Valley View Retirement Center

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Emily Peraldi and Brian Balisi arrived at the facility unannounced to conduct a required annual visit. At 10:15 a.m., the LPAs met with the Administrator and explained the reason for the visit. At 10:42 a.m., the LPAs along with the Administrator, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPAs observed the kitchen/dining area. Knives are stored in the inaccessible kitchen. Kitchen appliances appear to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:52 a.m., hot water measured at 117.1-degree Fahrenheit. BEDROOMS: The LPAs observed nine (9) resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. Between 10:48 a.m. and 11:30 a.m., hot water measured between 105.4 and 117.1-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. OUTDOOR SPACE: At 10:53 a.m., the LPAs observed the back and front of the facility which has a covered outdoor area for resident use. There is a gate on the side of the facility designated for an emergency exit. There are no bodies of water on the premises. The facility only has a parking lot, no garage nor basement. Continued on LIC 809-C. COMMON AREAS: The LPAs observed common area to be relatively clean and properly furnished. The LPAs observed the fire extinguisher to be fully charged and last serviced on 10/05/2023. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. Fire alarm, fire sprinklers and fire doors were observed and passed by the Fire Department. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the janitor closets and storage. Medications and first aid kits are located in a locked medication room. Laundry units and additional linens are located inside laundry room. RECORD REVIEW: Starting at 11:30 a.m., the LPA conducted a file review for all residents and staff. Staff records were reviewed for documents including, but not limited to health screening, TB test, staff training records, and fingerprint clearance. All files were in order. The Administrator’s Certificate expires 01/31/2024. The LPA reviewed resident records for nine (9) out of sixty-nine (69) residents. Resident’s records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. All files were in order. Additionally, the LPAs received a copy of valid liability insurance and Facility Disaster Emergency Plan. Between 11:19 a.m. and 11:46 a.m., the LPA conducted interviews with six (6) staff and eight (8) residents. Between 1:50 p.m. and 2:15 p.m., the LPA conducted a review of medication and medication documentation with Medication Technician for six (6) residents and observed all medications were properly documented and assisted with as prescribed. No deficiencies cited at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 12, 2023

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Resident is being mistreated by other residents while in care. Staff did not keep a resident's room free from bed bugs.

Licensing Program Analyst (LPA) Emily Peraldi conducted a subsequent visit to this facility today to deliver findings. At 2:02 p.m., the LPA met with the Administrator, Judith Montoya and explained the reason for the visit. During the initial visit on 11/21/2022 between 3:12 p.m. and 3:58 p.m., LPA Peraldi conducted a brief physical plant tour and conducted an interview with Staff #1 (S1). During todays visit, at 2:08 p.m., the LPA conducted an interview with the Administrator. On 05/23/2023, at 2:26 p.m., the LPA reviewed records and obtained copies of pertinent documents. On 05/23/2023, at 2:28 p.m., the LPA, along with the Administrator conducted a physical plant tour. On 05/23/2023, between 2:29 p.m. and 3:34 p.m., the LPA conducted interviews with eight (8) out of sixty-nine (69) residents, including Resident #1 (R1). On 05/23/2023, between 3:16 p.m. and 3:22 p.m., the LPA conducted interviews with three (3) staff. Continued on LIC 9099-C. Unsubstantiated Regarding the allegation: Resident is being mistreated by other residents while in care. On 11/15/2022, the Department received a complaint in which it was alleged that Resident #1 (R1) was being bullied by other residents while at the facility. Interviews with the Administrator revealed that R1 had an argument with R1’s boyfriend, Resident #2 (R2) last year in November. The Administrator explained that R1 and R2 had an argument in the dinning room. The Administrator explained that staff in the dinning room attempted to deescalate the situation but that R1 and R2 told them to “mind their business.” The Administrator explained that the following day, the Administrator spoke with R1 regarding the argument with R2. The Administrator stated that R1 said that R1 and R2 are no longer arguing. The Administrator stated that on the following day of R1 and R2’s argument, the Administrator held an all staff meeting and training regarding the incident. The Administrator provided a copy of the Inservice Education Employee Training Sign-Up Sheet, dated November 22, 2022. The purpose of the training was for staff to ensure that R1 will be feeling safe and respected. At 3:34 p.m., the LPA conducted an interview with R1. R1 explained that R1 is feeling okay and has not had any issues with other residents. R1 did not mention being bullied by other residents. Furthermore, other resident interviews did not reveal that residents had issues with other residents. Staff interviews revealed that if residents are arguing or have issues with one and other, that staff intervene and deescalate the situation. The information obtained during the investigation did not include evidence sufficient 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. Regarding the allegation: Staff did not keep a resident's room free from bed bugs. On 11/15/2022, the Department received a complaint in which it was alleged that the facility had bed bugs. The interview with the Administrator revealed that there have not been bed bugs at the facility. The Administrator explained that the facility receives monthly pest control maintenance from a company called Western Exterminator Company. The Administrator explained that the monthly pest control maintenance includes both interior and exterior treatment of the building. The Administrator explained that if a resident has a bug or insect problem, the Administrator schedules Western Exterminator Company to treat the problem immediately. The Administrator provided the LPA copies of the most recent invoice from Western Exterminator Company, dating from November 2022 and March 2023. During today’s visit, the LPA observed eight (8) resident rooms. The rooms were observed to be furnished appropriately with clean linens. The LPA did not observe bed bugs in the rooms. The interviews with residents revealed that the residents have not observed bed bugs recently. The information obtained during the investigation did not include evidence sufficient 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. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, May 23, 2023 · control 29-AS-20221115115733

