Trudez Home Care

Allegation investigated: Resident was severely dehydrated in care which resulted in hospitalization Staff neglect led to resident sustaining multiple pressure injuries Staff mismanaged resident's medication Staff handled resident in a rough manner

On 10/10/23 at 10:00 AM, Licensing Program Analysts (LPAs) Abeye Duguma, Leslie Ngo-Castaneda and Huma Rahimi conducted a subsequent visit to this location to deliver the findings on the above-mentioned allegations. LPAs met with Ramijia Bergonio and explained the reason for the visit. Ramijia Bergonio was designated by the Administrator to sign and accept this report. The complaint investigation was initiated by LPA Duguma and completed by Senior Investigator Edward Hector from Community Care Licensing (CCLD) Investigations Branch (IB). --- Resident was severely dehydrated in care which resulted in hospitalization. It was alleged that Resident #1 (R1) was severely dehydrated which resulted in hospitalization. During the investigation, on 03/27/2023, IB investigator conducted interviews with facility staff and residents. On 05/02/2023, IB investigator conducted interviews with other witnesses. On 05/03/2023, IB investigator requested and received R1’s medical records from the home health agency and hospital. (Cont. on LIC 812-C) Unsubstantiated Staff revealed that they always keep juice and water next to R1’s bed and that R1 was drinking fluids regularly. A review of medical records from the home health care agency revealed that R1 had no signs and symptoms of dehydration. A review of hospital records did not reveal any information to verify that at the time of admission to the hospital R1 was dehydrated. . Based on interviews and record review, there is no sufficient evidence to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Staff neglect led to resident sustaining multiple pressure injuries It was alleged that Resident #1 (R1) developed stage three (03) injuries while in care of the facility. During the investigation, on 03/27/2023, IB investigator conducted interviews with facility staff and residents. On 05/02/2023, IB investigator conducted interviews with other witnesses. On 05/03/2023, IB investigator reviewed medical records previously requested from the home health agency and the hospital. Staff revealed that R1 never had stage 3 pressure injuries prior to R1’s hospitalization on 08/28/2022. A review of home health records verified the information revealed from staff. Upon review of hospital record, no medical information was noted to conclude that R1 had Stage 3 pressure injuries at the time of admission to the hospital on 08/28/2022. The medical records and interviews revealed consistent information that R1 was admitted to the hospital with stage three (03) pressure injury. Based on interviews and record review, there is not enough evidence to support the allegation that there was a lack of care resulting in R1 developing a stage three (03) pressure injury. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Staff mismanaged resident's medication It was alleged that staff stopped giving the resident’s prescribed medication without doctor’s consent. To investigate the allegation, on 02/27/2023 at 10:30 AM, LPA Duguma requested documents and interviewed three (03) staff between 11:30 AM to 1:00 PM. On 10/10/2023 at around 12:00 PM, LPAs interviewed two (02) out of four (04) residents. (Cont. on LIC9099-C) During record reviews, the Medication Administration Records revealed that Resident #1 (R1) was given medications as prescribed by the physician. During interviews with staff, all staff stated that R1 was given medications as prescribed. During interviews with residents, two (02) out of four (04) residents stated that staff give medications as prescribed by the physician. LPAs were unable to interview two (02) out of four (04) due to diagnosis. Based on interviews and record review, there is not enough evidence to support the allegation that medication was not given to R1 as prescribed. Therefore, the allegation is UNSUBSTANTIATED at this time. --- Staff handled resident in a rough manner It was alleged that staff handled the resident in a rough manner. To investigate the allegation, on 02/27/2023, LPA Duguma interviewed three (03) staff between 11:30 AM to 1:00 PM. On 10/10/2023 at around 12:00 PM, LPAs interviewed two (02) out of four (04) residents. During interviews with staff, all staff stated that they are not handling residents in a rough manner, and they are gentle with everyone. During interviews with residents, two (02) out of four (04) residents stated that staff are gentle and do not handle them in a rough manner. LPAs were unable to interview two (02) out of four (04) due to diagnosis. LPA Duguma attempted to contact other parties but to no avail. Based on interviews, there is not enough evidence to support the allegation that staff handled resident in a rough manner. Therefore, the allegation is UNSUBSTANTIATED at this time. No health and safety hazards noted during this visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Oct 10, 2023 · control 31-AS-20230224103159

