Parkside Villa Assisted Living

Allegation investigated: Staff did not seek timely medical care for resident

Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by the Siklalic Garcia, Manager. LPA identified herself and disclosed the purpose of the visit and shared findings with the Manager. On July 29,2020 a complaint was received regarding the alleged incident that staff did not see timely medical care for resident. On July 24, 2020 the Licensee (LC) called Veteran's Affair (VA) via tele-health (scheduled) for Resident (R1). During the call, Licensee explained "violent" behavior to Attending Physician (AP1) to increase medication, respiradone, to "control" R1's behavior. Continued on 9099C Substantiated AP1 advised that antipsychotic medications require medical evaluation "to rule out a medical problem, such as UTI or urinary retention." AP1 explained to licensee that UTI and urinary retention contribute to increased behaviors. Per AP1's interview and medical notes, licensee stated to AP1 on July 24, 2020 that R1 had hit a nurse and an incident report was submitted to CCLD (unknown date). No such incident report was submitted to CCLD. AP1 ordered the resident to be seen on July 24, 2020 but the client was not brought to the VA to be evaluated. This was corroborated by interviews with AP1 and Licensee. On July 27, 2020 R1 was brought into to be seen and AP1 determined that R1 was retaining 600 cc of urine even though the resident was able to release some urine. According to AP1, anything more than 100 cc of urine is urinary retention and requires additional medical attention. AP1 ordered the Licensee to bring R1 to the ER with a recommendation of a bladder scan for the urinary retention and insertion of a foley catheter. In the interim, to rule out untreated UTI, per medical procedure according to the VA's Licensed Medical Social Worker, AP1, and AP2, that antibiotics were prescribed. AP2 during an interview on August 14, 2020, stated that the benefits of prescribing antibiotics for the UTI far outweighs untreated UTI. Any side effects from the antibiotics would not be as significant as an untreated UTI and that it would be overseen by the physician. Medical records: Resident complained of suprapubic pain for one week. This was noted by AP1 in the VA report. July 28, 2020 Licensee was asked to come back into the office because the VA found out that they had an ultrasound machine, as well as, lab results for the urinary analysis. Lab results returned negative for a UTI but that R1 still had 600 cc of urine. AP1 ordered that the resident be taken to the ER that night. Per Licensee's interview, the resident refused to be brought to the hospital for a foley catheter, therefore, Licensee did not take R1 to the hospital. On July 29, 2020 Resident was brought to the ER for a foley catheter insertion. During interview on August 18, 2020 with the Licensee denied that a physical or violent incident occurred. Licensee denied there was an incident that occurred regarding resident hitting staff. AP1 suspected that Licensee was lying to manipulate AP1 into ordering a medication increase. Based on LPA's interview with the Licensee, Licensee was inconsistent regarding the physical incident that R1 apparently hit a nurse. Licensee admitted that he "presented symptoms to the doctor to see what we can get for R1" to address the behaviors." Continued on 9099C August 5,2020 R1 was seen by AP2 at the VA and an infection was ruled out, aka, not a UTI. The medical assessment was that the "it was behavioral" because the white blood cells were not elevated, only lung congestion (which is consistent with diagnosed CHF). On August 6, 2020 R1 was sent back to the hospital for pulling out the Foley catheter. Per Licensee, urologist advised that catheter is no longer needed but that the resident will continue to be evaluated. August 10, 2020 El Centro Medical ER visit - at 1853, patient is retaining 215 mL of urine; On August 14, 2020 AP2 referred to a psychiatric/geriatric physician to be seen on September 21, 2020 to determine suitability of placement or whether resident requires a higher level of care. Based on the evidence, interviews conducted, and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Licensee ignored doctor's orders to bring R1 into the VA clinic on July 24, 2020 to rule out a medical problem after tele-health consultation. After in-person visit, Licensee ignored doctor's orders for catheter insertion and did not bring the resident to the ER post-visit. R1 expressed to the physician that R1 was experiencing pain for the past week. "Change me, change me," which was expressed by R1 prior to doctor's visits, Licensee dismissed it as a dry diaper and ignored any continence issues. Interview with AP1 and medical notes indicate that the urinary retention could be from untreated prostate cancer. Hence, AP1 ordered an emergency room visit. Licensee, based on a non-medical background, did not feel like the catheter was necessary because R1 was able to void, even though the ultrasound indicated that the resident was retaining 600cc of urine. Licensee did not bring R1 to the ER on July 29, 2020 after a follow-up examination for catheter insertion. An exit interview was conducted with Sikalalic Garcia, Manager. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Administrator and her signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Aug 24, 2023 · control 08-AS-20200729131655

Allegation investigated: Staff chemically restrain resident Resident sustained unexplained injury while in care

Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings. LPA was allowed entry by Sikalalic, Manager. LPA identified herself and disclosed the purpose of the visit and shared findings with the Manager. On July 29, 2020 a complaint was received regarding the alleged incidents that staff chemically restrain resident; resident sustained unexplained injury while in care. Resident's medication was not changed. LPA unable to verify the medication count at this time. MAR indicate that the medication was given as prescribed. There was no increase in dosages. VA did not order additional medication based on reconciliation documented on VA notes. Continued on 9099C Amended report.2 Unsubstantiated Resident sustained unexplained injury while in care Licensee was not at facility at the time of the follow-up call on August 18, 2020. Unable to conduct interviews with staff. Currently no indication of a fall or injury at this time. Medical assessment record shows that resident was a fall risk. Based on the review of documentation, the allegations of: Staff chemically restrain resident and Resident sustained unexplained injury while in care is Unsubstantiated due to a lack of conclusive evidence. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Sikalalic Garcia, Manager . A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Administrator and her signature on this report confirms receipt of the Licensee Rights. Amended Reportthe state’s words, verbatim · CDSS document, Aug 24, 2023 · control 08-AS-20200729131655

