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Type of visit: Case Management - Other

On 11/8/2023 Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced case management visit regarding upon missing death report regrading a client that pass away at Eden hospital. The special incident report that submitted to CCLD on 11/3/23. LPA spoke with Abigail Cruz program supervisor and explained the purpose of the visit. LPA interviewed staff (S1) regarding client (C1) care prior to the incident. LPA obtained death report, progress notes/ care notes, and the after-visit summary C1 was admitted to the hospital. After reviewing the documents C1 was places on hospice care on 11/1/23. C1 was seeing by C1 internal medicine doctor on 10/12/23 to access C1 medical condition. S1 stated that according to the doctor C1 was doing fine. After reviewing documents C1 cause of death is aspiration pneumonia, sepsis, and acute hypoxic respiratory failure. No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Nov 8, 2023

Type of visit: Case Management - Other

On 10/26/2023 Licensing Program Analyst (LPA) K. Nguyen conducted an unannounced case management visit regarding a self-reported incident that occurred on 10/18/23. LPA spoke with Program Supervisor, Abigail Cruz and explained the purpose of the visit. LPA received a special incident report regrading a client that wasn’t giving medication at the time that was being prescribed. During the investigation LPA interview S1, reviewed and obtained C1 medication record, C1 changing in condition, and review staff training record that was stating on the special incident report. No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Oct 26, 2023

Allegation investigated: Resident sustained injuries while in care. Facility did not seek medical attention for resident. Facility is not adequately staffed to meet the needs of the resident's.

On 1/26/2023 at 11:40AM Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver complaint finding for the above allegations. LPA met with Administrator, Joseph Gapasin and explained the purpose of the visit. During the complaint investigation, LPA toured 4 resident's bedrooms, interviewed 2 staff, and attempted to interview 4 residents. Based on information obtained, R1 is self-inflicted and staff took preventative action to prevent R1 from sustaining future injuries. Staff seek medical attention on a timely matter. Facility have adequate staff after LPA reviewed staff payroll that correspond to staff’s schedule. UNSUBSTANTIATED Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 26, 2023 · control 15-AS-20220912135604

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff is rough with the resident. Staff has inappropriate interactions with residents assistant in front of the resident. Staff behavior is a health and safety risk to residents in care.

On 01/12/2023, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to deliver findings for the above allegations. LPA met with Administrator Joseph Gapasin and informed him the purpose of the visit. During the course of investigation, LPA conducted records review and interview. Based on records review there was no incident report regarding R1 being handled in rough manner, R1 also do not have incident report of any type of bruising. Based on staff interview, they are not aware of any staff handling anyone roughly. Staff stated that they have not witnessed or heard any staff acting inappropriate behavior towards residents in care. LPA attempted to interview R1, but R1 is non-verbal, LPA also attempted to interview other residents, but residents did not answer LPA’s questions. ...Continue to LIC9099C... Unsubstantiated LPA observed during the visit that residents are comfortable, well dressed and staff are attending to each resident. Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Exit interview conduct and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 12, 2023 · control 15-AS-20210805161616

Type of visit: Case Management - Other

On 01/12/2023, LPA visited the facility to deliver findings, while LPA was touring the facility a case management visit was opened. While LPA was going around the facility, the following was observed. · Unlocked medication drawer & unlocked knives storage located at the kitchen counter. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.the state’s words, verbatim · CDSS document, Jan 12, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Jan 12, 2023

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. Storage where knives are kept was observed unlocked and medication drawers was unlocked which poses an immediate health and safety risks to persons in care.the state’s words, verbatim · CDSS document, Jan 12, 2023

Plan of correction: Staff locked the storage while LPA was at the facility. Licensee and administrator stated staff will be in-serviced. Proof to be submitted by 01/16/2023.

Allegation investigated: Staff engaged in inappropriate behaviors with resident Resident sustained unexplained bruises while in care Staff are mismanaging resident's medications

On 3/30/2022 at 1:20 PM, Licensing Program Analysts (LPAs) L. Francisco and K. Nguyen arrived unannounced to conduct complaint investigation for the above allegations. LPAs met with Administrator, Joseph Gapasin and explained the purpose of the visit. During the course of the investigation, LPAs obtained information, collected documents, interviewed 5 staff and 2 witnesses. Allegation: Staff engaged in inappropriate behaviors with resident Based on interview with 5 staff, 5 of 5 denied sleeping on C1's bed or witnessed other staff sleeping on C1's bed. W2 stated W2 witnessed S5 resting on C1's bed. REPORT CONTINUES ON 9099C Unsubstantiated However, W2 was unable to produce proof of incident. LPA was unable to prove or disprove allegation. Allegation: Resident sustained unexplained bruises while in care According to W1, C1 has Self Injuries Behavior (SIB) where C1 hits his head and neck. 5 of 5 staff stated due to C1's vision impairment, C1 would often bump into walls and furniture which would cause the bruising. Allegation: Staff are mismanaging resident's medications Based on interview with 5 staff, 5 of 5 staff denied throwing medications away. LPAs reviewed a sample of clients medications and compared it with Medication Administration Record. LPAs did not observe any discrepancies. LPAs were unable to prove or disprove allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 30, 2022 · control 15-AS-20211209152709

