Courtyard Plaza

Allegation investigated: . Staff will not allow resident to have visits/calls from family members

Licensing Program Analyst (LPA) conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator. The reason for today's visit was explained. On today's visit, LPA Yee interviewed Evelina Papazyan at 10:01am, Staff #1 at 10:56am, Staff #2 at 12:25pm, Resident #1 at 10:28am and a telephone interview with family member at 11:43am. Copies of facility documents were requested at 10:23am. Per information obtained from interviews, Resident #1 was placed at the facility by the resident's oldest daughter in March 2023. In early August 2023, the other two daughters of Resident #1and their children flew in from Hawaii and visited with Resident #1 and had an ejnjoyable time. When the oldest daughter found out about the visit, she hand delivered a self drafted letter, dated August 13, 2023, to 3 staff continued on LIC9099-C Unsubstantiated stating that effective immediately Resident #1 was not allowed to have any visitors except the persons that were named in the letter. The persons named in the letter are, the names of the resident's oldest daughter, a granddaughter, 2 grandsons and a family friend. The letter also had the following restrictions: that Resident #1's mail was to be held in a secure place until it was picked up by Resident #1's oldest daughter. the facility was also told not to accept or transfer any calls received from anyone except the persons named on the list and the she is to be notified immediately Also if anyone visits or calls and states that "they were given permission by..." it should not be accepted with any exception and she is to be notified immediately Included with the letter was a copy of the Power of Attorney. Per interview with the Administrator, the oldest daughter was told that the letter she drafted with the restrictions and the Power of Attorney documents were not enforceable and were filed. Staff were instructed that if any of Resident #1's family questioned them, they were told to refer them to the Administrator. On 9/26/23, office staff received call from one of the daughter's of Resident #1 and she was very upset and was yelling at staff because she was told she and the rest of the family could not visit or call Resident #1. Per the Administrator, she nor any of the staff ever told the daughter or any of the family that they could not visit or call mom. This was confirmed by Staff #1 and Staff #2. The children of Resident #1 are currently on bad terms and are involving the facility in their family disputes which the facility is choosing to stay out off and ensuring Resident #1's personal rights are protected. Per telephone interview with the family member at 11:43am, the family member was specifically asked if the Administrator or any staff told them that they could not call or visit Resident #1 and the response was a firm no. The staff were very nice. The sister is the one telling them that they cannot visit or call Resident #1 by providing the documents to the facility to enforce. Per the family member they were not yelling at the staff, They were upset and talked loud. Per information received on today's visit, there is insufficient evidence to support the above allegation. Therefore, the findings of the above allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of the report was given.the state’s words, verbatim · CDSS document, Oct 3, 2023 · control 29-AS-20230925123516

Allegation investigated: . Staff did not treat resident with dignity and respect. 2. Facility staff are not ensuring the facility is free of vermin.

Licensing program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegations and initially met with Indra Lopez, Staff. Staff contacted Evelina Papazyan, Administrator and she arrived at 10:55am to conduct the visit. On today's visit, LPA Yee conducted interviews with Evelina Papazyan, Administrator at 10:55am, Indra Lopez, Staff at 10:49am, Resident #1 at 11:27am, Resident #2 at 12:13pm, Resident #3 at 12:40pm, Resident #4 at 1:09pm and Staff #2 at 1:54pm, Staff #3 at 1:59pm, Staff #4 at 2:02pm and Staff #5 at 2:19pm. Copies of documents from Resident #1's file was obtained. Per information obtained from interviews conducted about allegation #1, Staff did not treat resident with dignity and respect, Resident #5 had moved to the facility in mid-June 2023 and was confused. Residen# #5 was missing from own bedroom and was found sleeeping on Resident #1's bed by staff. Resident #5 was being escorted back to own room by Staff #4 when Resident #1 saw them coming out of their room. Unsubstantiated Resident #1 started screaming and causing a scene and demanded to know what Resident #5 and Staff #4 were doing in Resident #1's room. Per Staff #4, Resident #1 did not observe Resident #5 sleeping on the bed. Resident #5 was escorted back to own room and the staff were able to calm Resident #1 down. This incident was reported to Georgina Osuna, Medication Technician in mid-June 2023. Georgina was informed that Resident #1 got upset because Resident #5 was seen by Resident #1's room. This incident occurred in mid-June 2023. Per interview with Resident #1 today, Resident #1 returned to own room and found Resident #5 on the bed. Resident #5 was confused and Resident #1 got staff to escort Resident #5 back to own room. This incident happened 2 days before this complaint was reported to Licensing on 9/6/23. Per Resident #1, they spoke with the Administrator in the lobby about the incident with Resident #5 on 9/6/23 and the Administrator asked Resident #1 "you liked him in your room." Per Resident #1, the question made them feel they were dis-respected and treated like a prostitute. Per Resident, the Administrator does not know me and no one has ever touched this body. Resident #1 was so upset and felt that a complaint should be filed. Resident #1 was not able to provide any witnesses present in the lobby to corroborate the remark made by the Administrator. Per Resident #1, the incident was told to Resident #2 - Resident #5. Per interview conducted with the Administrator, she denied knowing anything about the bedroom incident or having any discussions with Resident #1. Per the Administrator, she would never make such a comment. Per interviews conducted with staff and residents, no one could corroborate that Resident #5 was found in Resident #1 room at anytime from 9/4/23-9/6/23 other than the one time in mid-June 2023. All staff and residents interviewed also indicated that it was not in Evelina's nature to make such a dis-respectful comment and that Resident #1 does not like the Administrator and wants her fired. Resident #1 also tells lies. Based on the information obtained today, there is insufficient evidence to support the allegation that staff did not treat the resident with dignity and respect. In regards to the allegation that Facility staff are not ensuring the facility is free of vermin, Per interview with Resident #1, there is no complaint regarding the facility having flies and fleas. Per Resident #1, there are no fleas or flies in resident's bedroom or in the facility except for the flies or bugs that manage to come in when the residents leave the doors open or come in when the residents open the door. This was never meant to be written as a complaint. Based on today 's investigation, the above allegations are UNSUBSTANTIATED. Exit interview was conducted and a copy of the report providedthe state’s words, verbatim · CDSS document, Sep 13, 2023 · control 29-AS-20230906165547

Allegation investigated: .Financial abuse 2. Due to neglect and lack of care, Resident #1 (R1) developed multiple wounds, 3. Staff failed to address resident medical needs, resulting in R1 developing a fungus on multiple body parts 4. Administrator failed to have knowledge with regards to residents’ physical and mental well-being and care needs 5. Administrator failed to treat residents and collateral agency representatives with dignity and respect 6. Staff failed to update appraisals to accurately reflect residents’ current physical and/or mental status 7. Staff failed to provide necessary care with activities of daily living to residents, including bathing, dressing, and grooming

Licensing Program Analysts (LPAs) Elsie Campos and Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA’s met with Administrator Evelina Papyzan and explained the reason for the visit. During today’s visit, the LPA’s interviewed staff at 10:10 a.m., 10:26 a.m., 10:37 a.m., 10:46 a.m., 11:35 a.m., 11:49 a.m., 12:01 p.m., and 2:10 p.m. An interview was also conducted with a family member of Resident #1 (R1) at 12:15 p.m., and an interview was attempted with the facility house doctor at 11:20 a.m. The LPA’s conducted interviews with representatives from collateral agencies at 1:10 p.m., 1:23 p.m. and 3:10 p.m. **Continued on LIC 9099-C** Unsubstantiated PAGE 2 Regarding the allegation: Financial abuse It was alleged that R1’s bank was sending multiple rent payments to the facility, which totaled upwards in excess of over $50,000. It wasn’t until R1’s family member contacted the facility in which the facility confirmed that R1’s bank had indeed sent multiple payments. The LPA reviewed the invoice of R1’s rental payments to the facility from July 2020 – June 2022. R1’s balance at the start of October 2020 was $6,700, which was due to a missed rental payment in August 2020. However, a payment was received on 10/01/2020 and 10/30/2020 in the amount of $3,350 for each payment, which brought R1’s balance to $0. However, for the month of November 2020, R1 was charged the November rental fee of $3,350, yet R1’s bank sent two (2) payments to the facility in the amount of $3,350 on 11/04/2020 and 11/13/2020. At the end of November 2020, R1 had overpaid the facility by $3,350. R1’s rate changed from $3,350 to $3,800 due to a change of services, as R1 began to receive tray services three times a day. Per interviews, this change was initiated by R1, as R1 did not eat in the dining room. As R1’s bank made a duplicate payment in November 2020, R1’s payments were current up until 3/1/2021. R1’s invoice indicated that R1’s bank did not send a payment to the facility for March 2021. However, in April 2021, R1’s bank made three (3) payments to the facility in the amount of $3,800 on 4/2/2021, 4/7/2021, and 4/9/2021. Further review confirmed that R1’s bank sent two (2) payments to the facility in the amount of $3,800 in May 2021, June 2021, and between the months of September 2021 – June 2022. Yet, this was not caught by the facility staff nor the licensee until R1’s family member contacted the facility about this error. The LPA reviewed a check that was paid out to R1’s family member, which totaled out to $52,750 on 6/22/2022. An interview with R1’s family member confirmed that R1’s bank had sent automatic payments but confirmed that the facility was unaware of this oversight in overpayments. The Administrator stated that they did not know why R1’s bank had sent multiple payments. The Administrator believed that there was one time that a rent payment was late for unknown reasons, and the Administrator asked R1 to call their bank in order to remedy the situation. However, it is assumed that an additional automatic payment cycle was then set up. The Administrator admitted that the corporate office was responsible for completing and compiling invoices, and stated that their only responsibility was to scan over rent checks. Continued on LIC 9099-C PAGE 3 The Administrator claimed that as a result of this incident, they now meet with the corporate office monthly to confirm who is late on payments and/or who may have a surplus of credit. The Administrator agreed that this was an egregious oversight and should not have happened. Based on the information obtained in interviews and record review, there is insufficient evidence to support the claim that the licensee intended to financially abuse R1. As a result, the licensee regularly checks accounts to mitigate any similar issues of overpayment. This allegation is deemed Unsubstantiated at this time. Regarding the allegations: (1) Due to neglect and lack of care, Resident #1 developed multiple wounds and (2) Staff failed to address resident medical needs, resulting in Resident #1 developing a fungus on multiple body parts It was alleged that the staff neglected to address R1’s medical needs, which resulted in R1 developing a fungus on multiple body parts. A review of a Risk Assessment, which was completed upon R1’s admission to the facility on 3/18/2018, indicated that R1 did not believe in modern medicine and although they were considered pre-diabetic, R1 allegedly did not agree with the diagnosis. R1’s appraisal upon move-in indicated that R1 was independent and did not require assistance with activities of daily living. The LPA reviewed R1’s facility appraisals from 2018-2022 and per the appraisals, R1’s care needs did not change, nor did R1’s capacity to manage their individual needs independently. A review of R1’s facility documents confirmed that R1 was self-responsible and per the physician’s report completed 1/17/2021, R1 did not exhibit any cognitive delay. Interviews with the Administrator and a review of resident documents confirmed that R1 was not taking any medication and it was alleged that R1 did not have a prescribed doctor prior to admission to this facility in March 2018. However, records and interviews with the Administrator reported that R1 did not ‘believe in modern medicine’ and although R1 was considered diabetic, R1 refused to take medication to manage the condition. An Incident Report dated 4/28/2022 reported that R1’s Doctor requested to see R1, as R1 regularly refused to see the doctor. Per the report, the doctor confirmed that R1 was diabetic and claimed that R1 needed to check their glucose daily. **Continued on LIC 9099-C** PAGE 4 R1 allegedly claimed that they never took their medications as they did not believe in modern medicine. Also, R1 was observed to have fungus growing on their ring finger. At the time of the incident, R1’s doctor prescribed fungal cream, yet it was alleged that R1 refused to take the medication as they did not believe there was an issue. Interviews with staff and a review of care notes revealed that R1 allegedly refused to participate in body checks. As R1 did not require assistance with dressing, bathing, or grooming, staff were unaware of the fungus that developed on R1. Once it was observed, staff contacted the house doctor. However, R1 refused fungal treatment. On an Incident Report dated 5/20/2022, R1 was observed to have fungus on their feet. It was reported the resident’s doctor. R1 was recommended to go to a higher level of care to treat R1’s fungus. As a result, R1 was transferred to a higher level of care. Based on the information obtained from interview and record review, there is insufficient evidence to support the above-mentioned claims. Staff interviews and records indicated that staff made regular attempts to meet R1’s needs. However, R1 exercised their right to refuse care. Once the staff were able to identify that R1 needed additional care, the staff sought out the facility doctor and R1 was transferred to a higher level of care. The allegations “Due to neglect and lack of care, Resident #1 developed multiple wounds” and (2) “Staff failed to address resident medical needs, resulting in Resident #1 developing a fungus on multiple body parts” is deemed Unsubstantiated at this time. Regarding the allegation: Administrator failed to have knowledge with regards to residents’ physical and mental well-being and care needs It was alleged that the Administrator was unaware of R1’s care needs, as the complainant alleged that R1 required significant assistance to meet their grooming and toileting needs. Interviews conducted with the Administrator confirmed that during the time that R1 was at the facility, R1 did not receive assistance with activities of daily living. However, R1 was physically and cognitively able to care for their own needs. It was noted that regarding R1, staff would communicate their concerns with the house doctor and would make recommendations to be seen, but R1 exercised their right to refuse. **Continued on LIC 9099-C** PAGE 5 Records review and interviews revealed that R1 did not ‘believe in modern medicine’ and R1 was not taking medication at their own request. Although R1 was documented as being diabetic, R1 (at their own choice) did not take insulin. In addition, R1 did not eat food offered at the facility, did not follow the prescribed diabetic diet, and had food delivered to their room from outside the facility. A review of R1’s facility documents confirmed that R1 was self-responsible and per the physician’s report completed 1/17/2021, R1 did not exhibit any cognitive delay. An Incident Report dated 4/28/2022 reported that the facility house doctor requested to see R1, as regularly R1 refused to see the doctor. Per the report, the doctor confirmed that R1 was diabetic and claimed that R1 needed to check their glucose daily. R1 allegedly claimed that they never took their medications as they did not believe in modern medicine. On an Incident Report dated 5/20/2022, R1 was observed to have fungus on their feet. It was reported to the facility doctor, and R1 was recommended to go to a higher level of care to treat the fungus. As a result, R1 was transferred to a higher level of care. Information from staff interviews supported claims that R1 did not receive any assistance with dressing, bathing, grooming, or toileting. Staff noted that R1 was capable of carrying for their own needs and did not experience a change of condition that would have affected their capacity for self-care. Had this of happened, it would have been reported. Staff claimed that they would attempt to complete body checks with R1, but R1 would refuse such care and would claim to be ‘all right’ and not require additional assistance. A review of skilled nursing notes confirmed that R1 was admitted to a nursing facility on 5/20/2022, with the admitting diagnosis of bilateral feet fungal infection and nail infection of the right ring finger. R1 did not arrive with any medications, but R1 was oriented to person, place, time, and situation and was able to communicate their needs. It was further documented that R1 required supervision/stand-by assistance with oral hygiene, showering/bathing, and upper body dressing. Staff at the nursing facility attempted to teach R1 about diabetic monitoring and practices, yet R1 initially ‘showed no interest’ in learning how to check their blood pressure. However, R1 became more compliant with the medication regimen as the weeks progressed at the skilled nursing facility. R1 never returned to the facility after being admitted to the skilled nursing facility on 5/20/2022. **Continued on LIC 9099-C** PAGE 6 Based on the investigation, there is insufficient evidence to support the claim that the Administrator failed to have knowledge of R1’s physical and mental well-being, and care needs. All staff, including the Administrator, were aware of R1’s status when they resided at the facility. Staff claimed that R1 was independent, and without cognitive delay, and R1 regularly denied care assistance. This allegation is deemed Unsubstantiated at this time. Administrator failed to treat residents and collateral agency representatives with dignity and respect On the allegation of ‘Administrator failed to treat residents and collateral agency representatives with dignity and respect’, the RP’s concern is that the administrator is known to be rude and aggressive when speaking to collateral agency representatives and residents. To investigate the allegation the LPA’s conducted resident interviews and collateral agency representative interviews. The residents’ interviews revealed that they feel respected and cared for here, and they are treated with dignity and respect. Residents’ interviews revealed that they have never witnessed staff treat residents inappropriately. Interviews with staff revealed that the administrator is nice and respectful, and staff interviews revealed that they always treat residents with dignity and respect, even at times when residents are disrespectful. Additionally, collateral agency representative interviews denied claims that the administrator has disrespected them or failed to treat residents with dignity and respect. It was further communicated that the administrator has never been rude or disrespectful and that the administrator may have a strong personality to which can be perceived as discourteous. However, interactions with the Administrator have been deemed professional. Based on the information obtained through interviews, there is insufficient evidence to support the allegation that ‘Administrator failed to treat residents and collateral agency representatives with dignity and respect’. Therefore, this allegation is Unsubstantiated at this time. Staff failed to update appraisals to accurately reflect residents’ current physical and/or mental status On the allegation that ‘Staff failed update appraisals to accurately reflect residents’ current physical and/or mental status’, it is the concern of the complainant that the appraisals did not accurately reflect the residents care needs. On 7/18/2022 the LPA’s obtained physician reports and appraisals for 78 residents. **Continued on LIC 9099-C** PAGE 7 In interviewing residents and comparing their appraisals with their care needs the LPAs observed that the care needs identified in the appraisals aligned with the information received via resident interviews. It appeared through staff interviews that they are appropriately screening residents and reporting to the administration to ensure that they are documenting changes in condition. The administrator confirmed that they update all appraisals and conduct assessment of resident’s care needs before admission, after admission and when there is a change in condition. Based on the information obtained through record review and interviews, there is not sufficient evidence to support the allegation that staff failed to update appraisals to accurately reflect residents’ current physical and/or mental status. Therefore, this allegation is deemed Unsubstantiated at this time. Staff failed to provide necessary care with activities of daily living to residents, including bathing, dressing, and grooming. On the allegation that ‘staff failed to provide necessary care with activities of daily living to residents, including bathing, dressing, and grooming’, it is the concern of the complainant that residents are not being bathed, groomed or assisted with activities of daily living. On 7/18/2022 the LPA’s obtained physician reports and appraisals for seventy-eight (78) residents. In interviewing residents and comparing their appraisals with their documented care needs, the LPAs observed that the care needs identified in the appraisals aligned with the information received via resident interviews. Interviews conducted confirmed that residents were provided with assistance as described in their care plan, which could include assistance with bathing, dressing, eating, grooming, and other activities of daily living. Throughout the LPA’s visits, staff were observed escorting residents to mealtime and throughout the facility, staff assisted with grooming needs, and so forth. Residents appeared clean and well kept. Based on the information obtained through record review and interviews, there is not sufficient evidence to support the allegation that ‘staff failed to provide necessary care with activities of daily living to residents, including bathing, dressing, and grooming’. Therefore, this allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted and a copy of this report was issued.the state’s words, verbatim · CDSS document, May 16, 2023 · control 29-AS-20220708115334

