Ruby Cottage

Allegation investigated: The Licensee does not have liability insurance.

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry to the facility by staff Hazel Balonda , and explained the reason for the visit. Administrator Venus Bravo arrived at the facility at 9:55am. The department received a complaint on 07/10/2023 and the initial 10 day visit was conducted on 07/18/2023. During the visit LPA Mendivil interviewed staff and obtained copies of liability insurance policies. Regarding the allegation the licensee does not have liability insurance, the investigation revealed the following: Based on witness' report the facility had a lapse in liability insurance. Interviews with Adminstrator Venus Bravo indicate the facility did not pay for coverage timely and therefore there was a lapse in liability insurance. Substantiated Per review of liability insurance policies old policy ended on 06/08/2023 and the new policy is effective 07/20/2023 resulting in a lapse. Therefore based on records reviewed and interviews conducted the allegation that the Licensee does not have liability insurance is determined to be SUBSTANTIATED, meaning the complaint allegation was valid and that a violation has occurred The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8. An exit interview was conducted and a copy of this report and appeal rights were provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 17, 2023 · control 22-AS-20230710150926

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.605 · Plan of correction due date: Aug 17, 2023

all residential care facilities for the elderly … shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee. This requirement was not met as evidence by Licensee stated they did not pay renewal for liability insurance. This poses a potential safety risk to those in care.the state’s words, verbatim · CDSS document, Aug 17, 2023

