St. Jeanne Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit. LPA was granted entry and met with Administrator, Mirafe Deramas, who was informed of the purpose of the visit. At the time of the visit there was three (3) staff and four (4) residents present. The facility is a one-story with four (4) bedrooms, two (2) bathrooms, two sitting areas, and a backyard. The clients served are elderly adults 65 years old. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and resident interviews. LPA observed the following: Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed the facility's infection control plan which met department requirements. LPA reviewed staff records and found that all staff had infection control training. Physical Plant: LPA observed the resident bedrooms and staff office. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed outdoor furniture and shaded area for residents. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to clients. The smoke detector and carbon monoxide was operational, and the hot water temperature 117F. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Care & Supervision/Administration: Adequate staff are present for the supervision of residents during the visit. LPA also reviewed the staff scheduled showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed two (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Three (3) resident files were reviewed, and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All resident medication was locked in a cabinet located in the kitchen. LPA reviewed medications for (3) residents and found all medication listed on MARS and all required labeling was found to be in place. LPA observed MARS for three out of five residents that did not have signatures from staff indicating medication had been dispensed to the residents since 07/30/2023. A deficiency will be issued along with a plan of correction. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire and earthquake drills, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the storage and first aid kit with all required items. An exit interview was conducted where a copy of this report along, LIC809D, and appeal rights were reviewed and provided to the Administrator, Mirafe Deramas.the state’s words, verbatim · CDSS document, Aug 1, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jesse Gardner conducted an announced pre-licensing inspection to the facility to complete the pre-licensing inspection and Comp III. LPA arrived at the facility and was met with Administrator Mirafe Deramas. Administrator Deramas accompanied LPA on a tour of the inside and outside of the facility. This is a change of ownership Pre-Licensing inspection; thus 5 residents were currently in care. The facility is a four bedroom, two bathroom home. The facility has a living room, dining room/kitchen. Per the approved fire clearance, the licensee is approved for 5 non-ambulatory residents, and 1 bedridden resident. All bedrooms are furnished with bed, night stand, dressers and have adequate lighting for residents use. The facility currently has linens, towels and a sufficient amount of hygiene products for residents. The bathrooms have grab bars and non-skid mats installed. The water temperature was tested and measured between 111.8 to 115.0 degrees Fahrenheit. The smoke alarms and carbon monoxide alarm were tested and are in operating order. LPA observed one fully charged fire extinguisher which was present in the dining area. The kitchen was observed to have dishes, silverware and pots and pans. The knives were stored in a locked drawer in the kitchen. The medications, will be stored in a locked cabinet in the kitchen. The chemicals will be stored in a locked room outside. The backyard was observed to provide access to residents via a driveway, and also was observed to provide plenty of shade via a covered patio and covered outside area. LPA found all facility features to be in compliance and in line with Title 22 Regulations. An exit interview was conducted and a copy of this report was reviewed with and provided to Administrator Mirafe Deramas.the state’s words, verbatim · CDSS document, Aug 24, 2022

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 4 COVID Mitigation Plan discussed? YES Method: Telephone call with CAB COMP II Participants: LICENSEE/ADMINISTRATOR: MIRAFE DERAMAS Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Aug 12, 2022