Inspection Reports for Genesis Manor V
550 Bethany Cir, Claremont, CA 91711, CA, 91711
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Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 0
Oct 22, 2024
Visit Reason
The inspection was an unannounced required annual inspection visit conducted to evaluate compliance with licensing and regulatory requirements.
Findings
No deficiencies were observed during the visit. The facility met all regulatory requirements including physical plant safety, food service, resident rights, disaster preparedness, health-related services, staffing, personnel training, infection control, and operational requirements.
Report Facts
Personnel records reviewed: 4
Residents in care: 6
Fire clearance approved capacity: 6
Hospice residents allowed: 4
Hospice residents present: 0
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Markie | Administrator | Met with during inspection; Administrator Certificate pending approval. |
| Kimberly Ramirez | Licensing Program Analyst | Conducted the inspection visit. |
| Tony Vasallo | Supervisor | Supervisor named in report. |
Inspection Report
Complaint Investigation
Census: 5
Capacity: 6
Deficiencies: 0
Jan 16, 2024
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations including staff preventing home health agency staff from performing their duties, uncleared staff working in the facility, and the facility lacking a qualified administrator.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Staff and residents interviewed denied the allegations, and records showed appropriate staff clearance and a qualified administrator. No deficiencies were observed or cited.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff preventing home health agency staff from performing duties, uncleared staff working at the facility, and lack of a qualified administrator. Interviews and records review did not support these allegations.
Report Facts
Capacity: 6
Census: 5
Staff interviewed: 6
Residents interviewed: 4
Administrator certificate expiration: Apr 23, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Gerry A. Markie | Administrator | Listed as the qualified administrator with valid certification |
| Valeria Maldonado | Licensing Program Analyst | Conducted the complaint investigation |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation |
| David Markie | Administrator | Listed as the qualified administrator with Certificate# 6015176740, expiration 4/23/2024 |
| Art Bastes | Caregiver | Met with Licensing Program Analyst during unannounced visit |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 0
Nov 3, 2023
Visit Reason
An unannounced Annual Required 1-year Visit was conducted to evaluate the facility's compliance with licensing requirements for serving elderly residents with dementia.
Findings
The facility was found to be clean, well-maintained, and compliant with all observed requirements. No deficiencies were cited during the inspection.
Report Facts
Residents on hospice care: 0
Resident bedrooms: 5
Staff files reviewed: 3
Resident files reviewed: 5
Emergency drills dates: Last documented drills were conducted on 10/12/23 and 10/25/23.
Kitchen perishables supply: 2
Kitchen non-perishables supply: 7
Kitchen sink water temperature: 111.5
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David E. Markie | Administrator | Met with Licensing Program Analyst during inspection. |
| Kimberly Ramirez | Licensing Program Analyst | Conducted the unannounced annual inspection. |
| Tony Vasallo | Supervisor | Supervisor overseeing the licensing evaluation. |
Inspection Report
Complaint Investigation
Census: 4
Capacity: 6
Deficiencies: 0
Oct 9, 2023
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations including staff preventing home health agency staff from performing their duties, uncleared staff allowed to work in the facility, and the facility not having a qualified administrator.
Findings
The investigation found no preponderance of evidence to substantiate the allegations. Staff and residents interviewed denied the allegations, and records showed appropriate staff clearance and no unauthorized administrators. No deficiencies were observed or cited.
Complaint Details
The complaint investigation was unsubstantiated. Allegations included staff preventing home health agency staff from performing duties, uncleared staff working at the facility, and lack of a qualified administrator. Interviews and records review did not support these claims.
Report Facts
Capacity: 6
Census: 4
Staff interviewed: 6
Residents interviewed: 4
Resident receiving home health care: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Valeria Maldonado | Licensing Program Analyst | Conducted the complaint investigation visit |
| Fernando Fierros | Licensing Program Manager | Oversaw the complaint investigation report |
| Gerry A. Markie | Administrator | Facility administrator present during investigation |
| Alaina Hendrick | Licensee | Licensee present during investigation |
Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 1
Nov 7, 2022
Visit Reason
The inspection was an unannounced required annual visit to evaluate the facility's compliance with regulations, including infection control, medication management, and staff records.
Findings
One deficiency was found related to the refrigerator not containing the required minimum one week of nonperishable foods and two days of perishable foods, posing a potential health and safety risk. Other areas such as resident records, medications, and infection control were found compliant.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Refrigerator/freezer did not contain the minimum one week of nonperishable foods and two day minimum of perishable foods, posing a potential health, safety or personal rights risk to persons in care. | Type A |
Report Facts
Residents reviewed: 5
Staff records reviewed: 4
Residents medications reviewed: 5
Plan of Correction Due Date: Nov 8, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| David Markie | Administrator | Met during inspection and exit interview |
| Kimberly Ramirez | Licensing Program Analyst | Conducted the inspection and evaluation |
| Tony Vasallo | Supervisor | Supervisor overseeing the inspection |
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