Marble Terrace

Allegation investigated: . Staff yell at resident 2. Staff make inappropriate comments towards resident 3. Resident denied phone calls 4. Staff do not provide residents with activities 5. Staff did not safeguard residents personal belongings 6. Residents are left unattended 7. Resident sustained injury while in care 8.Staff do not provide adequate food service

Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit to deliver the final findings of the allegation mentioned above. LPA met with Administrator Bozena Kozbial and the following was determined: Allegation # 1: Staff yell at resident: Concerns were expressed “Staff yell at residents. On June 30, 2021, and April 28, 2023, from various times, 10am to 4pm, LPA conducted interviews with the complainant, staff, and residents. On both days, according to interviews, residents have never witnessed staff yell or scream at them; nor have they witnessed staff yell or scream at other residents. Residents reported they were happy at the facility, and staff were respectful and caring. Therefore, based on interviews, LPA could not prove “Staff yell resident”, and at this time, the allegation is UNSUBSTANTIATED. Unsubstantiated Allegation # 2: Staff made an inappropriate comment to the resident; Concerns were expressed, “Staff made an inappropriate comment to the resident. On June 30, 2021, and April 28, 2023, from various times, from 10am to 4pm, LPA conducted interviews with the complainant, staff, and residents. From information obtained, LPA determined that, there were no witnesses, who heard staff make any inappropriate comment to any residents at the facility. Residents reported to LPA, the have never heard staff be inappropriate to residents while in care, and reported, that staff are respectful and caring. Therefore, based on interviews, the allegation is deemed UNSUBSTANTIATED at this time. Allegation # 3: Resident denied phone calls: Concerns were expressed that “resident was denied phone calls”. On June 30, 2021, and April 28, 2023, from various times, from 10am to 4pm, LPA conducted interviews with the complainant, staff, and residents. It was reported that resident #1 (R1) was denied making long distance phone calls and staff was listening to R1’s personal phone calls. Interviews reported that all residents are allowed to make local and long-distance, and residents always have access to the facility phone. Residents reported to LPA, that they rarely use the facility phone, because they have personal cellphone. Residents also stated, they have privacy, and never observed staff listening to their phone calls. Administrator and all staff also denied interfering with R1’s personal call. Therefore, based on interviews, the allegation is Unsubstantiated at this time. Allegation # 4 Staff do not provide residents with activities: Concerns were express, that “Staff do not provide residents with activities. On June 30, 2021, and April 28, 2023, from various times, from 10am to 4pm, LPA conducted interviews with the complainant staff, and residents. The Administrator stated that they do offer activities to the residents, however the residents in care enjoy their privacy and are not very active. The Administrator stated that for the most part, residents deny certain activities, but they do engage in conversations, games, and TV watching in the common rooms with staff. LPA conducted interviews with residents who were able to communicate, and they stated that they do not care much for games or activities. They enjoy watching TV, talking to family, and enjoy their privacy, and for the most part, keep to themselves. Based on interviews, the allegation mentioned above is Unsubstantiated at this time. Allegation # 5: Staff did not safeguard residents’ personal belongings: Concerns were expressed, that “Staff did not safeguard resident’s personal belongings. On June 30, 2021, and April 28, 2023, from various times, from 10am to 4pm, LPA conducted interviews with staff, residents, and witness. LPA received documentation. from the facility, that during the day of resident #1 (R1) moving out of the facility, R1 signed a document, showing which items were being given to her, and what R1 was leaving with. It was also reported to LPA, that R1’s family member, had possession of R1 property before she moved into the facility, and the family member also moved R1’s property into a storage unit. R1 was not aware of what was in the storage, and R1 was not aware of what property was given to R1 when R1 moved into the facility. Facility staff reported to LPA, for a period of time, the facility maintained R1’s personal property in their garage, but after a period of time, the family member removed the property for R1. LPA determined, there is no accurate documentation of what property R1 had. Also, LPA observed on the day R1 moving out of the facility, R1’s property was being moved out with R1’s family friend. Therefore, based on interviews, and observation, the allegation is Unsubstantiated at this time. Allegation # 6: Staff do not provide adequate food service: Concerns were expressed that “Staff do not provide adequate food service”. On June 30, 2021, and April 28, 2023, from various times, from 10am to 4pm, LPA conducted interviews with staff, residents, and conducted a physical plant inspection. During the visit on April 28, 2023, LPA toured the facility and observed an abundance of fresh fruits and vegetable, and an adequate supply of perishables. Residents reported to LPA that the food is good, and there are no issues or concerns with the quality. Also, during the visit, LPA observed the lunch that was served, and it observed to be healthy and fresh. There was also a variety of food for residents. Therefore, based on interviews and observations, the allegation is Unsubstantiated at this time. Allegation # 7: Residents are left unattended: Concerns were expressed that “Residents are left unattended”. On June 30, 2021, and April 28, 2023, from various times, between 10am to 4pm, LPA conducted interviews with staff, and residents. LPA conducted interviews with staff and residents. Interviews of staff denied leaving any resident unattended at the facility at any given time. Interviews with residents indicated that they have not experienced and/or observed staff leaving them unattended at any time. Based on interviews, the allegation is Unsubstantiated at this time. Allegation # 8: Resident sustained injury while care. Concerns were expressed that “Resident sustained injury while in care. On June 30, 2021, and April 28, 2023, from various times, between 10am to 4pm, LPA conducted interviews with the complainant, staff and residents. Information obtained, revealed resident # 1 (R1) was admitted to the facility with already an injury to the leg, and was receiving home health services to treat the wound on the leg. Interviews also revealed, there was no witnesses of R1 being injured, or that staff injured R1. Therefore, based on interviews, there is insufficient evidence that R1 sustained an injury while in care, and the allegation is Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Aug 11, 2023 · control 31-AS-20210621085541

