Loving Care Facility

Allegation investigated: Staff are billing resident in excess of the agreed rate

Licensing Program Analysts (LPAs) Emily Peraldi and Martha Arroyo conducted an unannounced initial complaint visit to this facility for the allegations noted above. At 8:15 a.m., the LPAs met with staff and explained the reason for the visit. At 8:50 a.m., the Administrator arrived at the facility. Entrance interview conducted. At 8:20 a.m., the LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards. LPA Peraldi conducted interviews with one (1) resident and the Administrator at 8:23 a.m. and 9:02 a.m. At 9:06 a.m., the LPAs reviewed and requested copies of pertinent documents. Additionally, at 11:01 a.m., LPA Peraldi conducted an interview with Individual#1 (I1). At 3:51 p.m., LPA Peraldi conducted an interview with a resident’s responsible person. Continued on LIC 9099-C. Unsubstantiated Regarding the allegation: Staff are billing resident in excess of the agreed rate. The Department received a complaint on 08/11/2023 regarding the facility charging a different amount from the agreed rate that was given to Individual #1 (I1). It was alleged that I1 was living at the facility for an agreed rate of $800; however, I1 was offered and accepted another room at the accessory dwelling unit (ADU) at the back of the facility for $1200. During the interview with the Administrator, it was revealed that I1 was never a resident at the facility but rather a tenant living at the ADU, an independent living facility located behind the facility. The Administrator denied the allegation of charging her current residents more than the agreed rate. Furthermore, interview conducted with I1 did not provide additional information to support the above allegation. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. 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 at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 17, 2023 · control 29-AS-20230811134049

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Emily Peraldi and Martha Arroyo conducted a Case Management – Deficiencies to issue citations for deficiencies observed during an unrelated complaint investigation. Entrance interview conducted. Prior to visit, LPA Peraldi printed out the facility personnel report summary from the Licensing Information System (LIS). Upon arrival, it was revealed Staff #1 (S1) is the main caregiver during the week. Per record review, conducted by LPAs on the Guardian website, S1 does not have fingerprint clearance. Interviews with the Administrator revealed that S1 started working at this facility on July 27, 2023. The Administrator explained that S1 will obtain their fingerprint clearance. The LPAs reminded the Administrator that staff that are not fingerprinted or are not associated to the facility cannot be working at the facility. The Administrator stated that the facility will ensure that all staff will have a criminal record clearance and are associated to the facility prior to working at the facility. Additionally, the LPAs had a conversation with the Administrator regarding the Unlicensed complaint that the Department received on 08/14/2023 located at the accessory dwelling unit (ADU) at the back of the facility. The Administrator stated that the ADU is not licensed and is an independent living facility and that she is not part of the operation. The Administrator explained that the Operator of the independent living facility has their own lease agreement and only accepts tenants who do not require aspects of care and supervision. Information obtained and reviewed from investigation conducted on 08/17/2023, revealed that one (1) out of three (3) tenants (Tenant #1) were found to require assistance with activities of daily living such as but not limited to medication management, bathing, and dressing. Furthermore, record review and interviews conducted revealed the Administrator misrepresented the facility by accepting a resident who required care and supervision and was placed in the independent living facility located in facility’s ADU. Continued on LIC 809-C. During the interview with the Administrator, it was revealed that one of the residents was hospitalized on July 23, 2023 and the Administrator did not send an incident report regarding the hospitalization to the Department. The LPAs reminded the Administrator that a written report shall be submitted to the licensing agency within seven days of the occurrence of any of the events such as a hospitalization. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 809-D). Civil Penalties assessed in the amount of $500. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted, today's reports and appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 17, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Aug 18, 2023

87355(e)(1) Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Healthh...all prior to working...(1) Obtain a California clearance... as required by the Department… This requirement is not met as evidenced by: Based on record review and interviews conducted, the licensee did not comply with the section cited above as S1 does not have a criminal record clearance which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 17, 2023

Plan of correction: Licensee agreed to get S1 a criminal record clearance and ensure all staff are associated to the facility by 08/17/2023.

From the deficiency page — Deficiency type: Type A · Section cited: HSC1569.58(2) · Plan of correction due date: Aug 18, 2023

HSC-1569.58(2) Engaged in conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility… This requirement is not met as evidenced by: Based on interviews conducted, the licensee did not comply with the section cited above as the Administrator misrepresented the facility by taking a resident needing assistance with ADLs and placing them in the independent living facility, which poses an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 17, 2023

Plan of correction: The Administrator will review H&S Code 1569.58 and submit a statement of understanding to CCL by poc due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 21, 2023

87211(a)(1)Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency...This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above, as an incident report was not submitted for a resident’s hospitalization which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2023

