North County Cottage

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an unannounced annual visit. LPA met with Administrator Mary Jane Estiller, and informed her of the purpose of the visit. Facility is approved for thirteen (13) elderly residents, ages 60 and above; all whom may be non-ambulatory; in which four (4) residents may be bedridden. Facility has a hospice waiver for six (6) residents. LPA conducted resident and staff interviews. The facility is one-story with nine (9) bedrooms and bathrooms in each room. Three (3) rooms are private and the rest are shared, two (2) in each room. There is one main shower room. LPA inspected the facility inside and out. The front entrance, interior and exterior surroundings were inspected and observed to be clean and in good repair with no pathway obstruction; facility's temperature throughout the facility measured at 75 degrees. Facility's water temperature measured at 105.3 degrees. All bathrooms were inspected and observed to be clean with working toilets and sinks. There is sufficient lightings and mattress pads in all of the residents’ bedrooms. Smoke and carbon monoxide detectors were inspected and found to be in working order. LPA inspected the fire extinguishers and they were found to be in compliance. Cleaning solutions were observed in a locked secure area. There were no bodies of water observed on the premise. The facility does not have firearm and/or ammunition on grounds. LPA observed the kitchen area and there are 7 day non-perishable and 2 day of perishable food items was observed and found to be properly stored. All required postings are posted in the hallway area of the facility. Staff records were reviewed. All staff present have a criminal record clearance on file and are properly associated to the facility. Continued 809... Random resident records were reviewed. LPA observed they had the required documentation and physicians reports are up to date. LPA inspected medications and medications appear to be dispensed appropriately according to the physician's orders. Last fire drill was conducted June 27, 2023. No deficiencies were observed during today's annual inspection. An exit interview was conducted and a copy of the report and LIC 811 was provided to Administrator Mary Jane Estiller.the state’s words, verbatim · CDSS document, Jul 20, 2023

Allegation investigated: Unlawful eviction.

Licensing Program Analyst (LPA), Kayla Hilario, conducted an unannounced visit to deliver findings regarding the above-mentioned allegation. LPA was allowed entry, discussed the purpose of the visit, and met with Caregiver Gil Ortega. LPA spoke with Administrator Mari Dee Sandra Cid via telephone and discussed the purpose of the visit and findings. The Department’s investigation included a tour of the facility, observations, records reviews, and interviews with staff and outside sources. Prior to the investigation, LPA interviewed the reporting party and reviewed the facility file. It was alleged that the licensee unlawfully evicted Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1]. On 01/12/2022, R1 was sent to the hospital for evaluation of change in condition. While there, resident tested positive for COVID-19. Resident was medically cleared to return to ***Continued on 9099c***This is an amended version of the original report to include signatures.*** Substantiated the facility on 01/13/2022. Facility staff admittedly refused to allow resident to return to the facility as they reported there was no private isolation room available. Hospital staff corroborated that resident was ready to return to the facility on 01/13/2022 and that R1 no longer met the criteria to be hospitalized. After discussion with a licensing program manager, facility staff arranged an isolation room and planned for the return of R1 to the facility on 01/14/2022. The licensee’s violation was in preventing R1’s discharge back to the facility following medical clearance. Licensee did not serve R1 with either a 30-day notice or a 3-day notice to quit as required by law, nor did the licensee have a valid reason to issue an eviction. California Department of Social Services, Community Care Licensing Division (CCLD), Adult and Senior Care Program, Provider Information Notice (PIN) 20-38 ASC, page seven (7) states that, “Licensees who have difficulties with accepting returned residents who are confirmed COVID-19 positive from a hospital or SNF, should immediately contact the Regional Office and local health department before the resident’s return.” Facility staff did not seek guidance on the return of R1 until the issue was elevated by an outside source. Based on observation, interviews with staff and outside sources, and review of records, a preponderance of evidence exists to substantiate the allegation. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was discussed and reviewed with Administrator Mari Dee Sandra Cid via telephone. An exit interview was conducted with caregiver Gil Ortega to whom a copy of this report, the Confidential Names list (LIC811), PIN 20-38, and the Licensee/Appeal Rights (LIC9058 03/22) were provided via hardcopy at the conclusion of the visit. ***This is an amended version of the original report to include signatures.***the state’s words, verbatim · CDSS document, Sep 22, 2022 · control 08-AS-20220114132002