Allegation investigated: Facility has bed bugs

Licensing Program Analyst (LPA) Emily Peraldi, conducted an unannounced 10-day initial complaint visit to this facility. At 10:42 a.m., the LPA met with the Administrator, Judith Montoya and explained the reason for the visit. At 10:52 a.m., the LPA conducted an interview with the Administrator. Between 11:10 a.m. and 12:00 p.m., the LPA along with the Administrator, conducted a physical plant tour. The LPA also interviewed seven (7) out of seventy-one (71) residents. At 11:00 a.m., the LPA reviewed records and obtained copies of pertinent documents. Continued on LIC 9099-C. Unsubstantiated Regarding the allegation: Facility has bed bugs On 10/14/2022, the Department received a complaint in which it was alleged that the facility has bed bugs. At 10:52 a.m., the LPA conducted an interview with the Administrator. The Administrator explained that the facility receives monthly pest control maintenance from a company called Western Exterminator Company. The Administrator said if a resident has a bug or insect problem, the Administrator schedules Western Exterminator Company to treat the problem. However, the Administrator said there hasn’t been any recent concerns regarding bugs or insects. The Administrator provided the LPA copies of the most recent invoice from Western Exterminator Company, dated 09/14/2022. During today’s visit, the LPA observed seven (7) resident rooms. The rooms were observed to be furnished appropriately with clean linens. The LPA did not observe bed bugs in the rooms. The interviews with residents revealed that the residents have not observed bed bugs recently. The information obtained during the investigation did not include evidence sufficient 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. Exit interview conducted. A copy of the report was issued via email.the state’s words, verbatim · CDSS document, Oct 19, 2022 · control 29-AS-20221014155150

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:42 a.m., the LPA met with the Administrator and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures. At 11:10 a.m., the LPA and the Administrator began the physical plant tour inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with the Title 22 Regulations. BEDROOMS: The LPA observed multiple resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Passageways were free and clear from obstruction. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skids mats. Between 11:09 a.m. and 11:26 a.m., the LPA observed hot water to be measured between 105.8 and 108.1-degree Fahrenheit. COMMON AREAS: At 11:16 a.m., the LPA observed staff cleaning common areas and hallways on both the first and second floor. At 11:22 a.m., the LPA observed common areas to be relatively clean and properly furnished. The LPA observed fire extinguishers throughout the facility hallways on both floors and all were last serviced on 10/10/2022. Fire alarm system was observed and was last tested on 07/27/2021 with an expiration date of 05/31/2024. The LPA observed cameras installed in the hallways and common areas. Continued on LIC 809-C. KITCHEN: At 11:45 a.m. LPA observed the kitchen/dining area. Knives are stored in the locked kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. OUTDOOR SPACE: LPA observed the side and front lot, which has a covered outdoor area for resident use. There is an open gate at the front of the facility. Medications and first aid kits are in a locked medication room located on the ground floor. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the maintenance room. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a 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 policies and procedures as it pertains to infection control are adequate. No deficiencies. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 19, 2022

Allegation investigated: Facility is in disrepair.

