Sunny Garden

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) M. Flores arrived at the facility unannounced to conduct a required annual visit. LPA was granted entry by staff and explain the purpose of the visit. Facility Manager, Maricris Magpili arrived at the facility minutes after. The residence was set at 70 F temperature and free of passageway obstructions inside and outside. LPAs observed four bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean, and furnishing was in good condition. Hot water temperature was measured at 105.3 degrees F. Kitchen toured, supply of food observed, and food stored properly for perishable and nonperishable. Medications are locked in a cabinet next to the shared living area. Knives are locked in the kitchen area. Cleaning supplies are locked under the kitchen sink. Smoke detectors and carbon monoxide were checked and operating. Fire extinguishers were charged and was serviced on 3/29/2023. Emergency disaster drills are conducted quarterly, last drill completed on 4/11/2023. There was outdoor seating for the residents. Outdoor area was clean and free of obstruction. An exit interview was conducted, and a copy of this report was provided to Facility Manager whose signature confirms receipt. LPA requested the following updated forms faxed to CCLD by 10/20/23: Designation of Facility Responsibility (LIC308), Plan of Operation, Administrative Organization (LIC309), Personnel Report (LIC 500), LIC613, Proof of current Liability Coverage, Administrator's certificates and Administrator’s CPR/First Aid.the state’s words, verbatim · CDSS document, Oct 13, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lady Cabrera arrived unannounced for an Annual Required Inspection. LPA met with Administrator Carlo Santos. LPA stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trashcans with lid. Hand washing posters were observed by the bathrooms. Bedrooms were checked. The exterior tour was conducted. LPA checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. Exit interview was conducted. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 11/03/2022 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.the state’s words, verbatim · CDSS document, Oct 27, 2022

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.

Allegation investigated: Facility did not seek timely medical treatment for resident. Facility did not notify responsible parties of issues with resident's health. Resident was unable to get assistance during night. Staff are not wearing masks.

Licensing Program Analyst (LPA) Lady Cabrera conducted the subsequent complaint investigation visit to the facility. Administrator Carlo Santos was available via telephone and designated Caregiver Norrine Porciuncula to sign the reports. During the course of this complaint investigation LPA interviewed staff on duty, obtained and reviewed facility records. It was determined based on the interviews and records review that the above allegations are SUBSTANTIATED. Per records and interview, facility did not seek timely medical treatment for resident. Per facility Staff Notes, on 08/20/2021 at 7:30a.m., Resident (R1) complained of right hip and lower back pain prior to verbalizing that R1 “slid down” to facility staff. Facility staff did not notified RP and did not contact 9-1-1 to have R1 medically assess. Based on temperature logs and interviews, on 08/20/2021 at 8a.m. Resident’s (R1) temperature was 102.4. R1’s Responsible Party (RP) was not notified of R1’s change of condition. Substantiated Per Physician’s Report dated 05/25/2021, R1 was diagnosed with Alzheimer’s Dementia and indicated R1 doesn’t know day/night and had confusion. Per R1's Appraisal dated 07/08/2021, it indicates R1 needs special observation/night supervision. Facility provided a call button to R1. Staff reported they would respond to the call button, but at times R1 did not need help. Per interviews, facility staff removed R1’s call button battery at night due to R1 would push the call button often at night and disturbed other residents. Per interviews and LPA’s observation, on 09/14/2021, Licensee failed to protect the personal rights of clients in care to receive safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of clients in care, in that facility Staff (S1) and S2 failed to wear face coverings while providing care and supervision to clients in care, in violation of official government orders requiring the wearing of face coverings while working under specified conditions. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Citations are being cited on the attached LIC 9099D. Designated Caregiver was provided with the LIC9099, LIC9099D and Appeal rights provided. Exit interview conducted. Based on the interviews conducted and records review the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Designated Caregiver was provided with the LIC9099. Exit interview conducted.the state’s words, verbatim · CDSS document, Nov 23, 2021 · control 24-AS-20210908105203

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(g) · Plan of correction due date: Dec 3, 2021

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance… This requirement was not met as evidenced by: Based on records review and interviews, Licensee did not ensure to have facility staff contact 9-1-1 to have R1 medically assess, which poses a potential risk to the health, safety or personal rights of the clients in care.the state’s words, verbatim · CDSS document, Nov 23, 2021

Plan of correction: Licensee to review 87465 Incidental Medical and Dental Care. Licensee shall submit a written letter indicating they have read and understand the regulations to CCLD. Document of this will be provided to CCL by 12/03/2021.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Dec 3, 2021

87211 Reporting Requirements (a) Each licensee shall…(1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days… (D)Any incident which threatens the welfare, safety or health… This requirement was not met as evidenced by: Based on records review and interviews, the Licensee did not communicate with the R1's Responsible party regarding R1’s health condition, which poses a potential Health, Safety and Personal Rights risks to persons in care.the state’s words, verbatim · CDSS document, Nov 23, 2021

Plan of correction: Licensee to review 87211 Reporting Requirements. Licensee shall submit a written letter indicating they have read and understand the regulations to CCLD. Document of this will be provided to CCL by 12/03/2021.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.312(a) · Plan of correction due date: Dec 3, 2021

§1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement was not met as evidenced by: Based on records review and interviews, Licensee did not ensure care and supervision for R1 who was diagnosed with Alzheimer’s Dementia. Per records, it indicates R1 needs special observation/night supervision. Facility staff removed R1’s call button battery at night, which poses a potential risk to the health, safety or personal rights of the clients in care.the state’s words, verbatim · CDSS document, Nov 23, 2021

Plan of correction: Licensee to review 87705 Care of Persons with Dementia. Licensee shall submit a written letter indicating they have read and understand the regulations to CCLD. Document of this will be provided to CCL by 12/03/2021.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Dec 3, 2021

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations This requirement was not met as evidenced by: Based on interviews, Licensee did not ensure facility staff to wear face coverings while providing care and supervision to clients in care, which is a potential risk to the health, safety or personal rights of the clients in care.the state’s words, verbatim · CDSS document, Nov 23, 2021

Plan of correction: Licensee to review 87468.1 Personal Rights of Residents in All Facilities. Licensee shall submit a written letter indicating they have read and understand the regulations to CCLD. Licensee will provide training for all staff regarding Personal Rights of Residents. The written letter and training roster will be provided to CCL by 12/03/2021.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lady Cabrera arrived unannounced for an Annual Required Inspection. Administrator Carlo Santos was available via telephone and designated Caregiver Norrine Porciuncula to sign the annual report. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned. Hand sanitizer was readily available to clients and visitors. Social distancing is maintained in the common areas. Bathrooms have trashcans with lid. Hand washing posters were observed by the bathroom and kitchen sink. The exterior tour was conducted. Cleaning and PPE supplies were checked. Client’s files have updated emergency contact information. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. Administrator certification is current. Deficiencies are cited in LIC809D. Designated Caregiver was provided with LIC809, LIC809D and Appeal Rights. Exit interview was conducted. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 12/03/2021. As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.the state’s words, verbatim · CDSS document, Nov 23, 2021

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.