Ivy Park at San Lauren

Allegation investigated: Staff do not provide the resident with water

On 07/06/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct the required 10-day site inspection. LPA reviewed Hospice Care notes, interviewed Administrator and relative of Resident R1. Based on the information received, we have found that the complaint was Unfounded, meaning that the allegation is false, could not have happened and or is without reasonable basis, therefore, we have dismissed the complaint. No deficiency cited on today's visit. Exit interview conducted. A copy of this report was provided to Administrator. Unfoundedthe state’s words, verbatim · CDSS document, Jul 6, 2023 · control 24-AS-20230626122017

Allegation investigated: Resident being left in soiled linins/diapers

On 06/14/23, Licensing Program Analyst (LPA) L. Salazar contacted Administrator, Doug Rice to discuss the above allegation. LPA requested Resident R1's Hospice Care Plan and facility communication logs for the month of June 2023. LPA reviewed conducted interviews and reviewed records. Records show R1 is currently receiving Hospice Care services. LPAs review of facility communication logs show R1 stated they did not want to be touched and did not want the caregiver to change their briefs on 06/02/23, 06/03/23, and 06/10/23. A review of hospice care notes show R1 has had a significant decline in their health and is refusing care, medication and is eating less than 25% of their meals. Hospice care is provided 3 days a week which includes treatment for Sacral wound care. Unfounded (Continued from 9099) Interviews with Hospice state R1 has had increased agitation and behaviors R1 is refusing care and making accusations that caregivers are refusing to give meds. Multiple Care conferences with the nurses and facility staff have been documented that the allegations are not true. Based on records review and interviews, we have found that the complaint was Unfounded, meaning that the allegation is false, could not have happened and or is without reasonable basis, therefore, we have dismissed the complaint. Exit interview conducted. No Deficiencies cited. A copy of this report was provided to Administrator.the state’s words, verbatim · CDSS document, Jun 14, 2023 · control 24-AS-20230607104223

Allegation investigated: Facility staff were not present at the facility. Facility staff did not respond to a resident's pull chord for assistance.

Licensing Program Analysts (LPA)'s Shawna Doucette and Darius Williams conducted a visit to commence a complaint investigation and deliver findings. LPA's identified themselves and discussed the purpose of the visit and the elements of the allegations with Administrator Douglas Rice. LPA requested records for pull chord history from 3/15/23 to 3/31/23 at which Administrator stated he was unable to provide due to the system recording over every 2 days. Administrator submitted days of 4/7/23 and 4/8/23. LPA interviewed staff, residents, and witnesses. LPA obtained a copy of the Fire Departments report regarding this incident. Based on records review and interviews, facility had one staff on duty who was not present at the facility for approximately 30 minutes. Facility staff did not answer pull chords for residents in care. Substantiated Based on the Departments record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Health and Safety 1569.49 (c)(3) is being cited on the attached LIC 9099D. Civil penalty was issued. Citation for 87411(a) is being cited on 24-AS-20230321111428. Refer to Case Management on 6/8/23 for additional deficiencies. An exit interview was conducted with Administrator, a copy of this report with plan of corrections, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 8, 2023 · control 24-AS-20230330093440

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.49(c)(3) · Plan of correction due date: Jun 9, 2023

1569.49 Civil penalties; regulations setting forth appeal procedures for deficiencies (c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation for any of the following serious violations:(3) Absence of supervision as required by statute or regulation. This regulation was not met as evidenced by: On 03/29/23 Facility did not have staff present in the faciltiy and did not provide care to R1 for at least 30 minutes which poses an immediate health, safety, and/or personnnel rights risks to residents in care.the state’s words, verbatim · CDSS document, Jun 8, 2023

Plan of correction: Plan of Correction POC Facility agrees to submit a plan to have suffiecient staff and to train staff on emergency procedures for emergency leave by POC due date 06/9/23. Licensee will submit staff training by 6/30/23. Civil Penalty was issued.

