Arcadian Residential Community

Allegation investigated: -Staff are not meeting resident's needs. -Staff are not providing adequate food service to resident.

Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegations, and close the complaint. LPA met with Lulin 'Lucy' Wu, administrator, and informed the reason for visit. During the course of investigation, LPA reviewed residents file, and inspected the food supplies. LPA reviewed residents records, and obtained copies of the following documents: LIC601 Identification and Emergency Contact Information; LIC602A Physician's Report; Appraisal. LPA interviewed staff (administrator and S1), licensees and residents on 3/30/22 and 8/31/22. ...... continued on 9099C (page 2) Unsubstantiated Page 2 Allegation: Staff are not meeting residents’ needs. It was alleged that there is a resident who screams like this resident is in pain 24/7. It was further alleged this resident may have a flesh-eating bacterium from not getting the diaper changed enough making this resident screams day and night. When LPA arrived to the facility on 3/20/22, LPA heard a resident crying and learned that this resident is R5, LPA observed staff went to R5's room and calmed R5 down. Administrator and licensees Wendy Wong and Olive Manalastas stated that R5 has screaming, crying and yelling behaviors. Review of R5's records confirmed administrator and licensees' statements. Administrator stated R5 is on hospice and that they were working with the hospice agency to address the behaviors. S1 confirmed that facility had worked with the hospice agency and R5's medications were adjusted to address the medications. During visits on 8/31/22 and 8/23/23, LPA no longer heard R5 crying or screaming. On 3/30/22, 8/31/22 and 8/23/23, LPA observed R5 clean and no smell of urine. Five residents were interviewed on 3/30/22 and 8/31/22. R1 indicated that the only time she does not hear R5 cries is when she (R1) goes to sleep. Three residents stated they are not bothered by R5's crying and two of these 3 residents stated it's R5's behavior. LPA was not able to obtain information from R5 and 1 of the other residents. Based on information gathered and LPA unable to obtain information from R5, the allegation of staff are not meeting resident's needs is closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. .......continued on 9099C (page 3) Page 3 Allegation: Staff are not providing adequate food service to resident. It was alleged that resident (R1) is a vegan and the facility keeps giving R1 meat and food with gluten. LPA interviewed R1 who stated she has food allergy and needs super foods but has not told the staff of her food preferences. Administrator stated R1 likes tofu & fruits which the facility provides. Administrator also stated R1 likes organic food so the staff drive R1 to the store so R1 can buy the organic items she prefers. The other 4 residents interviewed indicated they like the food facility serves. Review of R1's record showed R1 is interested in organic farming. R1's LIC602A Physician's Report didn't indicate R1 being vegan, having food allergy or on special diet. LPA inspected the food supplies which were observed of different varieties. Based on information gathered, the allegation of staff are not providing adequate food service to resident is closed as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted, and copy of this report provided. LPA conducted inspection on 3/20/22 and 8/31/22 and didn't observe any broken pipes. Facility was observed to have running water. LPA checked the tap water and observed it clear and no residue. Licensee and administrator stated they was no incident of water and sewer pipes being in disrepair or damaged. All 4 residents interviewed indicated there's no problem or issue with water. Based on information obtained, the allegation is closed as unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. No deficiency cited. Exit interview conducted, and copy of this report providedthe state’s words, verbatim · CDSS document, Aug 23, 2023 · control 15-AS-20220324113028

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management in response to the Unusual Incident Report (UIR) for resident (R1) submitted by the facility to the Department on June 27, 2023. LPA met with Lulin 'Lucy' Wu, administrator, and licensees, Wendy Wong and Olive Manalastas, and informed the reason for visit UIR indicated that on June 26, 2023 at 8:30 am. staff was going to help resident (R1) with morning grooming and noticed R1 unresponsive. Staff immediately called 9-1-1, and started CPR. At 8:45 am, the paramedics pronounced time of death. Police Officer arrived at the facility, took report. and called Coroner's Office. Coroner grant the release of R1's body. R1's son and daughter came to the facility, and called the mortuary. On this day, August 16. 2023, LPA reviewed R1's records including but not limited to LIC602A Physician's Report, doctor's order of medications and Medication Administration Record. LPA obtained copies of documents and conducted interviews. No deficiency cited during today's visit. Exit interview conducted, and copy of this report provided.the state’s words, verbatim · CDSS document, Aug 16, 2023

