Walnut Creek Care Home

Type of visit: Case Management - Annual Continuation

On 09/12/2023 at 10:00 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at facility for continuation of required annual inspection. LPA was greeted by staff members Fe Alolod and Nestor Avecilla. Licensee Asha Jain arrived at approximately 11:15 AM. During the Inspection, LPA observed that the facility has a sufficient supply of food: 2 days perishable and 7 days nonperishable. A comfortable inside temperature of 75 degrees was maintained. The facility was clean. The staff were attentive to residents' needs. The annual inspection of the facility is complete. 1 Type-A citation was issued during visit (refer to LIC809-D for details). Exit interview conducted with Licensee and a copy of this report was provided via email.the state’s words, verbatim · CDSS document, Sep 12, 2023

Type of visit: Required - 1 Year

On 07/27/2023 at 08:50 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced at facility for required annual inspection. LPA was greeted by staff member Nestor Avecilla. Licensee Asha Jain arrived at approximately 12:30 PM. During the Inspection, LPA observed that the facility has a sufficient supply of food: 2 days perishable and 7 days nonperishable. A comfortable inside temperature of 75 was maintained. The facility was well maintained, and clean. LPA interviewed 2 residents,1 staff member, and reviewed the records for 5 residents and 5 staff members. The annual inspection of the facility is incomplete and the LPA will return at a later date. 3 B-Type citations were issued during visit. Exit interview conducted with Licensee and a copy of this report was provided via email.the state’s words, verbatim · CDSS document, Jul 27, 2023

Type of visit: Case Management - Deficiencies

On 05/04/2023 at 8:30 AM, Licensing Program Analyst (LPA) J Sampair arrived unannounced for a Case Management visit. Upon entering the facility, LPA informed Caregiver Norma Solon of the purpose of the visit: rodent control. During the 04/04/2023 inspection, this LPA had identified and showed rodent feces in a kitchen drawer to Caregiver Norma Solon, but failed to cite the facility. This return to the facility was to cite them. During this inspection of the kitchen, the LPA observed at 8:45 AM that the drawer had been cleaned and sanitized. He did not observe any other rodent droppings. However, he did observe and feel and thick coat of grease and grime on the kitchen drawers and in the cabinets. LPA and Administrator (ADM) Asha Jain spoke about this briefly over the phone and ADM arrived at approximately 9:30 AM to inspect the kitchen herself. During that time, she acknowledged that the level of grease and grime in and on the drawers and cabinets was unacceptable. She also discovered the likely source of the grease and grime was the absence of a working exhaust fan over the stove. 1 A-Type and 2 B-Type citations issued for the deficiencies above (refer to LIC809-D for details). Exit interview conducted with ADM by phone and a copy of this report provided via email.the state’s words, verbatim · CDSS document, May 4, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 29, 2023

87303 MAINTENANCE AND OPERATION (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Based on observation, there was no exhaust fan in the kitchen, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 4, 2023

Plan of correction: On or before the due date, the Licensee shall have an exhaust fan installed in the kitchen above the stove. When completed, Licensee shall inform LPA.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87470(a)(2)(A) · Plan of correction due date: May 11, 2023

87470 Infection Control Requirements (a) A licensee shall ensure that ... (2) Environmental cleaning and disinfection activities shall be ... completed, at a minimum, as follows: (A) Surfaces ... shall be cleaned and disinfected on a regular basis ... [and] when these surfaces are contaminated or visibly soiled. This requirement was not met as evidenced by: Based on observation, inside and outside of kitchen cabinets had a visible and tactile accumulation of grease and grime, which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 4, 2023

Plan of correction: On or before the due date, the Licensee shall completely remove all grease and grime from all cabinets, handles, drawers, inside of cabinets, and all of the contents of those cabinets (including food and any spice containers). When completed, Licensee shall inform LPA.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87555(b)(27) · Plan of correction due date: May 5, 2023

87555 GENERAL FOOD SERVICE REQUIREMENTS (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidenced by: Based on LPA observation of rodent feces in kitchen drawer on 04/04/2023 that he had shared with Caregiver Norma Solon, which posed an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 4, 2023

Plan of correction: Licensee had removed rodent feces and disinfected the kitchen drawer before LPA's arrival at the facility today, so citation cleared during inspection.

Allegation investigated: Staff did not ensure that resident's medication were stored in the container they were originally received in.

On 04/04/2023 at 10:00 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to inspect facility concerning the allegation above. LPA explained purpose of the visit to Caregiver Nestor Avecilla who then reported the allegation to the Licensee Asha Jain by phone. At 10:45 AM, Staff S3 opened the locked medication cabinet for LPA who confirmed that the medications were not being stored in their original container, a practice confirmed by staff S1, S2, and S3. Based on staff interview and LPA observation, the preponderance of evidence standard has been met; therefore, the above allegation has been found to be SUBSTANTIATED. Deficiency cited per Title 22 California Code of Regulations is listed on the LIC9099-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided via email. Substantiatedthe state’s words, verbatim · CDSS document, Apr 4, 2023 · control 15-AS-20230329133115

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(5) · Plan of correction due date: Apr 5, 2023

87465 Incidental Medical and Dental Care (h) The following ... shall apply ... (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by: Based on LPA J Sampair's 10:45 AM observation and staff confirmation of 3 out of 3 resident's medications being stored outside of their original container, which poses an immediate Health, Safety or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 4, 2023

Plan of correction: During visit, resident medications were all removed from pill boxes and returned to original containers.

