565801730-4-11-2024-29-AS-KDUK-D3KS7A-20240321133712

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801730
Report Date: 03/21/2024
Date Signed: 04/11/2024 04:20:44 PM

Document Has Been Signed on 04/11/2024 04:20 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	FINEST LIVING AT ARCADE		FACILITY NUMBER:	565801730
ADMINISTRATOR:	GARNER J. CRUZ		FACILITY TYPE:	740
ADDRESS:	350 SOUTH ARCADE DRIVE		TELEPHONE:	(805) 628-3776
CITY:	VENTURA	STATE: CA	ZIP CODE:	93003
CAPACITY:	6	CENSUS: 5	DATE:	03/21/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Marlene Santos		TIME COMPLETED:	01:45 PM

NARRATIVE

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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a required annual visit at 09:14AM. LPA met with facility staff Marlene Santos. Entrance interview conducted. The Administrator was contacted, but was unavailable during today's visit. Facility staff is authorized to sign today's reports.

Beginning at 09:44AM, the LPA, along with facility staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that facility is in compliance with Title 22 Regulations. The following was observed:

Fire extinguishers are fully charged and serviced on 06/07/2023. Carbon Monoxide detector was tested at 12:10PM, smoke detectors were tested at 12:14PM and all were functional at the time of the visit.

KITCHEN: The LPA observed the kitchen, which had visible debris and sticky substances inside the pantry, as well as dirt and grime around the appliances. Kitchen appliances appeared to be in operable condition. The facility did not have a sufficient supply of seven (7) days non-perishable food in all food groups. Staff indicated expired food was recently thrown away, so they have less food present today. Perishable food supply was observed to be sufficient. Cleaning supplies and sharps are located in separate locked cabinets.

COMMON AREAS: This includes the living room and dining room areas. LPA observed common area to be clean and properly furnished at the time of the visit. Living room does contain an appropriately-screened fireplace. The LPA noted cameras in the common areas.

BATHROOMS: There are two (2) bathrooms for resident use and one (1) for staff use. Resident restrooms were observed to be equipped with nonskid surfaces and contain nonskid mats. Grab bars were observed in the bathrooms. However, no paper products were supplied in either restroom. Staff indicated one resident does use too many paper products, so the supplies are not readily provided. The water temperature was

Report Continued on LIC 809-C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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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Document Has Been Signed on 04/11/2024 04:20 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FINEST LIVING AT ARCADE	FACILITY NUMBER: 565801730
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87303(a)

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. 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 as inside kitchen pantry was observed to be dirty and sticky, a drawer is falling out of the cabinet in the kitchen, and both bathrooms contain drawers which are not securely attached to the cabinets, which poses a potential health and safety risk to persons in care.
	POC Due Date: 04/04/2024
	Plan of Correction
1 2 3 4	Staff agreed to clean all areas of the kitchen, and ensure broken drawers in both the kitchen and bathrooms are repaired by POC due date. Staff will provide proof to CCL by POC due date.

Type B

Section Cited

CCR

87307(a)(3)(D)

Personal Accommodations and Services

(D) Hygiene items of 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 section cited above neither resident bathroom contains paper towels nor toilet paper, which poses/posed a potential personal rights risk to persons in care.
	POC Due Date: 04/04/2024
	Plan of Correction
1 2 3 4	Staff agreed to provide paper products in both resident restrooms and an alternate plan for the resident who uses too many paper products and provide proof to CCL by POC due date.

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: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FINEST LIVING AT ARCADE	FACILITY NUMBER: 565801730
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1569.69(b)

Other Provisions

(b) Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. 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 as 2 (two) of 2 (two) staff files reviewed, both of which administer medications did not contain proof of annual medication training, which poses a potential health and safety risk to persons in care.
	POC Due Date: 04/04/2024
	Plan of Correction
1 2 3 4	The staff indicated they will communicate this with the Licensee and/or Administrator. A representative of the facility will provide proof of annual training for both staff to CCL by POC due date.

Type B

Section Cited

CCR

87463(c)

Reappraisals

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 resident file reviews, all contained appraisals which were more than a year old, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2024
	Plan of Correction
1 2 3 4	Facility staff agreed to communicate the need for annual appraisals to the Licensee/Administrator. Appraisals will be completed and facility representative will provide proof to CCL by POC due date.

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: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/11/2024 04:20 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FINEST LIVING AT ARCADE	FACILITY NUMBER: 565801730
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1569.695(c)

Other Provisions

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 as the facility's most recent documened drill took place in 2021, which poses a potential safety risk to persons in care.
	POC Due Date: 04/04/2024
	Plan of Correction
1 2 3 4	Facility staff will ensure that the facility conducts an emergency drill, documents, and provide proof to CCL by POC due date.

Type B

Section Cited

CCR

87608(a)(5)(A)

Postural Supports

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 as R1 has a full bed rail with no doctor's orders and not on hospice and R2 has 2 half bed rails - one on the bottom half of the bed and the other on the top half, effectively creating a full bed rail with no doctors orders, which poses a potential personal rights risk to persons in care.
	POC Due Date: 04/04/2024
	Plan of Correction
1 2 3 4	Facility staff agreed to communicate with responsible parties of both residents, determine whether the bed rails are necessary and if so to obtain doctor's orders/an exception for these residents. If the rails are unnecessary they will be removed. Either way, proof will be sent to CCL by POC due date.

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: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FINEST LIVING AT ARCADE	FACILITY NUMBER: 565801730
	VISIT DATE: 03/21/2024

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measured in one shared resident bathroom and measured within the required range.

BEDROOMS: There are six (6) resident bedrooms designated for private resident use. There is also one staff room. All resident rooms were observed to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Alarms were observed on resident exit doors, however they were not in the "on" position and therefore not being utilized during today's visit. Additionally, R1's bed was observed to contain a full bed rail. R2's bed was observed to contain 2 half bed rails, effectively creating a full bed rail.

OUTDOOR SPACE: The backyard has a patio area with patio furniture including a table and chairs for resident use. All passageways were observed to be clear. There were no bodies of water on the premises.

RECORD REVIEW: Staff and resident records were reviewed for documents including, but not limited to: health screening, TB test, staff training records, fingerprint clearance, resident physician's report, needs and service appraisal, and personal rights. 5 (five) resident files were observed. 3 (three) of 5 (five) resident files contained an appraisal which was more than 1 year old. 2 (two) of 5 (five) residents did not contain orders for the bed rails being utilized. 5 (five) staff files were observed. Administrator does not have proof of CPR and first aid, 2 (two) staff, both of which administer medications for residents did not contain proof of annual medication training.

INFECTION CONTROL/EMERGENCY DISASTER PLANNING: During today’s visit, the LPA reviewed the facility's infection control practices and the facility's emergency disaster plan. The facility’s policies and procedures as it pertains to infection control are adequate. Emergency disaster plan has not been updated since 02/20/2022. The last documented disaster drill was in 2021. Staff indicated none have been conducted in this current year.

MEDICATION REVIEW: Medications for 2 (two) residents were observed. All medications observed were labeled, stored, and properly documented at the time of the visit.

INTERVIEWS: During today's visit, LPA interviewed 2 (two) staff and 2 (two) residents.

Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Facility staff was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of the report and appeal rights were provided. A copy of today's report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024

LIC809 (FAS) - (06/04)

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