567609703-2-18-2022-29-AS-AASO-CBS387-20220218170104

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 567609703
Report Date: 02/18/2022
Date Signed: 02/18/2022 05:02:49 PM

Document Has Been Signed on 02/18/2022 05:02 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:	REESEJOY CARE HOME		FACILITY NUMBER:	567609703
ADMINISTRATOR:	DELA VEGA RAMIREZ, ROBERTO		FACILITY TYPE:	740
ADDRESS:	1355 JUANITA AVE		TELEPHONE:	(805) 278-4043
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY:	6	CENSUS: 5	DATE:	02/18/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Roberto Del Vega Ramirez		TIME COMPLETED:	01:15 PM

NARRATIVE

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Licensing Program Analysts (LPA) Angel Ascencio arrived at the facility unannounced to conduct a required annual visit at 11:00 a.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Roberto De La Vega Ramirez and discussed the reason for the visit. Entrance interview conducted.

The LPA, along with Administrator, toured the physical plant areas inside and outside at 11:30 a.m to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations.

BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 4 (four) total bedrooms for resident use – 2 (two) are shared rooms and 2 (two) are private rooms. There is also 1 (one) staff room and 1 (one) office room.

RESTROOMS: 2 restrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. Carbon monoxide and smoke detectors were observed to be in working condition at the time of visit.

The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. Laundry room was locked and contained storage cabinets for laundry supplies. The garage was observed locked and contained the emergency food supply, personal protective equipment and storage space. Continued on LIC -809 C

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

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 02/18/2022 05:02 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: REESEJOY CARE HOME	FACILITY NUMBER: 567609703
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/18/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87608(a)(5)(B)

Postural Supports

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 4 out of 5 which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/04/2022
	Plan of Correction
1 2 3 4	Admin stated they will contact the hospice agency to obtain bed rail orders for the 4 residents that are missing. Admin will send the bed rail orders to LPA via email at: angel.ascencio@dss.ca.gov.

Type B

Section Cited

CCR

87705(g)

Care of Persons with Dementia

(g) As required by Section 87468(a)(12), residents with dementia shall be allowed to keep personal grooming and hygiene items in their own possession, unless there is evidence to substantiate that the resident cannot safely manage the items. 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 hydrogen peroxide, Norisc Cream, body lotion, and Aquaphor in an unlocked restroom accesible to residents which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/04/2022
	Plan of Correction
1 2 3 4	Admin locekd up teh personal grooming items during the tour. Admin will provide training on Section 87468(a)(12). Admin will send LPA training meterials and attendees to email: Angel.ascencio@dss.ca.gov.

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: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

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: REESEJOY CARE HOME	FACILITY NUMBER: 567609703
	VISIT DATE: 02/18/2022

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KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit.

INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices at 12:15 p.m. There is 1 entry into the facility. Upon entry, the facility has a central point for symptom screening. LPA noted that the facility is allowing visitors for both indoor and outdoor visitation. The LPA observed an adequate supply of Personal Protective Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate.

The following recommendations were made:

- Post PINs and educate staff, residents, and families on changing policies and procedures from the Department

During today's tour, LPA walked into an unlocked restroom that contained hydrogen peroxide, hyrocotizone, Norisc Cream and body lotion accessible to persons in care. Admin stated they will be locking the items and it will not happen again. LPA also walked into rooms that had bed rails. LPA reviewed resident files and it was revealed that 4 (four) out of 5 (five) residents did not have a bed rail order. Admin stated they have been a long time hospice resident and will contact the hospice agency to obtain the order.

The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

2 citations were issued during today’s visit. Exit interview conducted. A copy of the report with appeal rights was provided via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

LIC809 (FAS) - (06/04)

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