River Park Homes II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced Required 1 Year visit and met with caregivers Cecilia Ansagay and Josephine Prado. LPA met with Ceclia primarily and explained the purpose of today's visit. Around 12:15pm the administrator Amparo Garcia arrived and met with LPA. This is a single level facility licensed for 60 and over all of which may be non-ambulatory. Hospice waiver on file for 2 residents. As of today's visit, there is only 1 resident on hospice. During visit, LPA toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator is observed to be fully operational and functioning. There is an additional refrigerator in the garage for resident supplies as well. Laundry area is observed in the garage. Both washer and dryer are observed to be functioning and in operation during today's visit. LPA toured all resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. Each room had the required furniture items as outlined in Title 22. Smoke and Carbon Monoxide detectors are in place and functioning. There is a common hallway bathroom in between resident room 2 and 3. This bathrooms water temperature is measured at 105.6F. There is an additional bathroom in room 1. Water temperature is measured at 105.5F in this bathroom. Both bathrooms had non-skid mats available for resident use, as well as required bathroom supplies such as soap, paper towels, toilet paper, and trash cans. Continued on next page... Page 2. LPA observed the pantry located in the hallway adjacent to room 4 as fully stocked. Next to this is the linen closet which is observed to be in place for resident supplies. LPA toured the exterior areas of the facility and found the emergency exits to be clear of obstructions. Fire extinguisher is observed adjacent to the kitchen's dining area as charged and ready to use. LPA reviewed resident medications at random and observed them to be recorded accurately. LPA reviewed staff and resident files on site and all files observed are current. Last disaster drill on record is observed to have taken place on 01/18/2025. Administrator certificate is observed as current No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with the administrator, and a copy of the report is provided on this day. Technical violation issued on the following LIC9102TV.the state’s words, verbatim · CDSS document, Jan 28, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marcela Yanez conducted an unannounced Required 1 Year visit and met with Staff S1 Cecilia Ansagay. Administrator Amparo Garcia was not able to come to facility for personal reasons was contacted via telephone. LPA announced the purpose of the visit. During visit, LPA Yanez toured the facility inside and out. LPA toured the garage area and observed food storage areas and locked cabinets for cleaning supplies. LPA observed the kitchen area and observed locked cabinets for medications, sharp objects, and cleaning supplies. LPA observed perishable food supply of at least two days and a non-perishable food supply of at least seven days. Refrigerator temperature measured with thermometer was 45 degrees F and freezer was 0 degrees F LPA toured three resident bedrooms. Each bedroom had available bedding and clothing storage areas as well as functioning lights. LPA had Staff S1 test the smoke detectors in the hallway and found the smoke detector to function properly when tested LPA toured two out of two resident bathrooms. Each bathroom had available soap and paper towels and functioning lights. The water temperatures in the bathroom sinks measured with thermometer at 131 to 141 degrees F, second time was tested at 130 to 138 degrees F. and third time was tested at 130 to 138 degrees F. LPA toured the outside area and found the exits to be clear of obstructions. LPA observed fire extinguisher was last serviced on 3/27/23. LPA was not able to review resident files and staff files S1 did not have access to files. Designated Administrator was not able to come to facility for personal reasons. Deficiencies were cited as per California Code of Regulations Title 22 (see LIC 809D) This report was reviewed with Administrator Amparo Garcia over the phone and ADM agreed to have S1 sign on their behalf and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 9, 2025

Allegation investigated: Facility is not adhering to infection control plan. Facility did not notify residents' family and other agencies of current covid outbreak.