Allegation investigated: Staff failed to ensure residents are regularly observed for changes in physical, mental, and social functioning; Staff failed to assist residents with the self-administration of medication; Staff failed to ensure residents are adequately hydrated; Staff failed to ensure that facility was in good repair at all times; Staff failed to ensure that modified or prescribed diets were provided; Staff failed to ensure that the facility was clean and sanitary.

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced a subsequent complaint visit at 9:30 a.m. to investigate and deliver the findings for the above allegations. The LPA met with facility representative Evelina Papazyan, and explained the reason for the visit. On 07/13/2022, Licensing Program Analysts (LPAs) Salia Walker, and Sandra Urena conducted an unannounced visit at 8:30 a.m. to investigate the above allegations. The LPAs met with facility representative, Evelina Papazyan and explained the reason for the visit. The LPAs conducted record review, from 9:12 a.m. to 12:30 p.m. Toured the facility, and briefly spoke with staff, and residents from 9:19 a.m. to 12:30 p.m.; and from 2:00 p.m. to 3:00 p.m. On 07/15/2022, Licensing Program Analysts (LPAs) Salia Walker, Sandra Urena, Ashley Smith, and Elsie Campos conducted a subsequent complaint visit at 10:10 a.m. to investigate the above allegations. The LPAs met with facility representative, Evelina Papazyan, and explained the reason for the visit. The LPAs interviewed staff at 10:45 a.m., and interviewed residents from 10:30 a.m. - 3:00 p.m. LPA Morgan interviewed the Administrator on 07/18/2022, at 10:45 a.m. Unsubstantiated Staff failed to ensure residents are regularly observed for changes in physical, mental, and social functioning. On the allegation that ‘Staff failed to ensure residents are regularly observed for changes in physical, mental, and social functioning’ ; it is the concern of the complainant that R1 was not observed for changes in condition, resulting in R1 developing wounds all over the body and developing fungus in different part of the body as well. To investigate the allegation, LPA Urena reviewed R1’s file, Physician Report, Incident Reports, and medical records. LPA Morgan interviewed the Administrator on 07/18/2022 at 10:45 a.m. The Physician’s Report revealed that R1 was observed to be able to ambulate with a walker, and able to manage all Activities of Daily Living (ADLs), all checked ‘yes’ for Capacity for Self-Care, including medication administration. An Incident Report dated 4/28/2022, indicates that R1’s Doctor requested to see R1 because R1 refuses to see the doctor. Doctor confirmed that R1 was diabetic and claimed that R1 needed to check their glucose daily. R1 allegedly claimed that they never took their medications as they did not believe in modern medicine. PCP explained the concerns and R1 allegedly communicated understanding and reiterated that they did not believe in modern medicine. On 4/28/2022, physician saw resident, and the physical examination revealed that R1 had fungus on their nails, but R1 refused to follow the doctor’s orders. R1 is ‘anti-medication’; declined home health care, antibiotics, and fungal cream as suggested by the doctor. R1 is independent, handles all of their own ADLs, facility recommended resident to be seen by the podiatrist, and psychologist but resident shows no interest. An Appraisal/Needs and Services Plan dated 4/29/2022, indicates that R1 does not believe they need assistance with ADLs. A review of a Risk Agreement (signed by R1 and Administrator on 3/18/2018) was noted to have the following: resident refuses to take medication, and doesn’t believe in modern medicine; resident orders food from the outside; resident understands complication and risks associated with not taking medication or following diet. Resident doesn’t believe they are diabetic. Resident’s doctor, and family are aware of her choice. On an Incident Report dated 5/20/2022, R1 was observed to have fungus on their feet. It was reported to the resident, and the resident’s PCP. R1 was recommended to go to a SNF or hospital to get the fungus treated. Administrator assisted resident with placement, and resident was transferred to a Post-Acute Nursing Home. On 07/18/2022, LPA Morgan interviewed the Administrator, and the interview revealed that residents are checked daily, a couple of times a day, and stated, ‘It depends though, if a resident is incontinent then they are checked at least four times per shift and throughout the day, and on the residents needs too. But if they are independent and do not need services, we still do wellness checks. We check on them every meal to make sure they are ok, or the caregivers will check on them. If a resident needs care and refuses, we will do a new appraisal, I would contact the family, we would encourage them, but if I think they are putting themselves in a dangerous situation, we will think they need a higher level of care, and I put in a 30 day notice. Based on the information obtained through record review, and interviews there is not sufficient evidence to support the allegation that Staff failed to ensure residents are regularly observed for changes in physical, mental, and social functioning. Therefore, this allegation is deemed Unsubstantiated at this time. Staff failed to assist residents with the self-administration of medication. On the allegation that ‘Staff failed to assist residents with the self-administration of medication’; it is the concern of the complainant that R1 was in need of medication for diabetes, however the administrator claimed that R1 was not in need of medication. To investigate the allegation, LPA Urena reviewed R1’s facility records, and Physician Report. The record review of the Resident Appraisal (dated 3/4/2022) revealed that R1 did not ‘believe’ in modern medicine and believes in holistic health, and wellness. Physician’s report indicates that R1 was diagnosed as diabetic. Incident report dated 04/28/2022 indicates that the physician conducted a visit to see R1 at the facility, and confirmed that R1 was diabetic, and claimed that R1 needed to check their glucose daily. R1 allegedly claimed that they never took their medications as they did not believe in modern medicine. Physician explained the concerns and R1 allegedly communicated understanding and reiterated that they did not believe in modern medicine. Physician gave treatment options, and R1 rapidly responded that they did not believe in treatment or modern medication and said they were aware of their rights as a resident. R1 ultimately refused treatment. Based on the information obtained through record review, there is not sufficient evidence to support the allegation that staff failed to assist residents with the self-administration of medication. Therefore, this allegation is deemed Unsubstantiated at this time. Staff failed to ensure residents are adequately hydrated. On the allegation that ‘Staff failed to ensure residents are adequately hydrated’; it is the concern of the complainant that when R1 arrived at the medical office, R1 was observed to be severely dehydrated’; to investigate the allegation, LPA Urena interviewed residents, staff and administrator. The Administrator stated that residents are offered liquids throughout the day, in addition to the liquids(water, milk, juice, coffee) offered through their daily meals, and snacks. The staff stated that they offer liquids to residents throughout the day. The LPA observed on the day of the visit a water dispenser located, and readily available in the common area of the activity room. The LPA interviewed residents about their access to liquids, and if they felt they got enough liquids. Ten out of ten residents stated that they are offered juice, coffee, and milk during meals and water throughout the day, and they have access to water. Based on the information obtained through record review, there is not sufficient evidence to support the allegation that staff failed to ensure residents are adequately hydrated. Therefore, this allegation is deemed Unsubstantiated at this time. Staff failed to ensure that facility was in good repair at all times. On the allegation that ‘Staff failed to ensure that facility was in good repair at all times’; it is the concern of the complainant that when R1’s responsible parties picked up R1’s personal belongings at the facility, they noticed the room to be ‘in need of repairs.’ To investigate the allegation, on 07/13/2022 and 07/18/202, LPAs Urena, and Walker conducted an inspection of the facilities’ physical plant, and interviewed residents, staff, and the administrator. The LPA’s inspected 20 of rooms, and the inspection revealed that eight out of ten rooms were observed to have minor repairs. Eight (8) out of ten (10) residents’ interviews revealed that they did not need any repairs in their room. Two residents stated that they did need repairs, but that the repairs were being addressed already. The administrator’s interview revealed that if a resident has something that needs to be fixed, administrator puts in a request for maintenance in the maintenance log, and they have 24hrs to respond. Facility also has a corporate maintenance person who can come in, facility has different vendors for different things if the in- house maintenance person cannot fix it. Some of the AC units are leaking. We call the AC company all the time and they take time to come. We contact them immediately as soon as it is reported. If they can fix it, they will take care of it. But if they need parts they have to order them. The LPA reviewed Maintenance Work Orders(MWO) logs dated between 04/22/2022 to 06/29/2022. The MWO logs revealed miscellaneous problems that needed to be fixed such as towel racks, broken door, broken lamp, etc. The log dates revealed that the time frame between the date the problem was reported, to the date of the completion of the repairs, was anywhere from one day to eleven days. Based on the information obtained through interviews, recorded review, and physical plant inspection, the facility is indeed in need of repairs. However, based on the interviews and record review, the facility is making every effort to address the repairs in a timely manner. Therefore, this allegation is deemed Unsubstantiated at this time. Staff failed to ensure that modified or prescribed diets were provided. On the allegation that ‘Staff failed to ensure that modified or prescribed diets were provided’; it is the concern of the complainant that the R1’s diet needs were not being addressed. To investigate the allegation the LPAs conducted record review, and residents’ interviews and staff and administrator interviews. The record review of manus indicated that residents receive two menus( Regular menu and the Special Diet Menu) to choose meals from. Residents are free to choose whatever meal they want. Administrator stated that residents are encouraged to follow their diet needs and restrictions, however the residents have the right to choose whatever meal they want. The administrator stated R1 was diabetic, but R1 ate what they wanted. R1 ordered a lot of food from outside the facility, and sometimes from the facility. R1 would sometimes call the front desk and order from the menu. We offer healthy choices, but R1 would pick whatever they wanted, although we would encourage R1 to pick a healthy choice. But R1 also had a lot of groceries coming in from outside the facility. Record review revealed that residents are offered a variety meals from the healthy menu, and the regular menu every week. Based on the information obtained through interviews, and record review, there is not sufficient evidence to support the allegation that Staff failed to ensure that modified or prescribed diets were provided. Therefore, this allegation is deemed Unsubstantiated at this time. Staff failed to ensure that the facility was clean and sanitary. On the allegation that ‘Staff failed to ensure that facility was clean and sanitary’; it is the concern of the complainant that when R1’s responsible parties picked up R1’s personal belongings at the facility, they noticed the room to be ‘filthy’ , no additional descriptive information was provided. To investigate the allegation, LPAs Urena and Walker conducted an inspection of the facilities’ physical plant. LPA’s conducted residents’ and staff interviews. The LPAs inspected 10 rooms, and the inspection revealed that 10 out of 10 rooms were observed to be in order, and in clean condition. Eight out of ten residents stated that their rooms are cleaned once a week. Although this allegation may have happened, based on the information obtained through observation of the physical plant, and interviews, there is not sufficient evidence to support the allegation that staff failed to ensure that the facility was clean and sanitary. Therefore this allegation is deemed Unsubstantiated at this time. Exit interview conducted with facility representative Evelina Papasyan. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 14, 2023 · control 29-AS-20220708115334

