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Inspection visit

Routine inspection

PETANI HAVENLicense 4105084828 citations on this visit
8 citations recorded

Inspector’s narrative

What the inspector wrote

LPA Audrey Jeung toured facility and grounds, including detached storage building. There are 3 shared client bedrooms, a staff room, 2 full bathrooms, living/dining room, TV room, and kitchen. Washer and dryer are located in 1-car garage. There are no accessible bodies of water or fire safety hazards observed. Carbon monoxide detector is tested and operable. Medications and sharps are stored appropriately and inaccessible to clients, a comfortable room temperature is maintained, and lighting is sufficient for safety. First-aid kit is maintained and complete. Client files are reviewed, including Centrally Stored Medications Records. A Disaster and Mass Casualty Plan is posted. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed, as well as staff training records. Ane Haupeakui and Tomasi Haupeakui oversee facility operations; Tomasi's RCFE administrator certificate expires 2/25. As per legislation, effective 1/1/2015, the following information is posted: 1) text of Health and Safety Code 1569.269 AND CCR Title 22 Section 87468 (Personal Rights form LIC613C), per AB2171; 2) CCLD Hotline information, per SB895. Proof of current liability insurance is given to LPA today. The following licensing forms are requested to be completed and submitted to CCLD BY 2/27/24: - Designation of Administrative Responsibility (LIC308) - Personnel Report (LIC500) - Emergency Disaster Plan (revised 9 page LIC610-E signed and dated on page 9) - Facility Sketch (LIC999) Deficiencies of the RCFE California Code of Regulations, Title 22, Division 6, Chapter 8 are observed and cited on following pages. Also, see Advisory Notes--5 pages.

Citations

8 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 1569.625(b)(2)Type B

    Based on staff record review, the licensee did not comply with the section cited above, as there is no documentation maintained that staff have received required 4 hours of training on postural supports, hospice care and restricted health conditions.This poses a potential health, safety or personal rights risk to persons in care.

  • 1569.626(a)(2)Type B

    Based on staff record review, the licensee did not comply with the section cited above, as there is no evidence that staff have required dementia training.This poses a potential health, safety or personal rights risk to persons in care.

  • 87202(a)Type A

    Maintain fire clearance before retaining specified persons

    Based on observation and record review, the licensee did not comply with the section cited above, as Client #2 is bedridden, as per MD report 1/24 and facility does not maintain bedridden fire clearance.This poses an immediate health, safety or personal rights risk to persons in care.

  • First aid training requirements

    Based on staff record review, the licensee did not comply with the section cited above, as there is no evidence that staff #1, #2, #3, #5 have current first aid training.This poses a potential health, safety or personal rights risk to persons in care.

  • 87411(f)Type B

    Health screening and fitness requirements

    Based on staff record review, the licensee did not comply with the section cited above, as 4 out of 5 staff do not have evidence of health screening and TB test results on file, which poses a potential health, safety or personal rights risk to persons in care. Staff #2, #3, #4, #5 do not have HS and TB results on file.

  • 87412(b)(3)Type A

    Based on observation and staff record review, the licensee did not comply with the section cited above, as Staff #6 is observed having contact with client #2, and does not have criminal record clearance and association with facility.This poses an immediate health, safety or personal rights risk to persons in care.

  • 87457(c)Type B

    Complete admission suitability appraisal

    Based on client record review, the licensee did not comply with the section cited above, as pre appraisals and/or reappraisals for both clients are not maintained. Client #1 was admitted 7/2020 and client #2 admitted 7/2023.This poses a potential health, safety or personal rights risk to persons in care.

  • 87705(c)(5)Type B

    Based on client record review, the licensee did not comply with the section cited above, as client #1--who is diagnosed with dementia--has MD report dated more than 1 year ago, which poses a potential health, safety or personal rights risk to persons in care.

FAQ · About this visit

Common questions about this visit

What happened during the February 13, 2024 inspection of PETANI HAVEN?

This was an inspection of PETANI HAVEN on February 13, 2024. 8 citations were issued: 2 Type A (serious) and 6 Type B.

Were any citations issued to PETANI HAVEN on February 13, 2024?

Yes, 8 citations were issued (2 Type A, 6 Type B). The first citation was for: "Based on staff record review, the licensee did not comply with the section cited above, as there is no documentation mai..."

What type of inspection was this?

This was an inspection. Inspections are conducted by CCLD as part of their licensing oversight.

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.