Sierra Palace for Elderly

Allegation investigated: Licensee did not safeguard residents personal property

On 7/31/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection at 0900 hours. LPA met with House Manager Rosa Perez and announced the purpose of the inspection. The purpose of this visit is to deliver the finding of the investigation completed by the Department. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility. During the course of the investigation, the department conducted inspections, conducted interviews, and reviewed records. Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has not been met; therefore, the above allegation is found to be unsubstantiated at this time. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 31, 2023 · control 24-AS-20230705141641

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff are not giving residents medication

On 07/05/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an initial 10-day complaint inspection. LPA introduce self, stated the purpose of the visit, and met with Manager Mary Chum. LPA requested to meet with Administrator Elizabeth Perera-Moreland. Administrator was called and stated unable to attend meeting. Administrator authorized General Manger (GM) Virginia Jimenez to sign and receive report. GM arrived shortly. LPA spoke with Administator via telephone and discuss the findings. During the course of the investigation, LPA conducted interviews and reviewed records. It was confirmed there is no client that reside at the facility listed in the complaint. Therefore, the allegation above is founded to be UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted. A copy of this report was provided to GM, whose signature on this form confirms receipt of this report. Unfoundedthe state’s words, verbatim · CDSS document, Jul 5, 2023 · control 24-AS-20230626153456

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Lady Cabrera conducted an unannounced case management visit to the facility. The purpose of the case management visit is to follow up on Special Incident Reports (SIR) submitted to CCL Office. LPA met Administrator Elizabeth Perera-Moreland and Virginia Jimenez, Manager. SIR 1: Staff (S1) was preparing for showers, when S1 came back into the kitchen she noticed Client (C1) was eating a nectarine that he got out of fridge. Staff noticed C1 started to choke and Staff immediately called Staff (S2) and S2 started performing the Heimlich and S1 called 911. C1 then spit out the piece of nectarine. SIR 2: On 12/01/2022, C1 was in the kitchen and got an apple from the basket located on top of kitchen counter. Staff was in the bathroom and the other caregiver was in the dining room talking to a resident, when she noticed C1 was choking. Staff started the Heimlich Maneuver and the piece of apple came out. 911 was called. The paramedics evaluated C1. Administrator will submit requested C1’s records for review and a follow-up may be required. Administrator was provided with a copy of this report.the state’s words, verbatim · CDSS document, Dec 28, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lady Cabrera arrived unannounced for an Annual Required Inspection. Administrator Elizabeth Perera was unavailable and designated Virginia Jimenez, Manager to meet with LPA. LPA stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by the kitchen sink. Bedrooms were checked. The exterior tour was conducted. LPA checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. On 02/09/2022, CCL received a Special Incident (SIR) Report Central Valley Regional Center regarding incident that occurred on 10/29/2021. As of today’s, date, CCL did not receive an SIR from the facility of the 10/29/2021 incident. Per SIR, Client (C1) was in the dining room area went up to C2 to hug him. C2 moved his hands and C1 grabbed C2’s wheelchair. C2 became upset and grabbed C1’s wheelchair and threw him down. When C1 was on the floor, C2 hit C1 on the face. LPA requested further documents regarding the 10/29/2021 and 11/03/2021 incidents. LPA will return to facility to address any concerns after records are reviewed. Deficiencies are being cited on the attached LIC 809-D. Exit interview was conducted. A copy of this report, LIC809, LIC809-D and appeal rights were provided. The Licensee’s signature on this form acknowledges receipt of these documents. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 03/02/2022 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.the state’s words, verbatim · CDSS document, Feb 23, 2022

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility is not following COVID-19 guidelines. Facility does not have proper PPE for staff.

Licensing Program Analyst (LPA) Lady Cabrera conducted the subsequent complaint investigation visit to the facility. During the course of this complaint investigation LPA conducted interviews and reviewed records. It was determined based on the interviews and records review that the above allegations are SUBSTANTIATED. On 09/28/2021, LPA tracked the facility during the COVID-19 outbreak. Based on interviews, Facility did not have adequate supply of proper PPE for their staff to utilize while caring for residents and did not follow Covid-19 guidelines. See attached LIC9099-D forthe state’s words, verbatim · CDSS document, Dec 14, 2021 · control 24-AS-20210924153141

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(d)(2) · Plan of correction due date: Dec 24, 2021

87307 Personal Accommodations and Services (d)(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure to have adequate supply of proper PPE for their staff to utilize while caring for residents and did not follow Covid-19 guidelines, which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 14, 2021

Plan of correction: Facility Manager and Licensee agreed to submit a revised mitigation plan to LPA by POC due date. Licensee has a 30-day PPE supplies. LPA obseved the PPE supplies at the facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87488.1(a)(2) · Plan of correction due date: Dec 24, 2021

87468.1 Personal Rights of Residents in All Facilities: (a)(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure to have adequate supply of proper PPE for their staff to utilize while caring for residents and did not follow Covid-19 guidelines, which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 14, 2021

Plan of correction: Licensee to review 87468.1 Personal Rights of Residents in All Facilities. Licensee shall submit a written letter indicating they have read and understand the regulations to CCLD by 12/24/2021.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Lady Cabrera conducted an unannounced case management visit to the facility. LPA met with Administrator Elizabeth Perera and stated the purpose of the visit. The purpose of the case management visit is to respond an incident report that was submitted to CCL Office incident occurred on 10/19/2021 regarding Resident (R1) and R2. R1 was in the living room watching television and R2 went up to him and pinched his hand. R1 then grabbed R2's wheelchair and pushed him away and R2's wheelchair flipped over and R2 fell. Staff immediately intervene and separated clients. Staff called non-emergency ambulance to evaluate R2. No follow-up required.the state’s words, verbatim · CDSS document, Dec 14, 2021

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Lady Cabrera conducted a case management visit to the facility. LPA identified herself and discussed the purpose of the visit Administrator Elizabeth Moreland was present via telephone. On 9/23/2021, CCL received a Special Incident (SIR) Report Central Valley Regional Center regarding incident that occurred on 08/01/2021. Per SIR, Resident (R1) was not administered his prescribed dosage of Phenobarbital (97.2mg twice daily) on 08/01/2021, 08/20/2021, 08/03/2021, 08/04/2021, 08/06/2021 and 08/11/2021. One each of these dates, R1 was administered AM dosage of the medication, but not the PM dosage of the medication as prescribed. Based on the LPAs interview and records review, the Licensee did not meet California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87465(b) Incidental Medical and Dental Care. Deficiencies are being cited on the attached LIC 809-D. Exit interview was conducted. A copy of this report, LIC809, LIC809-D and appeal rights were provided. The Licensee’s signature on this form acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Oct 4, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Oct 8, 2021

87465 Incidental Medical and Dental Care (a) A plan for incidental medical... shall be developed by each facility. The plan shall encourage routine medical... care and provide for assistance in obtaining such care, by compliance with the following: (5) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on records review and interviews, the Licensee did not meet the Incidental Medical Care, which poses an Immediate Health, Safety and Personal Rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 4, 2021

Plan of correction: Licensee reported all staff that are involved in passing medications to the residents have been trained on 08/18/2021. Licensee will submit a signed training roster to CCLD with a copy of the list of attendees by 10/08/2021.