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: Staff prevent resident from leaving the facility. Resident is isolated in room. Resident's personal items are not being safeguarded. Staff do not ensure that resident is hydrated (no water). Staff does not ensure that resident attends doctor visits. Staff has not addressed a change in resident's health condition. Resident grooming needs are not met. Staff yelled at resident.

On 04/04/2023, Licensing Program Analyst (LPA) Sandra Urena arrived at 9:30 a.m., unannounced to conduct a subsequent visit for the allegations listed above. LPA Urena met with Evelina Papazyan, and explained the reason for the visit. On 01/03/2023, Licensing Program Analyst (LPA) Sandra Urena arrived unannounced to conduct a subsequent visit for the allegations listed above. LPA Urena met with Evelina Papazyan, and explained the reason for the visit. LPA Urena conducted the following interviews: R1’s POA at 2:26 p.m., R1 at 2:48 p.m., Administrator at 3:10 p.m. The LPA obtained, and reviewed copies of documents pertinent to the investigation On 03/30/2022, Licensing Program Analyst (LPA) Salia Walker arrived unannounced for an initial complaint inspection for the above allegations. From 10:45 a.m. until 11:45 a.m., the LPA conducted an interview with the administrator. From 11:55 a.m. until 1:20 p.m., the LPA conducted interviews with four (4) staff. From 1:20 p.m. until 2:00 p.m., the LPA reviewed and obtained copies of documents pertinent to the investigation. Continues on LIC 9099C... Unsubstantiated Staff prevent resident from leaving the facility. On the allegation of ‘Staff prevent resident from leaving the facility’; the complainant’s concern is that the R1 is not allowed to leave the facility. To investigate this allegation LPA Urena conducted interviews, and observation of the memory care unit. The administrator stated that R1 resides in the memory care unit, consequently R1 is limited to the supervised area of the unit throughout the day, with the exception when residents are taken to the general common areas of the facility for activities . The LPA interviewed R1’s POA, who stated that they understand the limitations of R1, and not able to leave the facility unsupervised. The POA feels comfortable that R1 is allowed to go in and out of their bedroom unsupervised within the memory care unit, as R1 is still very independent in mobility. The POA was informed by staff and has witnessed that memory care unit residents are taken on supervised walks to the facility’s courtyard. The staff interviews revealed that residents are taken on supervised walks beyond the memory care unit. The walks are usually around 10:00 a.m. to 10:30 a.m. The LPA interviewed R1 about the allegation, and R1 stated that they go out to the courtyard, dining room and social room. On the day of the interview, the LPA observed R1 independently leaving their room, and going to the common area of the memory care unit. Per the administrator, R1’s family members have taken in the past R1 for overnight stays at their house, and family members are never prevented from taking residents leaving the facility. Based on the information gathered through interviews and observation, there is not sufficient evidence to support the allegation that staff prevent resident from leaving the facility. Therefore, this allegation is deemed Unsubstantiated at this time. Resident is isolated in room. On the allegation ‘Resident is isolated in room’, the complainant’s concern is that R1 is not taken out of the room for walks. To investigate this allegation LPA Urena interviewed R1, R1’s POA , staff and Administrator. The POA stated that R1 is taken on supervised walks to the courtyard, and the common areas of the facility. The Administrator stated that staff take residents on supervised walks to the courtyard, at about 10:00 a.m. to participate in daily exercises. Continues on LIC9099C... Staff’s interviews revealed that residents are brought downstairs to participate in the scheduled activities found in the Monthly Activities Calendar. Additionally, the Administrator shared pictures of R1 participating in activities while in the dining room, the main common room, and social room of the facility. R1 is seen participating in a bowling game. R1’s interview revealed that they do participate in the daily activities, and likes to go to the dining room. Based on the information obtained through interviews, observation, and documentation, there is not sufficient evidence to support the allegation that the Resident is isolated in their room. Therefore, this allegation is deemed Unsubstantiated at this time. Resident's personal items are not being safeguarded. On the allegation ‘Resident's personal items are not being safeguarded’; the complainant’s concern is that R1’s personal items are taken from their room (face creams, body lotions, food, pens, soaps, vitamins, decorative pillow). To investigate the allegation, the LPA interviewed R1’s POA, and Administrator. Per the POA, they are not aware of any personal items missing from R1’s bedroom, nor they have reported to facility staff that personal items are missing. The POA stated that R1 only has clothing and a few grooming items. The Administrator stated that they have not received reports of missing items. The LPA visited R1 in their room, and the LPA noticed personal items in the closet, and grooming items in the bathroom. When the LPA interviewed R1 about the allegation, R1 could not say if any items were missing. Based on the information obtained through interviews, and observation, there is not sufficient evidence to support the allegation that the Resident's personal items are not being safeguarded. Therefore, this allegation is deemed Unsubstantiated at this time. Staff do not ensure that resident is hydrated. On the allegation ‘Staff do not ensure that resident is hydrated (no water)’; the complainant’s concern is that the resident is not being offered water, and that the complainant has observed this. To investigate the allegation, the LPA interviewed R1’s POA, R1, staff, and Administrator. The POA stated that they are not aware of R1 being dehydrated. The Administrator stated that residents are offered liquids throughout the day, in addition to the liquids( water, milk, juice, coffee) offered through their daily meals, and snacks. The staff stated that they offer liquids to residents throughout the day. Continues on LIC 9099C... The R1 stated that they are not thirsty, and showed the LPA bottled water they have in their room. The LPA interviewed residents about their access to liquids and if they felt they got enough liquids. Five out of five residents stated that they are offered juice, coffee, and milk during meals and water throughout the day, and they have access to water. Based on the information obtained through interviews, and observation there is not sufficient evidence to support the allegation that the Staff do not ensure that resident is hydrated. Therefore, this allegation is deemed Unsubstantiated at this time. Staff does not ensure that resident attends doctor visits. On the allegation ‘Staff does not ensure that resident attends doctor visits’; the complainant’s concern is that the facility staff do not ensure that R1 sees their doctor to follow up on his condition (brain injury) or address their tooth pain with a dentist. To investigate the allegation the LPA interviewed R1’s POA, R1, and Administrator. R1’s POA stated that they are not aware of R1 experiencing a brain injury, or tooth pain. R1 stated that they did not have tooth ache. The LPA reviewed R1’s Physician Report dated 02/26/2021, and 04/03/2022, and the record review indicated that R1’s primary diagnosis is dementia, and other mental conditions(no brain injury was noted in the report). The facility’s protocol for dental appointments is the following: Residents inform the facility staff(med tech) if they are experiencing dental care needs. The med tech informs the administrator of the need for dental care for the resident. If the resident has a POA/responsible party, they inform the POA or responsible party to arrange for a dental appointment. If staff notices a resident in memory care unit who may require dental care, then staff informs the med tech or the administrator, who in turn contact the resident’s POA/responsible party. The facility provides transportation to dental appointments as needed, and will scheduled the dental appointment for those residents that require assistance making the dental appointments. All memory care residents going out to medical/dental appointments are chaperoned by a staff member(usually the Activities Director). Additional record review indicates that the facility’s doctor has seen R1 on a monthly basis. Based on the information obtained through interviews, and record review, there is not sufficient evidence to support the allegation that Staff does not ensure that resident attends doctor visits. Therefore, this allegation is deemed Unsubstantiated at this time. Continues on LIC 9099C... Staff has not addressed a change in resident's health condition. On the allegation ‘Staff has not addressed a change in resident's health condition’, the complainant’s concern is that R1 developed a skin condition on their chest, and was not addressed. To investigate this allegation the LPA interviewed the Administrator, and conducted record review. The administrator stated that staff did notice the skin condition on their chest, and was addressed by the facility’s physician. Record review of a physician’s prescription indicates that the facility’s physician prescribed a topical cream(Triamcinoze 0.1% ) on 01/21/2021 to be applied daily once a day on skin rash. Cream was applied until rash cleared. Facility's Skin Integrity log indicates that skin appeared clear by 02/18/2022. Based on the information obtained through interviews, and record review, there is not sufficient evidence to support the allegation that Staff has not addressed a change in resident's health condition. Therefore, this allegation is deemed Unsubstantiated at this time. Resident grooming needs are not met. On the allegation ‘Resident grooming needs are not met’; the complainant’s concern is that R1’s hair has not been cut in a very long time, and R1 resembles a homeless person, and wears non-fitting worn-out clothing. To investigate the allegation the LPA interviewed R1’s POA, Administrator, staff, and observed R1 in their room. The POA stated that on the times they have visited R1, R1 was observed clothing to fit ok (clothes are provided by the family members), and hair was clean and brushed. The Administrator stated that residents get a shower two times a week, and that haircuts used to be done by the hair stylist pre-COVID time. After COVID the family members take care of haircuts. The LPA visited R1, and observed R1 to be clean, hair length (normal), and was wearing well- fitting clothes. Based on the information obtained through interviews, and observation, there is not sufficient evidence to support the allegation that Resident grooming needs are not met. Therefore, this allegation is deemed Unsubstantiated at this time. Continues on LIC 9099C... Staff yelled at resident. On the allegation ‘Staff yelled at resident’, the complainant’s concern is that R1 is fearful of staff because they have been observed yelling at the resident. To investigate the allegation the LPA interviewed R1’s POA, R1, and residents. The POA stated that their have observed staff to be attentive and nice to R1. The residents interviewed stated that staff are very nice. The LPA interviewed R1 in their bedroom, and R1 stated that everything is ‘pretty good and that staff are nice people, and they have not yelled at them’. The LPA observed R1 to be engaging and did not observe R1 to be fearful of staff. Based on the information obtained through interviews, and observation, there is not sufficient evidence to support the allegation that Staff yelled at resident . Therefore, this allegation is deemed Unsubstantiated at this time. No citations were issued. Exit interview was conducted with the administrator. A coy of the report was issued.the state’s words, verbatim · CDSS document, Apr 4, 2023 · control 29-AS-20220324112126

Allegation investigated: Facility has pests.

