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25 | Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting a case management visit to cite deficiencies found during a health and safety check. LPA Maldonado met with Rhonwinn Hipolito- Executive Director (ED) & Michael Forsgren- Operations Manager (OM) and explained the purpose for the visit.
During today's visit, LPA Maldonado obtained a copy of the resident and staff roster, Facesheet and Physician's Reports for Residents# 1-5 (R1-R5), and conducted a tour of the physical plant, including rooms and restrooms (RR) for R1-R5, with assistance of ED and OM. LPA discovered the following:
R1's room had a foul smell. Private RR was inspected and toilet was observed to be splattered with feces around the seat. R1 stated RR has not been cleaned in a while (unable to specify time) and has asked staff several times for cleaning services, but has not received it. Per Needs and Services Plan, R1 is to receive housekeeping and Laundry services once a week and as needed. R2's room carpet was observed to be dirty and had dark spots throughout, as though something was spilled. R2 stated it has been this way for some time (unable to specify time). R4-R5 share a room. R4's blanket on the bed was observed to have 3 small feces stain. R4 stated it needs to be washed, however staff do not pick up the laundry and R4 has to take their belongings to the laundry room, located at the end of the hallway. Per R4's Needs and Services Plan, R4 is non-ambulatory, making it difficult for R4 to bring their laundry basket to the laundry room. Per R4-R5's Needs and Services Plan, housekeeping and Laundry services are to be provided once a week and as needed. RR was inspected and noted to smell like urine, non-skid mat was not observed in the shower, and the shower was dirty. A soiled brief was observed in a trash can near R4's bed that did not have a lid. R5 also stated if assistance was required, it would be hard to call for help using the call system in their room due to it being inaccessible by furniture placed in front of it.
During today's visit, deficiencies were observed and will be cited on LIC809-D.
An exit interview was conducted and a copy of the report and appeal rights were provided. |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/31/2023
Section Cited
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7 | 87303 Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times...(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.
This requirement was not met as evidenced by: | 1
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7 | Administrator will have the carpet cleaned in R2's room, and the restrooms cleaned in R1, R4 and R5's rooms. Pictures of the cleaned toilets and bathtubs will be emailed to LPA by the POC due date. |
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14 | Based on observation and interview, licensee failed to maintain (2) of (5) resident restrooms inspected, clean and odorless, and (1) of (5) resident room carpets clean, which poses a potential Health, Safety, or Personal Rights risk to persons in care. | 8
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Type B
03/21/2023
Section Cited
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7 | 80088 Furniture, Fixtures, Equipment, and Supplies(f) Solid waste shall be stored...in a manner that will not transmit...odors...(1)All containers...used for...solid wastes shall have tight-fitting covers kept on the containers...
This requirement was not met as evidenced by: | 1
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7 | Administrator will obtain a trash bin with a tight fitting lids in R4's room to dispose of soild waste appropriately. A picture of the bin will be sent to LPA via email by the POC due date. |
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14 | Based on observation and interview, the licensee failed to maintain trash bins with a lid to dispose of soiled adult briefs in R4's room, which poses a potential Health, Safety, or Personal Rights risk to persons in care. | 8
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
03/21/2023
Section Cited
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7 | 87468.1 Personal Rights of Residents in All Facilities
(a) Residents...shall have...the following personal rights:(2)To be accorded safe, healthful and comfortable accommodations...and equipment.
This requirement was not met as evidenced by: | 1
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7 | Administrator will rearrange R4's room furniture to give easy and safe access to the signal system. A picture of the rearranged furniture will be sent to LPA via email by the POC due date. |
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14 | Based on observation and interview, the licensee failed to allow safe access to the signal system in R5's room, as there is furniture placed in front of it making it inaccessible, which poses a potential Health, Safety, or Personal Rights risk to persons in care. | 8
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Type B
03/21/2023
Section Cited
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7 | 87307 Personal Accommodations and Services
(3)Equipment and supplies necessary for...maintenance of adequate hygiene...shall be...available to... resident...if...unable...the licensee shall assure provision of:(C)Clean linen, including blankets...
This requirement was not met as evidenced by: | 1
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7 | Administrator will ensure R4 receives laundry services as needed. A picture of clean bed linens on the bed will be sent to LPA via email by POC due date. |
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14 | Based on observation and interview, the licensee failed to ensure R4 had clean blankets on their bed, which poses a potential Health, Safety, or Personal Rights risk to persons in care. | 8
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