<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206776
Report Date: 02/28/2023
Date Signed: 02/28/2023 03:19:54 PM


Document Has Been Signed on 02/28/2023 03:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:IDEAL CARE CENTERSFACILITY NUMBER:
107206776
ADMINISTRATOR:IDONI, GREGORY AFACILITY TYPE:
740
ADDRESS:3618 W DAYTON AVETELEPHONE:
(559) 275-2488
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 6DATE:
02/28/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:59 PM
MET WITH:Care Staff - Joanna Gonzalez TIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Katie Brown conducted a Case Management - Deficiencies in conjunction with the Annual - Infection Control. Administrator (AD) Gregory Idoni was unable to be at the facility and authorized Care Staff (S1) Joanna Gonzalez to sign reports.

During the visit, LPA observed Diabetes and blood sugar reading supplies in the medication cabinet. Per S1, R2 does not have Diabetes but has orders for blood sugar to be tested.

During a record review, LPA identified the following:
1. R1 (diagnosis of MCI) and R2's (diagnosis of Dementia) Physician Reports are out dated.
2. R1 and R2's Physician Report state: unable to perform injections or blood sugar testing
3. Physician Orders related to Diabetic care for R1 and R2 were unavailable for review
3. R1 has a wheelchair "seat belt" - orders unavailable for review
4.R3 has half side rails on a hospital bed - orders unavailable for review

During the facility tour, LPA observed:
1. A package of disposable razors stored in a resident bathroom drawer

The following deficiencies were observed and noted on the attached LIC 809D. All violations that, if not corrected, will have direct and immediate risk to the health, safety or personal rights of clients in care.

An exit interview was conducted, and a Plan of Correction was developed and reviewed. A copy of this report and appeal rights were discussed and left with S1, whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 02/28/2023 03:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: IDEAL CARE CENTERS
FACILITY NUMBER: 107206776

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/28/2023
Section Cited

1
2
3
4
5
6
7
87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Defiency cleared at time of visit.

S1 immediately removed and secured razors in a locked cabinet.
8
9
10
11
12
13
14
Licensee did not ensure that items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. LPA observed a package of disposible razors in a resident bathroom drawer.

This poses an immediate health, safety or personal rights risk to residents in care.
8
9
10
11
12
13
14
Type B
03/14/2023
Section Cited

1
2
3
4
5
6
7
87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal…Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record… This requirement was not met as evidenced by:
1
2
3
4
5
6
7
AD has agreed to obtain physician's orders which indicate the need for the postural support for R1 and R3. AD will email a copy of the corrected physician's order to LPA by the due date.
8
9
10
11
12
13
14
Licensee did not ensure that a written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. R1 has a wheelchair seatbelt and R3 has half side rails on a hospital bed.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3


Document Has Been Signed on 02/28/2023 03:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: IDEAL CARE CENTERS
FACILITY NUMBER: 107206776

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2023
Section Cited

1
2
3
4
5
6
7
87629 Injections (a) The licensee shall be permitted to accept or retain a resident who requires intramuscular, subcutaneous, or intradermal injections if the injections are administered by the resident or by an appropriately skilled professional.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
AD has agreed to obtain a Physicians order related to injections for R1 and R2. The order shall include the need for staff assistance if appropriate. The order as well as proof of staff training as required will be provided to LPA via email by the due date.
8
9
10
11
12
13
14
Licensee did not ensure injections are administered by the resident or by an appropriately skilled professional. R1 has Diabetes and requires blood sugar and insuilin assistance. There are no orders or proof of training at the facility. R2 requires blood sugar readings. No orders or proof of training are available at the facility.
8
9
10
11
12
13
14
Type B
03/14/2023
Section Cited

1
2
3
4
5
6
7
87458 Medical Assessment (a) Prior to a person's acceptance... the licensee shall obtain and keep on file, documentation of a medical assessment... made within the last year...

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
AD has agreed to obtain a revised Physician's Report for R1, R2 and R3. The report shall accurately reflect the residents needs and orders. A copy of the Physician's Reports will be emailed to LPA by the due date.
8
9
10
11
12
13
14
Licensee did not ensure R1, R2 or R3 did not obtain an updated Physician's Report (PR). R1's PR dated, 8/13/16 with dx of MCI, R2's 3/2/17 dx of Dementai, R3's 8/24/21 is incomplete. R2 and R3's PR state unable to perform glucose or insuilin injections.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3