Allegation investigated: Facility has not providing refund after residents death

Licensing Program Analyst (LPA) Angela Panushkina conducted a subsequent complaint visit to this location to deliver the findings on the above allegation. LPA met with Consuello Cipriano, Staff Member, who granted access to the facility. Administrator was contacted and LPA explained the reason for the visit. LPA was informed that the Administrator cannot come to the facility and designated one of the staff members to sign the report. It is being alleged that staff failed to provide a refund to Resident#1 (R1)’s family after R1 passed and R1’s belongings have been removed from the facility. During the investigation LPA reviewed and obtained copies of pertinent facility and R1’s records. LPA also conducted interviews with staff and the R1’s family. Interviews revealed that R1 was admitted to the facility on 09/01/2021 with R1’s rent for the month of September 2021 paid in full. R1 passed away on 09/07/2021. Furthermore, interviews revealed that R1 had no Continue on LIC9099-C Substantiated belongings that had to be removed. A refund was requested by R1's family; however, a prorated refund was/has not been issued. Based on R1’s admission agreement, Health and Safety Code 1569.652 and Assembly Bill 261 a refund is to be issued within 15 days after the personal property of a resident has been removed. Therefore, based on the information obtained, the allegation is deemed Substantiated. Exit interview conducted, deficiency, appeal rights discussed, and a copy of this report was issuedthe state’s words, verbatim · CDSS document, Dec 21, 2022 · control 31-AS-20220210104450

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Dec 28, 2022

Termination of admission agreement upon death of resident; removal of resident’s... A refund of any fees paid in advance covering the time after the resident’s personal property has been removed... within 15 days after the personal property is removed. This requirement is not met as evidenced by: Based on record review & interview, licensee did not issue a refund within 15 days of R1's personal property being removed which posed a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 21, 2022

Plan of correction: Administrator will have to pay the pro-rated amount to R1's responsible party for the remaining days of September after R1 passed away and their belongings were removed. R1's rate for basic services was $2100/ month at the time of passing. Proof copy of check will be emailed to LPA by POC date

Type of visit: Required - 1 Year

At 10:15am Licensing Program Analyst (LPA), Angela Panushkina, conducted an unannounced annual inspection at the facility mentioned above. LPA was greeted by Consuello Cipriano (staff), who granted access to the facility. The Administrator was contacted over the phone and LPA explained the reason for the visit. At 10:30am, LPA conducted a tour of the facility with staff and the following was observed: Kitchen: LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. The fire extinguisher was last serviced on 04/11/2022. Medications: At approximately, 10:35am LPA observed medications are centrally stored and locked in a kitchen cabinet, area and inaccessible to residents in care. Bedrooms: There are three (3) bedrooms designated for residents use and have sufficient lighting. LPA observed full rails placed on bed. Facility has an extra room for the live-in staff members Bathrooms: At 11:00am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. LPA observed appropriate grab bar and non-skid mat. LPA observed appropriate hand washing signs posted in each bathroom. All trash cans in bathrooms had fitted lids to protect from cross contamination. Common Areas: The facility maintains a comfortable temperature at 74°F. The living room and dining area appeared clean and were properly furnished and the fireplace is adequately screened. No obstructions and or tripping hazards throughout the facility. During the walk through, LPA opened the closet door, by the main Continue on LIC809-C entrance, and observed a container with medications prescribed to Staff #2 (S2). LPA requested to remove medications from the closet and place it in a locked cabinet, immediately. The garage: Laundry area is located in an attached garage and kept locked and inaccessible to residents. Extra PPE supplies and food storage was also observed Outside areas: At approximately, 11:10am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for residents. LPA also observed various items stored in the backyard which need to be stored out of the way. LPA observed old/broken washer and a dryer, broken night stand, two mattresses and a hospital bed. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Gate was unlocked and easily accessible to open. Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 11:30am they were tested and observed to be operational. Additional Visit Information: Upon arrival to the facility LPA was told the facility currently has two (2) residents of which one (1) out of two (2) residents comes to this facility from 7:00am - 4:00pm for five (5) to seven (7) days a week. LPA attempted to contact Mr. Lopez to inform that the facility cannot be used as an Adult Day Care and if this individual is going to be at the facility they have to have a file for him/her. LPA also observed staff feeding the individual. From 11:30am to 12:00pm LPA conducted review of resident files and observed the following: R1's facility file had an Admission Agreement completed, only, and rest of the documents were left blank. In addition, the Physician Report was missing and LPA was informed that R1 moved to this facility on 12/18/22 and the facility still haven't received the completed document from R1's physician. LPA did not observe any orders on file for a full bed rails for R1. Deficiencies issued per Title 22. Exit interview conducted, appeal rights discussed and copy of this report issued.the state’s words, verbatim · CDSS document, Dec 21, 2022

