Abigail's Guest Home

Type of visit: Case Management - Annual Continuation

On 9/15/2023 at 12:40PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct Case Management - Annual Continuation. LPA met with Caregiver, Carlota Moises and explained the purpose of the visit. Administrator, James Santos arrived 2 hours later. During visit, LPA reviewed staff training and observed staff completed training which includes dementia, emergency, medication, hospice, ADL (Activities of Daily Living) care, and other topics. At around 2:20PM, LPA reviewed a sample of resident's medications. LPA interviewed 2 residents and 2 staff starting at 3:00PM. At 2:40PM, LPA observed R1 has a doctor's order for Cholecalciferol and Ferrous Sulfate. However, facility did not obtain the supplements and have not been giving the supplements to R1. Additionally, facility have been giving Multi-vitamins to R1 when there was a discontinued order on 4/11/2023. At 2:50PM, LPA observed centrally stored records have not been updated for R1. At 3:00PM, LPA was informed that S1's file is not available for review. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report, civil penalty, and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 15, 2023

Type of visit: Required - 1 Year

On 7/20/2023 at 11:50AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a Required - 1 Year inspection. LPA met with Caregiver, Carlota Moises and explained the purpose of the visit. 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 8/30/2022. One week of nonperishable and 2-day of perishable food supplies were available. Hot water was measured at 110.5 degrees F. 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. Indoor and outdoor passageways were free of obstruction. No bodies of water observed. LPA reviewed 5 resident records starting at 1:10PM. At 1:50PM, LPA observed R2 does not have a current needs and service plan and 3 out of 5 residents does not have a current medical assessment. At 1:55PM, LPA observed 4 out of 5 residents does not have TB test results on file. At 2:00PM, LPA observed 4 out of 5 residents does not have pre-placement appraisals on file. (Continue on LIC809C...) At 2:50PM, LPA observed not all staff files were available during record review. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. LPA will return at a later time to complete annual inspection. Exit interview conducted. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 20, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Resident developed pressure injury while in care. Facility staff did not seek medical treatment for resident. Resident left in soiled diapers.

On 10/14/2022 at 10:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to deliver complaint findings for the allegations above. LPA met with caregiver, Carlota Moises. Administrator, Aurelia Mendoza arrived about an hour later. During the investigation, LPA interviewed 4 staff and witnesses. LPA obtained and reviewed resident's file including physician's report, care plan, care notes, hospital documents, and home health information. Resident developed pressure injury while in care. Hospital documents indicated that R1 had skin excoriations on buttock. Interview with staff revealed that R1 had pressure injury off and on due to R1 scratching the area. Staff stated that gloves were put on R1 to prevent scratching and R1 is repositioned to prevent pressure injury. (Continue on LIC9099C...) Unsubstantiated Facility staff did not seek medical treatment for resident. Interview with staff revealed that R1 was vomiting and feeling weak. Staff called 911 and paramedics arrived to take R1 to the hospital. Resident left in soiled diapers. Interview with staff revealed that R1 is checked for incontinence care 3-4 times a day. S1 stated that R1 had bowel movement when paramedics were transferring R1, but paramedics did not allow staff to change R1's diaper. Interview with witness indicated that home health agency post hospitalization did not observe R1 in soiled diapers when home health nurse visited. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies are being cited on this date. Exit interview conducted with Aurelia Mendoza. A copy of this report provided.the state’s words, verbatim · CDSS document, Oct 14, 2022 · control 15-AS-20210610100816

Type of visit: Case Management - Other

On 10/14/2022 at 11:45AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit. LPA met with caregiver, Carlota Moises. Administrator, Aurelia Mendoza arrived about 30 minutes later. During a complaint investigation (15-AS-20210610100816), LPA observed the following deficiency. LPA observed facility did not submit incident report when R1 went to the hospital on 6/6/2021. Also, when R1 passed away on 6/26/2022, LPA did not receive death report for R1. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency by POC date may result in Civil Penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 14, 2022

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

Reporting Requirements. A written report shall be submitted to the licensing agency...within seven days of the occurrence of any of the events... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not meeting reporting requirements which poses a potential health and safety risk to the persons in care.the state’s words, verbatim · CDSS document, Oct 14, 2022

Plan of correction: Administrator has agreed to conduct training for reporting requirements to staff and submit staff sign-in sheet & materials to CCLD by POC date.

Type of visit: Required - 1 Year

On 7/8/2022 at 12:30PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct an Infection Control Inspection. LPA met with Caregiver, Carlota Moises. LPA spoke with licensee, Aurelia Mendoza on the phone and stated she was unable to be at the facility. Upon entry, LPA's temperature was checked and asked to fill out the visitor's log. LPA observed hand sanitizer at screening station. LPA toured facility including but not limited to bedrooms, bathrooms, kitchen, common areas, garage, and outdoor areas. LPA observed cough etiquette, signs & symptoms, and physical distancing posted in the common areas. All bathrooms were equipped with soap and paper towels. Hand washing posters were posted at bathrooms and sinks. During record review, LPA observed visitors log and temperature log for residents and staff. LPA observed facility does have a copy of Mitigation Plan on file. Staff was FIT tested and provided FIT testing completion card. LPA observed PPE, food supplies, and paper supplies are sufficient. At 12:50PM, LPA observed knives drawer was unlocked and cleaning supply cabinet had a missing lock. Caregiver stated administrator is aware of the missing lock and will be fixed soon. Caregiver locked up the knives drawer during inspection. At 1:00PM, LPA observed unlocked prescription creams in the hallway bathroom and unlocked medication on the table. Caregiver locked up prescription creams and medication during inspection. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies by POC date may result in Civil Penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 8, 2022

Type of visit: Required - 1 Year

On 7/21/2021 at 11:36AM, Licensing Program Analysts (LPAs) G. Luk and C. Lin arrived unannounced to conduct an Infection Control Inspection. LPAs met with Caregiver, Carlota Moises. LPAs spoke with licensee, Aurelia Mendoza on the phone regarding infection control inspection and licensee was unable to be at the facility. Upon entry, LPA's temperatures were checked. LPAs observed hand sanitizer at screening station. LPAs toured facility including but not limited to bedrooms, bathrooms, hand washing stations, kitchen, and common areas. LPAs observed cough etiquette, signs & symptoms, and physical distancing posted in the common areas. All hand washing stations were equipped with soap and paper towel. Hand washing posters were posted at hand washing stations. During record review, LPAs observed visitors log and temperature log for residents. LPAs observed facility does not have a copy of Mitigation Plan on file. LPAs observed PPE, food supplies, and paper supplies are sufficient. Facility was given Technical Assistance regarding infection control guidelines and documented on LIC9102. At around 12:30PM, LPAs were informed that facility did not document residents' observation notes. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency by POC date may result in additional Civil Penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jul 21, 2021

The state marks this report as 7 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.