Allegation investigated: . Resident sustained unexplained bruising 2. Resident sustained pressure injuries while in care

Licensing Program Analyst (LPA) Tuesday Cabiness met with Co-Administrator Bozena Kozbial to deliver the final finding of the allegations mentioned above. The following was determined: Allegation # 1: Resident sustained unexplained bruising: Concerns were expressed that resident # 1(R1) sustained unexplained bruising while in care at the facility. On March 10, 2021; May 25, 2021; March 11, 2022; and March 16, 2022, from various times from 8am to 4pm, LPA conducted interviews with the complainant, staff, and R1’s family member. LPA also requested resident and medical documents pertaining to R1. Records and information were obtained and reviewed. Based on interviews from staff and R1’s family member, R1 was on and off hospice for over (2) years. In February 2021, R1’s health began to deteriorate, and was R1 non-ambulatory and bedridden. R1 was provided the appropriate and proper level of care, but due to R1’s history of lower extremities edema and sensitive skin, R1 tended to bruise easily. R1 was not able to be interviewed due to R1 passing away on May 02, 2021. Medical records confirm a history of skin related issues and that R1 was completely dependent on staff for ADL’s (activities of daily living) which could explain Unsubstantiated any bruises. Also, interviews revealed that no one witnessed R1 being mishandled by staff and family and others were happy with the care provided by the facility. It was also revealed to the LPA that there were concerns with services provided to R1 without the permission of the Power of Attorney (POA) who questioned why R1 was assessed without their knowledge. Therefore, based on interviews, resident and medical records, pertaining to R1, the allegation is UNSUBSTANTIATED. Allegation # 2: Resident sustained pressure injuries while in care: Concerns were expressed that resident # 1 (R1) sustained pressure injuries while in care. On March 10, 2021; May 25, 2021; March 11, 2022; and March 16, 2022, from various times, 8am to 4pm, LPA conducted interviews with the complainant, staff, and R1’s family member. LPA also requested and reviewed resident and medical documents pertaining to R1. Records and information were obtained and revealed that R1 was on and off hospice for over (2) years. In February 2021, R1’s health began to deteriorate, and according to information obtained by staff, R1 was non-ambulatory and bedridden, and in February 2021, staff observed R1 developing a pressure injury on the coccyx area. Staff immediately contacted the primary physician, who then ordered home health to treat the wound. R1’s insurance, Kaiser Hospital, contracted an agency to assist in providing home health services for R1. On March 10, 2021; May 25, 2021; March 11, 2022; and March 16, 2022, from various times, from 8am to 4pm, LPA reviewed home health records, and it was reported that the beginning onset of R1’s stage 2 pressure injury was February 24, 2021, in which that was also the initial treatment for the wound. R1 had a history of lower extremities edema and sensitive skin and was totally dependent on staff for all ADL’s (assisted daily living). Home health was contacted to treat the wound and provided specific instructions for staff on proper wound care management. It was documented, on March 05, 2021, R1 sustained another wound, on the right big toe, during the time, home health was providing treatment for the initial wound. R1 already had a podiatrist for nail care, and staff were instructed to contact the podiatrist for the wound located on the toe. R1 was discharged from home health with the contracted agency on March 10, 2021 and R1’s primary insurance was to continue providing treatment. Although the allegation reported resident sustained pressure injuries while in care, R1 had resided in the facility since March 2017, and documents reviewed, revealed that the first onset of the first wound was in February 2021, observed by staff. Staff contacted the primary physician and home health services were ordered, and treatment was provided. LPA determined that the facility followed the appropriate protocols and procedures for R1, once the onset of the wound began, so there is insufficient evidence to prove resident sustained pressure injuries while in care. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit interview was conducted, and a copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 7, 2022 · control 31-AS-20210309100124