Allegation investigated: Facility not following COVID-19 guidelines.

Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced initial complaint visit to this facility to investigate the above allegation. LPA met with the licensee, Walditrudez Lopez, who called the Administrator Vergilio Lopez and LPA explained the reason for the visit. Licensee left shotrly after. Infection control: Upon arrival LPA was not screened by Consuelo Cipriano (staff) and was not asked any infection control questions. LPA had to prompt and guide staff through the screening process. Facility Mitigation Plan was incomplete and the LPA requested to re-submit it to Community Care Licensing Department (CCLD) for an approval. Deficiencies issued per Title 22. Exit interview conducte, appeal rights explained and copy of this report emailed to the Administrator. Substantiatedthe state’s words, verbatim · CDSS document, Feb 15, 2022 · control 31-AS-20220214161532

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Feb 17, 2022

87468.1 Personal Rights of Residents in all Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: 2) To be accorded safe, healthful and comfortable... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above. The licensee failed to follow the infection control protocol on screening procedures. Staff was not familiar with screening procedures, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 15, 2022

Plan of correction: Licensee agreed submit Mitigation Plan for an approval and train all staff on Mitigation Plan and infection control which includes screening. Staff sign-in sheet and training materials shall be e-mailed to LPA by POC date.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Angela Panushkina met with Consuela Cipriano for a case management. The purpose of the case management visit was to issue deficiencies observed during today's complaint investigation. Deficiencies observed have nothing to do with complaint. Entrance interview. LPA observed a hospice resident in room #1. Facility does not have an approval for hospice. Following citations issued for the identified deficiencies pursuant to Title 22 Regulations on LIC809D. Exit interview conducted, appeal rights discussed and a copy of this report provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 15, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87632(a)(1) · Plan of correction due date: Feb 17, 2022

87632 Hospice Care Waiver (a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency... (1) Specification of the maximum number of terminally ill residents which the facility wants to have at any one time. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. R1 was admitted on hospice as of 12/29/21. However, the facility did not have an approval for hospice, which poses an immediate health, safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 15, 2022

Plan of correction: Administrator has agreed to submit a hospice waiver or relocate the resident immediately. Proof of waiver request or relocation address shall be submitted (CCLD) Community Care Licensing Department

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Angela Panushkina, conducted a case management, in conjunction to a complaint investigation, with control number 31-AS-20220210104450. During the investigation, it was revealed that two deaths occurred at the facility on 09/07/21 and 01/28/22, and the facility did not submit any Death Reports to Licensing agency. LPA spoke with the Administrator over the phone and the Administrator could not provide an explanation as to why the Death Reports were not sent to Licensing agency. Administrator asked to contact the facility Licensee, Walditrudez Lopez, for more information. Licensee was contacted and could not provide any explanations to LPA regarding the Death Reports not being submitted. LPA expressed the concern of not reporting incidents to Licensing agency and requested both reports to be submitted to Community Care Licensing Department (CCLD) promptly. This is a potential health and safety risk to residents in care. Citation issued, and copy of this report was emailed to the Administrator, Virgilio Lopezthe state’s words, verbatim · CDSS document, Feb 15, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80061(b)(1)(D) · Plan of correction due date: Feb 22, 2022

