Marston

Allegation investigated: Staff did not ensure that facility medicine cabinet has a lock

On 09/15/2023 at 1:05 PM, Licensing Program Analysts (LPA), J. Clancy-Czuleger and Alona Gomez arrived unannounced to deliver complaint findings for the above allegations. LPA met with Kristabelle Alatas, Corperate board member and explained the reason for the visit. During the course of investigation, LPA obtained information, collected documents and interviewed _ staff. Based on LPA observation the facility is not locking the medication cabinet in a way that is inacsessable to the residents. There is a chain wraped around the knobs that falls off with the lightest touch. On the allegation facility staff did not ensure that facility medicine cabinet has a lock the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22 has been cited. Exit interview conducted. A copy appeal rights, and this report provided. Substantiatedthe state’s words, verbatim · CDSS document, Sep 15, 2023 · control 15-AS-20230912113556

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Sep 18, 2023

Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: The facilities medication cabinet not locked properly and has a chain wraped around the knobs that falls off with the lightest touchthe state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: The facility agrees to relocate the medications to a locked location that is not accessible to persons in care. Proof of correction will be sent to CCLD by POC date.

Type of visit: Case Management - Deficiencies

On 05/07/2021, Licensing Program Analysts (LPA) J. Clancy-Czuleger and Alona Gomez conducted a Case Management with in relation to the Special incident report submitted on 09/06/2023. During interview and record review it was determined that medication was given to R1 that was intended for R2. The facility w The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 15, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Sep 16, 2023

If the resident's physician has stated in writing that the resident is unable to determine ... facility staff designated by the licensee shall be permitted to assist the resident ...Once ordered by the physician the medication is given according to the physician's directions. requirement is not met as evidenced by: The staff gave the resident the wrong medicationthe state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: The facility will conduct an all staff training relating to medications and how to dispense it. Proof of correction will be sent to CCLD by POC date.

Type of visit: Case Management - Deficiencies

On 09/15/2023 at 1:05 PM Licensing Program Analysts (LPA) J. Clancy-Czuleger and Alona Gomez arrived unannounced to conduct a Case Management. LPA met with Kristabelle Alatas, Corporate board member. While LPA J. Clancy-Czuleger conducted a complaint investigation (15-AS-20230912113556) LPA observed the following deficiencies: Knifes and chemical cleaners were observed unlocked in the garage, bathrooms, bedroom and kitchen One of the resident records was not complete Two staff were not associated to the facility The facility does not have enough perishable foods Resident has oxygen and no sign Water temperature was measured at 134.1 degree F Ripped window screen in bedroom Fridge temperature is not below 40 F The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 15, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Sep 16, 2023

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Knifes and chemical cleaners were observed unlocked in the garage, bathrooms, bedroom and kitchenthe state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: The facility will lock up knifes and sharpe objects. The facility will also collect all chemicals from each room and lock them in a centerally stored location. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87506(a) · Plan of correction due date: Sep 16, 2023

The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: The facility staff was putting together the one of the resident records after the LPA asked for it, and gave it saying that it was not complete yet.the state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: The facility will complete the resident record Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)2) · Plan of correction due date: Sep 19, 2023

All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility:Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Two staff are not associated to the facility.the state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: The Administrator will submit a transfer request form with current I.D. to associate S2 and S3 to the facility by due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Sep 27, 2023

Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: The kitchen, and food storage areas do not have a enough nonperishable foodsthe state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: The facility will purchese more nonperishable foods. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(21) · Plan of correction due date: Sep 27, 2023

...refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. This requirement is not met as evidenced by: The temperature in the garage fridge was measured at 45 Degree Fthe state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: The facility will adjust the tempature of the garage fridge or discontinue use of the fridge. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87618(b)(3)(B) · Plan of correction due date: Sep 27, 2023

Ensuring that the use of oxygen equipment meets the following requirements: "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Containers of oxygen are being stored in the closet of one of the bedrooms.the state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: The facility agrees to add signs stating "No Smoking-Oxygen in Use" or remove the oxygen containers. Proof of correction will be sent to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(e)(2) · Plan of correction due date: Sep 15, 2023

Faucets used by residents shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F and not more than 120 degree F requirement is not met as evidenced by: Water temperature was measured at 134.1 F.the state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: POC cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87303(c) · Plan of correction due date: Sep 27, 2023

All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: The window screen in the back bedroom is rippedthe state’s words, verbatim · CDSS document, Sep 15, 2023

Plan of correction: The facility agrees to repair or replace the screen. Proof of correction will be sent to CCLD by POC date.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jill Clancy-Czuleger, conducted an unannounced pre-licensing inspection. License application is for 6 total capacity, of which 5 maybe non-ambulatory and 1 maybe bedridden. Fire clearance was granted on August 22,2022. LPA met with Cynthia Dinglasan administrator. LPA inspected the facility inside and out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. Fire extinguishers were observed fully charge and tags showed serviced February 22, 2022. The two-in-one carbon monoxide and smoke detector tested and observed functional. First aid kit checked and observed complete with manual. Hot water temperature in one of the bathrooms tested and measured at 110.4 degrees Fahrenheit. LPA observed Personal Protective Equipment (PPE) for residents, staff and visitors and a PPE station to monitor and record all incoming visitors. Continued on 809C... Continued from 809... Comp III was discussed with Applicant. No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Centralized Application Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. Exit interview conducted and a copy of this report will be given.the state’s words, verbatim · CDSS document, Dec 6, 2022

Type of visit: Office

Component II completion: Successful Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Ronald Uy (applicant/licensee, administrator) Interview Method: Telephone interview On 08/29/22, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Aug 29, 2022