Woodland Hills Manor

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angel Ascencio arrived at the facility unannounced to conduct a required annual visit at approximately 9:32 a.m. The LPA met with Administrator Eugenia Abrigo and explained the reason for the visit. At 9:47 a.m. the LPA toured the physical plant areas inside and outside with Administrator Eugenia Abrigo to ensure there are no health and safety hazards. BEDROOMS: The LPA observed six resident bedrooms and one staff bedroom. All bedrooms were private with Bedroom #1 and Bedroom #4 containing a private bathroom. All resident bedrooms had an exit to the exterior. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage between the beds. In addition, no bedroom was used as a passageway to another room, bath or toilet. RESTROOMS: The facility has four (4) bathrooms. Bathrooms are clean, sanitary and in operating condition with grab bars and non-skid surfaces. The LPA observed appropriate hand-washing signs in the restrooms. The resident bathroom has a shower with non-skid materials. The toilet and shower have grab bars. During the visit, the LPA observed signs in all of the bathrooms pertaining to proper hand hygiene. In addition, restroom hot water measured under 120.0 degree F. KITCHEN: Knives are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. Continued on LIC 809 - C COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. The facility smoke alarm system is hardwired and operated normally at the time of visit. Medications were observed to be locked in a closet by the kitchen and contained at least 30 days of worth of medication. The garage door was observed and contained a locked cabinet for laundry supplies. The backyard has a covered outdoor area equipped with furniture for client use. There were no bodies of water noted. GARAGE: There is a detached garage and a detached laundry room. The LPA observed an outdoor storage closet containing additional cleaning supplies, additional Personal Protective Equipment (PPE) and incontinence supplies. The garage was locked making it inaccessible to residents. The administrator indicated that the garage is used as a sleeping quarters for her niece who is associated to the facility. INFECTION CONTROL: During today’s visit, the LPA spoke with the Staff regarding the facility’s infection control practices. Upon entry, the facility had a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time and the LPA reviewed facility’s policies and procedures as it pertains to infection control. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were observed and cited (refer to LIC 809-D): -- At 09:47 a.m. and 09:50 a.m., during facility tour, disinfectant wipes and nail polish remover was observed in the kitchen counter accessible to residents in care. -- At 10:54 a.m., during resident file review, the Appraisal/Needs and Services for all resident was not observed/missing. Continued on LIC 809 - C Page 2 of 3 -- At 11:15 a.m., during resident file review, the LIC 602 Physicians Report for R1 and R2 indicated that R1 and R2 are bedridden. The Fire Inspection Safety Request indicated only Room #5 as a bedridden room. R1 and R2 are living in a non-ambulatory room. An immediate $500.00 civil penalty was accessed. -- At 11:30 a.m., during resident file review, R3 and R4 did not have the LIC 602 Physician’s Report in their file. -- At 11:35 a.m., during resident file review, R3 and R4 did not have their Tuberculosis results on file. -- At 12:00 p.m., during resident file review, R1, R3, R4, and R5 did not have bed rail order in their resident file. -- At 12:20 p.m., during medication review, LPA Ascencio did not observe 5 out of 5 resident’s PRN Authorization Letter in resident’s file -- At 12:25 p.m., LPA Ascencio could not complete medication audit as 5 out of 5 residents did not have their Centrally Stored Medication Form updated with current medications. -- At 01:00 p.m., during staff file review, LPA Ascencio observed an expired Administrator Certificate. Administrator stated they have not yet renewed their certificate but will be submitting documentation for re-certification. LPA Ascencio did not observe Administrator Eugenia Abrigo in the Active or Pending list on the CDSS.CA.GOV website. -- At 01:35 p.m., during staff file review, S1 and S2 had fingerprint clearance but were not associated to the facility. LPA Ascencio checked the Guardian website and did not observe S1 and S2 associated to Woodland Hills Manor (191222545). A civil penalty of $500.00 per staff (R1 and R2) not associated to the facility was accessed. -- At 01:40 p.m., during staff file review, LPA Ascencio did not observe S1 and S2 initial 40-hour training for staff, 20 hours ongoing annual training, Dementia Training, Medication Management Training and Quarterly Disaster Training Missing. Exit interview conducted and a copy of the report and appeal rights were issued. Page 3 of 3the state’s words, verbatim · CDSS document, Jun 14, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at approximately 9:10 a.