Reporting Requirements. (b) during the operation of the facility...(1) below, a report shall be made to the licensing agency within...seven days following the occurrence of such event... (D) Any injury to any client.. This requirement was not met evidenced by: Based on the interviews and record review, the Administrator did not comply with the section cited above by not reporting an incident/death of two residents to Licensing agency, which poses a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Feb 15, 2022

Plan of correction: Administrator ensured LPA that incident/death reports will be submitted acording to Licensing regulations. Death reports for both residents shall be submitted to LPA by POC date.

Allegation investigated: Allegation: Resident 1 (R1) developed a prohibited health condition due to improper care

An unannounced subsequent complaint visit was conducted on this day by Licensing Program Analyst (LPA) Yelena Avetisyan. This investigation was conducted by Edward Hector, Investigator with Community Care Licensing Division’s Investigations Branch. Regarding the allegation it was reported that resident 1 (R1) had a significant decline in condition from 12/9/2020 which was not reported to the resident’s physician. In addition, it was reported that on 6/2/2021 during a semi-Annual medical visit conducted at the facility R1 was found to have an unstageable pressure injury which R1’s physician did not have knowledge of. During the course of the investigation, From November 5, 2021 through November 12,2021 Investigator Hector conducted interview with various individuals including the licensee, facility staff, resident 2 (R2), and R1’s family/responsible party. On 6/7/2021 during the initial 10 day complaint visit LPA Avetisyan conducted interviews with the administrator and staff 1 (S1). On 7/16/2021 Investigator Hector received and reviewed R1’s medical records from Kaiser Permanente. Substantiated Information obtained from the interviews conducted and records reviewed revealed the following: Staff 1 (S1) observed the development of the pressure injury approximately the first week of May 2021 and provided treatment to the pressure injury. S1 expressed observing the area of the pressure injury progress to the color black. S1 reported that she and R1’s family/responsible party would provide wound care to R1. According to S1, R1’s family/responsible party contacted the doctor, which resulted in a visit by a medical staff. When interviewed on 11/5/2021 the licensee Waldi Lopez informed investigator Hector that R1 was on Palliative care with Kaiser before reported as having a pressure injury. Licensee also stated that they contacted Kaiser reported the residents decline and need for hospice care. Licensee could not provide a timeline of when these actions were taken. Licensee also indicated that R1’s responsible party would provide wound care to the resident with staff. When interviewed on 11/12/2021 R1’s family/responsible party disclosed being aware that S1 was treating R1’s wound, however she did not witness S1 or any facility staff provide wound care and denied assisting S1 or other facility staff to provide wound care. Additionally, R1’s responsible party indicated that she had no knowledge of the extent of the injury until Kaiser began treatment. On 12/9/2021 LPA Avetisyan conducted interview with the Kaiser Nurse Practitioner (NP) who visited R1. During the phone call the NP conducted review of R1’s medical records. While reviewing the records NP confirmed that R1 did not have an order or was receiving Palliative care prior to the 6/2/2021 home visit. R1’s records did not document communication from any individual regarding the change in R1’s condition or the pressure injury. The 6/2/2021 visit was a Semi-Annual visit and was not conducted due to a requested follow up. Information obtained during the course of the investigation revealed that the licensee/ administrator /staff neglected to address the change in R1’s condition by failing to notify R1’s physician when the pressure injury developed. Additionally, Staff 1 who is not a skilled medical professional provided improper care to the pressure injury resulting in the pressure injury worsening and being documented as Unstageable on 6/2/2021 therefore the allegation is Substantiated at this time. Exit interview conducted, with staff and copy of report, citations, civil penalties and appeal rights emailed to info@trudezhomecare.comthe state’s words, verbatim · CDSS document, Dec 21, 2021 · control 31-AS-20210604142033