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Esther Miller, Community Health Nurse II Corina De Leon, Liason Infection Preventionist Hosniyeh Bagheri, Infection Preventionist Hilary Metcalf, Infection Preventionist Assistant Cinthya Coronado with Imperial County Public Health Department's Healthcare Associated Infection (HAI) Program conducted an on-site visit. LPA and nurse identified themselves and discussed the purpose of the visit with Siklalic "Laly" Garcia, House Manager. The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, screening protocols as well as the use of personal protective equipment. During today's visit, House Manager were interviewed and a walk-though of the facility was conducted. A debriefing was conducted with Administrator at the conclusion of the visit. During today's visit, no deficiencies were issued. An exit interview was conducted with the House Manager and a copy of this report, along with Licensee Rights (LIC9058 01/16), were provided.the state’s words, verbatim · CDSS document, Jul 12, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Liliana Silveira conducted an unannounced annual required licensing inspection. LPA was granted entry after identifying herself and disclosing the purpose of the visit by House Manager Siklalic Garcia. An overall tour of the facility was conducted inside and out. The inspection included, but was not limited to, verifying compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices. LPA reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC 808) with Siklalic including the following sections: Person in Care, Staff, Visitors, Facilities without COVID-19, Residents, Facility Plans for Infection Control and Physical Distancing. LPA assessed the strategies that the facility is employing for the prevention, containment and mitigation of COVID-19, implementation of infection control guidance, staff retention and essential health and safety. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, residents and visitors; a sign-in policy enacted for all visitors; signs were provided to be posted at facility entrance with the facility’s visitor policy and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff and encouraged for residents; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE. The facility is in compliance with and has implemented infection control practices as outlined in its LIC 808. Based on today’s inspection, no deficiencies were observed. An exit interview was conducted with Siklalic. A copy of this report, along with the Licensee Rights (9058 01/16) was emailed to Director Kevin Kahnis. An electronic response confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Mar 25, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Alexandre Vo, conducted an announced Pre-Licensing visit regarding the application for Change of Capacity. LPA met with Licensee, Kevin Kahnis, and Administrator, Quetzalli Kahnis, and was allowed entry into the facility after identifying himself and stating the purpose of the visit. Facility currently serves fifteen (15) elderly residents and request to increase the capacity to eighteen (18) elderly residents, ages 60 and above. This facility houses nine (9) bedrooms and four (4) bathrooms for residents' use. The Fire Clearance was approved on July 26, 2021 for ten (10) non-ambulatory residents and eight (8) bedridden residents who are to be housed in rooms number one (1), two (2), five (5), and seven (7). Facility has an approved hospice waiver for one (1). Facility serves residents diagnosed with dementia. Facility has two (2) kitchen staff and four (4) caregivers on shift during the visit. A tour of the facility was conducted inside and out. LPA was accompanied by Licensee, Kevin Kahnis, and Administrator, Quetzalli Kahnis during the inspection. According to the Licensee, the facility does not keep firearms, ammunition, or dangerous items on the property. The pool is fenced, has a self-closing latch, and is inaccessible to residents. There is a locked centralized storage area for medication and for confidential residents and staff files. The facility is clean and in good repair. Smoke alarms and carbon monoxide detectors are operational. The facility has a call pendant for residents and plan to obtain pendants for each resident upon capacity increase approval. Facility’s temperature was set at 78 degrees Fahrenheit. Hot water temperatures were measured at 110, 114, and 120 degrees Fahrenheit at faucets for residents’ use. There is appropriate furnishings including lighting, hygiene products, beds, storage capacity, clean linens in good repair. Indoor and outdoor passageways are free of obstruction. There are non-slip materials on rugs. Bathrooms are equipped with grab bars, non-skid mats, and showers, sinks, and toilets are operational. Chemicals and cleaning solutions are inaccessible to residents and are stored separate from the food supply. There is a seven-day supply of non-perishable food items, and a two-day supply of perishable food items. There is a shaded outdoor activities area. First aid and emergency supplies are present. Auditory devices are in place to monitor exits. Residents' special health care needs were reviewed. Required postings were observed to be placed in prominent areas, which include emergency exit plan, Resident’s Council, resident’s rights, facility’s visitation policy, the Department’s complaint poster, theft and loss policy, and information for the Long-Term Care Ombudsman. The certified administrator’s certificate is current through July 24, 2022. Surveillance cameras are in use in common areas and are reflected in the Facility Sketch, Plan of Operation, and residents’ admission agreement. The Plan of Operation was reviewed with the Licensee and Administrator. The facility has a designated activities director. Component III was waived. No deficiencies were observed during today’s visit. An exit interview was conducted. The Licensee was informed that the report will be forwarded to management for approval. A copy of this report and Licensee’s Rights (9058 01/16) were provided to the Licensee by electronic mail. An e-mail confirmation receipt was requested.the state’s words, verbatim · CDSS document, Aug 4, 2021