Paradise Manor

Allegation investigated: The facility bathroom has mold.

LIcensing Program ANalyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the invstigation finding and met with House Manager (HM) Melanie Gavina. On 12/21/2021, the Department received a complaint with the allegation that the facility bathroom has mold. On 12/27/2021, LPA conducted an initial investigation visit, toured the facility, inspected the food supplies, and interviewed ADM, 3 staff (S1 - S3), and 6 residents (R1 - R6). Continue on LIC9099-C. Page 1 of 2. Substantiated The facility bathroom has mold: On 12/27/2021, LPA interviewed 6 residents (R1 - R6). 5 out of 6 stated the staff cleaned the bedrooms and restrooms every day. 2 out of 6 residents stated there was mold on the top of the restroom. LPA interviewed Administrator (ADM) Lynda Miguel. ADM stated the facility staff cleaned all the residents' bedrooms and bathrooms every day. LPA toured the facility with S1 and ADM including the common area, 4 resident bedrooms and 3 restrooms. LPA found mold on the ceiling of one of the resident restrooms. LPA showed the mold on the ceiling of the restroom to S1. S1 agreed that it was mold. LPA showed the mold on the ceiling of the resident restroom, ADM admitted it was mold and stated the mold would be cleaned up by end of the day. Based on the observation and interviews, mold was found on the ceiling of one of the resident restrooms, and S1 and ADM admitted it was mold. The Department has investigated the above allegation. Based on observation, and interviews conducted, the preponderance of evidence standard has been met. Therefore, the Department found the above allegation to be SUBSTANTIATED. Deficiencies are being cited. See LIC 9099-D. Exit interview conducted with ADM. The report was provided to HM for signature. A copy of this report was provided to HM. Page 2 of 2 The facility does not serve food in good quality: On 12/27/2021, LPA interviewed Administrator (ADM). ADM stated the facility provided the meals to residents based on the food menu. ADM stated he/she did the grocery shopping for the facility and he/she tried to shop for different food supplies to make the food meals with changes and varieties. ADM stated it was hard to make each resident fully satisfied. ADM denied the facility provided raw food, expired food or spoiled food to residents. On the same day, LPA interviewed 3 staff. 3 out of 3 staff stated they all took turns to cook breakfast, lunch and dinner based on the menu. 3 out of 3 staff denied they provided raw food or expired food to residents. They all agreed that they provided sandwich for lunch. LPA interviewed 6 residents (R1 - R6), 4 out of 6 residents (R1 - R4) stated the facility food is good. 1 out of 6 residents(R6) was unable to answer the question. 1 out of 6 residents (R5) stated the facility provided the chicken with blood inside and pink inside, he/she stated he/she can cook better than staff but was not allowed to cook. 2 out of 6 residents (R3. R4) stated the sandwich for lunch is fine but they prefer to have hot food for lunch. LPA toured the facility with S1 to check the milk, perishable food and nonperishable food. LPA did not find expired milk or expired food. 2 day perishable food and 7 day nonperishable food were observed sufficient. Based on reviewing the food menu, all the weekday lunches were sandwich and many meals were supplied with "low fat", "low calorie" food. The Department has investigated the above allegation. Based on interview, record review, and observation the department has found the above allegation is unsubstantiated. An unsubstantiated finding indicates that although the allegation may have happened and/or is valid there is not a preponderance of evidence to show the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with HM and a copy of the report was provided. Page 2 of 2.the state’s words, verbatim · CDSS document, Oct 18, 2023 · control 26-AS-20211221115941

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Oct 19, 2023

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. This requirement was not met as evidenced by: Based on the observvation, mold was observed on the ceiling of one of the restroom which posed a immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2023

Plan of correction: Administrator stated he/she will submit a plan of correction by the POC due date to prevent the similar incident to occur again. LPA checked the bathroom today and there is no mold observed in the bathroom.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced annual inspection visit, and met with Assist Administrator (AADM) Melanie Gavina. Staff Nercisa Cabrera (S1) and Evelyn Bergunia (S2) and 5 residents (R1 - R6) were observed in the facility. LPA checked 5 resident files and 3 staff files. LPA toured the facility inside out with ADM. Living room, family room, kitchen, dinning room and 4 restrooms were inspected. 2 shared resident bedrooms, 2 single resident rooms, and laundry area were inspected. One staff live-in room was observed in facility. Two day perishable food supplies and seven day nonperishable food supplies were observed sufficient. Medication closet, and knives closet and cleaning product closet were observed locked. Room temperature was at 72 degree F, and hot water temperature was at 116 degree F in facility. Fire extinguisher was serviced on 5/10/2023. The temperature of freezer was observed at 0 degree F. The temperature of refrigerator was observed at 30 degree F. One of the screen of the bed room was broken. The facility was equipped with fire alarm system, smoke and carbon monoxide detectors. Smoke detectors and carbon monoxide detectors were tested by ADM, and they were working fine. Front yard and backyard were inspected. There was no obstruction to block the walkways. Deficiency was found. LIC809-D and Appeal Rights were attached. Exit interview was conducted with AADM. This report was provided to AADM for signature. A copy of the report was provided to AADM.the state’s words, verbatim · CDSS document, May 31, 2023

Type of visit: Case Management - COVID-19

Licensing Program Analyst (LPA) Marybeth Donovan conducted a Technical Assist (TA) Visit via Zoom platform with Melanie Gavina Facility Staff, Lori Kopplinger RN, Program Clinical Consultant, and Sarah Yip Licensing Program Manager to provide technical assistance to prevent and mitigate the spread of COVID 19 in the facility. LPA conducted a virtual tour of the facility. During today's TA-Visit, recommendations were discussed as follows: 1. Use updated list of COVID 19 Symptoms for Screening for visitors and staff 2. Use paper towels instead of cloth towels 3. Use foot operated waste receptacles in the kitchen, bathrooms and isolation room 4. Place PPE supplies in closed container next to Isolation Room 5. Enter isolation from inside the home and exit through the exterior door with contaminated PPEs. 6 Review OSHA N95 Fit Test Requirements for staff working with COVID 19 Positive residents 7. Use disinfectants with 2 minutes or less wet time LPA will forward updated COVID Symptom List, Screening Questionnaire, PPE Donning and Doffing Posters and Provider Information PIN 22-07-ASC Dated 2/8/2022 to include Visitation Guidelines. Report reviewed with Melanie Gavina and a copy emailed for signature.the state’s words, verbatim · CDSS document, Feb 18, 2022