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced complaint visit to investigate the above allegation and met with Evelina Papazyan, Administrator. LPA Yee explained the reason for today's visit. During today's visit, LPA interviewed the Adminstrator at 9:47am, Residents #1 through Resident #4 beginning at 10:16am - 11:12am, Resident #5 at 11:39am, Staff #1 at 11:52am, Staff #2 at 11:59am, Staff #3 at 12:04pm, reviewed and obtained copies of monthly inspection reports at 10:10am, toured bedroom #204 at 11:25am. Per information obtained from the interviews conducted with the Administrator, Staff Continued on LIC9099-C Unsubstantiated #1 through Staff #3, Resident #2- through Resident #4, all stated that they have not observed any fleas or any kind of pests at the facility. Per the Administrator, no one has complained of any insect bites until the time of this visit. Resident #1 just informed the Medication Tech this morning about the flea bites. During the interview and during the tour, Resident #1 indicated that the fleas are all over the bed and are invisible. Per Resident #1, the fleas were brought into the room via the bed linens. The facility has feral cats out in the back courtyard and one got into the laundry room through an open door. Per the Administrator, the laundry room is always locked. Resident #2, roommate of Resident #1, states that 2-3 fleas were observed on the bed a few nights ago and has not been seen since. Per Resident #2, the fleas are tiny and black. Resident #2, did not sustain any flea bites. Per tour of bedroom #204 and inspection of the beds, LPA Yee did not observe any fleas or any signs of a flea infestation on the white bed sheet. Resident #1 indicated that the flea bites were on the side of the right arm and behind the back of the left shoulder. Per inspection of Resident #1's right arm, the back of the neck an left shoulder, where the alleged flea bites were, the right arm was observed to be slightly swollen with scratch marks and did not look like flea bites and the back neck and left shoulder had no red marks or any signs of flea bites. As a precaution, the facility has notified the primary care doctor and will schedule a visit with the doctor to look at the resident's back, neck and arm. The facility has a contract with a pest control company that performs monthly preventative services. The common areas are treated monthly. The pest control company will make additional visits to treat the facility if there are any issues that come up, such as bed bugs, fleas, flies and ants. Per review of the services performed in the last 6 months, there have been no pest issues since September 2022. During today's investigation, LPA Yee was not able to conclusively determine if there are any fleas in the facility, therefore the allegation is UNSUBSTANTIATED at this time. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 28, 2023 · control 29-AS-20230323165111

Allegation investigated: . Resident not accorded dignity in their personal relationships with staff. 2. Facility does not provide adequate food service. 3. Improper rent increase.

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced intial complaint visit to investigate the above allegations and initially met with Indra Lopez at the time of arrival. The Administrator was contacted via telephone and arrived at 9:20am to conduct the visit. The reason for today's visit was explained. On today's visit, LPA Yee conducted interview with the Administrator from 9:22am - 10:13am, Staff #1 from 12:57pm-1:12pm and interviews with Resident #2 through Resident #6 beginning at 10:14m to 12:20pm in the conference room. Lunch was observed at 12:25pm. Resident #1's file was reviewed at 1:30pm. Copies of facility records, including the menu was obtained. Kitchen was toured from 2:14pm - 2:36pm. Continued on LIC9099-C Unsubstantiated Per interviews conducted with the Administrator and Staff# 1 regarding allegation #1-Resident not accorded dignity in their personal relationship with staff, they and all the other staff do not disrespect or harass any resident. They do not yell or call residents names. Residents interviewed deny that the staff disrespect them, yell at them or call them names. All the residents interviewed stated that the staff are very nice, lovely, kind and one resident even stated that they are fabulous. Per the residents, the person who is saying those things is a liar. Both staff and residents, have stated that the only person going around yelling, calling everyone names, and intimidating other residents and staff is Resident #1. Resident #1 is racist and does not like anyone that is from a different culture. Resident #1 curses at everyone, calls them names, makes offensive racial slurs while in the dining room or lobby and screams at residents from different cultures to leave their shared dining table. Per the administrator, she had a meeting with Resident #1 to address the resident's behavior in the dining room and how the other residents were feeling about being bullied. The residents ignore or stay away from Resident #1. In regards to allegation #2 - facility does not provide adequate foot service, residents interviewed indicated that the food at the facility is either okay, alright and one resident said it was perfect. Residents interviewed indicated that everyone complains about the food either because they don't like something due to personal preference or they want a variety of foods. Per review of the facility menu, the facility serves chicken, pork, fish and beef with various kinds of vegetables and rice, quinoa, bulgur and couscous. Residents want the facility to serve other types of fish in addition to tilapia. The facility has a food committee to discuss food issues and consider residents' food preferences that can be incorporated into the facility menu.. Regarding Allegation # 3 - improper rent increase, the facility increased the rent on 1/1/23 as a result of the increase in the annual SSI/SSP rate. All residents receiving SSI and ALW had rent increases except for residents on private pay. A copy of PIN 22-10-CCLD dated 11/15/2022 for the Estimated SSI/SSP Payment Standards effective January 1, 2023 was mailed to responsible parties/families and handed to residents who handle their own continued on LIC9099-C finances. Per the administrator, telephone calls were also made to the families and face to face meetings were conducted with the residents regarding the increase. Based on the information received on today's visit, the findings of the investigation is unsubstantiated for the above allegations. Exit interview was conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Mar 7, 2023 · control 29-AS-20230303104051

Type of visit: Case Management - Other

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced case management visit to correct the citation section cited on the LIC421 IM (7/17) generated on 1/20/2022 for complaint #29-AS-20210419162045. LPA Yee met with Indra Lopez, Administrator Assistant and the reason for the visit was explained. On 1/20/22, the substantiated findings of the investigation for complaint # 29-AS-2021041916204 was delivered and citations were issued under California Code of Regulations, Title 22, Division 6 Chapter 8, Section 80078(a) and immediate civil penalties were assessed using form LIC421 IM. Amended LIC9099, LIC9099-C and LIC9099-D reports were later generated to correct the section cited on the LIC9099-D to 87468.2(a)(4). The LIC421 IM was not amended at the time. The purpose of today's visit is to correct the citation referenced on the LIC421 IM to also read 87468.2(a)(4). Exit interview was conducted with Indra Lopez and a copy of this report was provided with a copy of the corrected LIC421 IM.the state’s words, verbatim · CDSS document, Feb 2, 2023

Allegation investigated: Staff failed to meet resident's medical needs (OT/PT were prescribed). Staff failed to meet resident's medical needs (resident wants to see R1's physician as R1 states R1's medication gives R1 chest pain).

On 01/03/2023 Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to investigate the allegations listed above. LPA Urena arrived at the facility at 10:30 a.m., met with Administrator Evelina Papazyan, and explained the reason of the visit. On 05/17/2022, Licensing Program Analyst (LPA) Salia Walker arrived unannounced for an initial complaint inspection for the above allegations. The LPA met with Administrator Evelina Papazyan at 9:20 a.m., and explained the reason for the visit. During the visit, the LPA conducted a physical plant tour with the administrator at 10:15 a.m., interviewed staff at 9:20 a.m., and 9:30 a.m.; reviewed and obtained copies of documents pertinent to the investigation; and interviewed residents at 11:45 a.m., 2:10 p.m., 2:22 p.m., 2:58 p.m., and 3:13 p.m. Further investigation is required prior to issuing findings. Continues on LIC 9099C. Unsubstantiated On the allegation that ‘Staff failed to meet resident’s medical needs for the OT/PT prescribed’, on 02/17/2022 LPA Walker interviewed R1 at 2:10 p.m. about needing or receiving occupational therapy (OT) or physical therapy (PT). The R1 stated that they never had OT or PT, that they had asked staff at another facility if they could get OT, but did not ask staff at Courtyard Plaza. Record review of R1’s Physician’s Report dated 02/04/2022 does not indicate that R1 needs to receive OT or PT. On 11/30/2022, LPA Urena attempted to interview the physician who signed the physicians report, but physician reported that they were unavailable. On 12/27/2022, LPA Urena contacted the physician who provided the Diagnosis Information in the Move In Record for Courtyard Plaza dated 02/08/2022. The physician stated that they would have to review R1’s medical records to provide more information about the need or recommendation for PT for R1. On 12/29/2022, LPA Urena contacted the physician a second time about R1’s medical record review, and the physician stated that they saw R1 twice during their stay at the facility. The last time the physician saw R1 was on 06/2022, and based on their physical assessment of R1, the physician stated that they had not recommended PT for R1. LPA Urena received R1’s medical records from physician’s office, and the record review confirmed the diagnosis, and medications orders as explained by the physician during the interview. Based on the information obtained through record review and interviews, there is insufficient evidence to support the allegation that Staff failed to meet resident's medical needs (OT/PT were prescribed). Therefore, this allegation is deemed Unsubstantiated at this time. On the allegation that ‘Staff failed to meet resident's medical needs (resident wants to see R1's physician as R1 states R1's medication gives R1 chest pain)’, on 02/17/2022, LPA Walker interviewed R1 about the allegation. R1 stated that they have never seen a doctor, and that the doctor comes to see them at the facility, and the doctor has prescribed their medication. Additionally, R1 stated, ‘I have not asked any staff here to see a doctor’. On 12/29/2022, LPA Urena interviewed the physician on record for R1. The interview revealed that R1 had not complained of any chest pain, consequently, the physician continued to prescribe the medications as stated in R1’s record. LPA Walker interviewed the administrator about their procedure to address residents’ medical emergencies, and any medication reactions. Continues on LIC 9099C... The administrator stated that 'if any resident ever complains of chest pain, they would immediately call 9-1-1. If the resident needs their medication, and the facility is managing it, the facility reorders the medications at least 20 days prior to running out of the medicine. If the resident is managing their own medications, the residents would tell us, and the facility staff would call the residents’ doctor if they request it'. LPA Urena conducted additional record review - Medical Administration Record (MAR's) on 01/03/2023 for R1, the record review revealed that the medication being taken by R1 did not produce an adverse reaction. Based on the information obtained through interviews, and record review, there is insufficient evidence to support the allegation that staff failed to meet resident’s medical needs. Therefore, this allegation is deemed Unsubstantiated at this time. No citations were issued. Exit interview was conducted with the facilities representative. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 3, 2023 · control 29-AS-20220511110219

Allegation investigated: Facility staff is interfering with resident's right to move from the facility.

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced complaint visit for the above allegation. LPA Urena arrived at the facility at 11:30 a.m., met with the Administrator Evelina Papazyan, and explained the reason for the visit. On the allegation of ‘Facility staff is interfering with resident's right to move from the facility’, the Reporting Party's (RP) concern is that the facility staff was interfering with the transfer of the resident to a new facility by way of using intimidating language, and making R1 cry and afraid. To investigate the allegation, LPA Urena conducted a collateral visit to interview R1 on 12/08/2022 from10:28 a.m. to 10:45 a.m. The interview with R1 revealed that R1 did not feel that anyone was interfering with the move from the facility to another location; and neither felt intimidated, nor made to cry. Continues on LIC 9099C ... Unsubstantiated Additionally, R1 stated that the only conversation they had with the facility staff, was about staff wanting to know the reason for R1 leaving the facility. The LPA interviewed the facility staff about their conversation with R1 prior to R1 leaving the facility, and the interview revealed that they did not in any way were inappropriate in the language they used with R1, and only wanted R1 to be informed about her rights. Based on the information obtained through interviews, there is insufficient evidence to support the allegation that Facility staff is interfering with resident's right to move from the facility. Therefore, the allegation is Unsubstantiated at this time. No deficiencies cited. Exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 8, 2022 · control 29-AS-20221205162841

Allegation investigated: Staff member yells at residents Staff failed to treat residents with dignity and respect Facility is in disrepair Staff member threatens resident with eviction.