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced investigation visit to deliver the investigation findings and met with Administrator (ADM) Amparo Que Garcia. On 2/9/2024, the Department received a complaint with the above allegations. On 2/15/2024, the Department conducted an initial investigation visit. LPA interviewed ADM, 2 staff and 4 residents. LPA toured the facility and checked the PPE supplies. Continue on LIC9099-C. Page 1 of 3. Unsubstantiated Facility is not adhering to infection control plan: The allegation is that a home care nurse did not receive a notice of 2 resident and 1 staff with COVID positive in the facility until he/she visited the facility on 2/8/2024, at 9:15AM, and observed 2 staff without wearing masks and were not adhering to infection control plan. On 2/15/2024, LPA visit the facility and interviewed Administrator (ADM) Amparo Que Garcia. ADM stated resident R1 tested COVID positive on 2/4/2024 and resident R2 tested positive on 2/5/2024. ADM stated R1 and R2 were isolated at their private rooms. ADM stated staff S1 tested negative and S2 tested positive on 2/5/2024. ADM stated S1 only takes care of COVID negative residents and S2 only takes care of COVID positive residents. ADM stated he/she notified local health department and CCL office. ADM stated he/she notified resident families and affected residents' family doctors. ADM stated he/she encouraged visitors not to visit the facility if not necessary. ADM stated on 2/9/2024, S2 was tested COVID negative and R1 and R2 were tested COVID negative on 2/12/2024. LPA interviewed staff S1. S1 stated he/she only takes care of COVID negative residents during the facility COVID period. LPA interviewed staff S2. S2 stated he/she only takes care of COVID positive residents during the facility COVID period. S2 stated he/she was wearing PPE when he/she entered R1 and R2's rooms. During LPA visit, LPA observed S1, S2 and ADM were wearing masks. LPA observed the COVID screening station with visitor log, mask, and thermometer in the main entrance. LPA checked the facility PPE supplies, and PPE supplies were observed sufficient. LPA interviewed resident R1. R1 just listened to LPA's questions but was unable to answer LPA's question. LPA interviewed resident R2. R2 stated facility staff took care of him/her during his/her COVID positive period but was unable to tell the name of the staff. Continue on LIC9099-C. Page 2 of 3. Based on the record reviewed, the facility notified CCL office on the phone on 2/7/2024 and sent the incident report to CCL office on 2/7/2024. Based on the observation, interview, and records reviewed, no evidence to indicate the facility is not adhering to infection control plan. Facility did not notify residents' family and other agencies of current covid outbreak: On 2/15/2024, LPA interviewed Administrator (ADM). ADM stated he/she notified CCL office and local health department. ADM stated he/she notified residents families for the COVID positive cases in the facility. ADM stated the facility notified visitors, including home heath nurse, not to visit the facility if not necessary. LPA interviewed 4 residents. 2 out 4 residents did not know the facility had COVID cases. On 2/19/2024, LPA interviewed 2 families of residents. 1 Out of 2 stated the facility notified him/her, the other one stated the facility did not notified him/her of the facility COVID positive cases. Based on the records reviewed, On 2/7/2024, two LPAs spoke with ADM and instruct ADM to notified local health department, and ADM stated he/she will notified local health department. On 2/7/2024, CCL office received the facility incident report of 3 COVID positive cases at the facility. Based on documents reviewed, observation, and interviews conducted, the Department found that the above allegations are UNSUBSTANTIATED. An unsubstantiated finding indicates that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation did or did not occur. No citations noted for today’s visit. Exit interview was conducted with ADM. A copy of this report was provided to ADM. Page 3 of 3.the state’s words, verbatim · CDSS document, Nov 5, 2024 · control 26-AS-20240209092923

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's required - 1 year annual inspection. LPA met with Designated Administrator, Justina Nicholas and Licensee, Amparo Garcia. During visit, LPA toured the facility with Designated Administrator, Justina Nicholas to include the dining room, kitchen, living room, resident rooms, bathrooms, staff room, garage, and backyard. All fire exit routes were free and clear of obstruction. All staff present are fingerprint cleared and associated to the facility. Facility temperature maintained at 71 degrees Fahrenheit. Fire extinguisher last serviced on 03/25/2023. LPA did not observe an operable carbon monoxide detector present. During visit, Licensee left the facility to purchase a carbon monoxide detector and installed the device during visit. Posters observed at the entrance to include an 8x10 complaint poster sign, ombudsman poster, COVID-19 related posters, and personal rights. Kitchen refrigerator maintained at 48 degrees Fahrenheit. Licensee was advised. Freezer maintained at 0 degrees Fahrenheit. Medications, sharp objects, chemicals and disinfectants observed locked. Resident bedrooms equipped with beds, linens, adequate lighting, chair, night stands, and dressers. 3 residents observed with half bed rails. LPA observed a physician's order for 3 out of 3 residents. 1 resident observed using an oxygen concentrator. The resident's file contains a physician's order. Licensee was advised to place an "oxygen in use" next to the residents bedroom. LPA observed an oxygen in use sign was posted at the front door. SEE LIC809-C. Bathroom supplied with hygiene products, paper supplies, lidded trash bins, and non-slid mats. LPA observed the hot water temperature in room #4 to be maintained at 109 degrees Fahrenheit. LPA observed the facility's hot water pressure for the sink and shower was very low in the bathroom located in the hallway. LPA observed that bathroom's hot water temperature takes more than 5 minutes to heat up. LPA measured the hot water temperature to be maintained at 100 degrees Fahrenheit. LPA observed the hot water pressure in room #1 was also very low. LPA observed the hot water temperature in that room also takes more than 5 minutes to heat up. LPA observed the hot water temperature in Room #1 to be maintained at 100 degrees Fahrenheit. Licensee states awareness of the issues with the facility's hot water temperature and hot water pressure. Licensee states they started having issues with the water in summer of 2023. Licensee states when the residents requests for warmer water for their baths, they'd boil water to create warmer water. Licensee was advised. LPA reviewed 3 residents (R1 - R3)'s records to include an admission agreement, physician's report, TB result, updated appraisal/needs and services plan, emergency identification form, safeguard of personal properties, personal rights, and centrally stored medication records. LPA reviewed 3 staff (S1 - S3) records. S1 - S3 files contains an updated 1st aid certification, health screening, TB results, and employee rights. During visit, the facility was unable to produce the staff annual training documentation to include annual training on dementia care, postural supports, and restricted health conditions. Licensee states the staff has been provided annual training, however, the training documentation is located in another location. The facility showed LPA staff training on hospice care which equaled 4 hours of training. Licensee was advised. Facility staff are trained on infection control practices. Facility conducts emergency drills quarterly. The last emergency drill conducted was dated in December 2023. Facility has an updated emergency disaster plan. Facility has a first aid kit. Facility has extra flashlights. Deficiencies are being cited per California Code of Regulations, Title 22. SEE LIC809-D. Advisory notes provided. This report was reviewed with Licensee, Amparo Garcia and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 30, 2024