Type of visit: Case Management - Deficiencies

During the unannounced complaint inspection at the facility on 04/04/2023, Licensing Program Analyst (LPA) J. Sampair conducted a complaint visit after observing additional deficiencies. LPA discussed these deficiencies with Caregiver Nestor Avecilla during the complaint investigation. Civil penalty issued because of a staff person working who was not associated with facility. Full rails on R1's bed without a physician's order. Staff not wearing a mask Facility cited for those deficiencies as per Title 22 of the California Code of Regulations listed on the LIC809-D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Apr 4, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(g)(2) · Plan of correction due date: Apr 11, 2023

87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by: Staff person Fe Alolod was not associated with facility.the state’s words, verbatim · CDSS document, Apr 4, 2023

Plan of correction: Until Fe Alolod has been associated with the facility, she shall not be allowed to work or volunteer in the facility. On or before the due date, Licensee shall associate Fe Alolod with the facility. Licensee shall inform LPA of successfully associating Fe with the facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468.1(a)(2) · Plan of correction due date: Apr 4, 2023

87468.1 PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES (a) Residents ... have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on observation by LPA J Sampair on 04/04/2023 at 10:00 AM of ataff S1 not wearing a mask, Licensee failed to protect the personal rights of residents, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 4, 2023

Plan of correction: Cleared during inspection when all staff put on masks and Licensee acknowledged that he did not know of that requirement by the Department and the California Department of Public Health.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(3) · Plan of correction due date: Apr 5, 2023

87608 Postural Supports (a) ... Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record... This requirement was not met as evidenced by: Full railings on R1's bed without a physician's order.the state’s words, verbatim · CDSS document, Apr 4, 2023

Plan of correction: Rails on R1's bed removed during visit.

Type of visit: Case Management - Other

On 7/13/22 at 4:10 PM, Licensing Program Analyst (LPA) J. Sampair received video and photo proof from Applicant Asha Jain of corrections for the deficiencies cited during the 7/6/22 inspection. After review of that proof of correction, LPA phoned Applicant Jain who then confirmed those corrections verbally. Additionally, she described the work she and her staff have done to not only bring their facility into compliance with the Title 22 regulations, but to go above and beyond in service to the residents of her facility. Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete.the state’s words, verbatim · CDSS document, Jul 13, 2022

Type of visit: Case Management - Other

On 7/7/12, LPA J. Sampair successfully completed the Component III training with the Applicant Asha Jain via TEAMS. During the training, Ms. Jain confirmed that she understood this category specific training and ways for her to address some of the commonly found problem areas operating a licensed facility to keep it within substantial Title 22 regulation compliance. Additionally, she demonstrated that she understood and appreciated her part in avoiding the common facility operation problem areas and pitfalls. Further, she expressed a desire to continue learning and willingness to reach out to the Regional Office and her LPA, because the Component III training does not cover ALL regulations, only those found to be most problematic, and that the regulations require Administrators to be knowledgeable of all regulations and amendments to the law.the state’s words, verbatim · CDSS document, Jul 7, 2022

Type of visit: Prelicensing

On 07/06/22, Licensing Program Analyst (LPA) James Sampair conducted an unannounced pre-licensing inspection and met with Applicant, Asha Jain. LPA explained purpose of the visit. LPA toured the facility inside and outside including but not limited to resident's bedrooms, bathrooms, dining room, common living areas, kitchen, and backyard. Resident's rooms were equipped with the proper furniture, but inadequate lighting. Resident's rooms had proper bedding and linens. Bathrooms were equipped with grab bars and nonskid mats. Living room is equipped with the proper furniture for the residents. All toxins and sharp objects were locked. Passageways and hallways were free of obstruction. Fire extinguisher is fully charged. Smoke and Carbon Monoxide detectors were operational. Medication cabinet was locked Hot water temperature was acceptable at 111 degrees F, the room temperature was 73.6 degrees F, and the freezer temperature was acceptable at 0 degrees F. There were sufficient 2 day perishable and 1 week non-perishable food supplies observed in the refrigerator, freezer, and additional food supplies were observed in storage in the garage. Complaint poster, personal rights, Ombudsman and rights to council posters were observed displayed near the dining area. Current Licensee cited for 2 Type-B deficiencies: This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 6, 2022

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 5 Method: Telephone call with CAB COMP II Participants: Asha Jain, Administrator/Owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming driver’s license number. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Staff training 4. Applicant and Administrator qualifications 5. Grievances, Complaints, Community resources 6. Food service 7. Medication management 8. Application document review and technical assistance: Pre-licensing inspectionthe state’s words, verbatim · CDSS document, May 25, 2022