Allegation investigated: Staff are not answering call bells timely

Licensing Program Analyst (LPA) Darius Williams and LPA Shawna Doucette conducted a follow up complaint visit. LPA's met with Administrator, Douglas Rice and discussed the purpose of the visit. LPA Williams interviewed witnesses, the Administrator, and reviewed records. On 3/28/2023, LPA Williams pulled a chord in room 206, which notifies the facility signal system. Staff took approximately 4 minutes and 32 seconds to respond, taken via LPA Williams phone timer. However, according to Kern Fire Department (KFD) record, on 3/29/2023 at approximately 11:02 pm, KFD responded to a residents peronsal pendant. When KFD arrived, no staff could be located in assisted living (addressed on complaint control # 24 - AS - 20230330093440). *Continued on LIC 9099-C* Substantiated KFD pulled a chord in a residents room to notify the facility signal system. Staff 1 arrived to the front desk approximately after 30 minutes the chord was pulled and informed KFD that they had to leave and drop their child off. According to, Witness 1, Witness 2, and Resident 2 interviews, all three reported they have experienced times when staff respond in under 10 minutes and times,it has taken staff longer than 20 minutes to respond, to the pull chord. LPA Doucette requested signal system call logs between 3/15/2023 - 3/31/2023, which were not provided. Based on LPA's, record review and interviews, the preponderance of evidence standard has been met, therefore the allegation, staff are not answering call bells timely, is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, 87411(a) is being cited on the attached LIC 9099-D page. A plan of correction was reviewed and discussed with the Administrator. An exit interview was conducted and a copy of this report and appeal rights will be provided via e-mail.the state’s words, verbatim · CDSS document, Jun 8, 2023 · control 24-AS-20230321111428

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Jun 16, 2023

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. ... This requirement was not me evident by: Based on LPA's interviews and record reviews, on 3/29/2023, the Licensee did not ensure staff were present, for approximately 30 minutes, to respond to the facilities signall system, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 8, 2023

Plan of correction: Administrator agreed to provide copies of the facility signal system, to the Department between the dates of 6/9/2023 through 6/15/2023, for review. Seven records are to be provided to the Department by POC due date of 6/16/2023.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPA)'s Shawna Doucette and Darius Williams arrived at the facility unannounced to commence and complaint investigation and deliver findings for Complaint AS-20230321111428 and Complaint 24-AS-20230330093440. LPA's met with Administrator Douglas Rice. During the course of the investigation LPA's observed the following deficiencies. LPA requested records for the signal system for 3/15/23 to 03/31/23. Administrator stated he was unable to provide those records due to the system recording over every 2 days. During the course of the investigation after interviewing witnesses it was found the records are permanent and do not erase. LPA was unable to locate an incident report for R1 regarding incident in complaint 24-AS-20230330093440. LPA requested copy of the incident report for R1 while at the facility. Resident Care Coordinator Emily Conrad and Administrator Douglas Rice were unable to provide a copy of this incident report. Resident Care Coordinator stated facility does not have an incident report for this incident. Refer to 809D for cited deficiencies. An exit interview was conducted with Administrator Douglas Rice and a copy of this report was provided with plans of corrections and appeal rights.the state’s words, verbatim · CDSS document, Jun 8, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a)(3) · Plan of correction due date: Jun 20, 2023

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. (3) Ability to maintain or supervise the maintenance of financial and other records. This requirement was not met as evidenced by: Administrator did not provide requested records for the dates of 3/15/23 to 03/31/23 for the signal system at the facilty which poses a potential health, safety and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 8, 2023

Plan of correction: Plan of Correction POC Administrator agrees to submit a written plan on how this regulation with be met in the future by POC due date of 06/20/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Jun 20, 2023

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: Facility did not report emergency services responding for R1 which poses a potential health, safety and/or personal rights risk for residents in care.the state’s words, verbatim · CDSS document, Jun 8, 2023

Plan of correction: Plan of Correction POC Licensee agrees to submit an understanding of this regulation and a plan in writing on how this regulation will be met by POC due date of 6/20/23.

Allegation investigated: Staff didn't clean residents room timely Staff did not meet the feeding needs of the resident

On 05/22/23, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. During the investigation, LPA conducted interviews, reviewed medical records and telecommunications documentation. Telecommunication messages of date and time stamp videos show R1's room was not cleaned in a timely manner. LPA observed the LIC602 for Resident R1 dated 10/12/22, which states R1 does not have the capacity for self-care which includes ability to feed self. Interviews with staff state R1 is able to feed self and does not need assistance. Based on the information received, the preponderance of evidence standard has been met, therefore, the above allegations are found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D. If not corrected, this poses a potential risk to residents in care. (Continued on 9099-C) Substantiated (Continued from 9099) An exit interview and a plan of correction was developed by Administrator and reviewed with LPA. Plan of Correction is due by 06/12/23. A copy of this report was given to Administrator at the time of visit. (Continued from 9099) LPA observed a written personal property inventory form (LIC 621) for Resident R1, that was documented and signed at the time of admission. A copy was provided to R1's responsible party. The missing items mentioned in the allegation, were not observed to be documented on inventory the form. Interviews reveal items were purchased some time after admission and items were not requested to be added to the inventory form. Based on the information received, we have found that the complaint allegations are Unfounded, meaning that the allegations are without reasonable basis, therefore, we have dismissed the above complaint. No deficiencies cited. Exit interview conducted. A copy of this report was provided to Administratorthe state’s words, verbatim · CDSS document, May 22, 2023 · control 24-AS-20221209104049

