Motherly Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Andrew Martinez made an unannounced visit to conduct a required annual comprehensive inspection of the facility. LPA Martinez met with, explained the purpose of the visit to, and was granted entry into the facility by Director/Administrator Aurea Arquisola. Two (2) staff and (2) residents were present at time of visit. Facility is operating in the capacity approved by Community Care Licensing Division (CCLD); licensed for capacity of three (3) residents-- fire clearance for one (1) ambulatory and two (2) non-ambulatory, (1) of which can be bedridden in Room #1. Facility has hospice waiver for (3). LPA was accompanied by Director/ Administrator Arquisola to conduct a general inspection, which included, but was not limited to the following: Physical Plant: The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room, laundry area and attached two (2) car garage. LPA observed bedrooms designated for resident’s use are rooms #1 and #2; Bedrooms #3, #4, and #5 are being used by Licensee and family; all adults residing in home have appropriate criminal background clearances and associations to facility. LPA observed no obstructions to indoor passageways. Obstructions to outdoor passageway observed on left side of house. Technical Violation (TV) deficiency to be issued. The facility indoor temperature was maintained at a comfortable 75 degrees Fahrenheit. LPA inspected resident bedrooms to be equipped with sufficient lighting as well as required furniture (e.g., mattresses, nightstands and storage space). LPA observed bathrooms were clean and appliances were operating appropriately. LPA observed grab bars and non-skid mat in the resident bathrooms. Hot water temperatures measured at 107.2, 112.1, and 106.4 degrees Fahrenheit. The facility maintains an adequate supply of extra linens and towels. *** Continued on LIC 809C *** LPA observed a sufficient supply of hygiene items stored for residents use. The facility has sufficient furniture and space at the facility to accommodate persons in care. The facility is equipped with operating combined smoke detectors and carbon monoxide alarms. Posters such as personal rights, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. LPA observed the CCLD complaint poster to be the incorrect size per regulation, and there was no conspicuous posting of the facility's approved admissions agreement. Two (2) TV deficiencies will be cited. There was a designated storage space for resident/staff files, and a cabinet with the resident’s medications locked in the hallway. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. LPA observed frozen foods in storage freezer located in garage to be improperly stored, in uncovered containers. A TV deficiency will be issued. Care & Supervision: The facility has an administrator present in the facility during the visit and the facility's LIC 500 indicated staff are scheduled for 24/7 care and supervision of residents in care. However, Director/Administrator Arquinsola was unable to provide documentation that indicates (1) of (2) staff persons scheduled to work the night shift are qualified to provide night supervision, are familiar with the facility's planned emergency procedures, and no have proof that staff persons are trained in first aid. One (1) type A deficiency will be issued. Resident Record Review: LPA reviewed (2) resident files for admission agreements, updated physician reports, pre-placement appraisal, centrally stored medication list and needs and services plans. LPA observed that Director/Administrator Arquinsola has not completed the required Reappraisals or Needs and Services Plans for (2) of (2) residents. Two (2) type B deficiencies will be issued. LPA audited medications for (2) of (2) residents and observed medications and records to be completed and dispensed accurately. Staff Record Review: LPA requested review of personnel files for (4) of (4) staff listed on facility's LIC 500 for First Aid/CPR certification, criminal record clearance, training, and health screenings with tuberculosis (TB) test results. Director/Administrator indicated that (2) of (4) persons listed on LIC 500 do not have personnel files, and therefore there is no documentation of Health Screening records of (2) staff. Two (2) type A deficiencies will be issued. LPA also observed (4) out of (4) staff do not have valid/unexpired First Aid/CPR certifications. Another type A deficiency will be issued. *** Continued on LIC 809C *** Facility Record Review: LPA reviewed facility's quarterly disaster drill records which revealed the facility has only conducted fire drills for over the past year, has not varied the type of drill from quarter to quarter to take into account different emergency scenarios, and has not included all personnel listed on the facility's LIC 500. One (1) TV deficiency will be issued. LPA observed current liability insurance for facility. Based on today's observation, interviews and record review, four (4) type A, two (2) type B, and five (5) Technical Violation (TV) deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations An exit interview was conducted where this Facility Evaluation Report (LIC 809), Deficiency & Plans of Correction (LIC 809D), Technical Violations/Assistances (LIC 9102), and Appeal Rights, were discussed with and copies provided to Director/Administrator Aurea Arquisola.the state’s words, verbatim · CDSS document, Jul 8, 2026

