New Cedar Lane Care Home, Inc.

On 12/19/2024, Licensing Program Analyst (LPA) Tobola conducted an unannounced Annual Required – 1 yr. inspection for this facility and was greeted by Administrator Assistant, Myra Casamina. Licensees Rosa & Yolanda Diaz were notified and arrived later in the visit. The facility currently provides care for 17 residents, none of which are currently receiving hospice services and some of which with a diagnosis of dementia. LPA continued with a tour of the facility with staff, facility found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers located throughout the hallways, kitchen and common spaces were found to be charged. Facility is equipped with interconnected smoke and carbon monoxide detectors all of which were found to be in working order. In addition, fire safety systems monitored and serviced by outside agencies with last inspection in 2024. Emergency Disaster Plan has been updated with appropriate guidelines and evacuations sites. There was a sufficient supply of both perishable and nonperishable foods as required, with food stored in the kitchen and additional storage room, sufficient for residents in care. Food supply is replenished multiple times per week and stored in proper conditions. Facility provides a wide variety of meal preferences and preparation while also ensuring proper dietary restrictions are followed. Cleaning supplies and other toxins are safely stored in locked in designated storage and laundry room, which was secured upon inspection. There was a supply of hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings and bedding items. Residents that were out in the community were observed interacting with staff, fellow residents in the common areas, participating in activities and family visits. The facility encourages regular family visits and utilizes a large outdoor patio, garden, and common areas. LPA observed residents to have a strong relationship with staff, with LPA finding the level of care and engagement to be exceedingly positive. Continued onto LIC809-C 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 26 27 28 29 30 31 32 LPA conducted a sample file review for residents and found that the facility is in the process of updating medical assessments and reappraisal care plans for residents with a diagnosis of dementia. LPA found that the facility has contacted resident physicians and is in process of completing medical appointments. In addition, resident reappraisals have been completed for residents with signatures pending. LPA determined that the facility has taken appropriate steps and actively working on completing resident records. License agrees to ensure medical assessment and reappraisals for all residents are current. Technical Assistance issued. Upon a sample file review for staff, LPA found that annual training requirements and 1st aid & cpr certification were completed. Lastly, upon a spot check of medication and medication records, LPA found all items including prescription and fill dates to be documented. LPA requested the following documents be sent to CCL by COB 1/9/2025: LIC 308 Designated Facility Responsibility LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan No deficiencies cited during today's visit.

On December 21, 2023, Licensing Program Analyst(LPA) John Calandra arrived at the licensed facility to continue the Annual 1-year required visit from November 17, 2023. LPA Calandra met with Assistant Administrator, Myra Casamina. LPA Calandra interviewed 3 residents and 2 staff. One staff member could not be interviewed due to a language barrier (LPA unable to call language line as he had no phone service.) No deficiencies were cited during today's visit. A copy of this report was reviewed and provided.

On November 17, 2023, Licensing Program Analyst(LPA) John Calandra, and Licensing Program Manager(LPM)Jackie Jin arrived at the licensed facility to conduct an Annual 1-year required inspection. LPA Calandra and LPM Jin met with Assistant Administrator Myralee Casamina and Administrator, Rosa Diaz joined later. The visit commenced with a tour of the facility in which resident bedrooms, kitchen, living room, dining room, office, medication room, and basement. Adequate furniture and sufficient lighting were observed in resident bedrooms. Two days of perishables and 7 days of non-perishables were observed. All bathrooms were equipped with anti-skid flooring and grab bars. Water temperature in all bathrooms were measured between 105 and 114.6 degrees Fahrenheit. All fire extinguishers were last checked in March of 2022 and fire and carbon monoxide detectors were observed to be in working order. All fire extinguishers were observed to be charged. Sufficient night lights were observed throughout the facility. Sharps are stored appropriately and inaccessible to residents in the kitchen with a lock on the door and staff locks the door when he/she leaves the kitchen. The facility, backyard, and front yard were observed to be free of hazards/obstructions and no accessible bodies of water were observed. There are 15 residents, and 5 staff members present during the inspection. During an inspection of the kitchen and basement storage room, expired food was observed. In the presence of the LPA and LPM the Assistant Administrator Myralee Casamina removed the expired foods and disposed of them properly. A technical violation was provided. Furthermore, during the tour LPA and LPM observed the facility's medication room door to be open and accessible to persons in care. In the presence of the LPA and LPM, Assistant Administrator, Myralee Casamina locked the door. LPA and LPM advised that facility ensure medications room always being locked and train staff. 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 26 27 28 29 30 31 32 LPA Calandra and LPM Jin also observed Lysol wipes and spray to be unlocked and accessible to persons in care. Assistant Administrator removed them in the presence of the LPA and LPM. LPA Calandra and LPM Jin reviewed seven client records which were complete with signed Admissions Agreements, Physician's reports, Needs and Services/Care plans, signed consent forms, etc. A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility. LPA Calandra and LPM Jin requested for a copy of the facility's limited liability insurance to be sent to the department by November 24, 2023. LPA Calandra and LPM Jin will return to facility to complete the Annual Inspection at a later date. No deficiencies were cited during today's visit. A copy of the Report and Technical Violation was reviewed with Assistant Administrator, Myralee Casamina and Administrator/Licensee Rosa Diaz and left at the facility.

