Ana Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst Melissa Spaeth conducted an unannounced annual visit on 9/29/2023. LPA was greeted by the caregiver and stated the purpose of the visit. The caregiver confirmed there are three clients living at the facility. The facility is licensed for four ambulatory and two non-ambulatory residents. The Administrator arrived at 1:35 pm. LPA and Caregiver began the tour at 1:30 pm until 2:00 pm. LPA observed the following: Kitchen – LPA observed the kitchen area was neat and clean. LPA observed a two-day supply of perishable food and a seven-day supply of non-perishable food. There were no cleaning solutions stored underneath the kitchen sink. The knives were locked in a kitchen cabinet. The fire extinguisher was located nearr the kitchen. Common areas – LPA observed the living room/dining room contained comfortable seating, a dining room table, and chairs. The family room contained comfortable seating and a television. Hallway - LPA observed the locked hallway closet which contained residents' medication. There was a cabinet which contained clean linens. Garage – The garage was locked and contained the cleaning solutions, additional hygiene items, and additional refrigerator. Laundry Area – The washer and dryer were in the laundry area. A locked cabinet above the washer contained the first aide kit and additional first aid supplies. Bathrooms – LPA observed the two bathrooms. Both bathrooms contained hand soap, paper towels, slip resistant mats, grab bars and covered trash cans. Smoke/Carbon Monoxide Detectors – The detectors were tested at 2:00 pm and were operable. Backyard - LPA observed the backyard which has a shaded area with seating. LPA observed the pool has been filled in with dirt. LPA reviewed client records at 2:25 pm until 2:50 pm. LPA observed a caregiver does not have the required CPR and first aid training. LPA viewed resident's medications at 3:30 pm until 3:45 pm. Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted, Appeal Rights discussed, and a copy of the signed report was given to caregiver.the state’s words, verbatim · CDSS document, Sep 29, 2023

Allegation investigated: Resident's personal rights were violated

on 01/10/2023 at 1:43 p.m. Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced subsequent complaint visit for the above allegation. LPA met with the Licensee Wanda Smith and explained the reason for today’s visit. During the initial visit on 12/13/2022, LPA reviewed facility records, obtained copies of pertinent documents relevant to the investigation and conducted an interview with the administrator. On 01/10/2023 from 2:20 p.m. to 3:00 p.m. LPA conducted interviews with two (2) out of three (3) residents in care. Regarding the allegation that Resident #1's (R1) personal rights were violated: it is alleged Administrator "went through R1's personal belongings". LPA interview with Administrator revealed the first day R1 came to the facility they had three trash bags of clothes. Administrator stated they were helping R1 put their belongings away with R1 present and R1 was selecting items to keep and items to throw away. Administrator stated they continued putting belongings away the next day. Interviews with Resident #2 and Resident #3 revealed administrator has never gone through their personal belongings. (LIC 9099C continued) Unsubstantiated Based on the information gathered during the investigation, this allegation is deemed Unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Jan 10, 2023 · control 31-AS-20221206132655

Allegation investigated: Resident was wrongfully evicted

On 1/10/2023 at 1:48 p.m. Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced subsequent complaint visit. LPA was greeted by Licensee Wanda Smith and a tour of the facility was conducted. Allegation: Resident was wrongfully evicted: It is alleged that the administrator did not issue an eviction notice to resident #1 (R1). On 12/13/22 LPA conducted interviews, reviewed, and obtained documents pertinent to the investigation. A review of the documents on 12/13/2022 revealed no eviction notice on file for R1. On 12/13/22 the Administrator confirmed an eviction notice was not issued because the client was at the facility for less than 24 hours. On 12/13/22 the Administrator provided text message conversations between herself, R1’s, case manager #1 (CM1) and case manager #2 (CM2). The text messages reveal, non-verbatim; Administrator found drug paraphernalia among R1’s belonging and notified CM1 and CM2. (LIC 9099C Continued) Substantiated On 12/13/2022 Administrator stated R1's substance abuse was withheld from physician's report. Administrator states CM2 agreed to remove client from facility and administrator states they would have kept R1 in the facility if no other option was available. Based on the information obtained this allegation is deemed Substantiated at this time. Deficiency cited on LIC 9099 D. Exit Interview conducted. Copy of this report provided. Appeal Rights provided.the state’s words, verbatim · CDSS document, Jan 10, 2023 · control 31-AS-20221206132655

From the deficiency page — Deficiency type: Type B · Section cited: CCR 85068.5(a)(4) · Plan of correction due date: Jan 20, 2023

(a) The licensee shall be permitted to evict a client by serving the client with a 30-day written notice...for any of the following reasons: (4)...the client's needs cannot be met by the facility...The licensee did not comply with the above cited section, as evidenced by: Based on interviews conducted facility failed to provide R1 with a proper eviction notice which posed a potential health and safety risk and violation of Personal Rights to residents in care.the state’s words, verbatim · CDSS document, Jan 10, 2023

