St. Jude's Elder Care IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alberto Lopez made unannounced visit for required annual inspection. LPA met with Staff Chris Tan and Licensee Judy Regano arrived a short time later and assisted with the visit. 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: The Infection Control Plan has been added to the Operation Plan. The facility has a Dementia Waiver in place. A Hospice Waiver for 6 residents is approved. Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 2. Physical Plant and Environmental Safety: The facility is a single-story house and located in a residential neighborhood area. The facility has a small living room, big living room, dining area, kitchen, five residents bedrooms, three bathrooms, one live in staff room and a detached garage. Residents Bedroom#1- #4 has one bed, one chair, one night stand, one drawer, required beddings and sufficient lighting and closet space. Bedroom#5 has two beds, two drawers, two nightstands, two chairs, required beddings and sufficient lighting and closet space. The residents' bathrooms are clean, sanitary and in a good working condition. The residents bathrooms also have the required non-skid mat and grab bar. The hot water temperature tested in between the bathrooms and kitchen were tested 106.1 and 108.1 degrees F which are within the title 22 regulation. All the appliances in the kitchen and living room are working properly. All the knives and sharp utensils are locked in the medication cabinet in the kitchen. The cleaning supplies and other chemicals are stored and locked in the laundry room. The walkway, passageway and patio are free of obstruction. The facility has a pool in the backyard, but it was not locked. The fireplace is adequately screened. LPA also inspected the carbon monoxide detector and is mounted on the wall between the dining area and the small living room and it's working well. (Continued on 80C) 4. Staffing: The facility has sufficient staffing, and the night supervision staff did receive planned emergency training. 5. Personnel Record-Training: All the staff files are maintained in the facility. Staff employed are over the age of 18 and are fingerprint cleared and associated to the facility. All the direct care staff received Medication Management Training. The first aid training certificates for staff is current. 6. Resident Records-Incident Reports: Resident files are maintained at the facility and have the following documents in their files - Admission Agreements, Identification & Emergency Information, current Physician's Report, Pre-admission appraisal/Appraisal Needs & Services Plan. 7. Resident Rights-Information: The Complaint, ombudsman and CCLD poster and Residents personal rights are posted by the main entry. Visiting hours were posted at facility. 8. Planned Activities: Facility has sufficient space to accommodate indoor and outdoor activities. There are sufficient supplies and equipment to meet resident's physical capability. 9. Food Service: The kitchen was inspected and has sufficient supply of 2-day perishable & 7-day non-perishable food. Kitchen, food preparation area, and storage areas were observed to be very clean and sanitary. The food is properly stored in the refrigerator (clean, labeled and well maintained). Pesticides and cleaning supplies are kept away from the food preparation areas. Kitchen is kept very clean and free from rodents. 10. Incidental Medical and Dental: The medication is centrally stored and locked in the medication cabinet in the kitchen. Four (4) centrally stored resident medications were reviewed, which contained 30-day supply of medications. R4 did not have doctor’s order or label. Facility will provide transportation to resident for medical and dental appointment if needed. 11. Disaster Preparedness: The last fire drill was conducted on 10/01/2024. Records of resident Appraisal and Needs services plans are part of Emergency training. The facility has an updated Emergency Disaster Plan (LIC610E) and dated on 12/12/23. The facility has two alternative temporary shelter location. 12. Resident with Special Health Needs: Two (2) residents are receiving home health services. One (1) receive hospice care. No resident is currently on postural support. Half and full bed rails for mobility assistance were observed in resident rooms with physician order. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions. Deficiencies cited on 809D, Technical Advisory provided. Exit interview, copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 7, 2024

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: Required - 1 Year

Licensing Program Analyst (LPA) Wong conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Caregiver Chris Tan and Rita Regis Garcia. Administrator Judith Ragano arrived shortly after. The facility is licensed for 6 age range 60 and over. 6 non-ambulatory and approved hospice waiver for 6. Currently one resident is on hospice and two residents are on Home Health. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. 1. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. 2. Operational Requirement: The Infection Control Plan has been added to the Operation Plan. The facility has a Dementia Waiver in place. A Hospice Waiver for 6 residents is approved. Liability Insurance is updated and in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. 2. Physical Plant and Environmental Safety: The facility is a single story house and located in a residential neighborhood area. The facility has a small living room, big living room, dining area, kitchen, five residents bedrooms, three bathrooms, one live in staff room and a detached garage. Residents Bedroom#1- #4 has one bed, one chair, one night stand, one drawer, required beddings and sufficient lighting and closet space. Bedroom#5 has two beds, two drawers, two night stands, two chairs, required beddings and sufficient lighting and closet space. (See LIC 809C for continuation) The residents' bathrooms are clean, sanitary and in a good working condition. The residents bathrooms also have the required non-skid mat and grab bar. The hot water temperature tested in between the bathrooms were tested 105 and 108.1 degrees F which are within the title 22 regulation. All the appliances in the kitchen and living room are working properly. All the knives and sharp utensils are stored and locked in the medication cabinet in the kitchen. The cleaning supplies and other chemicals are stored and locked in the laundry room. The walkway, passageway and patio are free of obstruction. The facility has a pool in the backyard but it's secured with a fence and locked. The fireplace is also adequately screened. LPA also inspected the carbon monoxide detector and is mounted on the wall between the dining area and the small living room and it's working well. 4. Staffing: The facility has sufficient staffing in the facility to provide care and supervision to the residents . 5. Personnel Records-Staff Training: All the staff files are stored in the medication cabinet in the kitchen. All the staff in the facility are over 18 years old, fingerprint cleared and associated with the facility. LPA inspected three (3) staff files and they all have the required documents including: employee application, health screening, TB test result, Updated first aid certificate and CPR and required training hours. The facility administrator Judith Ragano and her administrator certificate expired 11/9/2023 and currently her administrator certificate is pending with the CCL since 09/01/2023. 6. Resident Records-Incident Reports: A total of five (5) resident files were reviewed. They contained admission agreements, Physician's Reports, Pre-Appraisal, Appraisal, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, and medication records. 7. Resident's Right/Information: RCFE complaint poster and Personal rights were observed posted and they are all posed on the board near the entrance way. The facility would provide internet service with at least one internet access device for the residents to use video call with their families or primary physician. 8. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. 9. Food Service: No resident is currently on any modified diet. Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. All the food in the kitchen are stored properly. 10. Incidental Medical and Dental: The medication is centrally stored and locked in the medication cabinet in the kitchen. Five (5) centrally stored resident medications were reviewed; which contained 30-day supply of medications. Facility will provide transportation to resident for medical and dental appointment if needed. 11. Disaster Preparedness: The last fire drill was conducted on 11/9/23. Records of resident Appraisal and Needs services plans are part of Emergency training. The facility has an updated Emergency Disaster Plan (LIC610E) and dated on 12/12/23. The facility has two alternative temporary shelter location. 12. Resident with Special Health Needs: Two (2) residents are receiving home health services. One (1) receive hospice care. No resident is currently on postural support. Half and full bed rails for mobility assistance were observed in resident rooms with physician order. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions. No deficiencies were observed during the visit. Exit Interview Conducted and a copy of the report was provided to Caregiver Rita Regis Garcia.the state’s words, verbatim · CDSS document, Dec 12, 2023