336405884-11-9-2021-18-AS-CCON-C8LS8H-20211109123911

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336405884
Report Date: 11/09/2021
Date Signed: 11/09/2021 12:39:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	INTEGRATED CARE COMMUNITIES - A1		FACILITY NUMBER:	336405884
ADMINISTRATOR:	EMELY C. RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	14265 NASON STREET		TELEPHONE:	(951) 601-9100
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	22	CENSUS: 15	DATE:	11/09/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Emely Rodriguez - Administrator		TIME COMPLETED:	12:15 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 Analysts (LPAs) Crystal Colvin and Venus Mixon arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPAs Colvin and Mixon met with Administrator Emely Rodriguez and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Below is a summary of what was observed: Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator Emely Rodriguez, who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. LPA Colvin was unable to locate a copy of the facility's Mitigation Plan at the Riverside Community Care Licensing (CCL) office, so Administrator Rodriguez emailed LPA Colvin a copy during today's inspection. LPA Colvin inspected three resident bathrooms. In all three bathrooms, there was minimal (#1) or no (#3 & #12) hand soap, paper towels, or hand sanitizer. This included the locked storage in the bathrooms, as staff must assist residents with hand washing due to the facility being locked Memory Care. LPA Colvin will be citing a deficiency as it is a requirement for residents to have items necessary for hygiene. LPA Colvin recommended to the Administrator that a hygiene "kit" be kept in each resident room in their locked storage in the bathroom. This "kit" could consist of" soap, paper towels, and hand sanitizer, and staff can unlock it and lock it back up after assisting the resident. Deficiency cited. LPA Colvin additionally observed that the trash cans in the residents' bathrooms did not have lids. PA Colvin will be issuing a Technical Assistance (TA) Advisory Note instead of a deficiency as there is little risk of contamination. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns) which LPA Colvin observed to not be sufficient for a 30-day supply. Administrator Rodriguez opened the facility's shed for LPA Colvin and Mixon, but there were no additional N955 masks or surgical masks in the shed. LPA Colvin will be issuing a TA Advisory Note instead of a deficiency as it is recommended that the facility maintain a 30-day supply of PPE at all times.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: INTEGRATED CARE COMMUNITIES - A1	FACILITY NUMBER: 336405884
	VISIT DATE: 11/09/2021

NARRATIVE

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LPA Colvin went over the various recommended training for facility staff with Administrator Emely Rodriguez in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE. LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator Emely Rodriguez informed LPA Colvin that at this time staff have not been fit tested, but that the Licensee was purchasing a machine to conduct fit testing for all staff of each facility. A TA Advisory Note will be cited due to CCL recommendation for all staff to be fit tested for N95 masks. LPA Colvin will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA Colvin will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. Additionally, most residents have been vaccinated and are practicing other COVID-19 precautions, which minimize the risk of them contracting COVID-19. Additionally, CalOSHA also requires staff to be fit tested for N95 masks if staff will be using N95s and providing personal care to residents who are positive for COVID-19.

LPA Colvin inquired about if the facility is still conducting COVID-19 surveillance testing of their unvaccinated staff members. Administrator Rodriguez informed LPA Colvin that the majority of their staff is vaccinated, but that they are conducting weekly testing of unvaccinated residents. In addition to going over the facility's policy for testing staff and residents for COVID-19, LPA Colvin also inquired about if the facility is still screening their residents daily for COVID-19 symptoms, which includes checking their temperature. Administrator Rodriguez confirmed that staff are continuing to monitor residents’ symptoms during medication pass, and that both staff and visitors are screened for COVID-19 symptoms prior to entering the facility. LPAs Colvin and Mixon additionally observed a sign-in log for visitors, where their temperature is recorded as well as answers to screening questions. LPA Colvin inquired about staff and residents wearing masks in the facility, as LPA Colvin observed all staff to be wearing face coverings, but several residents in the dining room were not. Administrator Rodriguez informed LPA Colvin that the majority of residents are vaccinated, and staff still encourage them to wear masks, but some refuse. LPA Colvin acknowledged that the facility cannot force residents to wear masks but can only encourage them to do so.

An exit interview was conducted with Administrator Emely Rodriguez and a copy of this report, LIC809D, appeal rights, and LIC9102 TA Advisory Notes were provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: INTEGRATED CARE COMMUNITIES - A1	FACILITY NUMBER: 336405884
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/09/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87307(a)(3)(D)

Personal Accommodations and Services: (a) Living accommodations and grounds shall be related to the facility’s function……(3) Equipment and supplies necessary…..shall be readily available….(D) Hygiene items o general use such as soap and toilet paper. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation the Licensee did not comply with the above regulation in 3 out of 12 bathrooms, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/16/2021
	Plan of Correction
1 2 3 4	Licensee agrees to have an all-staff meeting regarding ensuring resident bathrooms are kept stocked with hygeiene supplies (locked). Proof of all-staff meeting to be submited to LPA Colvin by Plan of Correction Date of 11/16/21.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2021

LIC809 (FAS) - (06/04)

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