A New Haven Care Home

Type of visit: Required - 1 Year

On 9/12/2023 at 8:50AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with caregiver, Leah Van Alstin and explained the purpose of the visit. Administrator, Robert Abella arrived 30 minutes later. The facility’s fire clearance was approved for 6 non-ambulatory residents of which 2 residents maybe under hospice care. LPA toured the facility including but not limited to bedrooms, bathrooms, dining area, kitchen, garage, and outdoor area. Smoke and carbon monoxide detectors were observed. Fire extinguisher was observed to be full and last serviced on 2/9/2023. One week of nonperishable and 2-day of perishable food supplies were available. Hot water temperature was measured at 105 degrees F in the hallway bathroom. LPA observed grab bars and non-skid mat in the bathrooms. There were adequate lights in each room. Resident rooms were observed to be cleaned and fully furnished. First Aid kit is complete. Last fire drill was conducted on 7/10/2023. LPA reviewed 3 resident and 2 staff files starting at 9:30AM. LPA reviewed a sample of resident's medications starting at 10:00AM. LPA interviewed 2 residents and 1 staff at 10:50AM. No deficiencies being cited on this date. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Sep 12, 2023

Type of visit: Required - 1 Year

On 10/6/2022 at 9:10AM, Licensing Program Analysts (LPAs) G. Luk and K. Nguyen arrived unannounced to conduct an Infection Control Inspection. LPAs met with staff, Myrna Tolentino. Administrator, Robert Abella arrived 20 minutes later. Upon entry, staff did not conduct COVID-19 screening for LPAs. Staff later checked LPAs' temperatures. LPAs observed hand sanitizer at screening station. LPAs toured facility including but not limited to bedrooms, bathrooms, kitchen, common areas, garage, and outdoor areas. LPAs observed cough etiquette, signs & symptoms, and physical distancing are posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at sinks and bathrooms. During record review, LPAs observed visitors log and temperature log for both residents and staff. LPAs observed facility has a copy of Mitigation Plan on file. Facility staff had FIT testing for N95 respirators completed and completion certificates were reviewed. LPAs observed PPE, food supplies, and paper supplies are sufficient. At 9:20AM, LPAs observed unlocked knives cabinet and key was on the lock. Staff locked up the knives cabinet and put away the key during inspection. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights was provided.the state’s words, verbatim · CDSS document, Oct 6, 2022

Allegation investigated: Resident sustained a stage 4 pressure injury while in care.

On 9/21/2022 at 9:58AM, Licensing Program Analysts (LPAs) G. Luk and M. Malik arrived unannounced to deliver complaint findings for the allegation above. Upon arrival, LPA met with caregiver, Jesusimo Tolentino and explained to him the reason for the visit. Administrator, Roberto Abella arrived 20 minutes later. Licensee, Arnold Soleta arrived an hour later. During the course of the investigation, the Department conducted interviews with staff, residents, witnesses, and complainant. Resident’s physician’s report, care plan, care notes, email correspondence, photographs of wound, and hospice records were obtained and reviewed. (Continue on LIC9099C...) Substantiated Record review showed staff did not change R1’s diaper or reposition R1 overnight. Interview with staff indicated that staff conduct diaper changes every 2-3 hours. However, staff stated that R1 was heavy to lift and would yell when staff tried to reposition R1. On hospice’s initial visit on 3/12/2022, R1 was found wearing two diapers and laying on top of chux pads. R1’s wound was already at a stage 4 when hospice began treating R1. W3 stated that a wound can develop from a stage 1 to a stage 4 within a couple hours if the resident is not repositioned, remains in the same position for hours, and their diapers are not changed. Based on the Department’s investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Health and Safety Code, are being cited on the attached LIC9099D. A $500.00 immediate civil penalty is being assessed on this day. Civil penalty determination related to serious bodily injury is pending. A formal conference with CCLD will be schedule at a later time. Exit interview conducted with Arnold. A copy of this report, civil penalty, and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 21, 2022 · control 15-AS-20220517085029

