The Hills of Hamilton

Type of visit: Case Management - Incident

Licensing Program Analyst, Amber Coleman, (LPA) arrived at The Hills of Hamilton Residential Care Facility to conduct a Health and Safety Case Management Visit. This Case Management visit is in response to a Special/Unusual Incident Report, (SIR) received by this agency on October 23rd, 2023. LPA met with Caregiver, Fely, introduced self and stated purpose of the visit; which is to gather more information about the incident. LPA was granted entry and signed in. Staff contacted Administrator to notify of LPA's visit. LPA spoke to Administrator and discussed purpose of the visit, the resident and the Physician's Report. LPA was informed R1 was admitted to the hospital and not present at the time of visit. During today's visit, LPA was accompanied on a tour of the facility, completed record reviews and staff interviews. At approximately 12:15pm LPA reviewed R1's Physician's Report, (LIC602) and observed that R1 is non-ambulatory, unable to transfer to and from bed and not able to leave the facility unassisted. With both staff and Administrator, LPA discussed the importance of the LIC602, ambulatory status, transfers, the level of care/supervision required for the resident. Additionally, R1's family involvement and communication with the family. Based on record reviews and staff interviews. A deficiency is being cited to address concerns mentioned above, per Title 22, California Code of Regulations. An exit interview was conducted to discuss plan of correction. A copy of this report was read/reviewed with Licensee; signature acknowledges understanding and receipt of report and attachments.the state’s words, verbatim · CDSS document, Oct 27, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80078(a) · Plan of correction due date: Oct 30, 2023

80078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement is not met as evidenced by: Based on interviews and record reviews, the Administrator failed to ensure the resident had assistance/supervision before leaving the facility on 10/12/23 which posed an immediate Health, Safety and Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 27, 2023

Plan of correction: Administrator agrees to complete a statement of understanding, by way of an LIC9098, complete a plan of communication with R1's family to ensure that the resident has supervision when leaving the facility. Administrator agrees to submit this plan of communication and LIC9098 form to the Community Care Licensing office by 10/30/23.

Type of visit: Prelicensing

Licensing Program Analyst, Amber Coleman, (LPA) arrived at The Hills of Hamilton for an announced visit to conduct the Pre-Licensing Inspection for Change of Ownership. LPA introduced self and stated purpose of the visit. LPA was greeted by Sophia Ramirez, Administrator and Marciel Nepomuceno and invited inside the facility. LPA signed in and was provided a space to set up and work, then provided a tour of the facility inside and out. LPA observed the following: Application: The application is for Residential Care Facility for the Elderly (RCFE). Fire clearance has been granted for five, (5) non-ambulatory and one, (1) bedridden resident. Fire clearance was approved on 5/24/2023. Buildings and Grounds: The home is composed four, (4) bedrooms, living room, dining room, kitchen, backyard, and attached garage. Interior pathways were unobstructed and free of clutter. Smoke, Fire and Carbon Monoxide alarms were tested and found operational - all hardwired to one another. Two, (2) Fire Extinguishers were observed fully charged and last inspected May 2023. The backyard included adequate seating and spacing for activities and shady seating for residents in care. Exterior pathways were clear and unobstructed. Pathway along the right side of the facility is to be used for exit as space permits. There are no pools or other bodies of water located on premises. Administrator and Licensee report there are no weapons or ammunition kept in the facility. Resident Rooms - each room included regulated mattress, bed linens, storage, seating, intact window screens and sufficient lighting. Each room also included extra linens and adequate storage space. One room has an attached bathroom. Bathroom appliances in working order and housed adequate paper and hygiene supplies. Bathrooms were observed to have non-slip bath mats available. As well as secure cabinets to hold hygiene supplies. The water temperature was tested and measured within regulation. Activity supplies observed in various spaces. The facility maintains telephone and internet services. The washing machine and dryer were observed secure in attached garage in good condition. Storage and Supplies: Medications will be stored inaccessible to residents in a secure cabinet in the kitchen. Also maintained in the cabinet was First aid kit, staff and resident files, disaster plans and various supplies. Cleaning supplies will be stored in secure cabinet under kitchen sink. Sharps designated secure drawer. Linens, personal hygiene supplies, and equipment observed are all in good condition and sufficient for approved census. Food Service: Utensils, dishware and storage space are sufficient for the requested capacity. The refrigerator and pantry observed to have adequate supply of food for the number of residents in care. Food observed included milk, eggs, bread, fresh vegetables and fruits. Forms: The following forms were observed to be posted at the home: Emergency Disaster Plan (LIC 610D), Personal Rights, Resident Rights, Facility Sketch/Evacuation Plans in each room. Labor laws and licensing information. LPA audited 4 resident files and observed them to include all regulated documentation. No deficiencies were observed during inspection. Care Tool utilized. LPA will inform the Centralized Applications Bureau the home is ready to be licensed. An exit interview was conducted. This report was reviewed, discussed then provided to Marciel Nepomuceno, Licenseethe state’s words, verbatim · CDSS document, Sep 29, 2023

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care):6 COMP II Participants: Maricel Nepomuceno, Licensee & Administrator Sophia Ramirez Interview Method: TEAMS Meeting On 9/11/2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting Pre-licensing readinessthe state’s words, verbatim · CDSS document, Sep 11, 2023