Manor Care Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted by the Administrator Erlina Somera, and the LPA explained the reason for the visit. The LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced within the year. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. The fire alarms/carbon monoxide detectors were tested and functioned properly. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Hot water measured at 105.7-degree Fahrenheit. Medications and first aid kits are located in a locked cabinet near the kitchen area. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Hot water measured at 107.6 degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Continued on LIC 809-C. OUTDOOR SPACE: The facility has a covered outdoor area for residents’ use. There is a gate on the side of the house designated for an emergency exit. There is also a front gate that self-latches. There are no bodies of water on the premises. The garage is not accessible to residents. The LPA observed a shaded sunroom with appropriate furniture and some exercise equipment. LPA observed enough space for residents to conduct some activities and exercise. RECORDS: Records review began at 10:30 a.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 11:19 a.m.; medications are centrally stored and locked in a cabinet in the kitchen area next to the refrigerator; medications are labeled and checked for expiration dates. The medications are documented properly on the centrally stored medications and destruction record. No errors observed during the medication review. The LPA reviewed the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Certificate of Liability of Insurance _ Emergency Drill Logs No citations were issued. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 25, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual visit. At 11:05 a.m., the LPA was greeted by the staff, and the LPA explained the reason for the visit. The staff contacted the Administrator on the phone, and the Administrator arrived shortly thereafter. At 11: 10 p.m., the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. At 11: 45 a.m., the LPA observed five (5) residents at the facility at the time of the inspection. The facility is licensed for four (4) residents. The LPA conducted residents’ interviews. Per the resident, the resident stated that they were brought to this facility for a few days (a week), and that they were going to be moved to another house in San Diego, CA. At the time of the inspection, the LPA observed a staff person from a congregate house arrive at the facility to pick up the resident not admitted to this facility. Per the staff, they were moving the ‘resident’ to another congregate house. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last purchased on 10/10/2023. Exit has functioning auditory devices; however the devices were turned off. The fire alarm/ carbon monoxide detectors were tested and functioned properly. Medications and first aid kits are located in a locked cabinet near the kitchen. Laundry units are located inside laundry room near the kitchen area. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away inside the laundry room cabinets. KITCHEN: The LPA observed the kitchen/dining area. Knives were observed in two unlocked kitchen drawers, and a pair of sharp scissors on top of the kitchen counter top. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Continues on LIC 809C... BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, three (3) for resident use and two (2) for staff use. The LPA observed residents’ bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are five beds. Room number three closet is blocked by one bed. The bed will need to be removed, as the facility is only licensed for four (4) residents. The staff's bedroom door, at the end of the hallway (next to room#3), was observed to be unlocked, and it was observed to have many personal items and other items, potentially dangerous for residents in care. Inside temperature was maintained at a comfortable level. Bedroom #2 was observed to have a camera monitor. The Administrator removed the camera monitor at the time of the inspection. RESTROOMS: Restroom is relatively clean and sanitary and in operating condition with grab bars and non-skid mats. The sinks had sufficient liquid soap, and paper towels. The LPA observed the staff’s bathroom to be unlocked and accessible to residents in care. The restroom had personal grooming items (razors) and chemicals accessible to residents in care. OUTDOOR SPACE: At 11:45 a.m., the LPA observed the backyard to be unavailable to residents in care due to construction, furthermore the front yard area did not have a shaded area for residents’ use. The front of the facility did not have a ramp accessible for residents to exit to the front yard and have outdoor time. Both sides (left and right) passageways to the facility were obstructed at the time of the visit. The LPA had a conversation with the Administrator regarding the construction taking place in the backyard without a permit. The administrator stated that they had informed (verbally) the department about the construction. The LPA informed the Administrator about informing the department through an official letter and to provide proof of a building permit. PATIO ROOM: The LPA observed a patio area next to the living room. The LPA observed a gas hotplate, and which was observed to be warm. The Administrator stated that the hot plate is used to cook meals that may give a strong odor to the rest of the house. The patio was observed to have many items that pose an immediate danger to residents in care. There are no bodies of water on the premises. A detached garage was observed. The garage door was unlocked and potentially accessible to residents in care. Due to time constraints, LPA Urena will return on another date to complete the Annual inspection. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 3, 2024