The state marks this report as 17 pages; the online copy we transcribed has 8. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 09/22/2024 at 11:15 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA Brown met with Licensee/Administrator Aurea Arquisola and was granted entry to the facility. At the time of the visit there was one (1) staff present, and one (1) resident present. LPA Brown explained the purpose of the visit to Licensee/Administrator Arquisola. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room, laundry area and attached two (2) car garage. The facility is Residential Care Facility for the Elderly (RCFE). Facility is Licensed for a capacity of three (3) residents, with a fire clearance for one (1) ambulatory and two (2) non-ambulatory of which one (1) can be bedridden in room #1. Facility has current hospice waiver for three (3). At the time of the visit census was one (1) resident. LPA Brown was accompanied by Licensee/Administrator Arquisola to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). LPA Brown observed no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 76 degrees Fahrenheit. LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, lamps, night stands and storage space. LPA Brown observed sufficient lightning. Moreover, LPA Brown observed that bathrooms were clean, and appliances were operating appropriately. LPA Brown observed grab bars and non-skid mat in the resident bathrooms. Hot water temperature was measured in resident’s bathroom and observed 106 degrees Fahrenheit. In addition, LPA Brown observed bedrooms designated for resident’s use are room #1 and room #2. Bedrooms # 3, #4, and #5 are currently been used by Licensee and family, all adults residing in home have appropriate criminal background clearances and associations to facility. LPA Brown observed an adequate supply of extra linens and towels. ***Continuation in LIC809C *** LPA observed a sufficient supply of hygiene items stored for residents use. However, LPA Brown observed no night lights maintained in hallways and passages to nonprivate bathrooms. Deficiency will be issued. Also, LPA Brown observed Resident #1 (R1) has half bed rails. Licensee/Administrator Arquisola reported to LPA Brown that R1 does not have written order from R1 physician indicating the need for half bed rail for mobility. Deficiency will be issued. Moreover, LPA Brown observed sufficient furniture at the facility. To add to that, the facility is equipped with operating combined smoke detectors and carbon monoxide alarms. However, LPA Brown observed no auditory device or other staff alert feature to monitor exits. Deficiency will be issued. Posters such as personal rights, the CCLD complaint poster, Ombudsman Poster and the Emergency Disaster plan were posted in a common area. There was a designated storage space for resident/staff files. There is a cabinet with the resident’s medications locked in the hallway. Food Service: Seven (7) days non-perishable and two (2) days perishable food supply observed at the facility. Care & Supervision: The facility has an administrator present in the facility during the visit. However, LPA Brown observed no sufficient number of staff to provide care and supervision to the resident in care as no staff's scheduled to work the night shift, awake and on duty as required for facility with dementia resident. Deficiency will be issued. Record Review: LPA Brown observed no Infection Control Plan developed by the Licensee at the facility. Deficiency will be issued. LPA reviewed one (1) resident file for admission agreements, updated physician reports, pre-placement appraisal, centrally stored medication list and needs and services plans. LPA Brown observed that Licensee/Administrator Arquinsola did not complete the required Pre-Admission Appraisal for Resident #1 (R1). Deficiency will be issued. LPA Brown observed R1 does not have the required annual medical assessment for resident with dementia. Deficiency will be issued. LPA reviewed two (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test results. LPA Brown observed records reviewed were complete. LPA Brown audited Resident #1 (R1) medications and LPA Brown observed four (4) of R1's medication were not given per R1's physician order. Deficiency will be issued. An exit interview was conducted where this report (LIC809), LIC809D, LIC9102 and Appeal Rights were discussed and provided to Licensee/Administrator Aurea Arquisola.the state’s words, verbatim · CDSS document, Sep 22, 2024

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.