Licensing Program Analyst (LPA) Emily Peraldi, conducted an unannounced 10-day initial complaint visit to this facility. At 09:58 a.m., the LPA met with Administrator, Judith Montoya and explained the reason for the visit. At 10:02 a.m., the LPA conducted an interview with the Administrator. Between 10:31 a.m. and 11:31 a.m., the LPA along with the Administrator, conducted a physical plant tour and interviewed fifteen (15) out of seventy-one (71) residents. At 12:05 p.m., the LPA reviewed records and obtained copies of pertinent documents. Regarding the allegation: Facility is in disrepair. On 09/27/2022, the Department received a complaint in which it was alleged that the facility’s air condition (AC) units were not working. At 10:02 a.m., the LPA conducted an interview with the Administrator. The Administrator explained that the facility has seven (7) central AC units for resident rooms and three (3) central AC units for the common areas and the kitchen/dinning areas. Continued on LIC 9099-C. Unsubstantiated The Administrator explained that all the central AC units are controlled through the thermostat and on the Administrator’s and Licensee’s phone through a phone application called Resideo. At 10:04 a.m., the Administrator showed the LPA the phone application that controls the resident room temperatures. The resident room temperatures are set to 75-degree Fahrenheit. The Administrator explained that some of the rooms upstairs have an additional window AC unit if the residents request one. The Administrator stated that the facility has not had major maintenance problems. The Administrator said that a company called, GreenAir goes to the facility once a month to conduct routine maintenance on all the central AC units. During the tour, the LPA observed seventeen (17) resident rooms. The rooms observed were maintained at a comfortable temperature. Additionally, at 11:09 a.m., the LPA observed the dining area room temperature to be at 76-degree Fahrenheit. At 11:31 a.m., the LPA observed the television/common room temperature to be at 75-degree Fahrenheit. The interviews with residents revealed that the residents are comfortable with their room temperatures. Based on the information obtained, there is insufficient evidence to support the claim that facility is in disrepair. This allegation is deemed Unsubstantiated at this time. Exit interview conducted with the Administrator. A copy of the report will be issued via email.the state’s words, verbatim · CDSS document, Sep 28, 2022 · control 29-AS-20220927145131

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management-Deficiencies inspection visit at the facility today due to a deficiency observed during the investigation of a complaint visit conducted on 06/21/2022. Between 1:00 p.m. and 3:20 p.m., the LPA along with the Administrator, conducted a physical plant tour. Between 3:15 p.m. and 3:40 p.m., the LPA observed hot water to be measured between 126.0 and 138.1-degree Fahrenheit. At 3:40 p.m., the Administrator observed the hot water temperature and requested maintenance and plumbing services to set the hot water no more than 120-degree Fahrenheit. At 4:15 p.m., staff adjusted the water temperature and the LPA observed the hot water temperature to be measured at 110.4-degree Fahrenheit. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Civil Penalties issued in the amount of $250.00. Exit interview conducted with Administrator. A copy of the report, civil penalties and appeals rights were reviewed and emailed to the Administrator.the state’s words, verbatim · CDSS document, Jun 21, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Jun 22, 2022

87303(e)(2) Maintenance and Operation Hot water temperature controls shall be maintained to ...of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in as the water temperature in resident bathrooms measured between 126.0 and 138.1 degrees F which poses an immediate health, and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jun 21, 2022

Plan of correction: Staff adjusted the water temperature during the visit. The administrator shall complete a 5-day water temperature log which indicates the water temperature is within the required range of 105-120 degrees and submit proof to CCL by 06/28/2022. Administrator stated that they will maintain hot water temperature between 105 and 120 degrees F and keep a monthly temperature log.