Plan of correction: The Administrator agreed to submit the incident report to the Department by 08/21/2023.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Emily Peraldi conducted a pre-licensing visit to the above noted facility at 11:26 a.m. The LPA met with applicant, Hasmik Nshanyan. This is a new facility. A dementia program was included in the plan of operation. A Hospice Waiver has been requested for four (4). The facility is one story. At 11:32 a.m., a physical plant tour was conducted inside and out. An approved fire clearance was received, clearing them for one (1) ambulatory resident, two (2) non-ambulatory residents and one (1) bedridden resident. Resident Room #1 is the ambulatory only room. The facility has one (1) shared rooms, Room #2. Resident rooms #3 has direct exits to the outside and is approved for bedridden. The facility does not have fire sprinklers. All resident rooms are set up with beds, nightstands, lamps, and closet space. There are chests of drawers and chairs for each room. 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. In addition, no bedroom was used as a passageway to another room, bath or toilet. There are no staff rooms and an awake night staff will be present. All rooms were free of odors. All window screens were clean and maintained in good repair. There are two (2) bathrooms in the facility, one in the hallway and one in Room #1. The resident bathrooms have a shower and have non-skid materials. Both of the restrooms have shower with grab bars. The hot water temperature was tested in the bathrooms and the kitchen and was found to be within the range of 105*F and 120*F. The hot water temperature was measured as follows: bathroom #1= 116.5*F, bathroom #2 = 115.8*F and the kitchen =115 *F. Resident and staff records will be stored in a locked kitchen cabinet. Medications will be centrally stored in a locked cabinet in the kitchen. The first aid supplies were complete. Continued on LIC 809-C. Kitchen knives are stored in a locked drawer in the kitchen. The supply of dishes, utensils, pots, pans and drinkware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of nonperishable food will be adequate. There are no pesticides (poisons) or toxins stored in any food storage area or preparation area with utensils. Appliances in the kitchen were clean and all appeared functional. The trash can has tight fitting lid for the kitchen. Kitchen, laundry and house cleaning supplies are stored in a locked kitchen cabinet as well in two locked closets. No flies or other vermin were observed. The common areas were appropriately furnished, and the lighting was adequate. There is a television and other entertainment equipment, games and/or activity supplies in the living room and dining area. There was sufficient space to accommodate both indoor and outdoor activities. Night lights are maintained in hallways and passageways to nonprivate bathrooms. Night lights are also present throughout the facility and rooms. All ramps were secure and non-slippery and were positioned at the level where wheelchairs and walkers may enter and exit the facility safely. There is not a fireplace in the living room. Alarms on all exterior doors were engaged at the time of visit and functional. In addition, the physical plant is consistent with the submitted facility sketch/floor plan. The facility had emergency lighting, which included flashlights. The applicant will have batteries prior to licensure. The facility has a furnace, which is able to heat rooms that residents occupy to a minimum of 68 degrees Fahrenheit; and, they have central air conditioning and are able to cool rooms to a comfortable range, not to exceed 85 degrees Fahrenheit. The facility smoke alarm system is hard wired. The smoke detector and carbon monoxide detectors were tested and functioned properly during the time of visit. There is one fire extinguisher, and it was fully charged and did not exceed the expiration date.The laundry units are located in a hallway. The supply of extra bed and bath linens is adequate. Personal hygiene items (shampoos, soaps) were adequate and are stored in one of the restroom closets. Extra incontinence supplies are stored in the restroom closet. There will be a functioning telephone on the premises. Required postings are located near the front entrance. The exterior passageways were clear of any obstructions. There is a covered patio area at the front of the house. There is patio furniture for resident use. The entire property is fenced. There is an accessory dwelling unit (ADU) behind the house, but the ADU is not part of the license. The ADU is separated from the front house by a gate. There are not any bodies of water on the premises at the present time. Continued on LIC 809-C. At 12:14 p.m., Comp III was completed. No correction were needed at this time. This report will be sent to the Centralized Application Bureau (CAB). You will be notified by the CAB Analyst when your license has been approved. You are not allowed to begin operating until you have been notified that your license has been approved by the CAB Analyst. Failure to comply could affect approval of your license. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, May 23, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Licensee/Administrator Hasmik Nshanyan Interview Method: Telephone interview Virtual interview (Skype, Go To Meeting, etc) In-person interview (Headquarter conference room) On 5/11/2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readiness New Licensees should create a Guardian account to manage their roster and assist future staff live scans without delays. To create a Guardian account, they will submit a Guardian Licensee User Access Form (LIC 9277LUA) to CDSS at GuardianLoginSupport@dss.ca.gov. A licensee/provider account will be created and CPMB will issue a new user notification email with a temporary password and link to the Guardian Agency portal. It is strongly recommended that the first step for an individual (i.e. new staff member) subject to background check should be to start the application process in Guardian rather than going directly to the Live Scan Vendor and submitting fingerprints. Proposed new staff will need to obtain an Applicant Instruction Form from the licensee which will provide a PIN code. This PIN will be required for new staff to submit an application in the Guardian system. Licensee will receive an alert of a new application to which the Licensee will choose to either ‘resume’ or ‘withdraw’. If resumed, Guardian will generate a prepopulated Live Scan form for the new staff to use when submitting their fingerprints to a Live Scan Vendor.the state’s words, verbatim · CDSS document, May 11, 2023