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Jan 23, 2022

Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3, 4, unstageable pressure injuries. This Requirement was not met as evidenced by: Based on information obtained during the investigation, the licensee/ administrator/staff did not comply with the cited section by retaining R1 at the facility who developed a prohibited health condition due to improper wound care which posed an immediate health and safety and personal rights risk to R1the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/Administrator and all staff will attend at least 8 hours vendorized training regarding all sections cited on this report as well as allowable, restricted health conditions, hospice care, exception request. Verification of scheduled training with the trainers credentials will need to be submitted to LPA by 12/23/2021 and verification of completed training will need to be submitted to LPA by 1/7/2022 A civil penalty in the amount of $500 has been issued due the neglect/lack of timely medical care which resulted in R1 developing a prohibited health condition.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87611(c) · Plan of correction due date: Dec 23, 2021

87611 (c) In addition to section 87411(d), facility staff shall have knowledge and the ability to recognize and respond to problems and shall contact the physician, appropriately skilled professional, and/or vendor as necessary. This Requirement was not met as evidenced by: Based on information obtained during the investigation, the licensee/administrator/staff did not comply with the cited section by not having the knowledge and the ability to respond properly by contacting R1’s physician when R1 developed the pressure injury which posed an immediate health and safety and personal rights risk to R1the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/Administrator and all staff will attend at least 8 hours vendorized training regarding all sections cited on this report as well as allowable, restricted health conditions, hospice care, exception request. Verification of scheduled training with the trainers credentials will need to be submitted to LPA by 12/23/2021 and verification of completed training will need to be submitted to LPA by 1/7/2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87631(a)(3)(A) · Plan of correction due date: Dec 23, 2021

the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances:(3) Residents with a stage one or two pressure injury must have the condition diagnosed by a physician or an appropriately skilled professional. A)The resident shall receive care for the pressure injury from a physician or an appropriately skilled professional. This Requirement was not met as evidenced by: Based on information obtained during the investigation the licensee/administrator/staff did not comply with the cited section by not having R1’s pressure injury diagnosed and cared for by a physician or an appropriately skilled medical professional which posed anthe state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: immediate health and safety and personal rights risk to R1. Licensee/Administrator and all staff will attend at least 8 hours vendorized training regarding all sections cited on this report as well as allowable, restricted health conditions, hospice care, exception request. Verification of scheduled training with the trainers credentials will need to be submitted to LPA by 12/23/2021 and verification of completed training will need to be submitted to LPA by 1/7/2022

