Somis Living II

Type of visit: Required - 1 Year

At 9:00 a.m. Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced Required - 1 Year visit to the facility. Upon arrival the LPA met with Licensee Jocelyn Cacal. Entrance interview conducted and the reason for the visit was explained. A tour of the physical plant was conducted with the Licensee between 9:18am - 9:30am to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The following was noted: Facility is a single story residence that consists of two (2) resident bedrooms and one (1) bathroom. All smoke alarms and carbon monoxide detector were tested and functioned properly during time of visit. LPA observed all required postings in the living area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. The LPA observed a sufficient amount of perishable and non-perishable food at the facility; Sharp objects are stored in a locked drawer in the kitchen. Bedrooms: The resident bedrooms were properly furnished with at least one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Bathrooms: The LPA observed the bathroom clean, properly supplied and had functional fixtures. The LPA observed grab bars and non-skid mats in the bathroom. Residents have sufficient amounts of supplies for personal hygiene. The hot water was measured in the bathroom during the physical plant tour. Hot water measured 117.4 Fahrenheit, within the required limit of 105-120 degrees. Common Areas: These included the living room and dining area. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Report will continue on LIC809-C Surrounding Grounds (Outdoors): There was a shaded area with proper furniture for outdoor use. There are no bodies of water on the premises. Record Review: At 09:50 a.m. a review of facility files was initiated. The LPA reviewed two (2) of two (2) Client Files. All documents reviewed appeared complete and current. The LPA reviewed five (5) of eight (8) staff files and the following was noted: two (2) staff (S1, S2,) were not associated to the facility. S1 was observed to be working at the facility by the LPA during the visit. Upon observation, the Licensee stated S1 has been working at the facility for 6 days, and S2 start day was going to be 10/21/23. Licensee submitted a transfer request to the regional office for S1 and S2 during the visit. The LPA advised the Licensee, S1 and S2 could not work at the facility until association was completed. The LPA observed documentation of Infection Control, Disaster prevention and last fire drill (conducted on 10/03/2023). The LPA obtained Client Roster, Staff Roster, and facility Sketch. Medications: At 1:45 p.m. a medications review was initiated for all residents. Medications are centrally stored and locked in a cabinet in the living room; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. Interviews: At 2:10 p.m. the LPA conducted two (2) staff Interviews. The LPA was not able to interview both residents due to residents being asleep. Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Civil Penalties assessed in the amount of $500, $100 X 5 day. Failure to correct the deficiencies may result in additional civil penalties. Exit Interview Conducted / Appeal Rights given / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, Oct 16, 2023

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Angel Ascencio conducted a pre-licensing visit to the above noted facility. The LPA met with applicant, Jocelyn Cacal. This is a change of ownership application. A dementia program was included in the plan of operation. A Hospice Waiver has been requested. The facility is one story. At 09:06 a.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for three (3) non-ambulatory residents; and, one (1) of bedridden residents. The bedridden room is in Room #1. The facility has 2 bedrooms, both are shared bedrooms,. All resident rooms have direct exits to the outside. All resident rooms are set up with beds, nightstands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds and furniture with a wheelchair or walker. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms – ‘awake night staff only. All rooms were free of odors. All window screens were clean and maintained in good repair. There is 1 bathrooms in the hallway. The resident bathroom has a shower with non-skid materials. The toilet and shower have grab bars. The hot water temperature was tested in the bathroom and the kitchen and was found to be within the range of 105*F and 120*F. Resident and staff records are stored in a locked filing cabin which is currently located in another section of the property. Medications are centrally stored in a locked closet in the living room.The first aid supplies were complete, including a thermometer and a current version of a first aid manual. They were stored in a hallway closet. Continued on LIC 809 - C Kitchen knives are stored in a locked drawer in the kitchen. Stove burners are rendered inaccessible to the residents by removing them when not in use. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of perishable and nonperishable food is adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. Trash cans had tight fitting lids. Kitchen, laundry and house cleaning supplies are stored in a locked cabinet located in the hallway. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a televisions and other entertainment equipment, games and/or activity supplies in the living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights were maintained in hallways and passageways to nonprivate bathrooms. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights, or other battery powered lighting, and batteries. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility's smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There is 1 fire extinguisher throughout the house. It is fully charged and does not exceed the expiration date. Hot water was tested in the bathroom, and the kitchen; and, the hot water ranged from 112 to 116 degrees Fahrenheit. The laundry area is located in the hallway. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in closet in the hallway. Extra incontinence supplies are stored in hallway closet. There is a functioning telephone on the premises. The emergency exiting plans/sketch are posted in the hallway. The emergency telephone numbers are posted in the hallway. Other required postings are posted at living room and hallway. The exterior passageways were clean and clear of any obstructions. There is a umbrella covered patio area at the side of the house with tables and chairs where residents can sit. The entire property is fenced. The gate to the driveway is automatic. Continued on LIC 809 - C There is another home at the property which is licensed. There no any bodies of water on the premises at the present time. The garage is not accessible from the house; the doors were locked. Pre-Licensing is complete and this facility has no deficiencies This report will be sent to the Centralized Application Bureau (CAB) once all corrections are received. You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license.the state’s words, verbatim · CDSS document, Sep 29, 2022