On 11/30/2022, Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to investigate the allegations above. LPA Urena arrived at the facility at 9:30 a.m., met with Administrator Evelina Papazyan, and explained the reason of the visit. The LPA and the Administrator conducted a brief physical plant tour of the facility at 12:45 p.m., and the LPA interviewed residents from 1:00 p.m. to 1:30 p.m. On 05/17/2022, Licensing Program Analyst (LPA) Salia Walker arrived unannounced for an initial complaint inspection for the above allegations. The LPA met with Administrator Evelina Papazyan at 9:20 a.m., and explained the reason for the visit. During the visit, the LPA conducted a physical plant tour with the administrator at 10:15 a.m., interviewed staff at 9:20 a.m., and 9:30 a.m.; reviewed and obtained copies of documents pertinent to the investigation; and interviewed residents at 11:45 a.m., 2:10 p.m., 2:22 p.m., 2:58 p.m., and 3:13 p.m. Further investigation is required prior to issuing findings. Continues on LIC 9099C... Unsubstantiated On the allegation of ‘Staff member yells at residents’, the Reporting Party’s (RP) concern is that the staff yells at R1, and the other elderly residents. To investigate the allegation LPA Walker conducted residents’ interviews on 05/17/2022, and LPA Urena conducted additional residents’ interviews on 11/30/2022. The residents’ interviews revealed that they have never observed staff yelling or screaming at anyone. R1’s interview revealed that staff are nice to R1, and R1 admitted that staff have not yelled at them. The interview with staff revealed that they don’t recall any incident that may have occurred resulting in raising their voice, and added that they have intervened only when residents are arguing with each other or with staff. They stated that they always treat residents with dignity and respect. Based on the information obtained through interviews, there is insufficient evidence to support the allegation that ‘Staff member yells at residents’ Therefore, the allegation is Unsubstantiated at this time. On the allegation of ‘Staff failed to treat residents with dignity and respect’, the RP’s concern is that staff are disrespectful to residents. To investigate the allegation LPA Walker conducted residents’ interviews on 05/17/2022, and LPA Urena conducted additional residents’ interviews on 11/30/2022. The residents’ interviews revealed that they feel respected and cared for here, and they are treated with dignity and respect. Residents’ interviews revealed that they have never witnessed staff treat residents inappropriately. R1’s interview revealed that staff are nice to R1, and R1 admitted to being disrespectful to some staff members due to being upset after a particular incident. The staff’s interview revealed that they always treat residents with dignity and respect, even at times when residents are disrespectful. Based on the information obtained through interviews, there is insufficient evidence to support the allegation that ‘Staff failed to treat residents with dignity and respect’. Therefore, this allegation is Unsubstantiated at this time. On the allegation of ‘Facility is in disrepair’, the RP’s concern is that the there is a back door which is broken, it has not been fixed and anyone can come into and leave the facility. On May 17, 2022 at 9:20 a.m., LPA Walker interviewed Administrator Evelina Papazyan about the broken back door. Continues on LIC 9099 C... The Administrator stated that the only thing that is currently in disrepair is the parking lot gate, ‘The City’s Waste Management backed up into our gate and broke it. Corporate is handling it. The driver came into the facility and told us he broke the gate, and provided the form on who to contact, and file the claim’. The city took a long time to get it fixed, but it is fixed now. LPA Walker interviewed R1 about the facility being in disrepair, and R1 stated, ‘I have not observed any broken doors'. The LPA asked the Administrator about the back gate. During today’s visit (11/30/2022) at 12:46 p.m., LPA Urena, and the Administrator conducted a tour of the parking lot. The LPA and the administrator walked to the rear of the facility where the parking lot is located. The LPA observed the parking lot gate to be in working condition. Additionally, LPA Urena observed a gate door that leads from the facility to the parking lot to be in working condition. The Administrator stated that the gate door is locked in the evenings, as soon as it gets dark. The facility’s front door is used at all times for residents, and staff to enter and exit the facility during the evening hours. Based on the observations, and the information obtained, there is insufficient evidence to support the allegation that ‘Facility is in disrepair’. Therefore, this allegation is Unsubstantiated at this time. On the allegation, ‘Staff member threatens resident with eviction’, it is the concern of the RP that R1 is being threatened by staff by saying that they would “Kick them out of the facility”. LPA Walker interviewed R1 regarding the allegation, and R1 stated, ‘The administrator did not threaten to evict me. They told me that I can go and come to the facility as I please, but they asked me to let them know so, they know where I am’. Residents’ interviews revealed that they have not experienced threats about eviction. LPA Walker interviewed the Administrator about the threats to evict residents. The Administrator stated that they do not threaten residents to be evicted. Evictions take place through eviction notices. Based on the information obtained, and although the allegation may have happened, there is insufficient evidence to support the allegation that ‘Staff member threatens resident with eviction’. Therefore, this allegation is Unsubstantiated at this time. No citations were issued. Exit interview was conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 30, 2022 · control 29-AS-20220511110219

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 9:15 a.m. The LPA met with Evelina Papazyan and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The facility obtains food delivery on a regular basis. The menu was posted and the facility offers various options for the residents to choose from. The dining room furniture was observed to be in good condition. BEDROOMS: The LPA observed randomly selected resident rooms, which were furnished appropriately with clean linens, furnishings and sufficient lighting. RESTROOMS: Restrooms are sufficiently stocked with hand liquid soap and paper towels. Appropriate hand washing signs were observed in all common restrooms. Water temperature was taken on the first and third floor in the common restrooms. The hot water measured between 113.7 degrees and 114.5 degrees Fahrenheit. The common restrooms on the second floor were closed for construction, as the toilets were being replaced and walls were being re-painted. COMMON SPACES: Common areas include the dining room, activity room, library, theater room, and patio. The activity calendar was posted in a common area. Activities are offered throughout the day. In the common areas, walls, flooring and furniture were checked for cleanliness and good condition. The fire extinguisher in the hallways were fully charged and was last serviced 2/2022. The emergency systems were checked in 11/2021 by the Los Angeles Fire Department and were deemed operational. At 9:38 a.m., the LPA observed that one (1) out of two (2) elevators was inoperable at the time of the visit; however, a work order was placed to repair the elevator. As stated, there was one working elevator for resident use. At 9:41 a.m., the LPA observed an unlocked supply closet, which stored painting supplies. In addition, painting supplies were stored outside of a resident room, as it was actively being painted. The Administrator was notified, and it was communicated that certain rooms were being remodeled at the time of the visit. These items were secured by the end of the visit. The facility has a courtyard equipped with furniture for resident use. There is a fountain, yet it is drained of water. No additional bodies of water noted. There are laundry areas throughout the facility for resident use. INFECTION CONTROL: There was a central entry point for screening and temperature checks. The LPA was appropriately screened upon entry into the facility. Staff were wearing appropriate face coverings. Infection Control signs were observed at the entrance and throughout the facility. Hand sanitizer was available for resident and staff use. The facility’s cleaning protocol was sufficient. There was record of staff and resident vaccinations, along with record of COVID screenings for staff, residents, and visitors. The LPA discussed changes around testing, visitation and vaccine requirements. At this time, the Administrator continues to conduct surveillance testing of all staff and residents on a bi-weekly basis. The facility's procedures as it pertains to infection control are adequate. 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, Nov 30, 2022

Allegation investigated: Insufficient staffing during evening hours. Staff are not present in the reception area; as a result, residents are not able to gain re-entrance into the facility during the evening hours.

Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent unannounced visit to investigate the above allegations. LPA Urena arrived at the facility at 10:30 a.m., met with Administrator Evelina Papazyan, and explained the reason for the visit. On 08/10/2022, Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint inspection for the above allegation(s). The LPA met with Administrator Evelina Papazyan at 9:22 a.m., and explained the reason for the visit. During the visit, the LPA spoke briefly with the Administrator and obtained copies of documents pertinent to the investigation. From 9:45 a.m. until 12:15 p.m., the LPA conducted interviews with facility residents. From 2:36 p.m. until 3:15 p.m., the LPA conducted interviews with facility staff. Continues on LIC 9099C... Unsubstantiated For the allegation that there is ‘Insufficient staffing during evening hours’, LPA Urena conducted additional record review, and interviewed the Administrator from 11:15 a.m. to 12:02 p.m. The record review revealed that four (4) staff are present during the evening shift which is from 3:30 p.m. to 11:30 p.m. Two staff are assigned to the Assisted Living unit, and two staff are assigned to the Memory Care Unit, seven days a week. The evening staff have assigned duties: Incontinence duties. The evening staff (Assisted Living Unit) alternate their schedules to complete their assigned duties throughout their shift. One staff conducts the assigned duties, while the other staff manages the front desk, and vice versa. Resident interviews revealed that staff check on them at night constantly during the night. Staff checks on them even if they are asleep; they have seen two(2) to three (3) staff working at night. They have noticed that the facility is short staffed at times, but there is always staff to cover for any staff that call out; the administrator will even cover, and they have seen the administrator cover when needed. There have been times when they needed help with changing their diaper here and there, and staff comes right away. Furthermore, the times they have called for assistance during the night the most they have had to wait was 10 minutes or less. Another resident stated that when they felt sick and threw up, they called staff and they came right away. The facility's electronic time keeping system for staff, revealed that four (4) staff members sign in at 3:30 p.m., and signed out at 11:30 p.m. Staff interviews revealed that there are four staff working the evening shift. Based on the information obtained through record review, and interviews, there is insufficient evidence to support the allegation that there is insufficient staff during the evening hours. Therefore, the allegation is Unsubstantiated at this time. For the allegation that ‘Staff are not present in the reception area; as a result, residents are not able to gain re-entrance into the facility during the evening hours’. LPA Urena conducted record review, and administrator interview. The residents’ interviews revealed that when their family comes to take them out, there have been times when they returned in the evening, and staff always come to the front door right away. No issues with gaining entrance back into the facility upon returning in the evening. Residents stated that when they have gone out, and return the front entrance has not been locked; to their knowledge the door is always open. The administrator’s interview revealed that evening shift caregivers alternate their assignments schedule, and one caregiver is always at the reception area, while the other caregiver completes her assignments. Continues on LIC 9099 C... A facility inspection of the front desk doorbell was conducted on July 26, 2022 at 11:44 a.m., by LPA Walker along with Administrator Evelina Papazyan. The Administrator pressed the doorbell button approximately four (4) times, and each time the speaker sounded the bell with a light. The doorbell system was functioning properly. On 11/15/2022, at approximately 1:47 p.m., LPA Urena, and the Administrator conducted an additional inspection of the doorbell system, and found the system to be functioning accordingly. The administrator stated that due to the change of weather, and the new daylight savings time, they now close the front door earlier than they did in the spring, summer and fall. The front door is closed when it gets dark outside, for the safety of residents and staff, and due to the homeless population living around the corner of the facility. Based on information obtained through interviews, record review and facility inspection, there is insufficient evidence to support the allegation that ‘Staff are not present in the reception area; as a result, residents are not able to gain re-entrance into the facility during the evening hours. Although the allegation may have happened or is valid, there is insufficient evidence to prove the allegation did or did not occur. Therefore, the allegation is Unsubstantiated at this time. No deficiencies cited. Exit interview conducted, and a copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 15, 2022 · control 29-AS-20220722135126

Allegation investigated: Facility staff failed to respond to resident’s emergency/alert alarm.

Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint inspection for the above allegation. The LPA met with Administrator Evelina Papazyan at 9:22 a.m., and explained the reason for the visit. On 07/26/2022, LPA Walker conducted an initial complaint inspection. During the visit, the LPA conducted a physical plant tour with Administrator Evelina Papazyan at 11:25 a.m. From 9:48 a.m. until 10:35 a.m., the LPA conducted an interview with the administrator. From 10:47 a.m. until 11:20 a.m., the LPA conducted interviews with facility resident(s). From 11:36 a.m. until 11:50 a.m., the LPA reviewed and obtained copies of documents pertinent to the investigation. On 07/27/2022, LPA Walker conducted telephone interview(s) with resident family member(s). Continue on LIC9099C.. Unsubstantiated During today’s visit, the LPA spoke briefly with the Administrator and obtained copies of documents pertinent to the investigation. From 9:45 a.m. until 12:15 p.m., the LPA conducted interviews with facility residents. From 2:36 p.m. until 3:15 p.m., the LPA conducted interviews with facility staff. Regarding the allegation, ‘Facility staff failed to respond to resident’s emergency/alert alarm,’ the complainant’s concern is that on 07/17/2022 (Time Unknown) Resident #1 (R1) allegedly pulled the emergency response cord located in their private restroom to alert staff that they were having a heart attack; and staff did not come to help R1. The complainant is also concerned that the reason for staff not responding to R1’s emergency call was due to no staff being present at the front desk at the time of the call. During the investigation, LPA Walker conducted interviews with the Administrator, R1, R1’s family member(s), and facility staff. Interview with the Administrator revealed that Staff #1 (S1) was present at the front desk on 07/17/22 at the time that R1 pulled the emergency response cord. According to the Administrator staff responded immediately as they contacted the Administrator to notify of R1 initially refusing medical attention. Interview with R1 revealed that that staff came to R1’s room at the time of the incident after pulling the emergency cord. However, R1 was not able to gage the time it took from the moment they knew something was wrong to calling out for help. Interview with R1 also revealed that staff took care of them Instantly once they saw R1. Interview with R1’s family member(s) revealed that R1 did not have a heart attack on 07/17/22. Interview with R1’s family member(s) also revealed that R1 advised that R1 initially pulled the “chain,” and from R1’s recollection was nothing happened which is when R1’s roommate went to find staff. However, R1’s family member(s) stated that based on time stamps from voicemails left by the facility staff, “it was a timely response." Interviews with facility staff confirmed that S1 was present at the front desk on 07/17/22 at the time R1 pulled the emergency response cord to gain assistance. Interviews with facility staff also revealed that staff responded timely, and notified the administrator, R1’s family, and contacted the paramedics. Based on interviews which were conducted, there is insufficient evidence to support the allegation ‘Facility staff failed to respond to resident’s emergency/alert alarm.’ 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. Exit interview conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 10, 2022 · control 29-AS-20220722135126

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff makes inappropriate comments towards resident. The administrator is raising many residents monthly rate without justification. The administrator is failing to provide residents receipts for payment of the monthly rate.