Type of visit: POC

An unannounced Plan of Correction (POC) in conjunction with a Subsequent Complaint (Complaint Control # 31-AS-20210604142033) visit was conducted on this day by Licensing Program Analyst (LPA) Yelena Avetisyan the purpose of this visit is to follow up on the Plan of Corrections (POCs) that were issued on 6/7/2021 On 6/9/2021, 11/27/2021, 12/9/2021 LPA Avetisyan sent an email to virgil.lopez@yahoo.com notifying the administrator that plan of corrections are still outstanding. A discussion was made via email however as of today's visit the licensee/administrator have failed to submit plan of corrections to the Department. Upon arrival to the facility LPA met with staff Consuelo Connie Cipriano and Manuel Cipriano. Ms. Cipriano contacted the licensee Waldi Lopez. Ms. Lopez informed the staff that administrator Virgilio Lopez is currently unavailable. Neither licensee or administrator were available to come to the facility. Per Staff the licensee has asked her to sign for the report. Approximately 2:30 pm LPA conducted a tour of the facility with Ms. Cipriano. While conducting tour LPA observed the following. RM 1: Currently being occupied by 2 residents. Resident 1 (R1) is currently utilizing a full rail and Resident # 2 (R2) is utilizing a half rail At 2:32 pm when asked staff stated that neither resident are currently receiving hospice services. Staff also informed the LPA that they have to reposition both residents every 2 hours because they are unable to do so. RM # 2 is currently being used as a staff room. RM # 3 is currently occupied by 1 resident (R4) RM#4 is currently being occupied by 1 hospice resident (R3) who is utilizing a full rail. LPA asked Ms. Cipriano where the 5th resident in residing. Staff walked the LPA to the living room and pointed toward a resident watching TV. LPA asked which room the resident is staying in. At 2:39 pm staff stated that the resident does not stay at the facility. Resident 5 (R5) is dropped off by family 7:00 am and picked up at 5:00 pm Tuesday through Saturday. From 2:45 pm LPA conducted review of the residents files and observed them to be incomplete. LPA also observed that licensee failed to complete the plan of corrections as cited during the 6/7/2021 visits. On 6/7/2021 the licensee was cited the following deficiencies. 87608 (a)(5)(B) : Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. During that visit the licensee was utilizing full bed rails for a resident who was on hospice however did not have the hospice care that documented the need for the full rails. Licensee was to submit copy of the hospice care plan as POC. During todays visit LPA observed 2 residents who are utilizing full rails (R1 and R4). R1 is not on hospice. R4 is on hospice however the licensee does not have the care plan that would indicate the need for the full rail. 87608 (a)(3) Postural Supports. A written order from a physician indicating the need for postural support shall be maintained in the resident’s record. The licensing agency is authorized to require additional documentation if needed. This requirement is not met as evidenced by: During that 6/7/2021 visit the licensee was utilizing postural support for 2 residents. Licensee was to obtain orders for the postural support and submit it to the LPA as POC. During today's visit LPA observed that R2 is currently utilizing postural supports and the licensee does not have any order from the physician. 87705 (c)(5)(A) Licensees who accept & retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment, & a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. During the 6/7/2021 licensee did not have current medical assessment for 4 residents who were diagnosed with Dementia. Licensee was to obtain current Medical Assessment for the residents, complete re-assessments and submit copies as POC. During todays visit LPA observed that the licensee does not have a current physicians report for R1. and physicians report for R2 is incomplete and inaccurate. At 3:23 pm LPA contacted the office of R1's PCP who will review the information and provide an update to the LPA. R1 was one of the 4 residents identified during the 6/7/2021 visit. 87465(a)(6)(D): Assistance with self-administration does not include forcing a resident to take medications, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. Licensee was to contact the residents physician and obtain orders to crush medications. During todays visit at 4:50 pm staff informed the LPA that she is currently crushing medications for R1 and R2 who are on a puree diet. Resident files did not document the order from the physician to crush the medications. 87465 (b)(c)(d) Licensee is required to have PRN authorization letter on file signed by a physician to determine whether or not the residents can communicate the need and/or symptoms clearly for the as needed (PRN) medication. During the visit licensee did not have PRN authorization letter for 4 out of 4 residents. During this visit while conducting review of the resident files LPA observed that the licensee/administrator did not obtain PRN authorization letters for any of their residents. 87465 (C3)(D3) (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. During the 6/7/2021 visit and todays visit record reviews revealed that the licensee is not utilizing PRN administration logs for resident. Licensee was to submit copy of blank PRN administration log and a written statement that the log will be completed as necessary. 87202 (a) (2) FIRE CLEARANCE. All facilities shall maintain a fire clearance. Prior to accepting persons over 60 years of age none ambulatory and/or bedridden the licensee shall notify the licensing agency and obtain an appropriate fire clearance. The licensee was retaining two bedridden residents without proper fire clearance. During the visit the administrator was informed that because this was a zero tolerance violation civil penalties in the amount of $500 was issued and that civil penalty in the amount of $100 per day would continue to accrue until they submitted an LIC 200 and facility sketch. LPA made several attempts to obtain the information, emailed the administrator a blank LIC 200 however the plan of correction was not submitted. During todays visit while speaking with staff and reviewing records revealed that the licensee continues to retain 2 bedridden residents (R1 and R2) in addition both residents rely on staff to perform all activities of daily living for them For failure to submit plan of corrections a civil penalty of $100 per day is hereby assessed for the period of 6/8/2021 to 12/21/2021 totaling $19,800.00 . The $19,800.00 penalty assessed is a continuation of the civil penalty issued on 6/7/2021 in the amount of $500.00 because this is a zero tolerance violation. On 6/7/2021 LPA conducted an initial 10 day complaint visit at which time the licensee was cited for the following deficiencies. Plan of Corrections were not submitted. 87466 Observations of Resident - Licensee/administrator was to notify the department in writing what steps would be taken to ensure that they are in compliance with the cited regulation 87465 (a)(5) Incidental Medical and Dental Care Services - Licensee/administrator and staff failed to provide proper medication assistance to residents. The licensee/administrator and all staff were to schedule and complete vendorized medication training and request a medication audit to be completed by a pharmacist. When asked staff confirmed not receiving medication training. 87465 (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: all the required information. The licensee/administrator/staff for not completing Centrally Stored Medication and Destruction record for prior resident. During todays visit LPA observed that the licensee does not have current/complete Centrally Stored Medication and Destruction record for all residents. 87465 (e) Incidental Medical and Dental Care: For every prescription ... for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Licensee/administrator did not have order from and a discontinue order signed by a physician for prior resident. Licensee/administrator was to contact the physician for the resident and obtain the needed prescriptions and discontinue orders. This Deficiency is cleared because the resident is no longer living at the facility. Pursuant to CCR, Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 809-D). Exit interview conducted, with staff and copy of report, citations, civil penalties and appeal rights emailed to info@trudezhomecare.com and virgil.lopez@yahoo.comthe state’s words, verbatim · CDSS document, Dec 21, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Dec 23, 2021