Type of visit: Required - 1 Year

On this day, August 16, 2023, at 11:40 a.m,, Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Lulin 'Lucy' Wu, administrator, and informed the reason for visit. Wendy Wong and Olive Manalastas, licensees, arrived after about 40 minutes. Facility has Infection Control Plan that was submitted and received by LPA on June 28, 2022. LPA toured the facility inside out with the administrator. LPA inspected the kitchen, dining room, living room, reception area, shower room, ensuite bathrooms/toilets, front, side and backyards. LPA randomly selected 6 residents rooms for inspection. Shower room was observed equipped with bathing chair, non-skid mat and grab bars. Toilets were also observed with grab bars, paper towel in dispensers for drying hands and toiletries. Food supplies were observed good for 2 days of perishables and 7 days of non-perishables. Central storage for medications was observed locked. Storages in the yard where cleaning supplies are kept were all observed locked. Facility has smoke and carbon monoxide detectors in operating condition. Hot water temperature in one of the ensuite toilets was tested, and measured at 106 degrees Fahrenheit. Facility conducts drills every quarter, and records showed last conducted July 15, 2023.. LPA reviewed 5 staff and 5 residents files, and interviewed 3 staff and 3 residents. Facility handles 8 of residents' allowance according to the administrator. Cash checked and compared with record. Medications inspected and compared with records and doctor's orders. ....continued on 809C LPA observed the following: -at 12:02 pm, uneven and cracked pavements on the side and backyards. -at 4:00 pm, LPA observed resident (R3) has 1 medication listed on LIC602A but the facility does not have the medication. It's not clear whether or not the medication is still needed. LPA received the following updated/current documents on this day: 1. LIC308 Designation of Facility Responsibility 2. LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan (9 pages) 4. LIC400 Affidavit Regarding Client/Resident Cash 5. Proof of Surety Bond Coverage 6. $3M Liability Insurance certificate Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates, and any repeat violation within 12 month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed withthe licensees and administrator. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Aug 16, 2023

Allegation investigated: Facility is in disrepair.

Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the investigation of the above allegation and close the complaint. LPA met with Lulin "Lucy" Wu, administrator, and informed the purpose of visit. LPA also met with licensees, Wendy Wong and Olive Manalastas. The licensees have to leave and excused themselves after about an hour. During the course of investigation, LPAs Hamitlon and Delmundo obtained copies of staff schedule and LIC9020 Register of Facility Residents, R1's documents including but not limited to LIC602A Physician's Report, Admission Agreement, LIC601 Identification and Emegency Contact Information. LPAs conducted interviews and inspection. .....continued on 9099C Substantiated During the 10-complaint visit, LPA Hamilton conducted inspection and noted that while touring R1's former bathroom, LPA observed some discoloration within the medicine cabinet as well as the tile grout near the base of the toilet. LPA observed a section of the wall directly behind the toilet was uneven. S1 stated the area was worked on 3 years ago to repair a leak. LPA Delmundo conducted inspection on this day, August 31, 2022, with Lulin Wu. LPA randomly selected 6 residents' rooms and toilets/showers for inspection. LPA observed the following in 5 of 6 rooms: missing baseboards in 2 rooms; part of flooring chipped; rusted bathroom lavatories; grab bar missing in the shower room; peeled bathroom door paint Based on observation, the allegation is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency is cited from Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with Lulin Wu. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided. Allegation: Facility is unsanitary. It was alleged that R1's room was unsanitary; there were cobwebs on the walls above R1's head, dried blood on R1's bed sheet and the bottom of the dresser was filthy. R1's family member (FM) was interviewed and stated that R1's room was unsanitary. When FM picked-up R1's belongings after R1 passed away, R1's hat was covered with mold. LPA Hamilton noted during his 10-day complaint visit that there's no obvious signs of unsanitary conditions. On this day, August 31, 2022, LPA Delmundo conducted inspection with Lulin Wu. LPA inspected the common areas, randomly selected 6 residents' room and bathrooms/shower, kitchen, dining area and storage. LPA did not observed any cobwebs and mold, nor facility being unsanitary. LPA interviewed S2 and S3 who both indicated that when R1 passed away, they packed R1's belongings and put them in boxes and bag and stored them in the storage until FM picked them up. They did not inspect the boxes and bag prior to handling them over to FM about a month after R1's death. LPA tried to interview R1's room mate who refused to be interviewed. Allegation: Facility staff did not provide to resident's responsible party resident's (R1) personal belongings. It was alleged that when R1's belongings were picked-up after R1's death, the wheelchair and walker were not given and photograph of R1's family member was not included with R1's belongings. LPAs Hamilton and Delmundo conducted interviews and obtained copies of LIC621, Staff S2 and S3 stated that when FM came to the facility to pick-up R1's belongings, they assisted FM in loading the items in FM's vehicle including the wheelchair and walker. S2 indicated she did not see the picture FM indicated missing when they packed-up R1's belongings. LPA reviewed the LIC621 which revealed the items which were allegedly missing were not listed. Based on the information obtained, the allegations are deemed unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted and copy of this report provided.the state’s words, verbatim · CDSS document, Aug 31, 2022 · control 15-AS-20201223144831

