Mountain View Cottages - I

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required-1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. LPA was met by Jennifer Discipulo and Rafia Kaysha Dinda Oktiafaza, Caregivers and explained the purpose of the visit. At 1:30pm, Jasbindar Singh, Administrator arrived and assisted LPA. The facility is license to serve (6) non ambulatory residents age 60 and above. Facility may retain (6) hospice residents. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control:Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are adhering to infection control requirements. The facility has an Infection Control Plan and reviews the infection control procedures in the facility annually. Operational Requirements: The Infection Control Plan has been added to the Plan. Liability Insurance policy in the amount of $1,000,000.00 each occurrence and $3,000,000.00 in the total annual aggregate is valid, expires on 03/09/2026. Facility does not handle residents' cash resources. Physical Plant & Environment Safety: This facility is a single story home consists of (5) resident bedrooms, (1) staff bedroom, (3) bathrooms, living room, family room, kitchen, dining room and backyard. There are (4) residents residing in the home. Resident bedrooms were toured. All bedrooms have sufficient storage space and lighting. Bathrooms have grab bars and non-skid mats. Knives, cleaning solutions, and disinfectants are locked and inaccessible to residents. There is a carbon monoxide detector located near the kitchen and smoke detectors are operable. LPA observed a fire extinguisher near the family room which was last serviced on 02/18/2025. Water temperature readings are within the required 105 - 120 degrees Fahrenheit. Indoor passageways were kept free of any obstruction and there are no pools or large bodies of water. Backyard was inspected and LPA observed boxes of miscellaneous items obstructing the passageways in the backyard and side yard. There is a sitting area with outdoor furniture but there is no umbrella or shade provided.*****Refer to LIC 809C for the continuation of this report.***** Staffing: A total of (4) staff members including the night staff and Administrator provide care and supervision to the residents. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have training and associated to the facility. Current Administrator's certificate is valid, expires on 04/11/2027. Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed (4) staff files including the Administrator. Proof of staff training, health clearance, and vaccinations are current. Dementia care is part of training for direct care staff. Resident Rights-Information: Resident rights are posted. Facility provides internet service and phone to the residents. Planned Activities: The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: There is sufficient food supplies of 2-day perishable and 7-day supplies of non-perishable items. The food is properly stored in the refrigerator. Pesticides and cleaning supplies are kept away from the food preparation areas. There is one (1) resident with restricted diet residing at this facility. Incidental Medical Services: The medications are centrally stored and in their original containers. The facility uses the Medication Administration Record (MAR) log to document medications given. Resident Records-Incident Reports: LPA reviewed (4) resident files. Residents files are maintained at the facility. Physician's Report (including TB and Ambulatory Status), Consent For Medical Treatment, Special Incident Reports, Client Personal Property and Clients Personal Rights observed. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan which is posted. Disaster drills are conducted quarterly, last drill was conducted on 12/01/2025. Residents with SHN: Facility accepts and retains residents with dementia. Currently, there are (3) dementia residents and (1) hospice resident in the facility. Facility has sufficient space to permit residents with dementia to wander freely and safely. Administrator ensures that there is at least one night staff person awake and on duty for night supervision of residents with dementia. (1) of the residents using half bed rail did not have a physician's order on file. Deficiencies cited on LIC 809D, Technical Violations and Technical Assistance issued. Exit interview, appeals rights and a copy this report was provided to Administrator, Jasbindar SIngh.the state’s words, verbatim · CDSS document, Jan 9, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection on 12/6/24. LPA met with Staff, Jennifer Discipulo, and explained the reason for the visit. Administrator, Jas Singh, arrived shortly after to assist with the visit. The facility is licensed to serve 6 non-ambulatory residents ages 60 and over. There is an approved hospice waiver for 6 residents. LPA conducted a tour, reviewed files and medications using the Compliance and Regulatory Enforcement (CARE) tools. The faciity consists of 5 resident bedrooms, 1 staff room, 3 bathrooms, living room, dining room, family room, kitchen, and laundry area. The backyard has a shaded area with table and chairs for residents to use. The bedrooms have sufficient storage space and lighting. Bathrooms have grab bars and non-skid mats. There are extra clean linens stored in the cabinet. Knives and cleaning products are locked. There is a carbon monoxide detector located near the kitchen and smoke detectors are operable. Sufficient food supplies are observed. The hot water temperature was measured at 127.4 degrees F which is above the required range. LPA reviewed all 6 resident files and their medications. The files contain the required documents and medications are being given as prescribed. The resident rights, local ombudsman, and licensing posters are located in a prominent area. LPA reviewed 3 personnel files. The administrator's (Jas Singh) certificate expires on 4/11/25. Staff have current CPR & First Aid certificates. Files contain the health screening with TB test results, personnel report, and annual training verification. Facility accepts and retains residents with dementia. There are no residents on hospice at this time but some are receiving home health services. No residents have a restricted or prohibited health condition. The facility has the updated Emergency Disaster Plan and signed annual by the administrator. Disaster drills are being provided to staff. A deficiency is being issued on the LIC809D. An exit interview was held and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Dec 6, 2024