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.269(a)(10) · Plan of correction due date: Sep 22, 2022

Enumerated rights; severability. To be free from neglect,...humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidience by: Based on investigation, licensee did not comply with the section cited above resulting in R1 sustaining a stage 4 pressure injury which poses an immediate health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Administrator has agreed to re-train all staff regarding care of residents with pressure injuries in various stages and submit training materials & staff sign in sheet to CCLD by POC date. A formal conference with CCLD will be schedule at a later time. $500.00 immediate civil penalty is assessed.

Type of visit: Case Management - Other

On 9/21/2022 at 10:30AM, Licensing Program Analysts (LPAs) G. Luk and M. Malik arrived unannounced to conduct a case management visit. LPA met with Administrator, Roberto Abella. Licensee, Arnold Soleta arrived 30 minutes later. While LPAs was at the facility conducting another visit, LPAs observed the following deficiencies. - During the Department investigation regarding complaint #15-AS-20220517085029, it was identified that facility did not report R2's death to CCLD. - It was also identify that S1 was not associated to the facility. LPAs reviewed Guardian and observed S1 was fingerprint cleared and not associated to the facility. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies may result in civil penalties. Exit interview conducted with Arnold. A copy of this report and appeal rights was provided.the state’s words, verbatim · CDSS document, Sep 21, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Sep 28, 2022

Reporting Requirements. A written report shall be submitted to the licensing agency...Death of any resident... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not submitting death reports for R2 which poses a potential health and safety risk to the person in care.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Administrator has agreed to review and re-train all staff regarding reporting requirements. Facility will submit staff sign in sheet and training materials to CCLD by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87355(e)(2) · Plan of correction due date: Sep 28, 2022

Criminal Record Clearance. All individuals subject to a criminal record review...Request a transfer of a criminal record clearance... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not associating S1 to the facility which poses a potential health and safety risk to the person in care.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Administrator has agreed to associate S1 and provide document to CCLD by POC date.

Type of visit: Case Management - Health Checks

On 5/23/2022 at 9:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a health and safety check as a result of a priority 2 complaint. LPA met with Administrator, Robert Abella. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, and outdoor area. Hot water temperature was measured at 105.8 degrees F in a resident's bathroom sink. 7-day of non-perishable and 2-day of perishable food supplies were sufficient. Resident's medications were kept locked in the cabinet. Smoke and Carbon monoxide detectors observe. First-aid kit was complete. Fire extinguisher was observed to be full and last serviced on 2/11/2022. There are no accessible bodies of water observed. At 10:00AM, LPA observed unlocked disinfectant under the kitchen sink and unlocked knives cabinet. Staff locked up disinfectant and knives during inspection. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights was provided.the state’s words, verbatim · CDSS document, May 23, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: May 24, 2022

Storage Space. Disinfectants, cleaning solutions,...other items which could pose a danger...shall be stored where inaccessible to clients. This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by having unlocked disinfectant and knives which poses an immediate health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, May 23, 2022

Plan of correction: Staff locked up knives and disinfectant during inspection. Deficiency cleared during inspection.

Type of visit: Required - 1 Year

On 9/10/2021 at 11:55AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with staff, Evaresto Borromeo and explained the purpose of the visit. Administrator, Roberto Abella arrived 30 minutes later. Upon entry, LPA's temperature was checked and asked to fill out visitor's log. LPA observed hand sanitizer at screening station. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common areas, and outdoor areas. LPA observed cough etiquette, signs & symptoms, and physical distancing are posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at sinks and bathrooms. During record review, LPA observed visitors log and temperature log for both residents and staff. LPA observed facility has a copy of Mitigation Plan on file. LPA observed PPE, food supplies, and paper supplies are sufficient. Facility was given Technical Assistance regarding infection control guidelines and documented on LIC9102. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Sep 10, 2021

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.