Ageway Boarding Care #3

Type of visit: Required - 1 Year

At around 9 am, Licensing Program Analyst (LPA) arrived unannounced to conduct annual required inspection. LPA met with staff Marina Velasquez and explained the purpose of visit. Administrator Mihael Dayeh arrived at a later time and left after a couple of hours due to a prior appointment. Mihael authorized staff Marina to sign reports. The facility has 6 residents and 2 staff observed during the visit. LPA inspected the facility inside and out including but not limited to resident room, bathrooms, dining area, garage and backyard. Hot water measured at 109 F in the common bathroom and 114.4 F in the kitchen. Chemicals were locked in the garage. Knives and other sharp objects were locked in a drawer in the kitchen. There was sufficient supply of perishable and non perishable foods. Smoke detectors and carbon monoxide were tested and observed functional. The facility temperature was observed at 72 F. There were several fire extinguishers observed that were full and last serviced on 1/13/2023. Administrator provided LPA updated liability insurance, Resident Roster, Lic 500. At around 9:45 am, LPA observed several wood planks in the backyard fence were down. At 10 am, LPA reviewed 2 resident files and 2 staff files. At 11:20 am, LPA reviewed medication and Medication Administration Record (MAR). At 1:30 pm, LPA interviewed 2 staff and 2 residents. ***continuation on Lic 809C*** Deficiency is cited per Title 22 California Code of Regulations. Please refer to LIC 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. Exit interview was conducted with Marina Velasquez and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Mar 30, 2023

Allegation investigated: Facility staff do not meet resident's hygiene needs.

On 1/26/23 at 9:45am, Licensing Program Analyst (LPA) Catherine Lin conducted an unannounced subsequent complaint investigation regarding the above allegation and deliver investigation findings. LPA met with staff and explained the purpose of the visit. Administrator was unable to come and have phone conversation with LPA. The Department has investigated this allegation and per observation and found that staff S2 didn’t dispose gloves after assisting resident’s toileting, continued assisting resident for getting a cup of water, putting up a blanket, and straightening resident’s clothes with the same pair of gloves during the investigation visit. Based on information obtained, the preponderance of evidence is met, therefore the allegations are SUBSTANTIATED. Continue LIC9099-C Substantiated Deficiency is cited from Title 22 California Code of Regulations and Health and Safety Code (see 9099D). 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 on-duty staff and Administrator over the phone. Exit interview conducted. Appeal Rights, LIC9099D, and copy this report provided. Allegation: Facility staff yell at resident - Unsubstantiated The Department has investigated this allegation and per records review and interviews, found that staff denied the alleged violation, both residents R2 and R3 stated that all staff were very nice, they have not witnessed any staff member yelled at resident. No other witness was found. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED. No deficiency cited. Exit interview conducted with staff and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 26, 2023 · control 15-AS-20221006145937

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a)(1)(B) · Plan of correction due date: Feb 2, 2023

87470 Infection Control Requirements (a) A licensee shall ensure that infection control practices are maintained as follows: (1) All staff and volunteers shall perform hand hygiene. (B) Hand hygiene shall be conducted as follows: This requirement is not met as evidenced by… Based on records review and interview, the licensee did not comply with the section cited above. LPA observed staff didn’t dispose gloves after assisting resident for toileting and continued to perform other tasks with the same pair of gloves which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: Administrator agrees to review regulation, retrain staff, and submit in-service training with staff signatures to CCL by the POC due date.

