, 2023

87303 Maintenance and Operation (a) (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 observation, the Licensee did not ensure to maintain the facility in good repair, which poses a health, safety, personal rights violation to clients in care.the state’s words, verbatim · CDSS document, Apr 5, 2023

Plan of correction: The Licensee shall repair the bedroom window by the POC due date. If the Licensee is unable to have the window repaired due to supply chain or repairman issues, the Licensee shall submit proof that the repair is in process by submitting a receipt to the RO by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rayshaun Nickolas conducted an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Nickolas arrived and met with Administrator, Victor Mercado. The administrator confirmed that there are currently no cases/exposures of COVID-19 within the facility. During the inspection, LPA Nickolas conducted a tour of the facility and made observations pertaining to the facility's infection control measures and other health and safety concerns. LPA Nickolas observed appropriate postings throughout the facility, including hand-washing etiquette, face coverings, and COVID-19 symptoms postings. The facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). LPA observed that the facility staff were wearing face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms. LPA observed resident lying on feces stained bedspread. LPA observed a dishwasher, mattress, crutches, and wheel chairs stored in the backyard. LPA observed heavily stained kitchen cabinets and counter tops. LPA was unable to locate the emergency disaster plan (LIC 610E) and Mercado confirmed that the facility has not completed the emergency disaster plan (LIC 610E). Based on observations made during today’s inspection, three deficiencies was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report was discussed, and a copy of this report was provided to Mercado at the conclusion of the inspection.the state’s words, verbatim · CDSS document, May 25, 2022