Allegation investigated: Failure to provide required Basic Services Failure to maintain facility clean, safe and sanitary Failure to meet residents needs for restricted health care conditions Failure to ensure compliance with personnel requirements

Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint visit. The purpose of the visit is to deliver the findings for an investigation initiated by LPA Eva Miller on 08/24/2020. The LPA met with Administrator Judith Montoya at 9:35 a.m., and explained the reason for the visit. On 08/24/2020, LPA Eva Miller initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint investigation was conducted virtually with the use of "FaceTime" with Administrators Gloria Padilla (A-1) & Judy Montoya (A-2). Interviews were conducted with the Administrator(s), and Staff #1 (S-1). A tour of the room assigned to Resident #1 (R-1) was conducted at 3:15pm. LPA Miller requested copies of pertinent facility files and documents. The LPA determined, at that time, that further investigation was required. Continue on LIC 9099C.. Unsubstantiated During today’s visit, the LPA conducted a physical plant tour with the administrator at 10:45 a.m., to ensure there are no health and safety hazards. From 9:06 a.m. until 9:30 a.m., the LPA conducted an interview with S1. From 9:35 a.m. until 10:45 a.m., the LPA conducted an interview the administrator; reviewed and obtained additional copies of documents pertinent to the investigation. From 10:56 a.m. until 11:07 a.m., the LPA conducted an interview with Resident #2 (R2). From 12:03 p.m. until 12:22 p.m., the LPA conducted a telephone interview with R1’s family member. Regarding the allegation, ‘Failure to provide required Basic Services,’ the complainant’s concern is that the facility is not providing Resident #1 (R1) with basic services as R1 was allegedly physically unclean at the time of visit on 08/18/2020. During the investigation, the LPA conducted interviews with S1, the administrator, R2, and R1’s family member. Interviews with S1, and the administrator revealed that residents are assisted with basic service needs such as bathing, grooming, and toileting on a ‘daily basis.’ Interview with R2 revealed, that that they would observe R1 showered ‘at least every other day,’ and was assisted in being ‘changed every day between 9:00 a.m. and 10:00 a.m.' Interview with R1’s family member revealed, that they would visit R1 at the facility about three (3) times a week. Interview with R1’s family member also revealed, that R1 appeared well groomed during visits, and confirmed staff would assist R1 with basic service needs. Based on interviews with the administrator, staff, R2, and R1’s family members, facility staff did assist R1 with basic services such as bathing, grooming, and toileting. Therefore, there is insufficient evidence to support the allegation ‘Failure to provide required Basic Services.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Regarding the allegation, ‘Failure to maintain facility clean, safe and sanitary,’ the complainant’s concern is that R1’s room was unkempt, which poses a potential safety risk to R1, as there were unclear walkways during the complainant’s visit. Continue on LIC 9099C.. During the investigation, LPA Miller conducted a tour via ‘facetime,’ of R1’s bedroom on 08/24/2020 at 3:15 p.m. During the tour, housekeeping was brought to attention due to excessive messiness at the time of observation. LPA Miller noted R2 tended to hoard. LPA Miller was advised that R2 recently discarded belongings. During today’s visit, LPA Walker conducted interviews with S1, the administrator, R2, and R1’s family member. Interviews with S1, and the administrator confirmed that R2 has a lot of belongings, and would ‘have the room out of order.’ Interview with the administrator also revealed, that staff have brought the housekeeping rules to R2’s attention, and the ‘hoarding’ has improved. Upon entry to R1 and R2’s bedroom, the LPA observed several belongings stored in the bedroom. However, the belongings were in order, and the room appear to be clean. Interview with R2 revealed, that staff clean their room ‘every day, seven days a week.’ Interview with R2 also revealed, that R2 acknowledges the ‘room is a bit full of items.’ Interview with R1’s family member revealed, that R1’s ‘room was always in order, ‘It wasn’t messy,’ R1 ‘was organized,’ and ‘staff would clean every day.’ Interview with R1’s family member also revealed, that staff would assist R1 in getting up from bed to change the sheets daily. Based on LPA’s observation, and Interviews conducted with S1, the administrator, R2, and R1’s family member. Although, R1 and R2’s bedroom contains several personal belongings, the facility staff ensure their room is clean, safe, and sanitary. Therefore, there is insufficient evidence to support the allegation ‘Failure to maintain facility clean, safe and sanitary.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Regarding the allegation, ‘Failure to meet residents needs for restricted health care conditions,’ the complainant’s concern is that R1’s vitals were not within normal limits. The complainant was also concerned that R1 did not have proper oxygen supplies, and that staff were not aware R1 needed oxygen. During the investigation, LPA Walker conducted a record review, interviews with the administrator, R2, and R1’s family member. Interview with the administrator revealed, that R1 ‘was never on Oxygen,’ and ‘there was no physicians order for oxygen’ while R1 was residing at the facility. Interview with the administrator also revealed, that R1’s roommate required oxygen, and that there were times R2 would share their oxygen with R1, against staff instructions not to, as it was not prescribed by R1’s primary physician. Continue on LIC 9099C.. During interview with R2, R2 denied sharing oxygen with R1 stating ‘you can’t do that without doctor’s orders.’ Interview with R1’s family member revealed, that R1 did not require oxygen supplies. Record review revealed, that there is no physicians order for oxygen prescribed to R1, nor that R1 required any oxygen supplies during R1’s stay at the facility. Based on record review, and Interviews conducted with the administrator, R2, and R1’s family member R1 did not have any physicians orders for oxygen supplies while living at the facility. Therefore, there is insufficient evidence to support the allegation ‘Failure to meet residents needs for restricted health care conditions.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. Regarding the allegation, ‘Failure to ensure compliance with personnel requirements,’ the complainant’s concern is that the facility staff had no knowledge of R1's needs for service, and that R1 was scheduled for dialysis. The complainant’s concern was also, that facility staff were unaware that R1 was living at the facility at the time of the visit. During the investigation, LPA Walker conducted interviews with S1, the administrator, and R1’s family member. Interview with S1 revealed, that ‘S1 and the Administrator were in charge of arranging transportation for R1’s dialysis.’ Interview with the administrator revealed, that the administrator and the facility med tech are the two (2) staff that have always scheduled and arranged transportation. Interview with the administrator also revealed, that there were times the arranged transportation would not show for R1, and the administrator would have to transport R1 themselves to the Dialysis appointments. The Administrator denied allegations of facility staff having no knowledge of R1’s needs for services, and scheduled transportation to Dialysis appointments. Interview with R1’s family member revealed, that R1 had Dialysis appointments ‘once a day,’ and that Staff would call R1’s family member if the facility was running late for R1’s Dialysis appointments. Continue on LIC 9099C.. Based on interviews conducted with S1, the administrator, and R1’s family member, the facility staff were aware of R1’s needs for service, scheduled Dialysis appointments, and the facility staff were aware that R1 was living at the facility at the time of the visit. Therefore, there is insufficient evidence to support the allegation ‘Failure to ensure compliance with personnel requirements.’ Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 29, 2022 · control 29-AS-20200820143226