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an annual infection control inspection. LPA met with the administrator, Bozena "Bonnie" Kozbial and advised her of the visit. The current census is five (5). Facility license and sketch, rights of resident council, grievance/complaint procedures, emergency disaster plan, resident bill of rights, personal rights, and neighborhood complaint procedures visibly posted. Annual fees are current and administrator certificate expires 7/31/2022 which is current and valid. Bonnie stated she is in the process of renewing her certificate. A physical plant tour of the facility inside and outside was conducted with the Administrator. The following common areas: living, dining, kitchen, resident bedrooms, bathrooms, staff room and office, were inspected to ensure the facility was in compliance with Title 22 Regulations: Kitchen/Food Supply: Food service area had Licensing requirement of (7) day nonperishable, and (2) day perishable. Food was properly stored in a healthy manner. Snacks and beverages are available for clients. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas were clean and inaccessible to pests. Appliances were functional and clean. Chemicals, household supplies, and knives, and medication was locked and secured. Living/dining/family/staff area and office: All indoor passageways were free from obstruction; inside temperature was comfortable and set at 72 degrees, with adequate lighting, and all areas were clean and appropriately furnished for resident’s comfort. Bedrooms: The facility has (4) bedrooms; (2) are private and (2) are shared. All bedrooms were properly furnished and supplied with appropriate bedding and linens. Rooms observed to have bedspread, sheets, pillowcase, mattress pad, and blankets, which were all in good repair. There were sufficient linens observed and available. Bathrooms: There are (3); all were clean, with soap and towels, grab bars, and non-skid mats. Hot water measured in resident’s bathroom at 113 degrees Fahrenheit. Surrounding Grounds: Smoke alarms and carbon monoxide detectors were tested and operating properly. Fire extinguisher is fully charged. The charge date is 5/18/21. Administrator stated the fire department will be out by mid May to inspect the facility and their fire extinguisher. First aid kit furnished and fully equipped. All exit doors have alarms; all were operating. There were no visible hazards, and passageways were free from obstruction. There is a covered patio in the backyard with appropriate seating for residents when sitting outside. There are exercise equipment for the residents to utilize. The swimming pool is gated with a five foot fence and is locked and secured all around. The front yard/driveway posed no immediate health and safety threat to the residents in care. There is fountain, but no water located at the front lawn. Pursuant to title 22, division 6, chapter 8, there were no deficiencies observed during the day's inspection. The administrator was advised and a copy of this report given.the state’s words, verbatim · CDSS document, May 3, 2022

Allegation investigated: Staff hit resident in care

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit. LPA met with the administrator and explained the reason for this visit. LPA conducted a physical plant walk through and did not observe any immediate health and safety issues. It is alleged that resident #1 (R1) was hit by staff # 1(S1) Previous visits regarding the allegation above was conducted on 9/13/21 and 9/28/21 and interviews were conducted with all residents in the facility. A finding of Unsubstantiated was given on the allegation above. However after review by management it was found that more interviews needed to be conducted. During today's visit LPA conducted interviews with facility staff regarding the allegation above from approximately 11:45am-12:30pm. Information obtained through interviews with staff present reveal they have never witnessed R1 hit by S1 or any other staff. Based on the information obtained this allegation is still deemed Unsubstantiated as it was before. Exit Interview conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 17, 2021 · control 31-AS-20210907115151

Allegation investigated: . Staff hit resident in care 2. Staff yelled at resident in care 3. Residents are not assisted with their showers 4. Staff did not safeguard resident's personal belongings

Licensing Program Analyst (LPA) Calvin Tsui and Alex Pritz conducted a subsequent complaint visit at the facility and met with Bonzena Kozbial at around 2:00pm. On 9/13/21 LPAs Calvin Tsui and Wendell Smith along with Licensing Program Manager Cassandra Harris visited the facility. Interviews where conducted with 6/6 of the residents and resident files where reviewed. Allegation #1, that "staff hit resident in care," is unsubstantiated based on the interviews conducted. 6/6 residents interviewed on 9/13/21 denied being hit or seeing other residents hit by staff. Allegation #2, that "staff yelled at resident in care," is unsubstantiated based on the interviews conducted. 6/6 residents interviewed on 9/13/21 denied yelled at by staff. Unsubstantiated Allegation #3, that "Residents are not assisted with their showers," is unsubstantiated based on the interviews conducted. 6/6 residents interviewed on 9/13/21 stated that staff where available to assist with showers. Allegation #4, that "Staff did not safeguard resident's personal belongings," is unsubstantiated based on the interviews conducted. 6/6 residents interviewed on 9/13/21 stated that staff did not touch their personal belongings or otherwise fail to safeguard them. report reviewed and signed exit interview conducted.the state’s words, verbatim · CDSS document, Sep 28, 2021 · control 31-AS-20210907115151