On 08/10/2022, Licensing program Analyst (LPA), Sandra Urena conducted a subsequent unannounced visit to investigate the allegations named above. The LPA met with the Administrator at 10:25 a.m., and explained the reason for the visit. During today’s visit the LPA conducted additional residents' interviews from 10:40 a.m. to 11:25 a.m. and staff at 1:45 p.m. On 06/10/2022, Licensing program Analyst (LPA), Sandra Urena conducted an initial 10-day unannounced visit to investigate the allegations named above. LPA Urena arrived at the facility at 10:12 a.m., met with Director Evelina Papazyan, and explained the reason for the visit. At 10:20 a.m., the LPA, and the Director conducted a brief tour of the facility. The LPA conducted record review at 10:45 a.m., and interviewed staff and residents from11:45 a.m. to 2:15 p.m. Further investigation is needed prior to issuing findings. Unsubstantiated Additionally, the administrator stated that the termination of services is stated in the admission agreement that the residents or their responsible parties sign. Based on the information gathered through the interviews, and record review, it was found that the residents are aware, and informed about the rent increase by receiving a 60-day notice, and about the termination of services based on the admission agreement signed by the residents themselves, or by their responsible parties. There is insufficient evidence to support the claim that the ‘administrator is raising many residents monthly rate without justification’. Therefore, this allegation is deemed UNSUBSTANTIATED at this time. The administrator is failing to provide residents receipts for payment of the monthly rate. On the allegation, ‘The administrator is failing to provide residents with receipts for payment of the monthly rate’. It is alleged that the administrator does not provide a receipt to residents when they pay their rent, even after residents request a receipt’. The LPA interviewed eleven (11) residents about receiving a receipt for the monthly rent paid. Ten (10) out of eleven residents stated that they do get a receipt, whether they one want one or not. One resident stated that they request not only a receipt, but also a photocopy of the receipt and the check together. The Staff #1(S1), interview revealed that residents who pay in person typically pay with a cashiers check. If S1 is not available, then typically another staff will receive the payment. If the resident is in a hurry, and cannot wait for the receipt, then the staff puts the receipt in the resident’ mailbox, and the resident can come back later to retrieve it. Record review for the months of April, May, and June, for ten (10) residents, revealed that copies of the receipts are kept in the office. The original is given to the residents. Based on the information gathered through the interviews, and record review, it was found that the residents receive a receipt for the rent payments. There is insufficient evidence to support the claim that the ‘The administrator is failing to provide residents with receipts for payment of the monthly rate’. Therefore, this allegation is deemed UNSUBSTANTIATED at this time. No citations were issued. Exit interview was conducted with the administrator. A copy of the report was issued. Staff makes inappropriate comments towards resident. On the allegation, ‘Staff makes inappropriate comments towards resident’. It is alleged that staff makes comments about residents’ ability to pay rent. The LPA interviewed residents from 10:45 a.m. to 11:15 a.m. about staff making inappropriate comments to residents. Ten out of 11 residents stated that staff are cordial and that they are treated well. Two out of 11 residents stated that they rarely interact with some of the staff, and more often with other staff. Residents have not heard staff make comments about the residents’ ability to pay their rent. Residents interviewed stated that they try to pay their rent on time, and have not heard inappropriate comments from staff. Interview with the administrator revealed that they have met with some residents, in a private setting to discuss back due rent, and has attempted to give guidance about prioritizing paying the rent on time. Based on the information gathered through the interviews, there is insufficient evidence to support the claim that staff makes inappropriate comments about residents’ ability to pay the rent. Therefore, this allegation is deemed UNSUBSTANTIATED at this time. The administrator is raising many residents monthly rate without justification. On the allegation, ‘The administrator is raising many residents monthly rate without justification’. It is alleged that the administrator is increasing some people’s rent, and no one can afford to pay more, and threatening residents with an eviction notice if they don’t pay the new increased amount. The LPA interviewed eleven (11) residents about the rent being increased. Ten (10) residents stated that when the rent is going up, they typically get a 60-day notice. Residents stated that the letter they receive says that the rent is being raised due to the ‘cost of living’. The LPA conducted a file review of eleven (11) residents’ files, and found that residents receive a letter stating the new amount for the rent. The letters found in the file review, gave residents a 60-day notice, stating the reason for the increase, that being the cost of inflation to run the facility, and cost of living. File review revealed that the Admission Agreement states that residents will receive a Termination 30-day notice if the resident fails to pay in full the monthly rent, within ten (10) days after the due date. The file review revealed that the residents are aware that the termination of services may happen, via their signature in the Admission Agreement. The LPA interviewed the administrator about the rent increase notices given to residents, and the administrator revealed that the rent increase is as stated in the 60-day notice.the state’s words, verbatim · CDSS document, Aug 10, 2022 · control 29-AS-20220602103108

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Salia Walker and Sandra Urena conducted an unannounced Case Management-Deficiencies visit at the facility today, due to deficiencies observed during the investigation of complaint control #29-AS-20220708115334. The LPAs met with Administrator Evelina Papazyan at 9:10 a.m. Entrance interview conducted. From 9:16 a.m. until 10:40 a.m.; and from 2:00 p.m. until 3:00 p.m., LPAs Walker, Urena, and Administrator Evelina Papazyan conducted a physical plant tour. During the physical plant tour, a random selection of ten (10) resident rooms were inspected. At 9:46 a.m., LPA Walker was advised by Resident #1 (R1) that the facility hot water temperatures were elevated. Five (5) out of ten (10) resident rooms hot water temperatures measure between 121.7 and 129.5 degrees Fahrenheit. The LPAs advised the Administrator faucets used by residents for personal care shall maintain hot water temperatures of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). The Administrator acknowledged. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D). Exit interview conducted. A copy of the report, and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 13, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Jul 14, 2022

87303(e)(2) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets.. shall deliver.. hot water.. not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based on LPAs observation, the licensee failed to ensure hot water temperature measured within 105 to 120 degrees F in resident rooms which poses an immediate health, and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 13, 2022

Plan of correction: The Licensee has agreed to do the following: 1. Submit proof by photos of tempurature adjustment. 2. Submit a hot water temperature log for five (5) days to maintain water temperature between 105 - 120 degrees F.

Allegation investigated: Facility will not accept resident back at facility

Licensing Program Analyst (LPA) Salia Walker arrived unannounced for an initial complaint inspection for the above allegation. The LPA met with Administrator Evelina Papazyan at 9:50 a.m., and explained the reason for the visit. During today’s visit, the LPA conducted a physical plant tour with the Administrator, Evelina Papazyan at 9:51 a.m. From 10:10 a.m. until 11:41 a.m., the LPA conducted an interview with the administrator. From 11:41 a.m. until 12:30 p.m., interviews were conducted with facility staff. From 12:30 p.m. until 1:00 p.m., the LPA reviewed and obtained copies of documents pertinent to the investigation. From 1:00 p.m. until 2:00 p.m., the LPA conducted telephone interviews with credible sources. Continue on LIC9099C.. Unsubstantiated Regarding the allegation, ‘Facility will not accept resident back at facility,’ the complainant’s concern is that on 6/29/2022 and 6/30/2022, hospital personnel called the facility staff to inform them that Resident #1 (R1) was ready to be discharged from the 5150 hold and the facility staff stated they would not accept R1 back to the facility, alleging that R1 checked themselves out of the facility with no intention of returning. The complainant is aware that R1 was not served with an eviction notice; and, that the facility staff gave R1 a check-out form which only states that all of R1’s property was given to R1 upon their discharge from the facility. However, they believed that the facility should still take R1 back, since this was R1’s last known place of residence. An interview with the administrator revealed that on 06/26/22, Law Enforcement was contacted by the facility after R1 used an object which R1 identified as a ‘gun’ to make threats towards facility staff and residents. According to the Administrator, Law Enforcement did not arrest R1 as they confirmed that the object was not a firearm, though visually, it would be difficult to tell if it was a ‘real’ handgun or not. The interview with the Administrator also revealed that on 06/27/22, the facility contacted the Psychiatric Emergency Team (PET) when R1 began making verbal threats to staff once more, stating things such as “on 4th of July, real fireworks are going to happen.” Interviews with facility staff revealed that on 06/27/22, after R1’s inappropriate behavior, two (2) PET team members arrived at the facility to assess R1; and, they determined R1 needed to be place on a 51/50 hold, which is the code for the temporary, involuntary psychiatric commitment of individuals who present a danger to themselves or others due to signs of mental illness. Interviews with facility staff also revealed that on 06/27/22, the PET team advised the Administrator that R1 wanted to voluntarily go with them and that R1 “didn’t want to come back to the facility after,” and asked if staff could gather all of R1’s belongings per R1’s request. LPA Walker conducted a record review, interviews with the Administrator, facility staff, and credible sources. The record review revealed that on 06/27/2022, R1 filled out and signed a ‘personal belongings removal form’ provided by the facility upon R1 requesting to ‘move out’ of the facility. The record review also revealed that on 06/27/22, R1 was placed on a voluntary 51/50 hold. The facility staff then discharged R1, as R1 removed all their belongings the same day. Continue on LIC9099C.. After a few days, R1 was ready to be discharged from the hospital. Interview(s) with credible sources revealed that R1 was an Assisted Living Waiver Program recipient and that staff from the Assisted Living Waiver Program was currently looking for an alternative placement for R1; and R1 is due to be discharged to R1’s new facility on 07/08/22. Interview(s) with credible witnesses also revealed that a Social Worker at the hospital stated to the ALW program coordinator that R1 can’t be released from the hospital until a placement has been found. Based on record review, and interviews which were conducted, R1 requested to move out of the facility and removed their belongings voluntarily. As a result, the facility staff discharged R1 upon request. Therefore, the facility does not have any obligation to take R1 back into the facility. Furthermore, there is insufficient evidence to support the allegation ‘Facility will not accept resident back at facility.’ As a result, 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. Exit interview conducted and a copy of the report was emailed.the state’s words, verbatim · CDSS document, Jul 6, 2022 · control 29-AS-20220630155544

Allegation investigated: Staff forged facility records

Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint visit to deliver the findings for the above allegation. The LPA met with Administrator Evelina Papazyan at 10:06 a.m., and explained the reason for the visit. On 01/25/22, LPA Salia Walker arrived unannounced to conduct an initial complaint inspection for the above allegation(s). During the visit, the LPA conducted a physical plant tour at 10:23 a.m., briefly spoke with staff, conducted a file review, and obtained copies of pertinent documentation. The Administrator was notified that this complaint was referred to Community Care Licensing Investigation's Branch (IB), and assigned to Investigator Jose Santana. The LPA determined further investigation was required before findings were delivered. Continue on LIC9099C.. Unsubstantiated On 05/24/22, LPA Walker conducted a subsequent complaint visit. Form 9:58 a.m. until 10:30 a.m., the LPA conducted an interview with the administrator. From 10:30 a.m. until 12:15 p.m., the LPA conducted interviews with facility staff. From 1:09 p.m. until 2:25 p.m., the LPA conducted telephone interviews. The LPA determined further investigation was required prior to issuing findings. On 06/24/22, LPA Walker conducted a subsequent complaint visit. During the visit, the LPA conducted a physical plant tour with Administrator Evelina Papazyan at 10:16 a.m. From 10:30 a.m. until 1:17 p.m., the LPA conducted interviews with facility residents. The LPA determined further investigation was required prior to issuing findings. Regarding the allegation, ‘Staff forged facility records,’ the complainant’s concern is that the Administrator is forging facility records by altering resident files such as their physicians’ reports. During the investigation, LPA Walker conducted a record review, interviewed the Administrator, facility staff, residents, and credible sources. To conduct a thorough investigation, the LPA interviewed residents and assessed their abilities in comparison to their physicians’ reports ensuring that their mental and physical abilities match what is on record. Record review confirmed that resident files were accurate, and no alterations, white outs, marks, or changes were found. An interview with the Administrator revealed that the Administrator is the person in charge of resident files. The interview also revealed that when a resident is relocated to the facility from another location, the previous business sends a copy of the resident’s recent physicians report. The Administrator also stated that ‘sometimes they fax it.’ The Administrator also stated that any changes to the physician’s reports are made only by the resident’s physician conducting the evaluation. Interviews with facility staff revealed that staff have ‘not observed any documents having white out, or alterations,’ and have ‘not observed the Administrator altering any documentation.’ Staff interviews also revealed that ‘documents usually come in a fax, or an email,’ and ‘then [staff] print copies for the files.’ Staff stated that ‘any changes that need to be made [staff] call the doctor,’ and advise of inaccuracies based on assessment. Continue on LIC9099C.. Interviews with credible sources revealed that Physicians conducting the medical assessments/ evaluations either fill out and sign the complete form themselves, or ‘discuss it with nurses, the nurses fill it out, and then [the physician] sign it.’ Interviews with credible sources also revealed that in-house physicians ‘first... do the physical, then... check the medication, and the history’ of the resident; and, if the residents can’t tell the physician their history, they review their medication to assess that resident. Interviews with credible sources revealed that some physicians have a personalized business stamp they utilize to avoid forgeries. Credible witnesses have not noted any white outs, marks, or alterations on resident’s physician reports and/or medical assessments. Based on record review, and interviews which were conducted there is insufficient evidence to support the allegation ‘Staff forged facility records.’ 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. Exit interview conducted and a copy of the report was emailed.the state’s words, verbatim · CDSS document, Jun 30, 2022 · control 29-AS-20220124092223

