374604171-11-3-2023-08-AS-AROS-CX8VZN-20231103165301

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604171
Report Date: 11/03/2023
Date Signed: 11/03/2023 04:53:11 PM

Document Has Been Signed on 11/03/2023 04:53 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	LO-HAR SENIOR LIVING		FACILITY NUMBER:	374604171
ADMINISTRATOR:	DUCHARME-FRANKLIN, KANDY		FACILITY TYPE:	740
ADDRESS:	768 DOROTHY ST		TELEPHONE:	(619) 444-8270
CITY:	EL CAJON	STATE: CA	ZIP CODE:	92019
CAPACITY:	68	CENSUS: 65	DATE:	11/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	Executive Director, Green		TIME COMPLETED:	04:55 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 (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Executive Director, Jared Green, after identifying herself and stating the purpose of the inspection. This facility serves sixty-eight (68) elderly residents; age 60 and above; fourty-one (41) may be non-ambulatory. There is also a Hospice care waiver for ten (10). Facility is equipped with a secured perimeter in the memory care units. This is a muti-unit property.. LPA was accompanied by the Executive Director, Green during a tour of the facility. A tour of the facility was conducted of the cottages and the two (2) memory care units in the community and included a sample of resident units, the dining area, recreation rooms, and food storage areas. Signal systems are in place and operational. PPE supplies are onsite. No bodies of water are on premises. Passageways were free from obstructions. According to Executive Director, Green, there are no weapons and/or ammunition stored on the premises. All doors were operational. Each resident had clean and sufficient bed linens. All extra linens towels, and washcloths are all accessible in rooms or in the locked facility store room. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. [CONTINUED ON LIC 809-C]

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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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Document Has Been Signed on 11/03/2023 04:53 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LO-HAR SENIOR LIVING	FACILITY NUMBER: 374604171
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87411

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living ….(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review the licensee did not comply with the section cited above in 3 of 5 persons which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/04/2023
	Plan of Correction
1 2 3 4	Will conduct a first Aide/CPR certified training to facilitate a training for updated First aide/CPR for all care staff.

Type B

Section Cited

HSC

87303e5

This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observations, the licensee did not comply with the section cited above in 2 of 6 showers which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 12/04/2023
	Plan of Correction
1 2 3 4	Executive Director agreed to purchase and place Non-Skid mats strips in shared room showers with the exception of shower rooms.

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: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: LO-HAR SENIOR LIVING	FACILITY NUMBER: 374604171
	VISIT DATE: 11/03/2023

NARRATIVE

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[CONTINUED FROM LIC 809]

Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. The food service area was observed to be neat and clean. Food menus and activities schedule were posted. Most chemicals and cleaning supplies were stored in a locked closed room. Centrally stored medications were properly stored and locked on medication carts. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions.

Staff records review verified that all staff records were not complete and compliant. Some direct care staff have First Aid certificates and First Aide/CPR certificates. LPA observed some slip-strips in showers.

Resident records reviewed and confirmed compliant. Administrator’s certification is current. LPA conducted a thorough review of In-service training procedures. Facility provides transportation arrangements for persons served who do not have independent arrangements. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs.

Deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with Executive Director, Green.

An exit interview was conducted with Executive Director, Green, to whom copies of this report, the LIC 809-D page, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy Rodgers	TELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2023

LIC809 (FAS) - (06/04)

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