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Eugenia Abrigo and explained the reason for the visit. At 9:27 a.m. the LPA toured the physical plant areas inside and outside with Administrator Eugenia Abrigo to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Knives are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 9:53 a.m. the LPA observed two expired packages of sandwich meat. An unsealed bacon package was also observed. The administrator was reminded to ensure that all food items are properly sealed and audited for expiration. The administrator discarded expired items at the time of the visit. BEDROOMS: The LPA observed six resident bedrooms and one staff bedroom. Bedrooms were private with Bedroom #1 and Bedroom #4 containing a private bathroom. All resident bedrooms had an exit to the exterior. All bedrooms were furnished appropriately with clean linens, furnishings, and sufficient lighting. RESTROOMS: The facility has 4 bathrooms. Bathrooms are clean, sanitary and in operating condition with grab bars and non-skid surfaces. The LPA observed appropriate hand-washing signs in the restrooms. At 9:29 a.m. the LPA observed accessible cleaning supplies under the bathroom sink in bedroom #1. Water temperature measured between 127.0 degrees Fahrenheit and 130.4 degrees Fahrenheit between 9:32 a.m. and 9:41 a.m. The administrator was reminded about water temperature regulations and adjusted the temperature at the time of the visit. Continued on LIC-809-C. COMMON SPACES: Walls and flooring were checked for cleanliness and good condition. Passageways were clean and clear of obstructions. No accessible bodies of water were observed on the property at the time of the visit. The facility has a designated visitation area located outside in a shaded area with appropriate furniture and seating for residents. The LPA observed all the required postings in the dining room and the hallway that promoted cough etiquette, signs and symptoms of COVID-19, and appropriate hand hygiene. Medications are kept locked inaccessible in the kitchen area filing cabinet. A medication lock box was observed in the kitchen refrigerator inaccessible to residents. Hand sanitizer was available for staff and resident use. Fire Extinguisher was last bought 5/22/2022. Administrator tested fire alarm system at 10:03 a.m., the LPA observed that it was working at the time of the visit. At 9:33 a.m. the LPA observed disinfectants accessible to residents in the common hallway and unlocked supply cabinet located in the hallway. The administrator secured all items at the time of the visit. GARAGE: There is a detached garage and a detached laundry room. The LPA observed an outdoor storage closet containing additional cleaning supplies, additional Personal Protective Equipment (PPE) and incontinence supplies. The garage was locked making it inaccessible to residents. The administrator indicated that the garage is used as a sleeping quarters for her niece who is associated to the facility. A fire extinguisher was observed at the time of the visit. INFECTION CONTROL: The facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol is sufficient. The facility can designate a single isolation room if the facility has a confirmed case of COVID-19. The Administrator continues to conduct testing, regardless of vaccination status. The facility’s policies and procedures as it pertains to infection control are adequate. At the time of the LPA’s arrival, staff was observed not wearing face masks. The administrator was reminded that face mask guidelines are still in place. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Licensee. A copy of this report, LIC 809-D, and Appeal Rights were discussed and provided to Administrator, whose signature on this form confirm receipt of these documents.the state’s words, verbatim · CDSS document, Jul 11, 2022

Allegation investigated: Resident was yelled at while in care. Facility staff left Resident in soiled clothing for an extended period of time.