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observations the licensee did not comply with the section cited by utilizing full bed rails for 2 out of 5 residents (R1 and R4). Licensee does not have the hospice care plan to indicate the need for the full rails for R4 and R1 is currently not on hospice. which poses an immediate health, safety & personal rights risk to R1 and R4.the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/Administrator will review the regulation., contact the hospice agency and obtained a current hospice care plan which will indicate the need for the full rail. Licensee will ensure to utilize full rail if order is obtained and not 2 half rails. Copy of the hospice care plans will be submitted as POC. Licensee/administrator will notify the Department in writing how they intend to clear the deficiency for R1. This deficiency is being recited because the licensee/administrator failed to submit the POC as discussed during the 6/7/2021 visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87608(a)(3) · Plan of correction due date: Dec 23, 2021

Postural Supports. A written order from a physician indicating the need for postural support shall be maintained in the resident’s record. The licensing agency is authorized to require additional documentation if needed. This requirement is not met as evidenced by: Based on Records review, observations the licensee did not comply with the section cited by not obtaining an order for postural support for R2 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/administrator will contact physicians and obtain orders for the postural support bed rail for R2 and submit copy as POC. This deficiency is being recited because the licensee/administrator failed to submit the POC as discussed during the 6/7/2021 visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(5)(A) · Plan of correction due date: Dec 21, 2021

(c) Licensees who accept & retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment, & a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. This requirement is not met as evidenced by: Based on LPA record review, the licensee did not comply with the section cited by not obtaining an complete Annual Medical assessment and not completing annual re-appraisals for 2 out of 5 residents diagnosed with dementia. This poses a potential health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/Administrator will obtain updated and complete medical assessments for R1 and R2 and complete re-appraisals. Copies of the documents will need to be submitted as POC. This deficiency is being recited because the licensee/administrator failed to submit the POC as discussed during the 6/7/2021 visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(6)(D) · Plan of correction due date: Dec 23, 2021

(D) Assistance with self-administration does not include forcing a resident to take medications, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. This requirement is not met as evidenced by: Based on interview with staff, the licensee did not comply with the section cited above by crushing and camouflaging medications with food without a doctors order for 2 out of 5 residents which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/administrator will contact R1 and R2's physicians and obtain an order to crush medications. Copy of the order will be submitted as POC. This deficiency is being recited because the licensee/administrator failed to submit the POC as discussed during the 6/7/2021 visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(b)(c)(d) · Plan of correction due date: Dec 23, 2021

