336409595-7-28-2021-18-AS-CCON-C5CRUC-20210728131943

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336409595
Report Date: 07/28/2021
Date Signed: 07/28/2021 01:19:59 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:	SCENIC VIEW HOME CARE		FACILITY NUMBER:	336409595
ADMINISTRATOR:	MARILYN HOLMES		FACILITY TYPE:	740
ADDRESS:	7349 LIPPIZAN DR		TELEPHONE:	(951) 727-0175
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	6	CENSUS: 5	DATE:	07/28/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Gerrado "Gerry" Holems - Facility Manager		TIME COMPLETED:	01:30 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) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with Facility Manager Gerrardo "Gerry" Holmes 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 Facility Manager "Gerry" Holmes, who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap. LPA Colvin observed the facility's two resident bathrooms and noted that one of the two bathrooms (#1) did not have any paper towels. LPA Colvin did observe a common hand towel, which "Gerry" stated the residents use to dry their hands. LPA Colvin will be issuing a Technical Assistance Advisory Note instead of a deficiency due to towels being available for residents to use in one of the bathrooms, and the other bathroom being stocked with paper towels. While touring the facility, LPA Colvin failed to observe any postings throughout the facility for cough etiquette, social distancing, or infection control. LPA Colvin inquired about the lack of postings, and Facility Manager "Gerry" informed LPA Colvin that each resident was given a folder of information instead. LPA Colvin did observe there to be postings in the bathroom regarding hand washing instructions. LPA Colvin will be issuing a Technical Assistance Advisory Note instead of a deficiency due to the residents having been provided with informational materials on infection control, and hand washing signs being posted in the bathrooms. LPA Colvin advised the Facility Manager that it is best practices to have the signs on infection control and COVID-19 posted throughout the facility, and informed the Facility Manager that if they need a copy of the posters, that LPA Colvin can email them a digital copy.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

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: SCENIC VIEW HOME CARE	FACILITY NUMBER: 336409595
	VISIT DATE: 07/28/2021

NARRATIVE

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LPA Colvin confirmed that the facility has a 30-day supply of gloves, masks, and sanitizer, and isolation gowns. LPA Colvin went over the various recommended training for facility staff withFacility Manager Gerrardo "Gerry" Holmes 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 additionally was advised by Facility Manager Gerrardo "Gerry" Holmes that the facility staff have been fit tested for N95 masks.

LPA Colvin inquired about the facility's vaccination rate and staff testing for COVID-19. Facility Manager "Gerry" informed LPA Colvin that the facility has a 100% vaccination rate with staff and 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. Facility Manager "Gerry" confirmed that staff are continuing to monitor residents symptoms, and that staff are screened for COVID-19 symptoms prior to entering the facility. LPA Colvin inquired about screening of visitors to the facility, and Facility Manager "Gerry" informed LPA Colvin that the facility is not allowing visitors at this time. LPA Colvin had observed signs outside of the facility prior to entering stating that only staff and residents are permitted in the facility at this time, and the Facility Manager confirmed that visits can only be done virtually. On 10/6/20, Community Care Licensing came out with updated guidance on visitation for residents at facilities without active COVID-19 cases in Provider Information Notice (PIN) 20-38-ASC, In this notice, it was stated that facilities MUST allow for in person indoor visitation so long as the facility has not had any cases of COVID-19 in the last 14 days, there is no staffing shortage, and there is no shortage of cleaning supplies and protective equipment. Since the facility meets this criteria, they are in violation of the visitation guidance which was provided over six months ago. This is a violation of residents personal rights, and there have been numerous additional PINs and Statewide Calls since PIN 20-38-ASC addressing how to allow for safe visitation within the facility, so the facility should be in compliance. Deficiency cited.

An exit interview was conducted with Facility Manager Gerrardo "Gerry" Holmes and a copy of this report LIC809D, appeal rights, and LIC9102 TA Advisory Notes was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

Page: 2 of 5

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: SCENIC VIEW HOME CARE	FACILITY NUMBER: 336409595
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/28/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87468.1(a)(11)

Personal Rights of Residents in all Facilities

(11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and interview, the licensee did not comply with the section cited above in 5 out of 5 residents, which poses/posed a potential personal rights risk to persons in care.
	POC Due Date: 08/02/2021
	Plan of Correction
1 2 3 4	Licensee agrees to start allowing for in person visitiation at the facility. LPA Colvin requests that the Licensee contact each of the residents' representatives (if any) to advise them of the update, as well as inform each resident of the change. Licensee to self-certify to LPA Colvin once all parties have been informed. Plan of Correction due 8/2/21.

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: 07/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2021

LIC809 (FAS) - (06/04)

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