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a)(2)(A) · Plan of correction due date: Jun 12, 2023

(a) A licensee shall ensure that infection control practices are maintained as follows:(2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: (A) Surfaces such as floors, chairs, toilets, sinks, counters and tabletops shall be cleaned and disinfected on a regular basis to ensure they are safe and sanitary. These surfaces shall also be disinfected when these surfaces are contaminated or visibly soiled. This requirement was not met as evidenced by LPA's interviews and observation of text messages, that included the time and date of a visibly soiled bathroom and floor in Resident R1's room. This poses a potential threat to residents in care.the state’s words, verbatim · CDSS document, May 22, 2023

Plan of correction: Administrator will provide LPA with the cleaning checklist for each resident room in the Memory Care. Checklists will document and identify any immediate concerns to be corrected same day. Administrator will send proof of staff signatures evidencing rooms have been checked daily for the next 30 days. Proof of signed daily checklist will be sent to LPA by 06/25/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87459(a)(6)(B) · Plan of correction due date: Jun 2, 2023

87459 Functional Capabilities (a) The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited to: (6) Eating, including the need for:(B) Assistance from another person. This requirement was not met as evidenced by LPAs observation of LIC602, evidencing a change of condition. A functional assessment for feeding was not documented as completed by facility. This poses a potential risk to residents in care.the state’s words, verbatim · CDSS document, May 22, 2023

Plan of correction: Administrator will provide proof that care staff has been retrained on how to document resident's change of condition and reassessing resident needs after a change of condition occurs.

Allegation investigated: Facility staff are not meeting resident's hygiene needs Facility staff are not meeting resident's dietary needs Facility staff are not cleaning resident's room and linens Facility staff do not reposition resident

On 04/14/23, Licensing Program Analyst, (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. During the investigation, LPA toured the facility and Resident R1's room, conducted interviews and records review. LPA observed R1's room and bedding to be clean, free from odor, pests, and debris. R1 was observed in a king size bed that has an adjustable base at the bottom. R1 demonstrated on a hand held remote control, how they reposition their bed if needed. LPA's observed R1's hair and nails to be trimmed and clean. Records review show R1 has been receiving Hospice services and at the end of life. Hospice records show R1 sleeps 18+ hours a day and has a decreasing appetite and eats 25 – 50% of meals per day and often refuses meals. LPA reviewed facility's menus for the month of November and December 2022. LPA observed facility menus to offer two different daily options for entrees, sides and dessert and also an alternative menu if requested. Based on the information received, we have found that the complaint was Unfounded, meaning that the allegations are false, or are without reasonable basis, therefore, we have dismissed the complaint. Exit interview conducted with Administrator and a copy of this report was provided at the time of visit. Nothe state’s words, verbatim · CDSS document, Apr 14, 2023 · control 24-AS-20230131114452

Allegation investigated: Staff did not administer resident's medication in a timely manner Staff are intimidating resident

On 04/14/23, Licensing Program Analyst, (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. During the investigation, LPA toured the facility and Resident R1's room, conducted interviews and records review. LPA interviewed R1 who denies feeling intimidated by any staff. R1 stated they believe staff speak loudly because it is common that the residents in the facility experience hearing loss. LPA observed R1's Medication Administration Records and Centrally Stored Medication and Destruction Record to accurately reflect the medication doses have been given according to physician's order. Based on the information received, we have found that the complaint was Unfounded, meaning that the allegations are false, or are without reasonable basis, therefore, we have dismissed the complaint. Exit interview conducted with Administrator and a copy of this report was provided at the time of visit. Nothe state’s words, verbatim · CDSS document, Apr 14, 2023 · control 24-AS-20230109154022