Allegation investigated: Facility has inadequate staffing

On 3/30/2022 at 1:20 PM, Licensing Program Analysts (LPAs) L. Francisco and K. Nguyen arrived unannounced to conduct complaint investigation for the above allegation. LPAs met with Administrator, Joseph Gapasin and explained the purpose of the visit. During the complaint investigation, LPAs obtained information, reviewed records, and collected documents. LPAs interviewed staff and attempted to interview clients. It was alleged facility has inadequate staffing. Based on interview and record review, C1 and C2 requires 1:1 care. LPAs reviewed February and March staffing schedule and observed 2 staff scheduled in the PM shift for the month of February and March, and 1 to 2 staff scheduled for NOC shift in the month of February and March. REPORT CONTINUES ON 9099C Substantiated Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. Appeal Rights and a copy of report provided.the state’s words, verbatim · CDSS document, Mar 30, 2022 · control 15-AS-20220325134953

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80065(a) · Plan of correction due date: Apr 6, 2022

PERSONNEL REQUIREMENTS (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by: Based on interview and record review, Licensee did not comply with regulation cited above. LPAs observed 2 staff were scheduled in PM shift and 1 to 2 staff in NOC shift for the month of February and March which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 30, 2022

Plan of correction: Administrator agrees to contact staffing agency and will submit a copy of staffing schedule for the month of April by POC date. LPA will follow-up with facility in the future.

Allegation investigated: Staff are overmedicating resident(s) Staff speak inappropriately to resident(s) in care

On 12/30/21 at 5PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent complaint visit to deliver the findings of above allegations. LPA explained the purpose of the visit with administrator. Allegation: Staff are overmedicating residents Investigation Finding: UNSUBSTANTIATED During visit on 06/16/21, Licensing Program Analysts (LPAs) A. O’Hollaren and L. Francisco reviewed residents (R1)’s / (R2)’s medications/dosages logs. LPAs observed R1’s/R2’s medications/dosages matched residents’ corresponding medication administration records (MARs). Staff (S1, S4, S5) confirmed with LPAs that they administer residents’ daily medications as prescribed and records them on the MARs. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. Continued on next page, LIC 9099-C Unsubstantiated Allegation: Staff speak inappropriately to resident(s) in care Investigation Finding: UNSUBSTANTIATED Based on interviews and observations, Licensing Program Analysts (LPAs) A. O’ Hollaren and L. Francisco interviewed staff (S1, S4, S5) on 06/16/21 who denied speaking inappropriately to residents in care. Staff stated they did not hear a staff yell or say “give him his medications so he can be knocked out” while working at the facility. LPAs tried to interview the four residents who were unable to validate occurrence of these incidents due dementia. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. No deficiencies cited. Exit Interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Dec 30, 2021 · control 15-AS-20210608160016

Allegation investigated: Insufficient staff to meet residents needs

On 12/30/21 at 4:30PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent complaint visit to deliver the findings of above allegation. LPA explained the purpose of the visit with administrator. Allegation: Insufficient staff to meet residents needs Investigation Finding: UNSUBSTANTIATED Based on interviews and observations by Licensing Program Analyst (LPA) A. O’Hollaren on 03/03/21, LPA observed 4 caregivers and one administrator assisting 4 residents at the facility during visit. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. Nothe state’s words, verbatim · CDSS document, Dec 30, 2021 · control 15-AS-20210222092730

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: Resident sustained unexplained injuries.

On 12/9/2021 at 2:00PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct complaint investigation and deliver complaint findings for the allegation above. LPA met with Administrator, Joseph Gapasin. During the investigation, LPA interviewed staff and attempted to interview clients. LPA obtained and reviewed client's assessment notes, individual service plan, nurse's progress notes, physician's report, and behavioral assessment. Interview with staff revealed that C1 didn't have bruise observed in the back/shoulder area. During visit, LPA did not observe bruises on C1's back/shoulder area. LPA made attempts to interview clients; however, the clients were all non-verbal and unable to respond to questions. Physician's report dated 11/17/2020 stated that C1 has SIB (Self Inflicted Behavior). (Continue on LIC9099C...) Unsubstantiated Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Dec 9, 2021 · control 15-AS-20211202162818

Type of visit: Required - 1 Year

On 11/18/2021 starting at 2:45 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct Infection Control Inspection. Upon arrival, LPA met with Chynell Johnson. Administrator, Joseph Gapasin later arrived at 3:15 PM. During the Infection Control Inspection, LPA toured facility with Care Staff including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. There is one central entry point for universal screening for staff, clients, and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for clients and staff. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Nov 18, 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.

Allegation investigated: Facility is not quarantining staff exposed to COVID

On 09/30/21 at 2:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced complaint visit and met with administrator (ADM). LPA explained the purpose of the visit with ADM. Based on review of Provider Information Notice PIN-21-23-ASC guidelines with ADM, LPA observed facility staff followed Centers for Disease Control and Prevention (CDC) guidance which states fully vaccinated facility staff who are asymptomatic do not need to be restricted from work for 14 days following an exposure to COVID-19. ADM agreed to review and discuss PIN-21-23-ASC with facility staff to address any concerns they may have regarding COVID-19 infection control. Continued on next page, LIC 9099-C Unfounded This department has investigated the complaint alleging that facility is not quarantining staff exposed to COVID-19. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. No deficiencies cited. Exit Interview conducted and a copy of this report provided to ADM.the state’s words, verbatim · CDSS document, Sep 30, 2021 · control 15-AS-20210929111834