Allegation investigated: Resident sustained pressure injury while in care

Licensing Program Analyst (LPA) Salia Walker conducted a subsequent complaint visit to deliver final findings for the above allegation. The initial visit was conducted on 01/25/2022 by LPA Salia Walker. During today’s visit, LPA Walker met with Administrator Evelina Papazyan and explained the reason for the visit. On 01/24/2022, the Department received a complaint regarding allegations of Neglect/Lack of Supervision. It was alleged that former facility Resident #1 (R1) developed Stage 3 pressure injuries while in care, which resulted from facility neglect. Continue on LIC9099C.. Substantiated On 01/25/2022, between 10:15am and 12:00pm, LPA Walker conducted the initial complaint visit. The LPA met with Administrator Evelina Papazyan at 10:22am and explained the reason for the visit. The LPA conducted a physical plant tour at 10:23am, briefly spoke with staff, conducted a file review and obtained copies of pertinent documentation. The Administrator was notified that the complaint was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Jose Santana. Investigator Santana conducted interviews with Witness #1 (W1) on 01/26/2022, at approximately 1:15pm; with the Long Term Care Ombudsman (LTCO) Region II Regional Manager on 01/27/2022, at approximately 2:00pm; with Witness #2 (W2) and R1 on 02/01/2022, from approximately 11:45m to 12:10pm; with Witness #3 (W3) on 02/09/2022, at approximately 4:00pm; with Los Angeles Police Department (LAPD) Van Nuys Station on 02/10/2022; with facility Administrator Evelina Papazyan and staff on 02/24/2022, from approximately 10:35am to 12:20pm; with CVHCare Home Health Nurse on 03/02/2022, at approximately 4:30pm; with facility staff on 03/04/2022, from approximately 3:35pm to 4:45pm; with CVHCare Home Health Nurse and Kaiser Permanente Panorama City Nurse Practitioner on 03/09/2022, from approximately 10:00am to 11:55am; with facility staff and Administrator on 03/16/2022, from approximately 1:40pm to 2:30pm; with former staff on 03/17/2022, at approximately 3:00pm; with Kaiser Permanente Case Manager on 03/29/2022; with CVHCare Home Health Nurses on 04/02/2022, from approximately 9:00am to 9:10am; and with R1’s former Primary Care Physician on 04/11/2022, at approximately 5:45pm. Additionally, Investigator Santana obtained and reviewed copies of R1’s facility records, medical records including hospital, Emergency Medical Services (EMS), CVHCare Home Health records, and photos of R1’s pressure injuries. R1’s Physician Report, dated 02/15/2020, listed the primary diagnosis as knee pain. R1 was listed as non-ambulatory with a history of backside redness and breakdown; did not have impairment of bowel and bladder; needed assistance with bathing and grooming; and was able to store and manage own medications. The Resident Appraisal, dated 03/01/2020, noted R1 as being non-ambulatory; requires the use of a wheelchair; needs assistance with activities of daily living (ADLS); can communicate clearly; is alert and oriented with no signs of confusion; likes watching tv and computer, sits in front of computer all day; and requires assistance with toileting, grooming and transferring. Continue on LIC9099C.. The Appraisal/Needs and Services Plan, dated 12/01/2020, listed R1 as needing escort assistance and help with all ADLs; fitted with a Foley catheter on 11/28/2020; alert, oriented and enjoys using computer. As of 10/04/2021, R1 had the same needs and services but now received CVHCare Home Health services for managing Foley catheter needs and skin issues. The Unusual Incident/Injury Report (UIR) submitted by the facility documented that on 10/25/2021, staff informed R1’s CVHCare Home Health nurse that R1’s wound was not healing because R1 sits in wheelchair from 6:30am to 10:00pm. The report stated that the nurse told R1 many times to lie on the bed during the day and not just sit on a wheelchair. On 10/28/2020, at approximately 12:30am, the UIR documented R1 was noted to have blood on their pull-ups, and was sent to Kaiser for wound evaluation. On 11/14/2021, at approximately 7:00pm, the UIR documented R1 was sent to Kaiser for wound evaluation due to the “wound treatment plan was not showing much progress”. On 11/18/2021, at approximately 8:00am, the UIR documented R1 was sent to Kaiser because “wounds were spotting on pull-ups, also, blood in urine…R1 sits on wheelchair for very long hours in front of computer and refuses to rest and reposition therefore the wounds bleed to the pull-ups”. R1 returned to the facility on 11/19/2021, at 6:45pm, with a diagnosis of acute hypoxemic respiratory failure and pneumonia. On 11/19/2021, at approximately 10:00am, the UIR documented the facility med tech reported to the Home Health nurse that R1’s “sore doesn’t improve, is getting worse” and explained that from 6:30am to 10:0pm, R1 sits in wheelchair playing on the computer and doesn’t want to get rest in bed. “The nurse answered me that this is the problem I have with him right now. He said he will report to his team”. On 11/20/2021, at approximately 6:15am, the UIR documented R1 called the facility office to report they were coughing up phlegm and feeling weak. R1 was transported to Kaiser. Kaiser Hospital records clarified that R1’s buttocks and coccyx pressure injuries were already at stage 3 upon R1’s 11/18/2021 admission. R1 arrived at the Kaiser Emergency Department again on 11/20/2021 at 6:41am due to chief complaint of shortness of breath and cough. R1 was diagnosed with hypoxia but was also found to have stage 3 pressure injuries of the left and right buttocks and right hip, with a deep tissue pressure injury of the left heel. Continue on LIC9099C.. R1 was admitted to Country Villa Sheraton Skilled Nursing Facility (SNF) on 11/22/2021 with a main concern of pneumonia and pressure injuries on buttocks and feet, which included stage 3 pressure injuries of the left buttock, right buttock, right hip, and sacro-coccyx, and an unstageable pressure injury of the left heel. Following wound care treatment, all of R1’s pressure injuries, with the exception of the unstageable left heel pressure injury, were resolved as of 01/05/2022. During the treatment, R1 used a low air loss mattress and was encouraged to turn and reposition every two hours. R1 was at high risk for further wound breakdown, wound infection, and slow wound healing due to complex medical diagnoses, contractures, and comorbidities. R1 completed physical therapy for the period of 11/23/2021 through 12/07/2021. On 01/07/2022, R1 was discharged to an assisted living facility with a front wheel walker, wheelchair, and a low air loss mattress. R1’s condition improved following physical and occupational therapies and medical management. R1 now required minimal assistance for transfers and was discharged with a home health referral to address pressure injury concerns, Foley catheter management, and care of other medical issues. On the allegation: Neglect/Lack of Supervision - Former facility Resident #1 (R1) developed Stage 3 pressure injuries while in care, which resulted from facility neglect: Information gathered reflected R1 moved into the facility on 03/01/2020 as a self-responsible resident. At the time of admission, R1 did not have any pressure injuries. The pressure injuries started to develop in mid-September 2021 when R1 became less mobile. R1 chose to sit in a wheelchair for hours at a time despite facility recommendations that R1 rest in bed. R1 felt pain on buttocks and believed there was probably an injury there, but it was R1’s choice to sit in a wheelchair for several consecutive hours at a time. Caregivers reported R1 sometimes declined pull-ups changes because R1 said it was too painful to be cleaned or that R1 was dry. When caregivers noted redness on R1’s buttock, CVHCare Home Health was notified and began treatment. While CVHCare Home Health documentation lists all of R1’s pressure injuries as stage 2 through 11/15/2021, Kaiser assessed them as being stage 3 upon hospital admission on 11/20/2021. These injuries were located on R1’s left buttock, right buttock, and right hip (measuring 1cm x 0.5cm), with a deep tissue pressure injury of the left heel (measuring 4cm x 3cm). R1’s skin was scaling and peeling, with areas of open skin from incontinence-associated dermatitis and areas of ulceration from pressure. Even though CVHCare Home Health declined to discuss R1’s treatment progress with the facility in spite of the facility’s requests, the facility was aware the pressure injuries were worsening and that R1 was not compliant with treatment. Continue on LIC9099C.. The facility’s response was to hospitalize R1, but failed to follow up with R1’s providers to coordinate care after discharge. Facility Administrator Evelina Papazyan claimed the facility requested a waffle/gel cushion for R1’s wheelchair to help relieve pressure, but there is no evidence from Kaiser there was any such request. Following R1’s facility departure, all of R1’s pressure injuries, with the exception of the left heel deep tissue pressure injury, healed during the course of the treatment at a skilled nursing facility despite R1’s comorbidities, showing R1’s ability to remain free of pressure injuries with adequate coordination of care. The allegation that R1 sustained Stage 3 pressure injuries as a result of the facility’s Neglect/Lack of Supervision is therefore Substantiated at this time. A $500 immediate civil penalty is assessed today. The Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(f). Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D). Exit interview conducted, appeal rights discussed, and a copy of this report issued. On 01/25/2022, between 10:15am and 12:00pm, LPA Walker conducted the initial complaint visit. The LPA met with Administrator Evelina Papazyan at 10:22am and explained the reason for the visit. The LPA conducted a physical plant tour at 10:23am, briefly spoke with staff, conducted a file review and obtained copies of pertinent documentation. The Administrator was notified that the complaint was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Jose Santana. Investigator Santana conducted interviews with Witness #1 (W1) on 01/26/2022, at approximately 1:15pm; with the Long Term Care Ombudsman (LTCO) Region II Regional Manager on 01/27/2022, at approximately 2:00pm; with Witness #2 (W2) and R1 on 02/01/2022, from approximately 11:45m to 12:10pm; with Witness #3 (W3) on 02/09/2022, at approximately 4:00pm; with Los Angeles Police Department (LAPD) Van Nuys Station on 02/10/2022; with facility Administrator Evelina Papazyan and staff on 02/24/2022, from approximately 10:35am to 12:20pm; with CVHCare Home Health Nurse on 03/02/2022, at approximately 4:30pm; with facility staff on 03/04/2022, from approximately 3:35pm to 4:45pm; with CVHCare Home Health Nurse and Kaiser Permanente Panorama City Nurse Practitioner on 03/09/2022, from approximately 10:00am to 11:55am; with facility staff and Administrator on 03/16/2022, from approximately 1:40pm to 2:30pm; with former staff on 03/17/2022, at approximately 3:00pm; with Kaiser Permanente Case Manager on 03/29/2022; with CVHCare Home Health Nurses on 04/02/2022, from approximately 9:00am to 9:10am; and with R1’s former Primary Care Physician on 04/11/2022, at approximately 5:45pm. Additionally, Investigator Santana obtained and reviewed copies of R1’s facility records, medical records including hospital, Emergency Medical Services (EMS), CVHCare Home Health records, and photos of R1’s pressure injuries. R1’s Physician Report, dated 02/15/2020, listed the primary diagnosis as knee pain. R1 was listed as non-ambulatory with a history of backside redness and breakdown; did not have impairment of bowel and bladder; needed assistance with bathing and grooming; and was able to store and manage own medications. The Resident Appraisal, dated 03/01/2020, noted R1 as being non-ambulatory; requires the use of a wheelchair; needs assistance with activities of daily living (ADLS); can communicate clearly; is alert and oriented with no signs of confusion; likes watching tv and computer, sits in front of computer all day; and requires assistance with toileting, grooming and transferring. Continue on LIC9099C.. The Appraisal/Needs and Services Plan, dated 12/01/2020, listed R1 as needing escort assistance and help with all ADLs; fitted with a Foley catheter on 11/28/2020; alert, oriented and enjoys using computer. As of 10/04/2021, R1 had the same needs and services but now received CVHCare Home Health services for managing Foley catheter needs and skin issues. The Unusual Incident/Injury Report (UIR) submitted by the facility documented that on 10/25/2021, staff informed R1’s CVHCare Home Health nurse that R1’s wound was not healing because R1 sits in wheelchair from 6:30am to 10:00pm. The report stated that the nurse told R1 many times to lie on the bed during the day and not just sit on a wheelchair. On 10/28/2020, at approximately 12:30am, the UIR documented R1 was noted to have blood on their pull-ups, and was sent to Kaiser for wound evaluation. On 11/14/2021, at approximately 7:00pm, the UIR documented R1 was sent to Kaiser for wound evaluation due to the “wound treatment plan was not showing much progress”. On 11/18/2021, at approximately 8:00am, the UIR documented R1 was sent to Kaiser because “wounds were spotting on pull-ups, also, blood in urine…R1 sits on wheelchair for very long hours in front of computer and refuses to rest and reposition therefore the wounds bleed to the pull-ups”. R1 returned to the facility on 11/19/2021, at 6:45pm, with a diagnosis of acute hypoxemic respiratory failure and pneumonia. On 11/19/2021, at approximately 10:00am, the UIR documented the facility med tech reported to the Home Health nurse that R1’s “sore doesn’t improve, is getting worse” and explained that from 6:30am to 10:0pm, R1 sits in wheelchair playing on the computer and doesn’t want to get rest in bed. “The nurse answered me that this is the problem I have with him right now. He said he will report to his team”. On 11/20/2021, at approximately 6:15am, the UIR documented R1 called the facility office to report they were coughing up phlegm and feeling weak. R1 was transported to Kaiser. Kaiser Hospital records clarified that R1’s buttocks and coccyx pressure injuries were already at stage 3 upon R1’s 11/18/2021 admission. R1 arrived at the Kaiser Emergency Department again on 11/20/2021 at 6:41am due to chief complaint of shortness of breath and cough. R1 was diagnosed with hypoxia but was also found to have stage 3 pressure injuries of the left and right buttocks and right hip, with a deep tissue pressure injury of the left heel. Continue on LIC9099C.. R1 was admitted to Country Villa Sheraton Skilled Nursing Facility (SNF) on 11/22/2021 with a main concern of pneumonia and pressure injuries on buttocks and feet, which included stage 3 pressure injuries of the left buttock, right buttock, right hip, and sacro-coccyx, and an unstageable pressure injury of the left heel. On the allegation: Neglect/Lack of Supervision - Former facility Resident #1 (R1) did not receive timely medical attention after developing stage 3 pressure injuries, and this was a result of facility neglect: Information gathered reflected R1 moved into the facility on 03/01/2020 as a self-responsible resident. The CVHCare Home Health nurse who treated R1’s pressure injuries, informed Investigator Santana that they did not communicate the plan of care or wound progress with the facility because they believed they could not share this information, given that R1 was self-responsible. The nurse further did not provide the facility with any instructions on what to do in between visits. Even if the facility had been successful in obtaining this information from CVHCare, the home health provider would have advised that R1’s pressure injuries were all at stage 2, not a prohibited health condition. The investigation did not uncover the identity of the anonymous complainant, and it is unknown how this individual learned that R1’s pressure injuries may have progressed to stage 3 weeks before 11/20/2021, but the available CVHCare documentation does not entirely support the notion that the wounds were at stage 3 prior to 11/15/2021 or that R1’s CVHCare nurse alerted facility administrator Evelina Papzyan of this. Regardless of its failure to be fully appraised of R1’s wound progress, the facility did arrange for R1 to be seen at the Emergency Department upon R1’s request several times from 10/28/2021 to 11/20/2021 because of a change in condition. The allegation the facility did not seek timely medical attention as a result of Neglect/Lack of Supervision is therefore Unsubstantiated at this time. Exit interview conducted, and a copy of this report issued.the state’s words, verbatim · CDSS document, May 24, 2022 · control 29-AS-20220124092223

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.312(a) · Plan of correction due date: May 27, 2022

1569.312(a) Basic services requirements: Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2 This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above, Licensee failed to coordinate care when R1’s pressure injuries worsened and R1 was not compliant with treatment, resulting in stage 3 pressure injuries, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 24, 2022

Plan of correction: The Licensee will submit plan to provide proper level of care and supervision to ensure resident needs are met to CCL by 05/27/22. An immediate civil penalty of $500 is warranted in accordance with California Health and Safety Code Section 1548(c)(1).

