Ward Residential Care Home I

Type of visit: Required - 1 Year

On 2/9/2023, Licensing Program Analyst (LPA) D. Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and met with Licensee, Alicia Poquiz. The facility currently provides care for 6 residents all of which were present at the time of visit. No residents are receiving hospice services and none of which with a of diagnosis of dementia. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Licensee. Facility was at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 5/19/2022 at the time of the visit. Smoke and carbon monoxide detectors were tested and found to be in working order. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations with food stored properly. Residents are provided various alternative food options per meal with the facility ensuring well balanced and nutritious foods. Residents were observed to be participating in their individual activities including listening to music, conversing with other residents or in the backyard. All resident bedrooms have appropriate lighting and furniture with a supply of extra blankets and linens. There was a supply of hygiene products and paper products available for resident use. LPA conducted a sample review of staff training and found that all staff have current CPR and 1st Aid training on file. Toxins are stored in a locked cabinet in the facility garage and found to be secured. Continued onto LIC809-C LPA Tobola measured water at faucets accessible to residents and measured at 106.7 degrees F which is within Title 22 Regulations between 105 and 120 degrees F. Infection Control: Facility has submitted an infection control plan for review. Posters have been placed at the front door, and facility has a station near facility entrance with a sign in sheet, hand sanitizer and other items designated for visitors and staff. There is a sufficient amount of PPE supplies available. All staff and visitors were observed to have appropriate face coverings and following facility COVID protocols. Residents and staff are also screened for symptoms on observation. No deficiencies cited during today's visit. LPA requested the following documents be sent to CCL by COB 2/23/2022: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility client’s/client’s Copy of Administrator Certificate(s) Copy of Liability Insurancethe state’s words, verbatim · CDSS document, Feb 9, 2023

Type of visit: Case Management - Incident

On 8/19/2022 Licensing Program Analyst (LPA) Tobola conducted an unannounced Case Management visit for the purpose of following up on an incident report and coinciding report of suspected abuse (SOC341) in which resident (R1) was reported to have physically injured staff (S1). LPA conducted interviews with Licensee, staff, clients, reviewed records and made observations. On the date of the incident, 8/3/2022, LPA found that Licensee contacted Vallejo Police Department and that S1 originally decided to file charges against R1 leading to R1 being arrested. LPA was informed that a court hearing will be scheduled for Licensee and S1 to attend. However, S1 has decided to not file charges with the decision to no longer accept R1 back to the facility. All staff including S1 and all residents were observed to be comfortable and in a safe condition. No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, Aug 19, 2022

Type of visit: Case Management - Incident

On 5/6/2022 LPA Tobola arrived unannounced for the purpose of following up on a facility self-reported incident in which resident R1 AWOL during an outing with R1's Case Manager. LPA was greeted by Lead Staff, Gracia Samonte. LPA contacted Licensee, Alicia Poquiz who was unable to meet at the time of visit but spoke with LPA by phone and provided additional information. On 4/29/2022 R1 was reported to have attended an program at the Caminar Wellness Center with a second resident R2 . Both R1 and R2 were transported by their Solano County Case Manager. Upon the end of the program the Solano County Case Manager was informed that R1 had a verbal altercation with another program participant and left the Caminar Wellness Center without notifying Wellness Center staff. Solano County Case Manager was unable to locate R1 and reported the AWOL to the Licensee, Alicia Poquiz and facility Caregiver Staff. R1 was on an outing with their father at the time of visit today. Acting Administrator, Victoria Lim had contacted Vallejo Police Department to report R1 as a missing person. R1's father was also notified by facility. LPA spoke with Lead Staff and was informed that R1's father had visited several hospitals in Solano County and located R1 at Sutter Solano on 4/30/2022. R1 was discharged and returned to the facility on 4/30/2022. Licensee has conducted meetings with R1's and R2's Case Manager and are currently postponing attendance to the Caminar Wellness Center to find more appropriate placement for resident supervision. Report was reviewed with Lead Staff and Licensee. No deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, May 6, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. Infection Control inspection for this facility and was greeted by Licensee, Alicia Poquiz (AP). The facility currently provides care for six (6) residents none of which with a diagnosis of dementia. LPA arrived at the facility and had temperature checked and logged. LPA continued with a tour of the facility with Licensee and facility staff; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 6/9/2021 at the time of the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Toxins are stored under kitchen and bathroom sinks and in the garage. LPA observed Lysol and Spic and Span cleaning solutions in an unlocked staff bathroom (photos taken). Licensee immediately removed cleaning supply solutions and locked staff bathroom. Residents do not use staff bathroom but LPA explained the health & safety risks that the accessible cleaning supplies may have towards residents. There was an ample supply of hygiene products and paper products available for resident use. All resident’s bedrooms have lighting & appropriate furnishings. Hot water measured at 119.8 degrees F which is within Title 22 regulations of 105 to 120 degrees F in faucets used by residents. Infection Control: Facility has submitted a mitigation program plan which has been approved. All staff and residents have been vaccinated with no reported or observed symptoms. Posters have been placed at the front door, and facility has a station at main entrance with a sign in, hand sanitizer and other items designated for visitors and staff. Staff are screened for temperature and symptoms on a daily basis and residents are screened on a daily basis. Continued onto LIC809-C Deficiency cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with facility Licensee, whose signature on this document confirms receipt. A copy of the signed report was emailed to Licensee.the state’s words, verbatim · CDSS document, Mar 10, 2022

Allegation investigated: Illegal eviction

On 8/20/2021 Licensing Program Analyst (LPA) Tobola conducted a compalint visit to deliver investigation findings and met with Lead Carestaff, Grace Samonte. Facility was toured, facility client files were reviewed and interviews with staff and outside parties were conducted. Complaint alleges the facility conducted an illegal eviction for client C1. Based upon record review and interviews with staff and Solano County Case Manager/Conservator and Housing Manager for C1, LPA found that there was miscommunication regarding C1's transfer to another facility. Although, Licensee notified the Housing Manager of C1's transfer the information was miscommunicated to the Conservator from the Housing Manager. LPA received conflicting information from various parties that discussed C1's transfer. A finding that the complaint allegations illegal eviction is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Appeal Rights Given. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 20, 2021 · control 21-AS-20210616101703

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Tobola conducted an unannounced post-licensing inspection to this facility and was greeted by Licensee Alicia Poquiz. Facility currently has 6 residents in care one (1) of which admitted to a crisis center and returning today and some of which with a diagnosis of dementia. LPA toured the facility on 08/05/2021 with Licensee and facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 6/9/2021. Facility smoke detectors and carbon monoxide detectors were connected, tested and found to be in working order. Hot water temperature measured between 109.7 and 110.1 degrees F in 2 out of 2 resident’s bathroom faucets within Title 22 acceptable regulation of 105 to 120 degrees F. Toxins are stored in a locked cabinet in the kitchen and laundry room. Dangerous items were stored inaccessible to residents with dementia. There was a supply of cleaners, hygiene products and paper products available for residents. The bathroom designated for residents at the facility were supplied with individual paper towels; hand soap dispenser was available. All 6 residents' bedrooms have lighting & appropriate furnishings. LPA conducted a file review for both staff and residents and found all files to be in order. Medications are centrally stored in a locked cabinet in the facility kitchen and hallway. LPA observed multiple unsecured prescription medication in the refrigerator (photo taken). Licensee immediately moved medications in a lockbox which will be kept in the refrigerator. Facility has PPE supply stored in the facility garage. In addition, LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Disaster Drills will be conducted bi-annually with the first drill to be completed next month. Appeal Rights Given.the state’s words, verbatim · CDSS document, Aug 5, 2021