374604269-2-28-2024-18-AS-JGEE-D2VTWM-20240228140546

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604269
Report Date: 02/28/2024
Date Signed: 02/28/2024 02:05:53 PM

Document Has Been Signed on 02/28/2024 02:05 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME:	FELICITA VIDA		FACILITY NUMBER:	374604269
ADMINISTRATOR:	MALASPINA, KIMBERLY		FACILITY TYPE:	740
ADDRESS:	930 MONTICELLO DRIVE		TELEPHONE:	(760) 747-4888
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92029
CAPACITY:	123	CENSUS: 86	DATE:	02/28/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Kimberly Malaspina, Executive Director		TIME COMPLETED:	02:15 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 Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection/1 year required visit. LPA was greeted and granted entry by Front Desk Mary Rhoden. The Administrator Kimberly Malaspina met LPA in the front lobby, where LPA explained the purpose of the visit. LPA conducted a review of the facility personnel roster and observed for all staff that LPA came in contact with to have obtained proper fingerprint clearance, and to be associated to the facility. The facility is licensed licensed to serve one hundred twenty three (123) elderly residents, all of whom may be non-ambulatory, seven (7) that may be bedridden. The facility has an approved hospice waiver for twenty five (25) residents. There are currently nine (9) residents on hospice. LPA conducted a tour of the interior and exterior of the facility and observed the following: The facility was clean, clutter odor free. The facility conducted their annual fire and alarm suppression testing on 2/27/24, with Escondido Fire Department, the has multiple smoke and carbon monoxide detectors throughout the facility. The detectors in each building were randomly checked and were observed to be operable. The facility conducts emergency disaster drills at minimum on a quarterly basis, the last drill conducted was on 2/27/24. The facility has a functional signal system that operates from each resident bedroom. This was observed by using the pull cords and staff responding to the applicable units. The resident rooms were observed to have adequate lighting, and the furniture was in good repair. The Sharps, disinfectants, cleaning solutions, and poisons are locked and were observed inaccessible to residents. There are known no firearms or ammunition on the premises. The hot water temperature was checked randomly in resident bathrooms throughout the building. The hot temperature was found to be within regulatory limits ranging from 116-118 degrees F.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: FELICITA VIDA	FACILITY NUMBER: 374604269
	VISIT DATE: 02/28/2024

NARRATIVE

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The medications were observed to be in a locked place that is inaccessible to residents. Resident files were reviewed and found to have the required documents (physician's report/physical, appraisal/needs and services plan and admission agreement).

The facility requires all medical staff (Med Tech) to have a current First Aid/CPR training. However, upon a review of staff files, LPA observed for the facility to be out of compliance as there was not a staff scheduled/on duty and on the premises at all times that had a current Cardio Pulmonary Resuscitation (CPR) and First Aid training certification on duty.

Based on today's visit a citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted where a copy of this report, appeal rights, and LIC9098 Proof of Corrections form were discussed and provided to Kimberly Malaspina, Administrator.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/28/2024 02:05 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: FELICITA VIDA	FACILITY NUMBER: 374604269
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/28/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

HSC

1569.618(c)(3)

Other Provisions

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in 3 out of 3 times which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/29/2024
	Plan of Correction
1 2 3 4	The licensee agrees to enroll all (11) Med Tech's , in CPR/First Aid training no later than 2/29/24. Proof of POC is to be submitted to the department by 5pm on the due date indicated (2/29/24).

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: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2024

LIC809 (FAS) - (06/04)

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