Community Care Licensing

Document Has Been Signed on 02/13/2025 03:13 PM - It Cannot Be Edited

FACILITY NAME:	ALONDRA HOME		FACILITY NUMBER:	157209397
ADMINISTRATOR/ DIRECTOR:	LAZAGA, CECILIA& JETHRONEL		FACILITY TYPE:	740
ADDRESS:	9817 ALONDRA DR		TELEPHONE:	(661) 563-0683
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY: 6		CENSUS: 6	DATE:	02/13/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:05 AM
MET WITH:	Licensee Jethronel Lazaga		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

SUPERVISORS NAME: See Moua LICENSING EVALUATOR NAME: Mai Yang LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025

FACILITY NAME: ALONDRA HOME	FACILITY NUMBER: 157209397
	VISIT DATE: 02/13/2025

Link to Parent Document Below:

FACILITY NAME: ALONDRA HOME	FACILITY NUMBER: 157209397
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2025

Type A

Section Cited

CCR

87355(e)(2)

87355(e)(2) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	LPA observed S1 at the facility not fingerprinted cleared and not associated the facility which poses/posed an immediate risk to the health and safety of the residents.
	POC Due Date: 02/14/2025
	Plan of Correction
1 2 3 4	S1 is not permitted back until associated and fingerprinted cleared. S1 is to be removed from the facility immediately.

Type A

Section Cited

CCR

87465(h)(2)

87465(h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when LPA observed at 10:44AM, the residents’ medications in pharmacy bag on the table in the activity room and the medical closet unlock which poses an immediate health, safety or personal rights risk to person in care.
	POC Due Date: 02/14/2025
	Plan of Correction
1 2 3 4	Licensee removed the residents’ medication to medication closet and locked medication closet. Licensee shall ensure to have resident’s medication are locked and inaccessible to residents at all times. POC cleared during visit.

SUPERVISOR'S NAME: See Moua LICENSING EVALUATOR NAME: Mai Yang LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025

Link to Parent Document Below:

FACILITY NAME: ALONDRA HOME	FACILITY NUMBER: 157209397
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2025

Type A

Section Cited

CCR

87309(a)

87309(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above when LPA observed knives stored in kitchen drawer unlock. Cleaning chemicals stored under kitchen sink unlock. LPA observed multiple chemicals in the garage unlock. Garage chemical cabinet in the garage was observed unlock and the outside shed was observed unlock accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2025
	Plan of Correction
1 2 3 4	Licensee locked kitchen drawer and garage chemical cabinet. Chemicals were removed and placed in garage chemical cabinet. Keys were removed from the lock on the kitchen drawer and garage chemical cabinet. Licensee locked outside shed and removed keys from pad lock. POC cleared during visit.

Type A

Section Cited

CCR

87555(b)(8)

87555(b)(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state, and local authorities. Good in damaged containers shall not be accepted, used, or retained. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, multiple perishable foods were observed with expired date which poses/posed an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2025
	Plan of Correction
1 2 3 4	Licensee disregarded expired food. POC cleared during visit.

SUPERVISOR'S NAME: See Moua LICENSING EVALUATOR NAME: Mai Yang LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025

Link to Parent Document Below:

FACILITY NAME: ALONDRA HOME	FACILITY NUMBER: 157209397
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2025

Type A

Section Cited

CCR

87465(h)(6)

87465(h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, licensee did not comply with the section cited above when R1’s medication Valacyclovir Hcl 1 gram, Pepcid Famotidine 20 mg, and Chewable Ginger 50 mg was not logged in centrally stored list which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/14/2025
	Plan of Correction
1 2 3 4	Licensee shall ensure that all resident’s medications that are centrally stored are record in the facility. Licensee to submit copies of Centrally Stored Medication Record (Lic 622) for R1 to CCL by POC due date 02/14/25.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: See Moua LICENSING EVALUATOR NAME: Mai Yang LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025

Link to Parent Document Below:

FACILITY NAME: ALONDRA HOME	FACILITY NUMBER: 157209397
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2025

Type B

Section Cited

CCR

87465(c)(3)

87465(c)(3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement was not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview conducted and records reviewed, all residents’ medications were administered on 02/11/25, 02/12/25 and on 02/13/25 at 08:00am. Staff did not recorded into the residents’ Medication Administration Record (MAR) which poses/posed a potential health and safety risk to the resident in care.
	POC Due Date: 02/21/2025
	Plan of Correction
1 2 3 4	All staff shall be retrained on in-service training on medications. Medication training shall also include administering medications, reviewing medications, and documentation. Documentation of training topics with staff attendance rooster shall be submitted to the Fresno CCL office by 02/21/25

Type B

Section Cited

HSC

1569.695

HSC 1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement was not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on interview conducted and records reviewed, last emergency drill conducted was on 07/03/24, which poses/posed a potential health and safety risk to the resident in care.
	POC Due Date: 02/21/2025
	Plan of Correction
1 2 3 4	Licensee shall ensure emergency drill are conducted quarterly. Licensee shall be submitted emergency drill conducted to the Fresno CCL office POC due date 02/21/25.

SUPERVISOR'S NAME: See Moua LICENSING EVALUATOR NAME: Mai Yang LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025

Link to Parent Document Below:

FACILITY NAME: ALONDRA HOME	FACILITY NUMBER: 157209397
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/13/2025

Type B

Section Cited

CCR

87412(c)(2)

87412(c)(2) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training… This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on records reviewed and interviews, S3 training material do not include dates, trainer’s name and number of hours completed which poses/posed a potential health and safety risk for the person in care.
	POC Due Date: 02/21/2025
	Plan of Correction
1 2 3 4	Licensee shall review regulation and ensure that all staff have the required training and orientation. Proof of trainings is to be submitted to the Fresno CCL office by the POC due date 02/21/25. Proof of training shall include the following: Trainer’s full name; Subject(s) covered in the training; Date(s) of attendance; and Number of training hours per subject.

Section Cited

	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

SUPERVISOR'S NAME: See Moua LICENSING EVALUATOR NAME: Mai Yang LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2025