Plan of correction: Licensee has since paid policy and updated copy was provided to LPA.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required post-licensing visit inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, 2 staff were on duty, who contacted facility administrator (AD) Venus Bravo about visit. As of 12/6/22, there are 0 active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted throughout the facility. The PUB475 "See Something, Say Something" poster was also observed at the main entrance of the facility and in the facility hallway. LPA De Perio observed the Administrator's Certificate for Venus Bravo, which expires on 8/4/24, and Arnold Bravo, which expires on 5/13/23. LPA De Perio toured the interior and exterior portions of the facility with staff on duty. The facility is a single level structure and is licensed for residents 60 years and over, of which 6 may be non-ambulatory, 0 bedridden and a hospice waiver for 6. NOTE: license also states that facility garage is not approved for client use. For this visit, there are a total of 6 residents in care of which 0 are on hospice. There are a total of 6 bedrooms, of which 4 are private resident rooms, 1 shared resident room and 1 shared room for staff. LPA De Perio toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 4 restrooms, of which were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 106.2 degrees Fahrenheit and hand washing signs were also posted in each restroom. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care and located in a locked drawer. Fire extinguisher was charged, mounted and located in the kitchen. LPA De Perio observed emergency disaster and evacuation plan posted at the entrance of the facility. Facility had back-up emergency food and water supply, located in the kitchen and in the garage. LPA De Perio observed that First Aid Kit had all the required components. The facility had an adequate supply of PPE that was located in the garage. Medications were locked in a kitchen cabinet and is made inaccessible to residents in care. Toxins were also observed to be locked and inaccessible to residents. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There is 1 gate in the backyard, which was observed to be self-closing and self-latching. No bodies of water were observed. LPA De Perio verified the Coronavirus 2019 (COVID 19) mitigation plan of the facility with AD Bravo. LPA De Perio discussed Assembly Bill 665 requires that a licensee of any adult or senior care residential facility that has internet service provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. LPA De Perio discussed with AD Bravo to review, and subscribe for emails regarding the Provider Information Notices (PINs) as well as to attend the CCLD Informational Calls to ensure that facility and staff are up to date. The PINs can be accessed at: www.ccld.ca.gov. LPA De Perio discussed the California Code of Regulations Section 87466 Observation of the Resident and Section 87211 Reporting Requirements with AD Bravo. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued. LPA De Perio advised AD Bravo to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA. LPA De Perio conducted an exit interview with AD Bravo and a copy of this report and copies of the regulations discussed were provided to the facility.the state’s words, verbatim · CDSS document, Dec 6, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Patricia Velazquez conducted an announced visit to Ruby Cottage. LPA Velazquez was allowed entry into the facility and met with Administrator Arnold Bravo. The purpose of today's subsequent Pre-Licensing visit was to follow-up on the issues that were present during the initial Pre-Licensing visit dated 05/19/2022. The following issues were observed and required correction: Repair or replace the cracked tile in the shower of a resident bathroom Repair the shower door handle in a resident bathroom and ensure the door closes properly Obtain the Complaint Poster and post in the entry area of the facility Relocate the Ombudsman poster to the entry area of the facility Obtain a First-Aid manual Clean and remove grease stains in both ovens Post handwashing instructions in each resident bathroom Add Cough Etiquette posters throughout the facility Obtain 2 more chairs for outdoor seating for residents Remove the rusted bench from the side yard Check the faucet in a resident bathroom that was spraying water in different directions onto the countertop On today's visit the aforementioned items have been addressed and corrected. The items reviewed during this visit are in compliance. The Pre-Licensing is now complete. The license will be granted upon completion of a final review and approval from the Licensing Program Manager and the Central Applications Bureau. An exit interview was conducted with Administrator Arnold Bravo and a copy of this report was provided at the time of this visit.the state’s words, verbatim · CDSS document, Jun 7, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Patricia Velazquez conducted an announced Pre-Licensing visit with Component III Orientation to Ruby Cottage. LPA Velazquez conducted the visit with Administrator Arnold Bravo. An initial application to operate a Residential Care Facility for the Elderly (RCFE) was submitted to the Central Applications Bureau (CAB) on 03/18/2022 for a capacity of 6 non-ambulatory residents. LPA Velazquez along with Administrator Bravo observed the following: Structure: Facility is a one story house with 5 resident bedrooms, 4 bathrooms, living room, family room, dining area, and kitchen. The facility has a light yellow stucco exterior with beige trim. There is an attached 3 car garage. There is a front yard comprised of grass with trees and plants as well as a cement walkway. The backyard has a shaded concrete area with seating for residents as well as a grassy area with trees and plants. The exit gate on the exterior of the home had a self-closing and self-latching mechanism. Signal System: The facility's central heating and air conditioning is controlled by a thermostat located in a hallway. Bedrooms Residents: All bedrooms accommodate non-ambulatory residents. Emergency flashlights were present in the facility. The resident bedrooms accommodate the residents' furnishings. All the required furnishings were present in each resident room. Bathrooms: All bathrooms have a working toilet, wash basin, and walk-in shower. Grab bars and a non-skid mat were present in each bathroom. Linens and Hygiene Supplies: Adequate supply of linens and hygiene supplies were located in a linen cabinet in a hallway as well as the resident rooms. Appliances: Refrigerator with freezer, dishwasher, washer and dryer, microwave, 4 burner stove top, and double ovens. Emergency Phone Numbers, Exit Plan: Readily available for review posted on a wall in a hallway next to the kitchen. Postings: The Complaint poster will be posted in the entry area of the facility. Coronavirus (COVID-19) postings were observed posted throughout the facility. Food Service and Menu: There was an adequate supply of 7 day non-perishable and 2 day perishables present in the facility. The sample menu was available for review. Smoke and Carbon Monoxide Detectors: Smoke detector and Carbon Monoxide alert systems were interconnected tested and found operational. Fire Extinguisher: Fully charged and mounted on a wall in the kitchen. Fire Clearance: Approved on 04/06/2022 for 6 non-ambulatory residents. Toxins and Sharps: The cleaning supplies were locked and stored in a cabinet located in a hallway. The knives and other sharp items were locked in a box located in a cabinet in the kitchen. Water Temperature: Tested and recorded at 115.0 degrees Fahrenheit in bathroom 1, at 115.5 degrees Fahrenheit in the left sink and at 114.4 degrees Fahrenheit in the right sink of bathroom 2, at 108.8 degrees Fahrenheit in bathroom 3, and at 116.7 Fahrenheit in bathroom 4. Medications, First Aid Kit & Manual: The First Aid kit was checked and found to be in order. The facility did not have a First Aid manual. It will be stored in a locked cabinet located in the kitchen. Medication is stored in a locked cabinet in the kitchen. Resident and Staff Files: Resident and staff records are stored in a cabinet next to the kitchen. Reading Material, Games, Equipment, & Materials: The facility had materials, games, and equipment present in the facility that commensurate with their plan of operation. Component III: Conducted at the Pre-Licensing visit, information was provided about how to operate the facility within compliance. The following items need to be addressed prior to licensure: Repair or replace the cracked tile in the shower of a resident bathroom Repair the shower door handle in a resident bathroom and ensure the door closes properly Obtain the Complaint Poster and post in the entry area of the facility Relocate the Ombudsman poster to the entry area of the facility Obtain a First-Aid manual Clean and remove grease stains in both ovens Post handwashing instructions in each resident bathroom Add Cough Etiquette posters throughout the facility Obtain 2 more chairs for outdoor seating for residents Remove the rusted bench from the side yard Check the faucet in a resident bathroom that was spraying water in different directions onto the countertop Facility does not appear ready for licensure. Any items noted during today’s visit are to be corrected by June 16, 2022. LPA Velazquez will conduct a subsequent Pre-Licensing visit to review the items listed above. An exit phone interview was conducted with Administrator Arnold Bravo and a copy of this report was provided at the time of this visit.the state’s words, verbatim · CDSS document, May 19, 2022