Plan of correction: The Administrator will review Section 85068.5(a)(4) and will submit to LPA a written explanation on how they will assure to follow Title 22 Regulations with regards to following requirements by POC date 01/20/2023.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Shira Stamps arrived at the facility for an unannounced one (1) year Required visit. LPA arrived at 1:40 pm, and was greeted by Licensee Wanda Smith, LPA informed the Licensee of the purpose of the visit. All clients were at their day programs. A tour of the physical plant was conducted with the Licensee at 1:45 pm. The facility has five (5) bedrooms and three (3) bathrooms currently occupying four (4) clients. One (1) bedroom and one (1) bathroom is designated for staff use only. One (1) bedroom is designated for the gym. The facility is Fire Cleared for two (2) non-ambulatory and a hospice wavier for four. The facility currently has three (3) ambulatory and one (1) non- ambulatory clients. Infection control: LPA reviewed the mitigation plan approved on 3/30/21. The facility is following current infection control recommendations. Upon arrival LPA was screened by the Licensee and asked all infection control questions. LPA was asked to sign-in and sanitize hands. Living and dining At 1:45 pm, LPA observed the living room to be neat and clean along with the dining room. The facility maintains a temperature of 82°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational at 2:01 pm. At 1:55pm, LPA observed the second living, dining room, and kitchen to be neat and clean. Food Inspection LPA conducted a tour of the kitchen around 1:48 pm and observed there to be sufficient stock of two-day perishables and seven-day non-perishables foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas care clean and inaccessible to pests. LPA observed all knives and sharp object being locked and inaccessible to clients in care. CONTINUED... Laundry The Laundry room is located near the garage. No chemicals/hazardous items were found. There is one (1) fire extinguisher located in the laundry room. The Fire extinguisher was observed to be full and last serviced 9/12/21. Resident Rooms LPA observed rooms to have the appropriate bedding. There is a night stand and sufficient lighting for each client. The medication cabinet was observed to be locked in the hallway. Bathrooms LPA observed all bathrooms to have the appropriated wash your hands signs posted. Hot water was tested at 1:54 pm and measured within regulation at 112.8 degrees F. Physical environment LPA toured the outside area of the facility at 1:57 pm. LPA observed a covered shaded area for clients. The above ground pool was taken down, and there are now no bodies of water on the premises. LPA observed a shed used for emergency supplies and storage. Garage At 2:00 pm, LPA observed the locked garage to be attached to the facility and is currently being used for storage, an extra refrigerator, PPE supplies, and chemicals/hazardous items. Administrative: Annual fee is current. An exit interview was conducted, and a copy of this report was given to the Licensee.the state’s words, verbatim · CDSS document, Jun 21, 2022

Type of visit: Case Management - Incident

LPA Spaeth arrived at the facility at 11:40. LPA was greeted by Administrator, Wanda Smith. LPA Spaeth stated the purpose of the visit is regarding an incident that occurred at the facility. Licensing Program Analysts (LPA) Melissa Spaeth conducted an unannounced Case- Management - Incident visit. The purpose of this visit is to follow up on a special report submitted to the department on July 7, 2021. The licensee reported that on 07/07/2021 two residents (R1 and R2) were involved in two inappropriate encounters within the facility. The two encounters both occurred on the same day and was reported to Administrator by caregiver. During this visit LPA reviewed R1's file at 11:45 am. Based upon LPA's review of the R1's file and under Title 22 General Regulations, the following citations were issued and recorded on LIC 809D.the state’s words, verbatim · CDSS document, Sep 20, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(5) · Plan of correction due date: Oct 1, 2021

87705 Care of Persons with Dementia (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, & reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This was not met based upon: LPA reviewed R1's records and observed the last medical assessment completed for R1 took place on April 25, 2019.the state’s words, verbatim · CDSS document, Sep 20, 2021

Plan of correction: Administrator will have resident physician's report completed by the resident's doctor.

Type of visit: Case Management - Incident

LPA Spaeth arrived at the facility at 10:30 am. LPA was greeted by caregiver, Ashlee Bennett. Upon entering the living room, LPA observed a female watching television. Caregiver stated new resident had moved into the facility. LPA was escorted to the resident sitting area. LPA observed two females and one male watching television. Caregiver stated residents are getting showers today and had been assisting residents. Administrator arrived at the facility at 10:45 am and LPA was greeted by Administrator. LPA Spaeth explained the purpose of the visit was to conduct a records review. LPA Spaeth began record review at 10:50 am. LPA Spaeth reviewed resident records and staff records. LPA completed record review at 12:00 pm. Further investigation is needed at this time. Exit interview conducted, appeal rights discussed. LPA confirmed with Administrator that a copy of the report will be emailed to Administrator via email.the state’s words, verbatim · CDSS document, Jul 21, 2021

Type of visit: Case Management - Incident

Licensing Program Analysts (LPA) Melissa Spaeth conducted an unannounced Case- Management - Incident visit. The purpose of this visit is to follow up on a special report submitted to the department on July 13, 2021. LPA met with staff Ashlee Bennett. Administrator Wanda Smith was not at the facility The licensee reported that on 07/07/2021 two residents were involved in two inappropriate encounters within the facility. The two encounters both occurred on the same day and was reported to Administrator by caregiver. During this visit LPA conducted interviews of the four residents and caregiver regarding the incident. The interviews were conducted from 1:45 pm until 2:25 pm. LPA toured the facility at 2:30 pm. LPA observed two resident rooms (one female room and one male room) and the staff bedroom located on the west side of the facility along with a bathroom. LPA walked through the kitchen to the east side of the facility passing through a small empty room, the exercise room then to the resident sitting area. There are two resident bedrooms along with resident bathroom and dining area. Caregiver explained one resident room is empty but two female residents share a room. LPA Spaeth observed three residents watching tv. Record review was conducted by LPA Spaeth from 2:45 pm until 3:26 pm. LPA reviewed two resident files and medication records. Further investigation of the incident is needed at this time. Exit interview conduct, appeal rights discussed. Report will be emailed to Administrator.the state’s words, verbatim · CDSS document, Jul 14, 2021