Type of visit: Required - 1 Year

On 04/06/23, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator on record is Doug Rice, Certificate#6053032740 , Exp. 07/15/2023. Facility census on this visit is 42 in Assisted Living and 24 in Memory Care. There are currently 9 residents receiving Hospice services and four residents are receiving Home Health Care services. A tour of resident bedrooms were observed to have the required lighting and furnishings and were free from odor and any passageway obstruction / fire hazards. Facility temperature was 71 degrees F. LPA observed the required postings for Non-discrimination, Personal Rights of Residents in RCFE (87468.1 and 87468.2), Complaint Poster and facility's visitation policy. Resident Council meeting minutes were observed from the last meeting of 03/27/23. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 119 degrees F. Cleaning supplies were observed to be locked in a janitorial closet located in Memory Care. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Menus for the facility were observed. (Continued on 809-C) (Continued from 809) Carbon monoxide detectors were observed to be operational. 35 Fire Extinguishers throughout the facility were observed with a service date of 04/01/23. First aid kits were observed to contain all required items. Medications were observed to be locked in Med cart located in a staffed locked medication room. Quarterly Emergency Disaster Drill logs were observed for staff. The following documents are requested to be updated and submitted to Fresno CCL by: 04/21/23: LIC309, Certificate of Liability Insurance. A sample of Resident and Staff files will be reviewed at a later date on an annual continuation visit. An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.the state’s words, verbatim · CDSS document, Apr 14, 2023

Type of visit: Required - 1 Year

On 03/10/2022, Licensing Program Analyst (LPA) Walton arrived unannounced at the above location to conduct an Infection Control Inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Douglas Rice. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Residents at the above facility have private apartments. LPAs checked residents’ locked medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. LPA is requesting the following documents be submitted to the Fresno CCL office by 03/24/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan LIC 610E Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020A, Surety Bond. No deficiencies issued. Exit interview conducted. A copy of this report will be provided via email due to COVID-19 precautionary measures. Report signed on site by Facility Representative.the state’s words, verbatim · CDSS document, Mar 10, 2022

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.

Allegation investigated: Staff do not prevent a resident from wandering while in care

This is an amended report. On 02/18/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Douglas Rice. Interviews revealed that the Bakersfield Police Department (BPD) were called to the facility due to R1’s aggressiveness towards staff and other residents. Upon BPD’s arrival to the facility, R1 was in the process of being transported to the hospital. Interviews with staff revealed that R1 has “never” left the facility unsupervised. Upon review of records, it was determined that on the date of the event, R1 was not found wandering the outside of the facility. CONTINUED TO 9099C Unfounded This agency has investigated the complaint alleging: Staff do not prevent a resident from wandering while in care. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No deficiencies issued during this inspection. An exit interview was conducted with the Administrator. A copy of this report will be provided via email due to COVID-19 precautionary measures. Facility Representative signature on file.the state’s words, verbatim · CDSS document, Feb 18, 2022 · control 24-AS-20211012140617

Type of visit: Case Management - Deficiencies

On 2/18/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a Case Management inspection at the above facility. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Douglas Rice. During the investigation of complaint number 24-AS-20211012140617, the following deficiency was observed: It was found that on 10/09/2021, Bakersfield Police Department responded to call from facility staff requesting assistance with R1. R1 was exhibiting an aggressive/combative behavior towards staff and other residents. An interview with the Care Coordinator revealed that facility staff “called 911” due to R1’s behavior. R1 was transported to the hospital. Care Coordinator “did not file an incident report” because “there was nothing the police could do”. Based on interview conducted, a deficiency is being cited in accordance with the California Code of Regulations, Title 22, Division 6, Chapter 8 on the attached 809D An exit interview was conducted with Administrator. A copy of this report and Appeal Rights will be provided via email, as COVID-19 precautionary measure. Report signed on-site by Facility Representative.the state’s words, verbatim · CDSS document, Feb 18, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Mar 18, 2022

87211 Reporting Requirements:(a) Each licensee shall furnish to the licensing agency…(1) A written report… within seven days of the occurrence of…(D) Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by: Based on interviews, the facility did not submit an incident report for R1 when R1 became aggressive towards staff and other residents resulting in R1 being transported to the hospital, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 18, 2022

Plan of correction: Licensee will submit a written statement detailing steps the facility will take to ensure the requirements of section 87211 are met to the Fresno CCL office by the POC due date. Administrator agreed that staff will be trained on the requirements for section 87211 Reporting Requirement Regulations by 03/17/2022 and documentation of training topics and attendance will be submitted to the Fresno CCL office by 03/18/2022.