St. Joseph Care Home-B

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Carol Fowler is conducting an Required-1 Year inspection, on 9/28/2023 at approximately 02:00pm, and met with Helen Rabago, Administrator. LPA observed two on duty during the inspection. Currently four (4) client in care. Facility has an approved fire clearance four (4) ambulatory and (2) two bedridden clients. The facility has required emergency disaster plan. Facility scheduled evacuation fire drill was conducted on 07/12/2023, including staff & client. Client,1 out of 1, special diets regarding food are followed per staff interviews, and per LPA's observations during the inspection. The LPA reviewed four (4) staff files. Administrator certificate for Helen Rabago is current-#6021326740, expires 10/28/2024. All staff have required criminal record clearance. All staff have required training. The LPA reviewed four (4) client files. Client files were complete. The LPA toured the facility with the Administrator. All exits were unobstructed. The facility fire extinguisher was serviced and tagged as required expires 04/08/2023. Facility had six (6) smoke alarms, and all were working properly when checked during the inspection. Facility had one (1) carbon monoxide detector that were working properly when checked during the inspection. Facility had a first aid kit stored in the hallway storage, it did have a required first aid booklet. The facility had a sufficient supply of perishable and nonperishable food. Continue on LIC809C The facility had food, water, and emergency supplies to meet the 72 hour shelter in place requirement. The facility had a sufficient supply of personal protective equipment(PPE) for use as needed. The facility had a sufficient supply of hygiene supplies, cleaning supplies, and paper products for use as needed. The LPA observed the facility to be clean and orderly during the visit. The LPA observed that resident rooms, common areas, hallways, and bathrooms had sufficient lighting for clients in care. Clients rooms had required accommodations per regulations. Facility had all medications locked up and inaccessible to clients in care as required. During the tour LPA observed the following deficiencies: unlocked toxins (cleaning supplies) no staff member who has cardiopulmonary resuscitation (CPR) training and first aid training on duty LPA is requesting the following forms be updated and submitted to CCL by 10/11/23: · LIC 500 -Personnel Report · LIC 610 - Disaster Plan · LIC 308 - Designation of Responsibility · LIC 308 - Copy of Administrator Certificate · Infection Control Plan If updated Control of property Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and copy of report and appeal rights given.the state’s words, verbatim · CDSS document, Sep 28, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and was greeted by Licensee, Helen Robago. The facility currently provides care for three (3) residents, some of which with a diagnosis of dementia. LPA arrived at the facility and had temperature and symptoms checked. LPA continued with a tour of the facility with Licensee; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 5/2/2022 at the time of the visit. Smoke and Carbon Monoxide detectors were inspected and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins and cleaning supplies are found to be stored in a secured cabinet located in the garage. In addition, sharps/knives and resident medications are stored in a designated secured cabinet in the kitchen. There was an ample supply of hygiene products and paper products available for resident use. All resident’s bedrooms have lighting & appropriate furnishings. Hot water measured between 108.5 and 108.8 degrees F which is within Title 22 regulations of 105 to 120 degrees F in faucets used by residents. Auditory alarms were located at each exit, tested and found to be in working order. LPA conducted a review of staff training records and found staff to have current CPR & 1st Aid Certification. Continued onto LIC809-C Infection Control: Facility to submit Infection Control Plan which will be reviewed. All staff and residents have been vaccinated with no reported or observed symptoms. Posters have been placed at the front door, hallways and restrooms promoting COVID mitigation and protocols. There is a station at main entrance with a sign in, hand sanitizer and other items designated for visitors and staff. Staff are screened for temperature and symptoms on a daily basis and residents are screened observation and change of condition. Licensee, Helen Robago's Administrator's Certificate 6021326740 expires on 10/28/2022. Licence will be submitting completed hours of training to CCLD for updated Administrator's Certification. No deficiencies cited during today's visit. LPA requested the following documents be sent to CCL by COB 9/20/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate(s) Copy of Liability Insurancethe state’s words, verbatim · CDSS document, Sep 6, 2022

Type of visit: Required - 1 Year

At 9:45 AM on 8/26/2021 Licensing Program Analyst Hansen arrived unannounced to conduct a required Annual 1 yr. Infection Control inspection and was met by Administrator Helen Rabago who took LPAs temperature and logged results in visitor’s binder. Facility has 3 residents at this time that has a capacity of 6. The facility was a comfortable temperature, free from obstructions and was well lit. There was a sufficient amount of perishable and non-perishable foods in the kitchen and garage. Extra hygiene products and linens were available and required bathmats and grab bars were observed. Water temperature in resident's bathroom measured 119.8 degrees F which is within acceptable range of 105 to 120 degrees F. Cleaning products and other toxins are located in locked cabinet in the garage. Knives/sharps are kept in a locked cabinet in the kitchen. Medications were centrally stored and locked in a kitchen cabinet as well. Staff & Residents with facility files are kept in living room cabinet (office). Fire extinguisher located in the living room was last inspected 7/12/2021. Smoke detectors located throughout the facility and carbon monoxide detector were tested and functional. Annual Fire Inspection was held on 7/12/2021. Exit doors have auditory alert system. Administrator told LPA last disaster/fire drill was in 2020 and are usually practiced quarterly but due to COVID they have been concerned about safety issues. Administrator informed LPA they would complete a drill soon and submit time to LPA Tobola along with copies of current 1st Aid and CPR certificates as she is unable to find but is certain they are current. Infection Control: Facility has submitted a mitigation program plan that has been approved. Posters have been placed at facility and entrance has small table with hand sanitizer and other items designated for visitors and staff before coming into work. Facility has PPE supply stored in hallway closet & garage. Facility has a 30-day supply of medication for residents. Residents aren’t wearing masks inside the facility. All staff had masks on during this visit. Continue LIC 809-C LPA Hansen reviewed Licensing Information System (LIS) with staff who stated that is correct except Landline needs to be changed to (707) 980-7833 and Mobile line is the (707) 333-1199. In addition, LPA advised facility to contact Local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. In addition, facility has a designated area for visitors in the living room & backyard as well residents have been using Facetime and telephone calls for visits. Staff have not had PPE training required or been N-95 fit tested. TV has been given and LPA has discussed with Administrator the requirements and importance of these. Administrator will contact local public health to obtain information to complete PPE training & N-95 fit testing and also submit proof to LPA Tobola or CCL RPRO. LPA Hansen is requesting Licensee to update and submit the following documents by 9/09/2021 to LPA or RPRO: Proof of PPE training & N-95 Fit testing Proof of Current Disaster/Fire Drill Current 1st Aid & CPR Certificates LIC 308 Designated LIC 309 Administrative Organization Articles of Corporation LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Aug 26, 2021

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.