Licensee is required to have PRN authorization letter on file signed by a physician to determine whether or not the residents can communicate the need and/or symptoms clearly for the as needed (PRN) medication. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not obtaining PRN authorization letters for 5 out of 5 residents which poses a immediate health, safety or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/Administrator will contact residents Physicians to obtain PRN authorization letters for all residents who they provide medication assistance to. Copies of the PRN authorization letters will need to be submitted as POC. This deficiency is being recited because the licensee/administrator failed to submit the POC as discussed during the 6/7/2021 visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(C3)(D3) · Plan of correction due date: Dec 23, 2021

(3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not keeping PRN administration records when given to 3 out of 4 residents poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Administrator will create PRN administration log to be utilized at the facility. A copy of the log with a written statement indicating that PRN logs will be used as necessary for all residents will be submitted as POC. This deficiency is being recited because the licensee/administrator failed to submit the POC as discussed during the 6/7/2021 visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Dec 23, 2021

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician & the resident's RP if any. This requirement is not met as evidenced by: Based on interview with staff the licensee did not comply with the section cited by not notifying prior residents physician of a change in conditionthe state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: which posed an immediate health, safety or personal rights risk to persons in care. Licensee/administrator will notify the department what steps will be taken to ensure that they are in compliance with the cited regulation at all time. This deficiency is being recited because the licensee/administrator failed to submit the POC as discussed during the 6/7/2021 initial 10 day complaint visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(5) · Plan of correction due date: Dec 23, 2021

Incidental Medical and Dental Care Services. The licensee shall assist residents with self administered medications as needed/prescribed This requirement is not met as evidenced by Based on interview, record review and medication count, the licensee did not comply with the section cited by not assisting prior resident with self administration of medications as prescribed. which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/Administrator and all staff will attend vendorized medication training. Training will need to be scheduled within 24 hours and completed within 14 days. Administrator will also contact a pharmacy and schedule a medication audit. Copy of the medication audit will need to be submitted as POC. This deficiency is being recited because the licensee/administrator failed to submit the POC as discussed during the 6/7/2021 initial 10 day complaint visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(6) · Plan of correction due date: Dec 23, 2021

(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: all the required information. This requirement is not met as evidenced by: based on record review the licensee/administrator did not comply with the section cited by not completing Centrally Stored Medication and Destruction record for 5 out of 5 residents which poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/administrator will complete form for all residents after the medication audit. Copy of the completed forms along with a written statement that the forms will be completed and updated regularly will need to be submitted as POC. This deficiency is being recited because the licensee/administrator failed to submit the POC as discussed during the 6/7/2021 initial 10 day complaint visit.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Yelena Avetisyan a conducted a Case Management Deficiencies visit to address deficiencies observed during the investigation of complaint control 31-AS-20210604142033. During the course of the investigation information obtained revealed that Staff 1 (S1) has been working at this facility since early 2019. S1's criminal record clearance was not transferred to this facility until 11/9/2021. During todays visit while speaking with Staff and reviewing records LPA observed that R1 and R2 depend on others to perform all activities of daily living for them. R1 and R2 are not currently receiving hospice care and the licensee/administrator did not submit an exception request. Pursuant to CCR, Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 809-D). Exit interview conducted, with staff and copy of report, citations, civil penalties and appeal rights emailed to info@trudezhomecare.comthe state’s words, verbatim · CDSS document, Dec 21, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Dec 22, 2021

Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is not met as evidenced by Based on interviews, and record review, the licensee & administrator did not comply with the section cited above by allowing S1 to work at the facility prior to associating S1 to the facility which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Transfer of Criminal record clearance was completed on 11/9/2021. Deficiency cleared during visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87615(a)(5) · Plan of correction due date: Dec 23, 2021

(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (5)Residents who depend on others to perform all activities of daily living for them as set forth in Section This requirement is not met as evidenced by: Based on interview and observation the licensee/administrator did not comply with the cited section by admitting 1 (R2) and retaining 2 (R1 and R2) residents who depend on staff to perform all activities of Daily living for them which poses and immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 21, 2021

Plan of correction: Licensee/administrator will notify the department how this deficiency will be corrected.