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Sep 27, 2022

87224 Eviction Procedure: (a) The licensee may evict a resident… Thirty (30) days written notice to the resident is required…This requirement was not met as evidenced by: Based on facility documents and interviews with staff and outside sources, facility staff admittedly did not comply with the Eviction Procedures for 1 of 11 residents. This posed a potential health and safety risk to residents in care. ***This is an amended version of the oringinal report to include signatures.***the state’s words, verbatim · CDSS document, Sep 22, 2022

Plan of correction: Licensee shall review the regulation in its entirety, conduct training to staff, and submit a letter verifying that the regulation is understood by all. Verification to be placed on letterhead, with the training provided, and staff in attendance. Licensee shall submit to letter to LPA by Tuesday 09/27/2022.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Chinwe Nwogene made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by House Manager, Mary Jane Laygo who was informed of the purpose of the visit. At the time of visit there was 1 staff and 12 residents present. The facility currently has zero positive or suspected Covid-19 cases. During today's visit, LPA Nwogene toured the facility inside and out with the Mary Jane and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer and paper towel) in all restrooms. LPA did not observe any pools or bodies of water within the premises. LPA was informed that no weapons or ammunition is maintained at the home. Mary was informed of the annual fees due, Mary stated that annual fees will be paid tomorrow 7/14/2022. The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks. The Facility will contact the resident's physician should there be any event of COVID-19 related illnesses. The facility has a designated infection control lead. The facility also cleans and disinfects the highly touched surfaces during each shift, and as needed. LPA observed PPE supplies. During the tour, LPA Nwogene also observed Kitchen knife laying on the kitchen counter. Mary Jane admitted facility has 3 dementia residents. Citation will be issued. Based on the observations made during today’s visit, the one (#1) deficiency was cited per Title 22, Division 6 of the California Code of Regulations. See LIC 809D. An exit interview was conducted, and a copy of this report was reviewed and provided along with appeal rights to Mary Jane Laygothe state’s words, verbatim · CDSS document, Jul 13, 2022

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Eva Torres conducted an unannounced infection control inspection. LPA met with Administrator Mary Laygo. The purpose of today's visit is to inspect and ensure that the facility is following the California Code of Regulations, Title 22, Division 6. The facility is approved for to serve thirteen (13) non-ambulatory elderly residents, ages 60 and above; in which four (4) out of the thirteen (13) may be bedridden. Facility has a hospice waiver for six (6) residents. Tour included: Infection Control: LPA reviewed and discussed the Mitigation Plan with the administrator. LPA also provided consultation while reviewing the facility's training records, staffing plan, and screening protocols, including but not limited to inspecting their disinfectant supply and the use of personal protective equipment (PPE). The administrator was advised to remain updated on the changes and directions set forth by the department, so that their COVID’s policy reflects the current information on COVID’s guidelines. Physical Plant: front entrance, interior, and exterior surroundings were also observed to be clean with no pathway obstruction. The facility does not have firearms and or ammunition on the grounds. Food Services: There are seven days non-perishable and two days of perishable food supply present, and all food was properly stored and available to residents. Records: The staff that were present at the facility have a criminal background clearance in file and are associated to the facility. All required postings, including COVID’s postings, were posted near the entrance and throughout the facility. The administrator certificate expires on 09/30/21. Based on today’s inspection, there were no deficiencies observed per Title 22 Regulation. LPA conducted an exit interview with the administrator. The Licensee Rights (LIC 9058 01/16) and a copy of this report with the administrator's signature on this form was emailed to them. A reply email or return receipt from the administrator will confirm receipt of documents.the state’s words, verbatim · CDSS document, Jul 6, 2021