Rosewood Retirement Community

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Darius Williams conducted an Case Management in response to two Incident Reports submitted by the faciity. LPA Williams met with Wellness Supervisor, Jesus Hernandez III and Administrator, Rochelle Balaban. Resident 1 resides in Independent Living and Resident 2 resides in the memory care unit. LPA Williams reviewed resident records. Based of discussion Administrator and Wellness Director reported they will be conducting an updated fall risk assessment on R1 and R2. No deficiency cited during the visit. An exit interview was conducted and a copy of this report will be provided via e-mail.the state’s words, verbatim · CDSS document, Sep 28, 2023

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Shawna Doucette met with Administrator Rochelle Balaban to conduct a case management visit regarding a Decision and Order notice from the Caregiver Background Check Bureau (CBCB) requiring immediate action. The notice required staff #1 to be immediately removed from the facility if present. Per the Administrator, the staff was not employed by the facility. A copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 29, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Darius Williams conducted an unannounced Annual Inspection visit. LPA Williams met with Director of Assisted Living, Cille Caldwell and Administrator, Rochelle Balaban. LPA Williams discussed the purpose of the visit. LPA Williams toured the facility with the Administrator and Director. The 1st and 4th through 9th floor are independent living. The 2nd and 3rd floor house the Assisted Living and Memory Care unit. The tour began on the 9th floor and ended on the 1st floor. All floor landings had emergency chairs in the stair wells. All independent living areas were clean and in good repair. The assisted living floors were clean and in good repair. LPA Williams observed four residents eating in the dining room on the third floor. All meals are prepared and catered from the first floor kitchen. Residents have their own bedrooms with an attached bathroom. Bathrooms were equipped with a non-slip mat and grab bars. The medication room and carts were observed locked on the second floor. The second floor also houses the Memory Care unit. Residents have their own bedrooms and bathroom. A extra shower is available for residents who require extra assistance; bathroom was equipped with grab bars and non-slip mat. Residents were sitting in the dining room eating. *Continued in LIC-809C* There is a large dining hall available on the first floor. Attached to the dining hall was the main kitchen where food is prepared. There was two days of perishable food and one week of non-perishable food. Refrigerators reflected approximately 36 degrees Fahrenheit (F) and Freezer reflected approximately -6 degrees F. There is a pool and two activities buildings adjoining the facility. The pool was clean, free of obstruction, and locked. Smoke detectors, carbon monoxide, and fire extinguishers were present and operational. LPA Williams reviewed nine employee files, via hard copy files and electronic record keeping system Relias, and ten resident files via their electronic record keeping system Unity. Nine of nine employee files had required annual training and criminal record clearances. 10 of 10 resident files had required documents. LPA Williams requested the following documents be provided to the department by 4/26/2023; LIC 500 Personnel Report, LIC 308 Designation of Facility Responsibility, Liability Insurance, and Administrator Certificate. No deficiencies were cited at this time. An exit interview was conducted and a copy of this report will be provided via e-mail.the state’s words, verbatim · CDSS document, Apr 19, 2023

Type of visit: Case Management - Other

On 7/1/22 at 11:05 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a case management - other inspection. LPA checked in at front desk and was met by Director of Assisted Living Cille Caldwell. LPA explained reason for inspection. Administrator Rochelle Balaban met with LPA and Cille on the second floor of the facility. LPA conducted a health and safety check. LPA made observations, and interviewed staff about the facility's signal system and SafelyU fall detection program. No deficiencies cited during today's inspection. Exit interview conducted. A copy of this report was given to Administrator Rochelle Balaban, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Jul 1, 2022

Type of visit: Required - 1 Year

On 3/21/22 at 9:00 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and met with Director of Assisted Living Cille Caldwell and Administrator Rochelle Balaban. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point for residents and visitors. Screening kiosks are used by visitors and staff. LPA toured facility and observed no obstructions or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Facility has medication room and uses med carts, where at least 30-day supply of medication was observed. Cleaning and PPE supplies were checked. A sample of staff records were reviewed for good health and infection control training. Facility staff was observed with masks on. Resident files are updated for emergency contact information regularly. Administrator certification is current. The following updated forms are to be submitted to CCL within 2 weeks: LIC500, LIC610E, proof of liability insurance No deficiencies cited during this inspection. Exit interview conducted. Due to COVID-19 precautions, a copy of this report was emailed to Administrator with Read receipt to confirm receipt of this report.the state’s words, verbatim · CDSS document, Mar 21, 2022

Type of visit: Case Management - Other

On 11/10/21 at 11:35 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a case management - other inspection. LPA met with Rochelle Balaban, Administrator and Faith Enriquez, Lead LVN. LPA amended Plan of Correction for deficiency issued on 10/18/21. No deficiencies cited during the inspection. Exit interview conducted. A copy of this report will be emailed to the email on record with "Read receipt" to confirm receipt of this report.the state’s words, verbatim · CDSS document, Nov 10, 2021

Allegation investigated: Facility staff are not administering medication as prescribed. Facility staff are not meeting resident needs.