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 14, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. -This requirement in not met as evidenced by: -Based on inspection, the licensee did not comply with the section above in 5 out of 6 rooms that were observed in disrepair which pose personal rights risks to persons in care,the state’s words, verbatim · CDSS document, Aug 31, 2022

Plan of correction: Administrator stated she'll have the items fixed and/or replaced/repaired. In additiion, adminitrator to check all other rooms and areas in the facility, and repairs done when needed. Pictures to be submitted by 09/14/2022.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Delmundo conducted an unannounced annual/infection control inspection. LPA met with Lulin Wu, administrator, and informed the purpose of visit. LPA also met with Wendy Wong and Oilive Manalastas, licensees. Facility has an approved LIC808 Mitigation Plan on file. Administrator submitted the facility's new Infection Control Plan and received by LPA Delmundo on June 28, 2022. LPA toured the facility inside out with Lulin Wu. LPA inspected the living room, dining area, kitchen, hallways, side and backyard. LPA randomly selected 7 bedrooms for inspection. There's adequate food supplies of perishables good for 2 days and non-perishables good for 7 days. LPA observed screening station by the front entrance with hand sanitizer, no touch temperature probe and Visitor's Log. Visitor's temperature and symptom checks are done at the entrance. Residents and staff are screened for COVID-19 symptoms, and temperature checked and recorded daily. Facility keeps record of proof of vaccination of residents and staff. Supplies of PPEs checked and observed adequate for 30 days, and antigen test kits are readily available. COVID-19 signages were observed throughout the facility. Trash bins were observed with foot pedal operated lids. Bathroom lavatories were observed with liquid soap and paper towels in dispensers. Some of the staff were fit tested for N95 respirator last year, Juiy 8, 2021. LPA verified, and Lulin stated some staff have been re-fit tested while others are scheduled for re-testing. Fire extinguishers checked and observed fully charge with tags showed serviced February 16, 2922. Hot water temperature in one of the common bathrooms was tested and measured at 106.6 degrees Fahrenheit. First aid kit inspected and observed complete with manual. . .....continued next page At 3:36 PM, LPA observed unlocked storage in the backyard where cleaning supplies are kept. The following updated/current documents were provided to LPA on this same day: 1. LIC308 Designation of Facility Responsibility 2, LIC500 Personnel Report 3. LIC610E Emergency Disaster Plan 4. Proof of $3M liability insurance. Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with Olive Manalastas and Lulin Wu. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.the state’s words, verbatim · CDSS document, Jul 6, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct an annual required inspection. LPA met with Administrator Lulin 'Lucy' Wu and informed the purpose the visit. Wendy Wong and Olive Manalastas, licensees, arrived after about 45 minutes. LPA toured the facility with Lulin Wu. LPA randomly selected 6 residents' rooms (room #'s 12, 8, 9, 5, C and B) for inspection. LPA also inspected the common areas, reception area, dining room, kitchen, shower room/bathroom, ensuite toilets. Medications are centrally stored in a locked area that is inaccessible to residents and refilled every 30 days. Per Lulin Wu, facility conducts inventory of medications every week. Perishable and non-perishable food supplies were observed sufficient. LPA observed a central screening station for COVID-19 with hand sanitizer and visitor's log by the entrance door. COVID-19 posters were observed posted all through out the facility. Personal protective equipments (PPEs) including but not limited to N95 respirators, surgical masks, disposable gowns, hand sanitizers, face shields were observed sufficient for 30 days. Water temperature in the bathroom was tested and measured at 115 degrees Fahrenheit. Fire extinguishers checked, observed fully charge and tags showed serviced February 10, 2021. Facility has working smoke and carbon monoxide detectors. LPA verified with the administrator and licensees who indicated fit testing for N95 respirators for all staff has not been conducted. A copy of current LIC500 Personnel Report received on this day. Exit interview conducted and copy of this report provided to Lulin Wu.the state’s words, verbatim · CDSS document, Jun 28, 2021

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.