Tice Valley Residential Care

Type of visit: Case Management - Health Checks

At 9:00 AM on 02/15/2023, Licensing Program Analyst (LPA) James Sampair began an unannounced health check visit concerning resident R1. LPA explained the purpose of the visit to MARK GUTIERREZ. During the visit, LPA interviewed staff S1 and S2 regarding their care for R1. From their statements, the only medical care being provided to R1 is that from the hospice nurse who comes to the facility 3 times a week. No citations issued during inspection. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Feb 15, 2023

Type of visit: Case Management - Deficiencies

During a health check visit on 02/15/2023, Licensing Program Analyst (LPA) James Sampair observed a deficiency concerning care for persons with dementia. During the LPA's inspection of the exterior of the building, it was observed that one of the 3 gates were not self-closing, for details refer to LIC 809D. One citation was issued during inspection. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Feb 15, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(h) · Plan of correction due date: Feb 22, 2023

87705 Care of Persons with Dementia (h) Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in 1 out of 3 gates that was not self-closing, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 15, 2023

Plan of correction: On or before due date, Licensee shall add self-closing mechanism to the gate without one.

Type of visit: POC

On 09/30/2022, Licensing Program Analyst (LPA) J. Sampair conducted an unannounced Plan of Correction (POC) inspection of the facility to verify that the POC corrections had been implemented in a manner consistent with POC dated 09/19/2022. Upon entry into the facility, the LPA identified himself and the purpose of the visit to staff members who immediately called Administrator Rachelle Santiago to come to the facility. The Administrator arrived after the LPA had completed his inspection of the facility inside and out. During his inspection, the LPA was able to verify that 1 of the 3 POCs were able to be cleared. The facility was fined for not clearing the other 2 by the due date a total of $1,500. Additionally, the facility was cited for 2 more deficiencies (refer to LIC 809-D). A total of 2 civil penalties and 4 deficiencies (1 Type-A and 3 Type-B) were issued during the visit. A copy of this report was provided via email.the state’s words, verbatim · CDSS document, Sep 30, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(j) · Plan of correction due date: Oct 7, 2022

87705 CARE OF PERSONS WITH DEMENTIA (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. Based on observation by the LPA, the Licensee did not comply with the section cited above. No auditory device is on 1 out of 7 of the facility exits, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 30, 2022

Plan of correction: Administrator agreed to install an auditory device and to provide picture proof to the LPA by the due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Oct 7, 2022

87405 ADMINISTRATOR - QUALIFICATIONS AND DUTIES (a) All facilities shall have a qualified... administrator . . . The administrator... shall be on the premises a sufficient number of hours.... The Department may require that the administrator devote additional hours in the facility... This requirement was not met as evidence by: Based on observation by the LPA, the Licensee did not comply with the section cited above. An Administrator has not been on premises a sufficient number of hours (20 per week minimum), which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 30, 2022

Plan of correction: Administrator agreed to: (1) update LIC500 to reflect days and hours she will be present as Administrator at the facility. (2) Review Title 22 regulation 87405 "Administrator – Qualifications and Duties". (3) Submit a self-certification that the regulation has been reviewed and administrator will abide by the regulation going forward. (4) Self-certification and updated LIC500 will be submitted by the POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Oct 1, 2022

87303 MAINTENANCE AND OPERATION (e) Water supplies . . . shall be maintained as follows: (2) Faucets used by residents . . . hot water . . . attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Based on observation by the LPA, the Licensee did not comply with the section cited above. The hot water temperature was measured at 130 degrees, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 30, 2022

Plan of correction: Administrator agreed to: (1) Self-certify that the hot water temperature was between 105 and 120 degrees F. (2) Purchase a thermometer to accurately measure water temperature. (3) Create and train staff in updating a daily hot water temperature log going forward.

Type of visit: Required - 1 Year

On 9/19/22 at 12:30 PM, Licensing Program Analyst (LPA) J. Sampair conducted an infection control annual inspection. Upon arrival, LPA explained the purpose of the visit to staff. Administrator Rachelle Santiago and LPA toured the facility inside and outside. Facility has an infection control plan in place that they are following. The designated infection control leader is the administrator. They have one central entry point that has been designated for universal entry screening with the station located near the front entrance with visitor's log, hand sanitizer, face masks, and no touch thermometer. Facility follows daily cleaning, sanitation of frequently touched common surfaces with disinfectants. COVID-19 signs were posted to promote hand washing, cough/sneeze etiquette and physical distancing. The temperature inside of the facility was 74.5, which was in the safe temperature range. However, the hot water temperature was dangerously high at 138 degrees. An administrator is on site at least the required 20 hour minimum each week to oversee business operations. Facility cited for 1 Type A and 2 Type B deficiencies (refer to LIC 809-D). Exit interview conducted, copy of Appeal Rights, and a copy of this report provided via emailthe state’s words, verbatim · CDSS document, Sep 19, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) James Sampair conducted an infection control annual inspection and explained the purpose of the visit with Administrator, Licensee, and Infection Control Leader Rachelle Santiago. LPA observed 3 staff wearing face masks during visit. Facility has a completed COVID-19 mitigation plan (LIC 808) in place dated 03/12/2021. LPA discussed the LIC 808 with administrator and reviewed up-to-date COVID-19 infection control practices. LPA inspected the facility inside and outside. LPA observed screening station located near the front entrance with visitor's log, hand sanitizer, face masks, and no touch temperature probe. Routine symptom screening (+/-) temperature and symptom check is done at entry for all staff, residents, and visitors. LPA observed COVID-19 signages posted in common areas to promote hand washing, cough/sneeze etiquette, and physical distancing. Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Ms. Santiago has conducted staff training on infection prevention, symptoms, transmission and proper donning and doffing of PPE. All staff and residents are fully vaccinated. There were sufficient food and water supplies in the kitchen refrigerators/freezers. Emergency paper & PPE supplies were observed stored in the facility. Facility room temperature was maintained at a comfortable level and the hot water temperature was within the safe 105 to 120 degree range. A certified administrator is on site more than the minimum of 20 hours a week to oversee proper business operation and compliance with COVID-19 infection control practices. Fire extinguishers were observed fully charged and Smoke and Carbon monoxide detectors were operational. Though pathways were free of obstruction and fire hazards, there was junk in the back yard and physical plant repairs needed that were cited as Type B. Exit interview conducted and a copy of this report was provided to the administrator.the state’s words, verbatim · CDSS document, Nov 18, 2021