St. John of Kronstadt Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alma Gonzalez conducted the required annual inspection. LPA met with Administrator Liana Vertelkina and discussed the purpose of today’s visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following 12 (CARE) tool domains were observed and reviewed: Infection Control, Physical Plant/Environment Safety, Operational Requirements, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Resident Rights/Information, Planned Activities, Food Service, Incidental Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs (SHN). During the visit LPA observed the following: Infection Control: The facility is using appropriate hand hygiene and wearing gloves while assisting residents. Staff are cleaning and disinfecting often for high touched surfaces. Facility has an Infection Control Plan in place. Operational Requirements: The fire clearance is approved for (21) ambulatory residents age 60 and above. Last Fire Drill was conducted 09/16/23. Staff are adhering to operational requirements. Staffing: There is sufficient staffing at the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. (See LIC809C for the continuation of this report) Personnel Records-Training: Staff files are maintained at the facility. LPA reviewed staff files for Facility Administrator and Staff 1 (S1) - Staff 2 (S2). Staff have current CPR/first aid training and sufficient on-going training that meets the annual requirement. Staff have their Health Screening and Tuberculosis Screening on file. Staff are also trained on Abuse Reporting. Administrator certificate expired 4/05/2023. Administrator stated the renewal documents were submitted to the recertification unit but an Administrator Certificate has not been received yet. Proof of document submittal was provided. Resident Rights-Information: RCFE complaint poster and Personal rights were observed posted in the facility as well as LTCO poster. Per Facility Administrator, facility provides wi-fi services for facility residents. Resident Records-Incident Reports: LPA reviewed Resident files for R1 2. Resident files are maintained at the facility. Admission Agreement, Physician's Report (including T.B and Ambulatory Status), Consent For Medical Treatment, Preplacement Appraisal Information, Resident Pre-Appraisal, Functional Capabilities, Appraisal/Needs and Services Plan, Resident Rights were observed. Disaster Preparedness: The facility has the Emergency Disaster Plan (LIC610D/9 pages) in place. Physical Plant & Environment Safety: LPA conducted a tour of the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The physical plant tour was conducted with the assistance of Administrator Liana Vertelkina. The physical plant consists of a single story building with 19 resident bedrooms which consist of 18 single and 1 shared room, each bedroom has a sink and toilet. There is a recreation room, Kitchen, Dining hall, laundry room, medication room, 3 storage rooms, 3 baths and 1 shower, Office, Staff restroom, visitor restroom and outside shaded patio. Resident rooms were randomly chosen for inspection and LPA observed that resident bedrooms have the required furniture, bed linens, sufficient lighting and closet/drawer space to accommodate each resident comfortably. Private resident bathrooms in rooms were inspected. Restrooms were clean, toilets and water faucets worked properly and were properly supplied, have functional fixtures and have secure grab bars, showers were free of mold/ mildew and non-skid mats or strips were properly in place. Hygiene supplies are provided. Water temperature was measured and temperature measured 116 degrees F. Resident bath towels, toiletries and personal hygiene supplies were adequately available. Refer to LIC 809C for the continuation of this report Planned Activities: Calendars and supplies for activities were observed. Food Service: There are sufficient food supplies of 2-day perishable and (1) week of non-perishable items. Additional food supply and disaster food supply was also observed. The food is properly stored in the refrigerator(s). Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept clean and free from rodents and other vermin. Plates, cups and utensils are kept cleaned and stored properly. Dining room has adequate seating. Posted menu observed. Health Related Services/Incidental Medical Services: The medications are centrally stored in a room by the office. Medication room is locked and inaccessible to facility residents. Medication was observed to be in bubble packs and/or original containers. LPA reviewed medication for R1-2. The facility uses the Medication Administration Records (MARs) to document medications given to residents. Medications are administered as prescribed by the Physician. Per Title 22 Regulations, there were no deficiencies observed during visit. Exit interview and a copy of this report was provided to Administrator Liana Vertelkina.the state’s words, verbatim · CDSS document, Oct 2, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced Annual Required / Infection Control visit to the above facility. LPA was met by Administrator Liana Vertelkina and the purpose of