Allegation investigated: Questionable Death

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit on 03/24/2022 to deliver findings for the above allegation. The initial visit was conducted on 12/16/2020 by LPA Eva Miller telephonically via a video chat and subsequent visits were conducted on 03/04/2022 and 03/11/2022 by LPA Camara. During today’s visit, the LPA met with the facility administrator, Judith Muro and explained the reason for the visit. On 12/15/2020, the Department received a complaint regarding the allegation Resident #1 (R1) suffered a questionable death while in care. (continued on 9099-C) Unsubstantiated On 12/16/2020, between 11:00 a.m. and 11:45 a.m., LPA Miller conducted the initial complaint visit. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint investigation was conducted telephonically. LPA conducted an interview and physical plant tour via video chat with facility administrator Judith Muro. LPA requested copies of pertinent documents relevant to the investigation and noted further investigation would be required. During LPA Camara’s visit to the facility on 03/04/2022 between 9:47 a.m. and 11:47 a.m., LPA interviewed the administrator at 9:47 a.m., staff 1 at 10:42 a.m. and staff 2 at 10:46 a.m. LPA obtained pertinent documents and conducted a brief facility tour at 11:18 a.m. LPA also conducted a telephonic interview with staff 3 at 3:33 p.m. During LPA Camara’s visit to the facility on 03/11/2022 between 11:35 a.m. and 12:28 p.m., LPA interviewed staff 4 at 11:07 a.m. and staff 5 at 12:15 p.m. as well as obtained more documents. LPA also conducted a collateral visit with R1’s physician on 03/11/2022 between 1:00 p.m. and 2:18 p.m. The administrator and staff stated that other than going to the dining room for meals, R1 stayed inside their single occupancy room. R1’s room was equipped with a television which R1 enjoyed watching and R1’s family sent care packages of snack foods which R1 also enjoyed. R1 was friendly but did not have any close friends at the facility. R1 only had one family member who would occasionally visit. R1 did not require assistance with activities of daily living. R1 did receive medication management. Staff stated that since R1 was mostly independent, when they would check on R1 they would knock on the door for permission to enter R1’s room. Staff stated R1 was last seen at approximately 5:00 p.m. on 12/09/2020, watching television in R1’s room. R1 said goodbye to the staff who checked in as they were leaving for the day. Staff observed R1 was lying in bed watching television; R1 had no complaints. Other staff indicated R1 never complained about not feeling well or anything else; R1 was a very pleasant person. On 12/10/2020, at approximately 08:00 a.m. staff were concerned because R1 had not come to the dining room for breakfast which was very unusual. Staff knocked on R1’s door and when there was no answer, they used a key to unlock R1’s door. It appeared R1 had been sitting on the side of the bed as R1 was found fully clothed and laying across the bed, deceased. Information gathered reflected R1 was initially admitted to the facility on 08/28/2017 from another assisted living facility. R1’s physician’s report used for admission was from a physician in Hudson, New York dated (continued on 9099-C) 03/23/2015. Physicians’ reports in the facility records for R1 were dated as follows: 09/17/2018, 10/09/2019, and 10/07/2020 all completed by R1’s primary treating physician. R1’s physician also examined R1 on the following dates: 10/04/2019, 06/12/2020, 07/16/2020, 10/11/2020 and 11/02/2020. According to R1’s physician, R1 visited his office on 10/04/2019, the other visits occurred at the facility. During the 10/04/2019 visit an electrocardiogram (ECG) was performed as well as a blood draw for lab work. The ECG showed R1 had suffered two prior heart attacks: one significant and one minor. R1 had no recollection of suffering previous cardiac events. R1’s physician stated R1’s lab results showed R1 appeared to be diabetic. R1’s physician explained it is not unusual for a person with diabetes to not feel chest pain; it is known as a silent heart attack. R1’s physician encouraged R1 to eat healthier and exercise. R1 was told to return to the physician’s office after fasting so more blood work could be obtained, and the physician could determine what type of diabetes medications to prescribe. However, R1 never followed through with getting fasting blood work done. R1’s physician stated R1 was capable of following up on medical appointments. R1’s physician was unaware of R1 having any family involved in her medical care. R1’s physician stated the lack of blood work did not cause R1’s death. R1 was taking two blood pressure medications. Staff who handle making medical appointments did not recall any requests from R1’s physician for fasting blood work. R1’s physician sees several residents who reside at the facility and has an office in a small room on the first floor of the facility. If the physician wants staff to follow up on something like appointments for blood work, the physician notifies one of the medication technicians. However, some of the physician’s patients handle their own follow up medical care needs. During the time surrounding R1’s death, the facility had an outbreak of COVID-19. R1 had a PCR test done on 12/06/2020 and tested negative for COVID-19. The death certificate indicated the immediate cause of death was acute myocardial infarction with underlying causes listed as hypertensive arteriosclerotic heart disease, diabetes mellitus, hyperlipidemia, and obesity. Based on the medical records, staff interviews and an interview with R1’s physician, it does not appear that lack of following through with blood work led to R1’s death. There is insufficient evidence to confirm that R1’s death was due to facility staff neglect; therefore, this allegation is deemed Unsubstantiated at this time. Exit interview conducted and a copy of the report issued.the state’s words, verbatim · CDSS document, Mar 24, 2022 · control 29-AS-20201215170320

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced Case Management – Deficiencies visit on 03/24/2022, in conjunction with complaint control # 29-AS-20201215170320 met with facility administrator Judith Muro and explained the reason for the visit. During the course of the investigation of the above noted complaint, it was discovered the administrator failed to obtain a current physician’s report upon admission of Resident #1 (R1). R1 was admitted to the facility on 08/28/2017 using a physician’s report from a physician in Hudson, New York dated 03/23/2015. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, today's reports and appeal rights were reviewed and issued.the state’s words, verbatim · CDSS document, Mar 24, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Mar 31, 2022

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement was not met as evidenced by: R1 was admitted on 08/28/2017 using a physician's report dated 03/23/2015, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 24, 2022

Plan of correction: Administrator will submit a plan for ensuring current medical assessments are obtained prior to resident admission to the facility. This will be submitted to CCL by 3/31/2022.