Type of visit: Case Management - Deficiencies

On 1/26/23 at 2:40 p.m., Licensing Program Analyst (LPA) Catherine Lin conducted case management, met with staff, and explained the purpose of visit. During the course of investigation on a complaint, the Department observed the following deficiencies. · Staff did not update needs & service plan (LIC625) when R1's health condition was changed. · Staff did not have care note for resident health condition change. Deficiencies are cited per Title 22 California Code of Regulations. Please refer to LIC 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. Exit interview conducted with staff and Administrator over the phone, Appeal Rights and a copy of this report were provided.the state’s words, verbatim · CDSS document, Jan 26, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Feb 2, 2023

87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate…. This requirement is not met as evidenced by… Based on records review and interview, the licensee did not comply with the section cited above. LPA observed staff didn’t reappraise resident when resident have pressure ulcers multiple times which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: Administrator agrees to review and understand regulation and submit a self-certification of being in compliance in future events to CCL by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(b)(13) · Plan of correction due date: Feb 2, 2023

87506 Resident Records (b) Each resident’s record shall contain at least the following information: (13) Continuing record of any illness, injury....impacts the resident's ability to function or needed services. This requirement is not met as evidenced by… Based on records review and interview, the licensee did not comply with the section cited above. LPA observed staff didn’t have care note for resident who have health condition change which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: Administrator agrees to review and understand regulation, retrain staff for note taking, and submit in-service training with staff signatures to CCL by the POC due date.

Type of visit: Case Management - Health Checks

On 10/14/2022 at 10:50AM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management health & safety check. LPA met with the lead staff and explained the purpose of the visit. LPA spoke with Administrator on the phone, Administrator authorized the lead staff to sign on the report. Upon entry, LPA toured the facility. LPA observed facility had sufficient food supplies in the kitchen and garage. LPA also observed adequate supply of PPE in the garage. LPA observed bathrooms has sufficient soap and paper towel supplies. Cough/sneeze etiquette and hand washing posters were observed posted in common areas and bathrooms. LPA observed the room temperature was 70 Fahrenheit degree, water temperature was 107 Fahrenheit degree, and fire extinguishers were last inspected on 1/26/22. Sufficient staffing was observed during visit. Staff was observed wearing surgical masks. Pathways and hallways were observed free of obstruction and fire hazards. There were no imminent health/safety concerns on today's date. No deficiency cited. Exit interview conducted with Lead staff and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 14, 2022

Type of visit: Case Management - Other

On this day 10/10/22, Licensing Program Analyst (LPA) C. Lin conducted a case management visit and met with Administrator. LPA explained to him purpose of the visit. During an investigation conducted by the Department, records obtained indicate that R1's pre-appraisal (LIC603) was not completed when admitting to facility on 3/1/2022. Administrator admitted it, agreed to have it complete, and keep it on file. A deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to submit proofs of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with Administrator. A copy of this report and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Oct 10, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Oct 17, 2022

87457 Pre-Admission Appraisal - General(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed..... This requirement is not met as evidenced by… Based on record review, the licensee did not comply with the section cited above. LPA observed resident R1's pre-admission appraisal was not completed while admitting to facility on 3/1/22, which poses a potential health and safety concern to persons in care.the state’s words, verbatim · CDSS document, Oct 10, 2022

Plan of correction: Administrator agrees to submit a copy of completed appraisal form (LIC603) to CCL by the POC due day.

Type of visit: Required - 1 Year

On 05/05/2022 at 10:50AM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct an Infection Control Inspection. LPA met with Marina Velasquez, Caregiver and explained the purpose of the visit. Upon entry, LPA's temperature was not checked. LPA observed screening station that contained hand sanitizer and COVID signage. LPA toured facility including but not limited to common areas, bathrooms, bedrooms, kitchen, garage and backyard. LPA observed cough etiquette and physical distancing posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hot water temperature in the shared clients’ bathroom was measured at 107.9 degrees Fahrenheit. Fire extinguisher was last serviced on 6/26/2021. During record review, LPA observed facility has a copy of Mitigation Plan on file. LPA observed PPE, food, and paper supplies are sufficient. The following forms are to be updated and submitted to CCLD by 5/12/2022: -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility Continued on LIC9099C Continued from LIC9099. -LIC610E Emergency Disaster Plan -An updated copy of Administrator certificate The following deficiencies were observed: -At 11:21AM, LPA observed a monitor sitting on kitchen counter top monitoring resident in bedroom #1. The following deficiency were observed (see LIC809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in Civil Penalties. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, May 5, 2022