today’s visit was explained. This is an RCFE with a capacity of 21. The facility is licensed to serve 21 ambulatory residents, ages 60 years and over. LPA and Administrator Liana Vertelkina toured the facility's physical plant inside and outside to ensure there are no health and safety hazards. LPA toured the common areas, resident rooms which include private restrooms, kitchen, dining area, public restrooms and outside patio/ smoking area. The following was inspected and toured: 19 resident bedrooms which consist of 18 single and 1 shared room, each bedroom has a sink and toilet. There is a recreation room, Kitchen, Dining hall, laundry room, medication room, 3 storage rooms, 3 baths and 1 shower, Office, Staff restroom and visitor restroom and outside shaded patio. All common areas were properly furnished and appeared comfortable. Resident bedrooms had the required furniture for comfort and safety and had sufficient lighting. All indoor and outdoor passages were free of obstruction. All bathrooms were observed to be clean and had the required hygiene items. Bathrooms all have a supply of hand soap and paper towels. Bathrooms had grab bars for each toilet, bathtub/shower and LPA also observed non-skid mats and/ or strips in resident bathtubs/ shower. All bathrooms were observed to be clean. Linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents. The hot water temperature measured 111 F, which is within the required 105 - 120 degrees. There is sufficient lighting throughout the facility. There are no large bodies of water on the premises such as pools. The grounds are well groomed and there were no hazards observed. Cleaning supplies are inaccessible to clients. The front exterior of the facility is clear of debris with steps and ramp leading to the facility entrance. Trash containers have covered lids. There are no security bars nor weapons on the premises. LPA observed the facility to be in good repair. Smoke detectors and carbon monoxide detector were in compliance and operational. Medications are properly stored, locked and inaccessible to clients. The following were observed/inspected: COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility, and in all common rooms bathrooms and hallways. Facility is conducting COVID-19 screening for all visitors. Residents are able to use a designated isolation room that will be used as isolation room if a COVID-19 positive case should arise. 30 day supply of medication for residents Facility has an adequate amount of PPE and facility has enough PPE for 60 + days. Residents were socially distanced according to local public health guidelines. Staff responsible for direct care and supervision were observed wearing masks. Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed. Hand Sanitizer: Available throughout the facility for client use. The resident's temperature is checked and logged daily. Staff temperatures are checked and logged daily. Staff and residents are tested only if showing symptoms for COVID19. All residents and staff are fully vaccinated and have received both booster vaccines for COVID-19. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview conducted with Administrator Liana Vertelkina and copy of report provided.the state’s words, verbatim · CDSS document, Nov 16, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced Required-1 year visit focusing on COVID-19 Infection Control Practices. LPA met with Administrator Liana Vertelkina and explained the purpose of today's visit. This is an RCFE with a capacity of 21. The facility is licensed to serve 21 ambulatory residents, ages 60 years and over. The following was inspected and toured: 19 resident bedrooms which consist of 18 single and 1 shared room, each bedroom has a sink and toilet. There is a recreation room, Kitchen, Dining hall, laundry room, medication room, 3 storage rooms, 3 baths and 1 shower, Office, Staff restroom and visitor restroom and outside shaded patio. The following were observed/inspected: COVID-19 Infection Control Practices (including signs) were observed at the entrance of this facility, and in all common rooms and hallways. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Residents are able to use their private accommodations as isolation rooms if they have private rooms and if residents have shared rooms there are designated rooms to be used as isolation rooms if a COVID-19 positive case should arise. 30 day supply of medication reviewed for (6) residents (Resident #1 through Resident #6) Facility has an adequate amount of PPE and facility has enough PPE for 90+ days. Residents were socially distanced according to local public health guidelines. Residents wearing masks. Staff responsible for direct care and supervision were observed wearing masks. Sufficient supply of perishable for 2 days and non-perishable foods for 7 days were observed (including paper goods, utensils etc). According to the California Code of Regulations, LPA did not observe any deficiencies, therefore no citations were issued at this time. An exit interview conducted with Administrator Liana Vertelkina 5and copy of report provided.the state’s words, verbatim · CDSS document, Oct 5, 2021