Allegation investigated: Facility staff did not provide a copy of resident's records to resident's representative in a timely manner

Licensing Program Analyst (LPA) Emily Peraldi, conducted an unannounced subsequent complaint visit to this facility. At 10:07 a.m., LPA met with the Administrator and explained the reason for the visit. During the initial visit on 06/23/2021, LPA Emily Peraldi interviewed the Administrator and seven (7) out of seventy-four (74) residents and requested pertinent documents. On 10/14/2021, LPA Peraldi toured the facility, interviewed the Administrator and received copies of requested documents. Regarding the allegation: Facility staff did not provide a copy of resident's records to resident's representative in a timely manner. Continued on LIC 9099-C. Substantiated On 06/18/2021, it was alleged that the facility did not provide a copy of resident’s records to Resident #1’s (R1’s) representative in a timely manner. To investigate on 06/23/2021, 10/12/2021 and 10/14/2021, LPA Peraldi conducted record reviews of pertinent documents. In addition, on 06/23/2021 and on 10/14/2021, LPA Peraldi interviewed the Administrator. The interview with the Administrator revealed that the facility had faxed over the R1’s records to R1’s representative on time but that R1’s representative never received it. The facility sent R’1s records again on 06/17/2021 via email to R1’s representative. Additionally, LPA Peraldi conducted an interview and requested documents from R1’s representative on 10/12/2021. The record review conducted on 10/12/2021, revealed that R1’s representative requested for R1’s records on 06/08/2021 and on 06/21/2021 records were received via email. Per regulation, the facility is required to provide prompt access to review all of resident’s records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. Per record review and interviews, the facility did not provide copies of R’1s records to R1’s representative within the two (2) business days’ time frame. Based on the information obtained, there is sufficient evidence to support the claim that facility did not provide R1’s records to R1’s representative in a timely manner. This allegation is deemed Substantiated at this time. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D): Exit interview conducted and report reviewed with Administrator. A copy of reports and appeal rights will be emailed.the state’s words, verbatim · CDSS document, Mar 18, 2022 · control 29-AS-20210618161840

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Mar 23, 2022

87468.2: Additional Personal Rights of Residents in Privately Operated Facilities. (19)To have prompt access to review all of their records...Photocopied records shall be provided within two (2) business days...This requirement is not met as evidenced by: Based on record review and interviews, the licensee did not comply with the section cited above, as the facility failed to provide R1’s records to R1’s representative in a timely manner, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 18, 2022

Plan of correction: The licensee agreed to do the following: An in-service training to be held with administrative staff in regard to regulation 87468.2 (a)(19). Sign-in sheet and appropriate documents to be submitted by 03/23/2022.

Allegation investigated: Staff do not administer resident's medication as prescribed

