Post-licensing visit·March 1, 2022

Licensing Program Analysts (LPA) Karina Canela arrived at L & S Gentle Care II to conduct an unannounced post-licensing inspection on 03/01/2022. LPA met with Imelda Padama, Licensee. LPA observed 6 residents in care. LPA discussed Emergency Disaster Drills to be conducted every 3 months. During today’s visit LPA observed the following items: · COVID-19 postings and screening station at entrance. · Supply of linens, paper products, and hygiene supplies available · Grab bars and non-slip mats in 2 of 2 bathrooms. · Fire Extinguisher charged · Required furnishings in all 6 resident bedrooms · Administrator Certification (expires 11/28/2022); Required postings (Personal Rights, Emergency plan/numbers, CCLD complaint poster, Emergency Disaster Plan, and visitor policy). · Water temperature was tested and within regulation of 105 to 120 degrees F · Auditory devices observed operational · Resident's medication was centrally stored · Food supplies were within regulation · Facility records were reviewed for residents and staff. Report continued on LIC 809-C During the inspection, LPA observed the following deficiencies (pictures taken): Half bed rails in resident bedrooms 2 - 6 and full bed rail in resident bedroom 1. As of 03/01/2022, Community Care Licensing Department (CCLD) has not received or approved an exception request for postural support - full bed rail. Additionally, LPA reviewed resident files and 6 of 6 residents do not have a prescription for the half bed rails used only for assistance with mobility. Licensee contacted the resident's doctors during inspection. Resident (R1) observed with a lap belt in wheel chair. As of 03/01/2022, CCLD has not received or approved an exception request for postural support - lap belt device. Licensee stated the device is used for safety for R1 not to fall out of the wheelchair. Cleaners and disinfectants observed unlocked and accessible in the laundry room (on the laundry room floor: 3 containers of liquid detergent, 2 containers of clorox; and in unlocked laundry cabinet: 3 containers of lysol toilet cleaner, 1 jug of fabuloso cleaner, and 5 spray bottle containers of non-labeled cleaning solution). Licensee locked cleaners and disinfectants during inspection. LPA observed alterations to the facility including a second backyard gate and a bedroom in the garage for staff use. Fire extinguisher observed without a service tag. Licensee stated the fire extinguisher was bought new and thought it did not need to be serviced until 1 year. Topical medications (4 tubes) in Resident (R2)'s bedroom. Licensee stated staff were using it and forgot to lock 2 of 2 backyard fence gates observed with a key chain trail metal clip. Licensee stated a neighbor's home was broken into and the facility felt safer with securing the fence gates. As of 03/02/2022, CCLD has not received a waiver request to secure the perimeter. Licensee stated they would request a waiver to lock/secure the perimeter from CCLD. Licensee removed during this visit and stated they understood the requirement. Report continued on LIC 809-C Individual (I1) was observed working and providing care to residents without being associated as required. LPA verified with L & S Gentle Care II faciltiy personnel roster printed on 03/1/2022 LPA explained prior to anyone working (including shadowing a staff and/or training), volunteering, residing or being present in any part of the licensed facility, they are required to be fingerprint cleared and associated to the facility. LPA explained Community Care Licensing (CCL) requirements and provided the regulation. Licensee stated they understood CCL's requirements and prior to anyone working, providing care, volunteering, or residing at a licensed facility, the individual must obtain a fingerprint clearance and be associated to the facility. A Civil penalty in the total amount of $100.00 was assessed today for individual (I1), who was not fingerprint cleared to this facility as required. Licensee associated the individual during today's inspection. LPA verified with CCL Santa Rosa Regional Office that I1 was associated as of 03/01/2022 Appeal Rights Provided. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Imelda Padama, Licensee, whose signature below confirms receipt. LPA discussed with licensee regarding lawful evictions. LPA requested documentation for staging of R1's wound to be submitted to CCL by 03/08/2022