Routine inspection·May 4, 2023

On 05/04/23, at 10:00 AM, an unannounced annual inspection was conducted by Licensing Program Analyst, (LPA) Kimberly Viarella at Graceful Living at Oakdale. LPA identified herself and the purpose of her visit to staff who contacted the Designee, Rainilda Clavano, and she arrived within 20 minutes. Designee reported census was 6 with 2 hospice and the 2 hospice were bedridden. 4 Residents were ambulatory. The facility was licensed for 6 nonambulatory and approved for a hospice waiver of 2. They did not have a dementia program at this time. The facility was not licensed for bedridden. The Licensee/Designated Facility Administrator, Voica Matis, Certification 6008538740, expires 1/6/2023. The tour began in the kitchen/areas. LPAs checked the food supply and found that there were enough groceries for 2 days of perishable and 7 days of non-perishable items at this time. Knives were secured in a locked drawer and chemicals were stored in a locked cabinet and separate from the food supply. The fire extinguisher was last inspected on 06/17/22, by Stanislaus Fire. The LPA observed the furniture, furnishings and lighting in the kitchen/family room, dinning/living room, and four bedrooms. All were in compliance. Two of the residents required oxygen and both of their bedrooms displayed the appropriate warning signs. The hot water was measured in the hallway bathroom and found to be 113 degrees, within the range of 105-120 degrees required. LPA observed that the 2 bathrooms in the house had grab bars and bath mats along with paper towels. LPA inspected the linen supply and found it to be sufficient for the residents in care. The tour progressed to the garage. The Designee opened all of the locked cabinets. The LPA observed cleaning supplies and other toxins in one, the others contained PPE, holiday decorations and general household storage. The LPA also observed a small refrigerator for resident medications. It was not locked at this time. Continued on LIC 809C The Designee led the LPA to an area being modified into a staff room. The building permit was posted. Community Care Licensing was not notified of these physical plant changes. The inspection continued to the exterior of the house. There were no bodies of water or outbuildings present. At this time, the backyard was enclosed with a gate on one side. The area was free of debris and trip hazards. Adjacent to the front door was a small sitting area for residents to enjoy surrounded by a half-wall. All screens were intact and gutters were clear. At the time of the inspection, medications were centralized and stored in a locked cabinet next to the refrigerator. Policies and procedures were discussed with staff in terms of dispensing and documenting the administration of resident medications. First aid kit was observed to be present and contained all of the necessary components at this time. LPA completed a review of 5 resident files. LPA looked for the following: a signed and dated admissions agreement, a physician’s report, proof of a negative TB test, ambulatory/non-ambulatory status, ID and emergency information, an appraisal and needs service plan, a centrally stored medication destruction record, safeguards for cash resources, safeguards for property/valuables, statement of personal rights, and cash resources information. All were complete and in compliance LPA reviewed 6 staff files. LPA looked for the following: first aid certificate, fingerprint clearances/exemptions, personnel record/job application, health screening, proof of negative TB test, medical training verification, employee rights, and criminal record statement. 2 out of 6 were missing annual training and 2 out of 6 were missing First Aid Certification. The following forms and documents were requested to be updated and submitted to CCL via email to kimberly.viarella@dss.ca.gov by 05/19/23: LIC 308 LIC 400 LIC 500 LIC 610 Updated Liability Insurance. (Continued on the LIC 809 C) According to the California Code of Regulations (Title 22, Division 6), the LPA observed the following deficiencies listed on the LIC 809 D. Civil penalties were assessed during today's visit. An exit interview was conducted with staff member, Rainilda Clavano . Copies of the Facility Evaluation Report and Appeal Rights were provided.