On 3/10/22, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA observed COVID-19 signs posted by the entrance. LPA was greeted the administrative manager, Gerogina Aguirre. LPA explained the purpose of the visit and LPA was screened at the front entrance. LPA toured facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, resident and staff daily monitoring records, containment strategies, PPE supply and the environmental cleaning supply are adequate; bathrooms are equipped with soap and paper towels, hand washing instruction is posted by the hand washing stations. Trash cans are observed to have foot operated lids. The facility has 2-bed rooms and private rooms. The beds in the 2-bed rooms are observed to be 6" apart from each other. The facility has 2 ready-to-go isolation carts set-up with PPE supplies. Medications and chemicals are observed to be locked in a storage room with a digital lock. Sharps are stored appropriately and inaccessible to residents in the kitchen with a lock on the door and staff locks the door when he/she leaves the kitchen. LPA Han recommended to lock the drawer that stores the sharps inside the kitchen in addition to the lock on the door. A comfortable temperature is maintained, lighting is sufficient for comfort and safety and food supply was checked and observed to be sufficient. First-aid kits are inspected and complete. There are 17 residents, and 5 staff members present during the inspection. LPA requested for the following documents to be submitted to CCL by Monday, 3/14/2022 - A copy of the current administrator certification, LIC308 Designation of Administrative Responsibility, LIC402 Surety Bond, Control of Property and LIC610E Emergency Disaster Plan and update the Mitigation Plan LIC808 to reflect the current COVID-19 management process. No deficiency cited today. This report is reviewed and discussed with the administrative manager and the administrator who arrived at the end of the inspection. A copy is provided.

The staff members and the Administrator also acknowledged that facility staff cleans the box and room and denied that R2 is required to clean the room and the box. LPA reviewed R2's monthly invoice which includes cat care by the facility. Based on records review, we have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. This report was discussed and reviewed with the Administrator and a copy was provided.

During the investigation, complainant indicated that R1’s allergy medications were increased due to R1’s allergies. LPA reviewed the available documentation and noted that R1 has allergies; at one point R1 was prescribed prednisone, due to R1’s asthma, caused by dust, dandruff and allergens, for 5-days. The physician also recommended a HEPA filter, and cleaning instructions as well as cautioning against any pets in the common areas. LPA observed R1's room has a HEPA filter, and R1’s room appears clean and in good repair. No dust was detected/observed on the bedside table and on the other furniture. LPA interviewed staff who denied the allegation, stating that the cat stays in R2's room all the time and there are no animals at the common areas within the facility at any time. Staff also stated to be following R1's physician's instructions on daily and weekly cleaning and R1 validated that it is being done and necessary steps to ensure the facility is cleaned. In addition, they have not noticed any animal hair, and/or dandruff partials during their daily cleaning. Based on record review, staff interviews and observation during the investigation, this allegation is unsubstantiated. Although the allegation may have happened and/or valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. This report is reviewed and discussed with the Administrator and a copy is provided.

On 6/15 /21 Licensing Program Analyst (LPA) Murial Han conducted an unannounced inspection and met with the Administrator, Rosa Diaz. LPA explained the purpose of the visit and delivered this finding. During the investigation of complaint control number 14-AS-20210601132624, LPA reviewed the Admission Agreement for Resident (R2) who was admitted with a cat, but the Admission Agreement did not include pet policy. After the admission, the facility developed an Addendum addressing the Pet Deposit and Monthly Pet Service Charge but it was not completed for R2. A Technical Violation was issued. No deficiencies were cited at this time.

LPA Jeung and LPA Han provided Technical Support to the Administrator during complaint investigation. Signs should be posted at entry gate directing visitors to the central entry point--which is on the side of the house--for proper COVID screening. COVID related signs are not present, such as cough etiquette, face covering, social distancing, etc. COVID related signs must be prominently posted throughout the facility. Hand-washing reminder instructions signs are not present in all bathrooms and sinks. LPA Jeung will email COVID-19 signs to the Administrator. Administrator is reminded of the following: - Review and implement elements of facility COVID Mitigation Plan - All unusual incidents which threaten the health and safety of residents and staff must be reported to CCLD mandated time frame, in accordance with Section 87211 Reporting Requirements.