Licensing Program Analyst (LPA), Martha Guzman Chavez conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegation. The initial visit was conducted on 10/08/2020 by LPA D. Perera and a subsequent visit was conducted on 10/12/2021 by LPA’s Martha Guzman Chavez and KaSandra Lopez. On today’s visit, LPA Guzman Chavez met with Med-Tech Rosalba Monarrez. Entrance interview conducted. During the initial visit on 10/08/2020, LPA D. Perera conducted a telephonic interview with Administrator, Judith Muro at 10:16 a.m. and obtained copies of pertinent documents. On 10/12/2021, LPA’s Guzman Chavez and Lopez conducted a physical plant tour with Administrator at 11:26 a.m. and conducted a file review of resident files between 10:45 a.m. and 11:25 a.m. Additionally, LPA’s interviewed Med-Tech at 12:10 p.m. and audited medications and centrally stored for three random residents between 12:19 p.m. and 12:48 p.m. Continued on LIC 9099... Unsubstantiated Conitnued from LIC 9099... It was alleged that staff do not administer resident's medication as prescribed. It was reported that Resident #1 (R1) medications had not been administered to them during the evening hours as prescribed. Furthermore, review of Medication Administration Record (MAR) by an outside nurse was observed to be mostly blank except for a couple initials to indicate medications were administered during September 2020 and on occasion in which the client refused his medication. Interview with the administrator revealed that the facility uses both the MAR and centrally stored to keep track of their medication. Administrator stated that pharmacy audits are conducted every six months and they check random samples of residents. According to administrator, R1 had no issues with their medication. If at any time, a resident was not able to pay for their medications, the facility paid. Furthermore, LPA obtained a statement from R1’s former pharmacy which stated, “they never withheld delivery of medications for patients for any reason such as facility not paying for copays because it is not the facility’s responsibility to pay. We also have a policy of trying all means to work with patients to set up payment plans for patients that cannot afford copays or to see if they are eligible for forgiveness.” During the medications and centrally stored audit, LPA’s observed the centrally stored to be complete. The centrally stored for September 2020 had medication Albuterol 90 mcg, to be taken by mouth four (4) times a day as needed; however, medication was self-administered by R1. At that point, R1 had the ability to request for those PRN when needed and staff would administer it. In fact, the centrally stored had refusals for certain medications, the nurse’s notes tracked the refusal for those specific times as well stating contact with residents’ doctor regarding medication refusal. Based on record review, the allegation of “Staff do not administer resident's medication as prescribed.” is deemed Unsubstantiated at this time. Exit interview conducted. No citations issued. A copy of report provided via email.the state’s words, verbatim · CDSS document, Jan 3, 2022 · control 29-AS-20200928134359

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit at 11:28 a.m. LPA was greeted and screened by staff. This annual had a specific emphasis on infection control practices and procedures. At 11:48 a.m. LPA and Administrator began the physical plant tour inside and outside to ensure there are no health and safety hazards and facility is in compliance with the Title 22 Regulations. OUTDOOR SPACE: LPA observed the side and front lot, which has a covered outdoor area for resident use. There is an open gate at the front of the facility. KITCHEN: At 11:51 a.m. LPA observed the kitchen/dining area. Knives are stored in the locked kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Emergency food and water are located in a storage room. At 11:55 a.m., LPA observed staff preparing food in the kitchen. BEDROOMS: LPA observed multiple resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Passageways were free and clear from obstruction. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skids mats. At 12:06 p.m. LPA observed hot water to be measured at 140.2-degree Fahrenheit. Administrator observed the hot water temperature and requested maintenance to set the hot water no more than 120-degree Fahrenheit. At 2:04 p.m. LPA observed hot water temperature to be measured at 106.1-degree Fahrenheit. Continued on LIC 809C. Continued from LIC 809 COMMON AREAS: At 12:00 p.m., LPA observed common areas to be relatively clean and properly furnished. LPA observed staff cleaning common areas and hallways on both the first and second floor. At 11: 59 a.m. LPA observed fire extinguishers throughout the facility hallways on both floors and all were last serviced on 10/21/2020. At 12:14 p.m. Administrator provided a copy of the Fire Alarm inspection report from 7/27/2021 indicating that the Fire Alarms passed inspection. Medications and first aid kits are in a locked medication room located on the ground floor. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the maintenance room. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a 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 has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. Between 11:30 a.m. - 2:00 p.m., LPA conducted Infection Control mitigation module with Administrator. The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided via email.the state’s words, verbatim · CDSS document, Oct 14, 2021

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an unannounced case management visit to the above facility. LPA met with Administrator Judith Montoya and explained the reason for today’s visit. On 12/24/2020, the Department issued PIN 20-48-ASC, which notified licensees of a requirement to submit a Mitigation Plan Report by 01/24/2021. The PIN advised licensees that ‘Due to the global COVID-19 pandemic, the California Department of Social Services is requiring all licensees of Adult & Senior Care facilities to submit a Mitigation Plan Report to address epidemic outbreaks or communicable diseases specific to COVID-19 by January 24, 2021 pursuant to the following sections of the California Code of Regulations (CCR): Title 22, (Section 87211(a)(2). Administrator had Mitigation Plan ready and handed a hard copy to LPA during visit. LPA returned to facility at 2:20pm to have report signed. Report singed by Representative of facility, Mark Ingber. Pursuant to Title 22, Division 6, facility observed to be compliant with regulation. No corrections needed at this time. Exit interview conducted. A copy of the report and appeal rights were provided via email.the state’s words, verbatim · CDSS document, Jul 12, 2021