On 11/3/21 at 8:45 AM, Licensing Program Analysts (LPAs) Malia Thao and Lisa Salazar arrived unannounced to conduct a complaint investigation. LPA explained reason for inspection at front desk and was granted entry. LPAs met with Griscel Garcia, Memory Care Manager and Administrator Rochelle Balaban. During the course of the investigation, LPAs made observations, reviewed records, and interviewed staff. Based on the observations, record reviews, and interviews, LPAs found that the facility staff were not administering medication as prescribed. R1's medication Acetaminophen 325mg tablet was started on 10/29/21 as a routine medicine to be given two tablets by mouth every 8 hours for pain. Starting from 10/29/21 to today, only 9 doses have been administered, but 7 doses were remaining on the bubble pack card not given as prescribed. All doses for 10/29/21 through 10/31/21 were given. Doses for 11/1/21 through 11/3/21 AM dose were not given and still in the bubble pack card. Continue on LIC9099C. Substantiated Continued from LIC9099. LPA found that 3 out of 8 residents sampled showed Activities of Daily Living (ADL) logs did not match the residents basic services as shown on the residents' Physician's Report for Residential Care Facilities for the Elderly form LIC602A. The above allegations are substantiated. Deficiencies are being cited based on LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC9909D. An exit interview was conducted and Plans of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and emailed to the email address on record with “Read receipt” to confirm receipt of this report.the state’s words, verbatim · CDSS document, Nov 3, 2021 · control 24-AS-20210503141827

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Nov 4, 2021

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(5) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: LPAs found that the facility staff were not administering medication as prescribed. R1's medication Acetaminophen 325mg tablet was started on 10/29/21 as a routine medicine to be given two tablets by mouth every 8 hours for pain. Starting from 10/29/21 to today, only 9 doses have been administered, but 7 doses were remaining on the bubble pack card not given as prescribed. All doses for 10/29/21 through 10/31/21 were given. Doses for 11/1/21 through 11/3/21 AM dose were not given and still in the bubble pack card. This poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 3, 2021

Plan of correction: Administrator will submit proof of plan to start a weekly med cart audit for two months by the LVN to CCL by due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.312(a) · Plan of correction due date: Nov 17, 2021

§1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (b) Assistance with instrumental activities of daily living in the combinations which meet the needs of residents. This requirement is not met as evidenced by: LPA found that 3 out of 8 residents sampled showed Activities of Daily Living (ADL) logs did not match the residents basic services as shown on the residents' Physician's Report for Residential Care Facilities for the Elderly form LIC602A. This poses a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 3, 2021

Plan of correction: Administrator will submit proof of in-service training of the facility's TouchScreen charting tablet system for all staff providing care to residents to CCL by POC due date.

Type of visit: Case Management - Deficiencies

On 11/3/21 at 10:00 AM, Licensing Program Analyst (LPAs) Malia Thao and Lisa Salazar arrived unannounced to conduct a case management - deficiencies inspection. LPAs observed the following deficiencies: 1. Steak knife out on the counter in the kitchen of the third floor, unsupervised. LPA Malia Thao observed food service staff walk out of kitchen/dining room, then LPAs entered kitchen/dining area with LVN Faith Enriquez and observed steak knife out on counter. While touring the memory care unit, LPAs observed from the hallway a disinfecting spray bottle on top of toilet tank in Room 244. Room 244's door was open, and disinfecting spray was accessible to room's resident as well as all other passing residents. 2. LPA found that R2 is diagnosed with dementia and last had a medical assessment completed on 2/20/2020. 3. R6's medical assessment form LIC602A did not include the resident's primary or secondary diagnosis. Deficiencies are being cited based on LPA observations, interviews conducted, and records review in accordance with the California Code of Regulations, Title 22, see LIC809D. Exit interview conducted. A copy of this report and appeal rights were emailed to email on record with Read receipt to confirm receipt of this report.the state’s words, verbatim · CDSS document, Nov 3, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Nov 4, 2021

