Senior Hope Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that five (5) residents reside at this facility and there are currently (2) staff members present. The facility caregiver (S1), Maria Sisat came to conduct the facility tour. There is an Infection Control Plan on file. Client Records-Incident Reports/Clients Rights-Information/Dental- LPA began review of client records. Five (5) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. There were four (4) residents that did not have current or updated physicians’ reports. Personnel Records/Training/and Staffing- LPAs began review of employee records- Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification. The administrator certification is current. Administrator, Robert Dimagiba’s certification expiration date is 06/17/2024. Food Service- Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. (Continued on LIC809C) (Continuation from LIC809) Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 106.0 degrees F. Laundry facilities and a locked room is present for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. LPA observed a facility phone, and it was verified to be operational as evidenced by LPA dialing the number to trigger a ring. The LIC 610, emergency disaster plan is maintained. There are no firearms at this home. The fireplace is not operable and secured. There is not a pool at the facility. Medications- are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Nine (9) smoke detectors and three (3) carbon monoxide were tested and found to be operational. There were two (2) fire extinguisher charged 08/09/2022. The caregiver stated that the last emergency disaster/ fire drill was done sometime last year but could not recall the exact date and did not have log of the information. (Continued on LIC809C) (Continuation from LIC809) Based on the information received during this visit today in the areas reviewed, there are two (2) deficiencies observed per Title 22, Division 6 of The California Code of Regulations Article 06. The four (4) resident’s physicians report will be cited under CCR 87458(a). Facility representative S1 states that she will send confirmation of contacting resident’s conservators to schedule an appointment for the physician’s report to be updated. The second deficiency was observed by facility file review and interview, S1 stated that they have not done a fire or emergency drill since last year. S1 stated that the Plan of Correction (POC) for the above deficiencies will be done by 06/23/2023. This LIC 809 and appeal rights was reviewed with and a copy will be provided to the head caregiver, S1, as evidence by the signature confirmation.the state’s words, verbatim · CDSS document, Jun 16, 2023

Type of visit: Required - 1 Year

On 06/23/2022, Licensing Program Analyst (LPA), Venus Mixson arrived at the above facility for an unannounced required annual with emphasis on infection control. LPA Mixson was greeted and granted entry by Administrator, Robert Dimagiba. LPA Mixson met with Administrator introduced self and stated the purpose of the visit. Present in the facility were 6 residents and 2 caregivers. There are currently no cases of COVID-19 within the facility. LPA Mixson toured the facility and made observations pertaining to the facility's infection control measures. LPA Mixson observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions and the proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, and cleaning and disinfection provisions are in adequate quantities. LPA Mixson later discussed infection control practices and procedures with Administrator. An exit interview was conducted, and a copy of this report along with the LIC 811 was provided to Administrator.the state’s words, verbatim · CDSS document, Jun 23, 2022