Post-licensing visit·December 13, 2022

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required post-licensing inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, 2 staff were on duty, who contacted facility administrator (AD) Jill Bonnin about visit. AD Bonnin was unable to be present during time of visit, however, provided consent for staff on duty (S1) Fely Marcelo to receive and sign report. NOTE: AD Bonnin's administrator's certificate expires on 3/17/24. As of 12/13/22, there are 0 active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted throughout the facility. The PUB475 "See Something, Say Something" poster was also observed at the entrance of the facility. LPA De Perio observed administrator's certificate (AD) for Jennifer Kum, which expires on 4/21/24. LPA De Perio toured the interior and exterior portions of the facility with S1. The facility is a single level structure and is licensed for 4 non-ambulatory residents, of which may be 60 years of age and over, with a hospice waive for 2. License also specifies that facility garage is not approved for resident use. For this visit, there are a total of 4 residents in care, of which 1 is on hospice. For today's visit, there is 1 resident in facility care, and 3 residents were attending day program. There are a total of 5 bedrooms, of which 4 are private resident rooms, and 1 is a vacant room, of which is currently under maintenance to be an activity room for residents. LPA De Perio toured each bedroom in the facility and observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. There are a total of 2 restrooms of which were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured to be at 108.8 degrees Fahrenheit and hand washing signs were also posted in each restroom. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Fire extinguisher was charged, mounted and located in the kitchen. Facility utilizes garage as a staff office. LPA De Perio observed the emergency disaster and evacuation plan, which is posted in the staff office. Facility had back-up emergency food and water supply, located in the kitchen and in the garage. LPA De Perio observed that First Aid Kit had all the required components. The facility had an adequate supply of PPE that was located in the garage. Medications were locked in the garage and is made inaccessible to residents in care. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are 2 gates in the backyard, which were self-closing and self-latching. No bodies of water were observed. LPA De Perio verified the Coronavirus 2019 (COVID 19) mitigation plan of the facility with S1 and AD Bonnin. LPA De Perio discussed Assembly Bill 665 requires that a licensee of any adult or senior care residential facility that has internet service provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. LPA De Perio discussed with AD Bonnin via phone call to review, and subscribe for emails regarding the Provider Information Notices (PINs) as well as to attend the CCLD Informational Calls to ensure that facility and staff are up to date. The PINs can be accessed at: www.ccld.ca.gov . LPA De Perio discussed the California Code of Regulations Section 87466 Observation of the Resident and Section 87211 Reporting Requirements with AD Bonnin. For today's visit deficiencies and citations were issued per Title 22 Division 6 of the California Code of Regulations. LPA De Perio advised AD Bonnin to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA. LPA De Perio conducted an exit interview with S1 and AD Bonnin and a copy of this report and copies of the regulations discussed were provided to the facility.