Allegation investigated: Licensee does not ensure staff are properly trained

Licensing Program Analyst (LPA), Esther Cortez conducted an unannounced initial 10-day complaint visit for the above allegation. The LPA met with administrator Erlina Somera and was explained the reason for the visit. During today's inspection, between 10:00 a.m. and 12:30 p.m., the LPA briefly toured the facility with the administrator, interviewed the Administrator, conducted a file review, and obtained copies of pertinent documents relevant to the investigation. On the allegation that the Licensee does not ensure staff are properly trained; it is the concern of the reporting party that the administrator doesn't really train staff and just provides paper work. File review revealed that staff #1 (S1) is missing 4 hours of Postural supports, restricted health conditions, and hospice required training, in addition to 6 hours of hands-on training. Based on the information obtained, the allegation is deemed Substantiated at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D). Exit interview conducted. Copy of report and Appeal Rights issued at the time of the visit. Substantiatedthe state’s words, verbatim · CDSS document, Jul 31, 2024 · control 29-AS-20240723095720

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c) · Plan of correction due date: Aug 14, 2024

87411(c) Personnel Requirements. All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625… This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above when S1 did not have 4 hours of training in postural supports, restricted health conditions, hospice, and 6 hrs of hands on training which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 31, 2024

Plan of correction: Administrator agrees to have S1 fully trained and submit proof to CCL by 08/14/2024.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:30 a.m., the LPA met with the Administrator and explained the reason for the visit. RECORD REVIEW: Between 9:45 a.m. and 11:00 a.m., the LPA conducted a file review for all residents and staff. Staff records were reviewed for documents including, but not limited to health screening, TB test, staff training records, and fingerprint clearance. The LPA could not identify staff records, including Administrator records. The Administrator’s Certificate expires 02/27/2024. In addition, the LPA was unable to identify the completed twenty (20) hours of annual training for the Administrator. The Administrator is in the process of hiring caregivers. No other staff records were presented. The LPA had several conversations with the Administrator with the goal of providing education in regard to staff records and training. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. The following was noted: One (1) out of four (4) residents with dementia diagnosis did not have updated physician’s report/ medical assessments. Four (4) out of four (4) residents require updated appraisals/needs and service plan. Additionally, the LPA requested updated copy of valid liability insurance and Facility Emergency Plan. At 12:46 p.m., the LPA, along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. At 12:53 p.m., the LPA conducted interviews one (1) resident and attempted to interview an additional two (2) residents. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 12:49 p.m., hot water measured at 96.1-degree Fahrenheit. The Administrator stated that they will adjust the water temperature between 105 and 120- degree Fahrenheit. Continued on LIC 809-C. BEDROOMS: The facility is a single-story residential home with five (5) bedrooms, three (3) for resident use and two (2) for staff use. The facility has three (3) bathrooms, one (1) for resident use and two (2) for staff use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. The LPA had a conversation with the Administrator regarding the second staff room. The second staff room was built without a permit and the Administrator will obtain the building permit. RESTROOMS: Restroom is relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 1:02 p.m. hot water measured at 96.4-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: At 1:09 p.m., the LPA observed the back of the facility which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. There is also a front gate that self-latches. There are no bodies of water on the premises. The garage is not accessible to residents. The Administrator did not have access to the garage during the time of the visit. The LPA observed a shaded sunroom with appropriate furniture and some exercise equipment. LPA observed enough space for residents to conduct some activities and exercise. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last purchased on 10/10/2023. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. Exit has functioning auditory devices. At 1:12 p.m., fire alarm/ carbon monoxide detectors were tested and functioned properly. Medications and first aid kits are located in a locked cabinet near the kitchen. Laundry units are located inside laundry room near the kitchen area. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away inside the laundry room cabinets. At 2:00 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for four (4) residents and observed that all medications were properly documented. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiencies were cited (refer to LIC 809-D). The Administrator was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Oct 10, 2023