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: LPA found steak knife out on the counter in the kitchen of the third floor, unsupervised. LPA Malia Thao observed food service staff walk out of kitchen/dining room, then LPAs entered kitchen/dining area with LVN Faith Enriquez and observed steak knife out on counter. While touring the memory care unit, LPAs observed from the hallway, a disinfecting spray bottle on top of toilet tank in Room 244. Room 244's door was open, and disinfecting spray was accessible to room's resident as well as all other passing residents. This poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 3, 2021

Plan of correction: Administrator locked door to 3rd floor kitchen and removed the disinfecting spray from Room 244 during the inspection. POC cleared.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87705(c)(5) · Plan of correction due date: Nov 17, 2021

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment.. both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: LPA found that R2 is diagnosed with dementia and last had a medical assessment completed on 2/20/2020. This poses a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 3, 2021

Plan of correction: Administrator will submit proof of a new medical assessment completed for R2 to CCL by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(b)(1) · Plan of correction due date: Nov 17, 2021

87458 Medical Assessment (b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis...other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by: LPA found that R6's medical assessment form LIC602A did not include the resident's primary or secondary diagnosis. This poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 3, 2021

Plan of correction: Administrator will submit proof of new medical assessment completed to show R6's primary and secondary diagnosis to CCL by POC due date.

Type of visit: Case Management - Other

On 11/03/21, Licensing Program Analysts (LPAs) L. Salazar and M. Thao arrived at the facility unannounced to deliver findings on complaint allegations. LPAs were greeted at the front desk where COVID precautionary measures were taken. LPAs stated the purpose of their visit and were allowed entry to the second floor. During the course of the investigation, LPAs toured the facility, observed medication carts, staff training records and obtained documentation for records review. Due to computer difficulties, facility was unable to retrieve some of the documentation requested. Based on the records that were reviewed, LPA Salazar provided Technical Violations (TV) for California Code of Regulations (CCR), Title 22, Division 6. See attached 9102 and 9102-C. LPA reviewed Hospice Care Plans with Staff S1, Staff S2 and Staff 3 and identified areas in the plan that may need to be addressed through training and/or plans of care. Technical Assistance (TA) for the following : Hospice Care; Pressure injuries, Medications Guide, and RCFE self assessment guide and Exit Interview conducted with facility Executive Director (ED), Manager of Memory Care Unit (S1) and Wellness Coordinator (S3). No deficiencies cited on today's case management inspection.the state’s words, verbatim · CDSS document, Nov 3, 2021

Allegation investigated: Facility staff financially abused resident. Facility increased resident's rate without proper notice.

On 10/18/21 at 8:45 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver findings. LPA was granted entry by front receptionist. LPA met with Administrator (ADM) Rochelle Balaban. During the course of the investigation, LPA conducted interviews and reviewed records. Based on LPA’s observations, interviews, and records reviewed, the preponderance of evidence standard has been met. Facility self reported S1 was found to have financially abused R1. S1 admitted to receiving checks from R1. Facility increased R1’s monthly fee due for January and February 2021 without the proper advance written notice of 60 days. The above allegations are substantiated. Deficiencies are being cited based on LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC9909D. An exit interview was conducted and Plans of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and emailed to the email address on record with “Read receipt” to confirm receipt of this report. Substantiatedthe state’s words, verbatim · CDSS document, Oct 18, 2021 · control 24-AS-20210126135433

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Dec 10, 2021

Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation... This requirement is not met as evidenced by: During the course of the investigation, facility self reported S1 was found to have financially abused R1. S1 admitted to receiving checks from R1. This poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2021

Plan of correction: Administrator will submit a plan by the due date, detailing how facility plans to ensure that resident is made whole for the money staff stole from resident. Plan shall include a date that staff will be re-trained on facility’s theft and loss policy and resident personal rights.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Nov 1, 2021

Increase in fee rates for elderly residents; 60 days’ written notice stating amount of and reasons for increase;...(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents...the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs,... This requirement is not met as evidenced by: During the course of the investigation, LPA found that facility increased R1’s monthly fee due for January and February 2021 without the proper advance written notice of 60 days. This poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 18, 2021

Plan of correction: Administrator will provide proof of a plan to properly notify residents once a resident no longer qualifies for the facility's internal benevolence funding program, to CCL by POC due date.