435201251-5-22-2024-26-AS-MPAA-D5J2LV-20240522173010

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 435201251
Report Date: 05/22/2024
Date Signed: 05/22/2024 05:30:58 PM

Document Has Been Signed on 05/22/2024 05:30 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME:	PRONTO CARE HOME		FACILITY NUMBER:	435201251
ADMINISTRATOR:	DIANA NATIVIDAD		FACILITY TYPE:	740
ADDRESS:	771 PRONTO DRIVE		TELEPHONE:	(408) 226-9838
CITY:	SAN JOSE	STATE: CA	ZIP CODE:	95123
CAPACITY:	6	CENSUS:	DATE:	05/22/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Diana Natividad		TIME COMPLETED:	05:00 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	On 5/22/2024 at 1:00 p. m. Licensing Program Analyst (LPA) Maria (Mita) Partoza arrived and conducted an unannounced required 1 year inspection visit and was greeted by resident 1 (R1) and staff (S1). Administrator, Diana Natividad was not present upon LPA's arrival. Staff contacted administrator and arrived shortly thereafter. LPA stated the purpose of the visit with ADM. LPA observed COVID-19 signs posted on the door prior to entering. The facility is a Residential Care Facility for the Elderly (RCFE) licensed to serve ages 60 and over and 6 of the residents may be non-ambulatory. Currently the resident has 3 ambulatory and 2 non-ambulatory residents that have neurocognitive impairment. 1 staff were present at the time of the visit. 1 out of 5 residents is at the rehabilitation center. 3 out of 5 are present at the facility and 1 out of 5 is in the living room watching television. At 1:22 p.m. LPA toured the facility inside and outside with ADM, including but not limited to the kitchen, bathroom, dining room, living room, residents’ rooms, staff room, backyard and walkways. LPA observed the Personal Rights disclosure, Long Term Care Ombudsman (LTCO) and Centralized Complaint and Information Bureau (CCIB) of the CA Department of Social Services (CDSS) prominently posted on the wall, visible to visitors, resident, and staff. The temperature inside the home was at 68 to 69.8 degrees F. . page 1 - see LIC 809C for page 2

SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: PRONTO CARE HOME	FACILITY NUMBER: 435201251
	VISIT DATE: 05/22/2024

NARRATIVE

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LPA and ADM toured 4 resident bedrooms and 1 staff room. LPA observed the rooms to have storage spaces that are sufficient to hold the resident’s personal belonging. 2 out of 4 residents’ room are shared room and 2 out of 4 are private room. 4 out of 4 bedrooms has exit doors leading to the backyard and are free from obstruction.

LPA observed that 4 out of 4 resident bedroom floor requires maintenance from visible food particles. LPA observed a commode inside one of the shared bedrooms. LPA observed the smell of urine permeating inside the facility. LPA observed that 2 of the bathrooms has grab bars and anti-skid mats, trash bins with lids. LPA observed bathrooms require maintenance such as but not limited to the upkeep of the sink, toilet, bathroom floor, tub and shower areas. LPA observed residents’ bed linens require attention and maintenance.

LPA observed that the facility has a wall pull fire alarm system but is not connected to the fire department emergency line. S1 stated the pull fire alarm is only for the facility to notify residents. S1 tested the wall pull alarm and it is in good working condition. The facility has carbon monoxide alert system that is in good working condition. LPA observed smoke alarms in the hallways and the resident bedrooms and are in good working condition. LPA observed night lights on the hallway. Hallways are free from obstruction. The doors going to the backyard from the living area open with ease and is not obstructed.

LPA observed walkways and ramps are free from obstruction and in good condition. LPA observed a gazebo in the backyard utilized as storage for items that are no longer used such as but not limited to walkers, wheelchairs, barbeque pit, a metal drink cooler that requires maintenance, an oxygen concentrator machine and boxes piled and stacked up. The contents are not visible to LPA.

LPA tested the water temperature for kitchen and bathrooms, water temperature was measured at 107 degrees F Dining, kitchen and living room area were observed to be sanitary and organized. The facility has sufficient supply of perishable food for 2 days and non-perishable food for 7 days. The fire extinguisher located in the kitchen is monitored by S1 and logs the date when checked.

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SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: PRONTO CARE HOME	FACILITY NUMBER: 435201251
	VISIT DATE: 05/22/2024

NARRATIVE

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LPA and ADM inspected the laundry area. LPA observed the laundry area is located at the garage. The washer and dryer are in good working condition, the laundry area has a cabinet that stores laundry detergents and cleaning supplies are kept locked and not accessible to residents.

LPA with ADM inspected the medication cabinet. LPA observed the medication cabinet is locked and is not easily accessible. LPA observed first aid kit in the kitchen cabinet. LPA observed that knives and sharp are locked and not accessible to residents.

LPA reviewed facility record, 3 out of 3 staff record and ADM stated that the facility's fire drill training was last conducted on 12/1/2023 and next training will be conducted this month of May 2024. Staff training records were up to date. Staff records were reviewed with current first aid certifications, clearance and training.

Residents' medications are labeled and current. LPA reviewed 3 out 3 resident records and observed that 2 out of 3 did not have an updated needs and services plan.

Deficiencies are cited during today's visit based on the California Code of Regulations (CCR) Title 22, see LIC 809D. An exit interview was conducted with administrator Diana Natividad. A copy of the report and appeals rights were provided.

end of report
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SUPERVISOR'S NAME: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/22/2024 05:31 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: PRONTO CARE HOME	FACILITY NUMBER: 435201251
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

87303(a)(1)

Maintenance and Operation

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. 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 section cited above in 2 of 2 maintenance requirement. The licensee did not ensure the sanitary condition of the bathroom and 2 resident's bedroom are free from the smell of urine, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 05/23/2024
	Plan of Correction
1 2 3 4	Administrator stated that carpet inside bedroom #1 will be changed. ADM stated that the bathroom will be cleaned and ADM is considering to have the bathroom maintained.

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: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC809 (FAS) - (06/04)

Page: 4 of 5

Document Has Been Signed on 05/22/2024 05:31 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: PRONTO CARE HOME	FACILITY NUMBER: 435201251
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/22/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87463(a)

Reappraisals

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: 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 2 out of 3 resident does not have an updated appraisal needs and services plan, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/07/2024
	Plan of Correction
1 2 3 4	Administrator stated that she will updaet all the appraisal needs and services plan accordingly. Administrator stated that the updated services plan will be emailed to LPA by the POC due date.

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: Romeo Manzano	TELEPHONE: (650) 388-2297
LICENSING EVALUATOR NAME: Maria Partoza	TELEPHONE: (669) 308-3994
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024

LIC809 (FAS) - (06/04)

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