Allegation investigated: Staff did not provide a comfortable temperature for a resident.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with Staff, Jacqueline Runtukahu. The purpose for the visit was explained. LPA obtained copies of the staff and resident rosters, toured the facility, and conducted interviews. Allegation - Staff did not provide a comfortable temperature for a resident. It is alleged that the facility has no air conditioning and is intolerable. LPA interviewed the Administrator, Staff #1 - #2, and Residents #1 - #5. The administrator and staff acknowledged that the facility was quite warm earlier this week due to the air conditioner not working properly. Administrator stated she immediately contacted the maintenance personnel to fix the air conditioner when staff reported it not working on 6/13/24. Substantiated Administrator confirmed the facility was quite warm during her visit and provided fans for residents to use. Staff stated they turned on the air conditioner as the temperature became warmer on 6/13/24 and discovered it was not blowing out cool air. Staff indicated visitors also stated the facility was quite warm. According to AccuWeather, the temperature in the area was in the mid 80s during that week. Staff stated the air conditioner has been fixed as of 6/19/24. According to residents, some complain about feeling either hot or cold. When feeling cold, they add extra layers or use a blanket to stay warm. During the visit, LPA toured the facility and checked the thermostat. The air conditioner is working properly, and the facility is at a comfortable temperature. Based on interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 20, 2024 · control 28-AS-20240618001037

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 20, 2024

87303 Maintenance and Operation (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. Based on interviews conducted, the licensee did not ensure the air conditioner is working properly which poses a potential health, safety, and personal rights to residents in care.the state’s words, verbatim · CDSS document, Jun 20, 2024

Plan of correction: The licensee shall ensure the air conditioner is in good repair at all times and submit proof of repair. **The POC has been cleared as of today. LPA observed the air conditioner working.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection on 12/12/23. LPA arrived unannounced and met with staff, Jacqueline Runtukahu. The reason for the visit was explained. Administrator, Jas Singh, arrived shortly after to assist with the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) Tools. The following were observed: Infection Control: The facility has submitted an Infection Control Plan. Staff are continuing to clean and disinfect the home. They are using appropriate hand hygiene and wearing gloves while assisting residents. Operational Requirements: The facility has a dementia care plan to accept or retain residents with dementia. There are no residents utilizing oxygen at this time. Facility has the required amount of liability insurance coverage. Physical Plant & Environment Safety: The facility consists of 5 resident rooms, 1 Staff room, living room, dining room, family room, kitchen, 3 bathrooms, and attached garage. The hot water temperature was measured between the required range of 105-120 degrees F. There are no swimming pool or bodies of water on the premises. The fireplace is adequately screened. There are smoke detectors located in each bedroom. Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. The food are properly stored in the refrigerator. Staffing: The facility has sufficient staffing to meet the needs of the residents. All staff members have current CPR & First Aid certificates. Personnel Records-Training: LPA reviewed 3 Staff files. The administrator's (Jasbindar Singh) certificate expires on 4/11/25. Staff have fingerprint clearance and associated to the facility. Staff files have the required documents such as personnel record, health screening with TB results, employee rights form, and in-service training. Staff also have appropriate dementia care training. Resident Records-Incident Reports: LPA reviewed 2 resident files. The files contain the admission agreement, medical assessment with TB results, consent forms, property valuable form, preappraisal form, and personal rights form. Resident Rights-Information: Information for appropriate reporting agencies are posted at the facility. Residents' rights are respected and implemented by staff. Planned Activities: Facility has sufficient space to provide indoor and outdoor activities to accommodate residents. Incidental Medical and Dental: LPA reviewed medications for both residents and are being administered as prescribed. Disaster Preparedness: The facility has an Emergency Disaster Plan posted with contact numbers and at least 2 relocation sites. Emergency procedures are indicated on the form. Disaster drills are conducted and documented quarterly. Residents with Special Health Needs: Facility accepts and retains residents with dementia. Staff are ensuring that incontinence residents are changed often and the facility remains free of odor from incontinence. There are no residents currently with prohibited or restricted health conditions. No deficiencies were issued today. An exit interview was held and a copy of this report was given to the administrator.the state’s words, verbatim · CDSS document, Dec 12, 2023