On 07/09/2021 at 8:30 am, Licensing Program Analyst (LPA) Sandra Urena conducted an announced subsequent complaint investigation visit regarding the above noted allegations. The LPA conducted the initial 10-day complaint visit to the facility on July 7, 2021. The LPA met with the Administrator and explained the reason for today’s visit. Regarding the allegation: Resident was yelled at while in care. It was alleged that Resident #1 (R1) was yelled at while in care. Per the complainant’s report, R1 had requested to be changed due to a soiled diaper; it was at this time that R1 was yelled at by the facility staff. Unsubstantiated On 07/07/2021 at 2:15pm, LPA Urena interviewed R1 in reference to the allegation, and R1 stated that R1 had requested repeatedly to be changed because R1 was cold due to the soiled diaper. It was at this time that the facility staff “yelled” at R1 saying that the facility staff was not R1’s slave. When R1 was asked if there were other incidents of being yelled at, R1 stated that this was the only time. The LPA asked R1 about an approximate time of day and date of the incident; R1 stated that R1 could not remember, but that the incident took place about four weeks prior to the LPA’s July 7, 2021 visit date. On 07/07/2021, at 9:35am, LPA interviewed two available residents out of the four remaining residents. When asked if they have ever heard staff yelling at residents or to them, they stated that they had not heard staff yelling, nor had they been yelled at while in care. They stated, “that doesn’t happen here” and that staff are “nice and sweet”. On 07/ 07/2021 at 1:30pm, LPA interviewed the complainant, who confirmed the allegations and did not have any other information to share. Based on the information gathered on the above allegation, although the allegation may have happened or is valid, there was insufficient evidence to confirm that “Resident was yelled at while in care”. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation: Facility staff left Resident in soiled clothing for an extended period of time. It was alleged that facility staff left Resident#1(R1) in soiled clothing for an extended period of time. On 07/07/2021 at 2:15pm, LPA Urena interviewed R1 in reference to the allegation. R1 stated that R1 had requested repeatedly to be changed because R1 was cold and uncomfortable due to the soiled diaper. R1 stated that R1 counted the hours of how long R1 had been left on the soiled diaper, and R1 counted six hours. Per R1, the facility staff yelled, and said R1 didn’t pay for the diapers. R1 stated that R1 asked a family member to send diapers. However, R1 also stated that the Hospice Agency was responsible for dispensing the diapers for R1. The LPA asked R1 if there were any other occasions when R1 was left in soiled diapers for an extended period of time, and R1 stated that after that incident, the facility’s administrator took over changing the diapers, and it did not happen again. Per R1, no other incidents of leaving R1 in soiled diapers for an extended period of time had happen prior to the alleged incident. The LPA asked R1 if any type of skin condition had developed due to the extended period being left in the soiled diaper and R1 said, “No”. The LPA asked R1 about an approximate time of day and date of the incident; R1 stated that R1 could not remember, but that the incident took place about four weeks ago from the July 7, 2021 visit date. On 07/07/2021, LPA Urena interviewed two available residents, out of the four remaining residents. When asked if their diapers or bed pads were changed when wet, both residents stated they were changed in a timely manner. On 07/07/2021 at 10:00am, LPA Urena interviewed the administrator about the schedule for changing soiled diapers and asked the administrator for a log of the times when diapers were changed. The Administrator stated that they don’t keep a log. Additionally, the administrator stated that diapers are changed four to five times a day, or as needed. The LPA asked the administrator to show the facility’s stock of diapers. The diapers are stored in the facility’s inside cabinets and in the garage area. There appeared to be an adequate amount of diaper packages in the garage. On 07/09/2021 at 9:30am, LPA Urena interviewed caregiver about the schedule for changing soiled diapers. Caregiver explained that the change of diapers usually takes place one time in the morning, one time in the afternoon, and one time around 6:00pm, however if the residents ask to be changed due to being wet/soiled, the diaper will be changed as needed. And staff checks throughout the day to see if residents are wet or soiled. On 07/ 07/2021 at 1:30pm, LPA Urena interviewed the complainant in reference to the complaint report and they did not have any other information to share. Based on the information gathered the above allegation, although one resident out of four stated that they were left in a soiled diaper for an extended period of time, there were no other witnesses to the event, nor did any other resident experience that issue. Therefore, although the allegation may have happened or is valid, there is insufficient evidence to confirm that a Resident was left in soiled diapers for extended period of time. Therefore, the allegation is deemed as UNSUBSTANTIATED at this time. Exit interview conducted/ No citations issued/ A copy of report given.the state’s words, verbatim · CDSS document, Jul 9, 2021 · control 29-AS-20210629122227