Inspection Report
Annual Inspection
Census: 5
Capacity: 6
Deficiencies: 1
Jan 9, 2025
Visit Reason
The inspection was an unannounced required 1-year comprehensive inspection to evaluate compliance with licensing regulations.
Findings
The facility was generally found to be in compliance with regulations including safety, medication storage, and resident accommodations. However, a Type B citation was issued due to failure to conduct quarterly emergency disaster drills, with the last drill conducted on 02/24/2024, posing a health and safety risk to residents.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to conduct quarterly emergency disaster drills with proper documentation including date, type of emergency, and staff participation. | Type B |
Report Facts
Residents present: 5
Licensed capacity: 6
Staff present: 3
Fire extinguisher inspection tag date: Nov 18, 2024
Last fire/disaster drill date: Feb 24, 2024
Plan of Correction due date: Jan 16, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jaime Vado | Licensing Program Analyst | Conducted the inspection and authored the report |
| Moddie Andaya | Administrator | Facility administrator met during inspection and involved in review of findings |
| April Cowan | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Annual Inspection
Census: 6
Capacity: 6
Deficiencies: 2
Feb 20, 2024
Visit Reason
The inspection was a required unannounced 1-year annual visit to evaluate compliance with regulations for the Pacific Care Home facility.
Findings
The facility was toured and found generally safe with proper storage of medications and sharps, operable safety equipment, and maintained client files. However, deficiencies were cited related to staff training and medical assessments for residents with dementia.
Deficiencies (2)
| Description |
|---|
| Licensee did not comply with required annual training on postural supports and restricted health conditions for 4 out of 5 staff records reviewed. |
| Two out of four clients diagnosed with dementia did not have current medical assessment and/or appraisal on file. |
Report Facts
Staff training noncompliance: 4
Clients without current dementia assessment: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rafael Jison | Administrator | Certified RCFE administrator overseeing facility operations |
| Moddie Andaya | Certified RCFE administrator | Oversees facility operations |
| Wilhelm Ick | Assistant RCFE administrator | Assists in overseeing facility operations |
| Cara Smith | Licensing Program Manager | Supervisor for the inspection |
| Audrey Jeung | Licensing Program Analyst | Licensing evaluator who conducted the inspection |
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