Paradise Villa Senior Care Ii

On 02/15/2024 at 1:45PM, Licensing Program Analyst (LPA) Lori Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Elizabeth Ulloa and explained the purpose of the visit. Elizabeth phoned the Licensee/Administrator, Konah Dolo to inform. Konah arrived shortly after. The facility’s fire clearance was approved for 6 (six) non-ambulatory. Hospice waiver for 6 (six). Administrator Certificate #6034041740 expires 02/19/2025. LPA toured facility with Konah and Rahab Mungai including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 5 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 150 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 02/17/2023. Emergency Disaster Plan was last posted on 02/15/2024. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 12/15/2023. LIC809 Continued... 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 LIC809-C Continued... LPA reviewed 4 residents records. LPA reviewed 5 staff records and 5 of 5 have current first aid training and associated to the facility. THE FOLLOWING DEFICIENCIES WERE OBSERVED DURING VISIT: At 3:01PM LPA observed broken gated fence and wood planks at outside backyard. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 02/22/2024: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report Liability Insurance Exit interview conducted. Appeal Rights and a copy of this report provided.

On 02/09/23 at 3:26 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Caregiver, Elizabeth Ulloa, and explained the purpose of the visit. The Licensee/Administrator Konah Dolo arrived approximately at 3:49 PM. The facility’s fire clearance was approved for 6. . LPA toured facility with Konah including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 5 total bedrooms which 5 bedrooms are occupied by the residents. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 154 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detector were in operating condition during visit. Fire extinguisher was last serviced on 06/11/2021. First aid kit was observed to be complete. At 4:30 PM, LPA reviewed 3 residents records. At 4:40 PM, LPA reviewed 2 staff records and 2 of 2 have current first aid training and associated to the facility. 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 Continued from LIC 809 The following deficiencies observed during the visit: At 4:07 PM LPA observed, car battery, electric plug, lamp, boxes, paint cans (BEHR), At 4:08 PM, LPA observed, excess debris/garbage bags at the side of garage, wood planks, broken gated fence at the back yard At 4:09 PM, LPA observed, 3 mattresses outside, bed frames, patio swing chairs, more wood planks on the other side of the house. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 02/16/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Facility Sketch Covid-19 Mitigation Plan Monkeypox Addendum Exit interview conducted. Appeal Rights and a copy of this report provided.