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: May 27, 2022

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes… and that appropriate assistance is provided when such observation reveals unmet needs…the licensee shall ensure…changes are documented and brought to the attention of the resident's physician… This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. The facility failed to communicate R1’s worsening pressure injuries/wounds with R1’s physician which attributed to R1’s stage 3 pressure injuries while in care, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 24, 2022

Plan of correction: The Licensee will submit plan to provide proper level of care and supervision to ensure resident needs are met to CCL by 05/27/22.

The state marks this report as 11 pages; the online copy we transcribed has 10. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Salia Walker conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20220124092223). LPA Walker met with Administrator Evelina Papazyan. The purpose of the visit is to issue citations for deficiencies observed during the complaint investigation. During the complaint investigation of complaint #29-AS-20220124092223, Investigator Santana observed the following deficiencies: The facility was aware that R1’s pressure injuries were worsening, but did not have a level of care meeting to discuss the change of condition with the resident, staff, and home health agency. R1’s Reappraisal was not updated to reflect the change of condition that R1’s pressure injuries were worsening and R1’s refusal to reposition self and follow the Home Health care plan. Citations issued, exit interview conduct, copy of report and appeal rights issued.the state’s words, verbatim · CDSS document, May 24, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(c) · Plan of correction due date: May 31, 2022

87463(c) Reappraisals(c):The licensee shall arrange a meeting with… a representative of the resident’s home health agency, if any, when there is significant change in the resident’s condition… This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above. Facility failed to have a level of care meeting to discuss R1’s change of condition when R1’s pressure injuries were worsening, and R1 was not compliant with Home Health care plan, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 24, 2022

Plan of correction: Licensee will submit a plan on how you will ensure level of care meetings are conducted in a timely manner when there is a change in resident condition. Submit to CCL by 05/31/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463(a)(3) · Plan of correction due date: May 31, 2022

Reappraisals(a)The pre-admission appraisal shall be updated...as frequently as necessary to note significant changes…(3) Any illness, injury…or change in the health care needs... specified in Sections 87455(c) or 87615, Prohibited Health Conditions. This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above. Facility failed to update R1’s appraisal with change of condition when R1’s pressure injuries worsened, and R1 was not compliant with Home Health care plan, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 24, 2022

Plan of correction: Licensee will submit a plan on how you will ensure level of care meetings are conducted in a timely manner when there is a change in resident condition. Submit to CCL by 05/31/22.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Salia Walker conducted an unannounced Case Management-Deficiencies visit at the facility today due to deficiency observed during the investigation of complaint control # 29-AS-20220511110219. At 10:27 a.m., During the physical plant tour with Administrator Evelina Papazyan, the LPA observed that the facility’s exit/ back door located in the dining room leading to the parking lot; contained a double action door latch. The Administrator advised the LPA that the reason for the latch is security purposes due to the location of the facility. The LPA advised the Administrator that exit doors are to have a single action latch allowing residents to egress in case of an emergency. Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D): Exit interview conducted, today's reports and appeal rights were reviewed and issued. Civil penalties issued.the state’s words, verbatim · CDSS document, May 17, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: May 17, 2022

87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as the exit/ back door leading to the parking lot contained a double action door latch, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 17, 2022

Plan of correction: During visit, the double action door latch was replaced with a single action door latch. POC met. This is a zero tolerance violation, resulting in a civil penalty in the amount of $500.

Allegation investigated: Staff did not seek timely medical care for resident Illegal eviction

Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint inspection for the above allegations. The LPA met with administrator Evelina Papazyan at 9:30 a.m., and explained the reason for the visit. On 12/08/2020, LPA Aja Richardson 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 Administrator Evelina Papazyan. At 11:00 a.m., the LPA initiated the visit with the Administrator, and conducted interviews with the Administrator as well as requested Resident #1 (R1's) records. The LPA determined further investigation was needed at that time. Continue on LIC9099C.. Unsubstantiated On 02/01/2022, LPA Walker conduct a subsequent complaint inspection for the above allegations. During the visit, the LPA conducted a physical plant tour with the administrator at 10:23 a.m., to ensure there were no health and safety hazards. From 10:50 a.m. until 12:40 p.m., the LPA conducted an interview with the administrator and obtained copies of documents pertinent to the investigation. From 12:45 p.m. until 1:13 p.m., the LPA conducted interviews with one (1) facility staff. The LPA determined further investigation was needed at that time. During today’s visit, the LPA conducted a physical plant tour with the administrator Evelina Papazyan at 10:06 a.m., to ensure there are no health and safety hazards. Regarding the allegation, ‘Staff did not seek timely medical care for resident,’ the complainant’s concern is that Resident #1 (R1) advised facility staff of being in excruciating pain at 2:30 a.m., and the staff did not call an ambulance until 7:30 a.m. to transport the resident to the hospital. To conduct the investigation, LPA Walker previously conducted interviews with the administrator, facility staff, and a record review. The interview with the administrator revealed that facility staff contacted the administrator to advise that R1 requested to be transported to the hospital at “around 3:00 a.m.” The administrator stated that the staff called the ambulance, and noted the wait time would be 3 hours. The interview with the administrator also revealed that staff advised R1 of the wait time, and asked if R1 wanted staff to call 9-1-1 instead. According to the administrator, R1 refused due to 9-1-1 not transporting them to the hospital of choice on different occasions. To the administrator’s knowledge, the paramedics arrived between 6:45 a.m. and 7:00 a.m. Interviews with staff revealed that R1 requested transportation to the hospital around 3:00 a.m., and staff called the paramedics. According to staff, the paramedics advised the wait time would be three (3) hours or more upon the initial call placed. According to staff, R1 was made aware of the wait time, but R1 wanted to wait to ensure they went to their preferred hospital. Interviews with staff also revealed that, they notified the administrator of incident due to concerns on “long wait time,” and was advised that resident’s personal rights allow R1 to deny services; and the facility needs to accommodate R1’s request. Continue on LIC9099C.. According staff, they continued to monitor R1, and asked if R1 would reconsider calling 9-1-1 instead. According to staff, R1 became upset, and continued to request to wait for the private paramedics which arrived “until after 6:00 a.m.” Record review revealed that R1 stated, “they told me it took that long to get an ambulance out there.” Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) during that time paramedics response times were delaying. However, the facility did contact paramedics immediately, and advised R1 of the arrival wait time. After receiving the complaint in November of 2020, R1 choose to move to another facility on 01/29/22. On 01/25/22, LPA Walker attempted to interview R1 at their new home, but R1 refused the interview and requested that they not be bothered. Based on record review, interviews with the administrator, and staff, the facility did seek timely medical care for R1. Therefore, there is insufficient evidence to support the allegation ‘Staff did not seek timely medical care for resident.’ 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, ‘Illegal eviction,’ the complainant’s concern is that the facility refused to take the resident back after being discharged from the Hospital. During the investigation, the LPA Richardson and LPA Walker conducted interviews with the administrator, and facility staff. Interview with the administrator revealed that on 11/28/20, R1’s case manager called the Administrator twice. According to the administrator, with the first call, the facility requested the hospital to send someone to train facility staff on how to properly change R1’s newly place medical device, an indwelling urinary Foley catheter placed greater than 2000 L drain. According to the administrator, the second call R1’s case manager confirmed they were going send a nurse to train the facility staff, but it would take about 48 hours to get someone out there. The administrator stated that at 7:00 p.m. they called the case manager, to follow up on why R1 hadn’t returned to the facility after 2 hours. According to the administrator, they were advised that the hospital did an assessment of the resident and determined R1 needed to be placed in a skilled nursing facility (SNF) for a few weeks prior to returning to the facility. The Administrator was not updated that R1 was not returning to the facility. Continue on LIC9099C.. An interview with the administrator revealed that the administrator later found that R1 was relocated to another board and care facility, and not a SNF. According to the administrator, they contacted the individual that arranged the transfer to inquire as to why R1 was relocated without proper discharge paperwork; and, to have the resident returned to their home at the above facility if R1 was willing to return. The administrator confirmed that R1 returned to the facility on 12/1/2020. Interviews with facility staff revealed that R1 returned to the facility with a catheter after being hospitalized on 11/28/20. A record review also revealed that R1 did return to the facility after being hospitalized on 11/28/20, and was not unlawfully evicted. Based on a record review, interviews with the administrator, and facility staff, R1 was not unlawfully evicted, as R1 did return to the facility after being discharged from the hospital. Therefore, there is insufficient evidence to support the allegation ‘Illegal eviction.’ 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. Exit interview conducted and a copy of the report was emailed.the state’s words, verbatim · CDSS document, Apr 11, 2022 · control 29-AS-20201130162840

Allegation investigated: Facility leaves residents in soiled clothing for extended period of time Facility staff are not ensuring that residents are eating and drinking Facility staff are not keeping the facility clean

Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint inspection for the above allegations. The LPA met with administrator Evelina Papazyan at 9:30 a.m., and explained the reason for the visit. On 10/14/2020, LPA Aja Richardson 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 telephonically with Administrator Evelina Papazyan. Between 10:30 and 11 am, LPA conducted interviews with Administrator and requested facility documents to be reviewed. The LPA determined further investigation was needed at that time. Continue on LIC-9099C.. Unsubstantiated During today’s visit, the LPA conducted a physical plant tour with Administrator Evelina Papazyan at 10:06 a.m., to ensure there are no health and safety hazards. From 9:30 a.m. until 11:28 a.m., the LPA briefly spoke with the administrator; and reviewed and obtained copies of documents pertinent to the investigation. From 11:28 a.m. until 12:44 p.m.; and between 1:33 p.m. until 1:47 p.m., the LPA conducted interviews with facility residents. From 1:10 p.m. until 1:33 p.m.; and between 2:00 p.m. until 2:30 p.m., the LPA conducted interviews with facility staff. Regarding the allegation, ‘Facility leaves residents in soiled clothing for extended period of time,’ the complainant’s concern is that residents go 8-10 hours without being changed, due to the facility having insufficient Personal Protection Equipment (PPE) gear such as gloves. During the investigation, LPA Richardson conducted an interview with the administrator. LPA Walker also conducted interviews with facility residents, and staff. Interview with the administrator revealed that residents were changed 4 or 5 times per shift, in 8 hour shifts. Interviews with facility residents revealed that staff would check on the resident ‘regularly’ wearing PPE gear ‘like mask, shields, and gloves.’ Interviews with residents also revealed that staff would change, and dispose of their gloves in between duties to avoid cross contamination. Interviews with facility staff revealed that during the COVID-19 Pandemic in the year of 2020, the facility continued to perform their duties in providing services to the residents such as assistance with the changing of clothes, brushing teeth, and hair to get the residents ready for the day. Interviews with staff also revealed that staff wore ‘full PPE gear,’ including gloves; and that staff would change, and dispose of their gloves every time they entered/left a resident room. Based on interviews with the administrator, facility residents, and staff, there is insufficient evidence that residents would go 8-10 hours without being changed, due to the facility having insufficient Personal Protection Equipment (PPE) gear such as gloves. Therefore, there is insufficient evidence to support the allegation ‘Facility leaves residents in soiled clothing for extended period of time.’ 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. Continue LIC-9099C.. Regarding the allegation, ‘Facility staff are not ensuring that residents are eating and drinking,’ the complainant’s concern is that residents are not receiving appropriate care. The complainant is also concerned that food is dropped off to the resident rooms, but staff do not ensure that residents are eating and drinking. To conduct the investigation, the LPA attempted to contact the complainant to obtain additional information such as specific residents that required assistant with meals. However, after multiple attempts the LPA was unsuccessful. During the investigation, LPA Richardson conducted an interview with the administrator. LPA Walker also conducted interviews with facility residents, and staff. Interview with the administrator revealed that Staff would go inside resident rooms with the exception of residents who requested their food be dropped off outside their door. Interviews with facility residents revealed that staff would deliver their meals into their rooms, and would check their plates once they were done. Interviews with residents also revealed that some residents did go through occasions when they would not eat all their meal, however, ‘staff would call on the intercom, or cell phone to check in and offer something else.’ Interviews with staff revealed that staff would monitor residents were eating by checking the plates when picking up the trash. Interviews with staff also revealed that residents that required assistance with feeding were assisted by staff in proper PPE gear. According to staff, if a resident did not want to eat, the facility would offer other options, including ‘Ensure’ as additional nutrition. Staff also reported to the front desk/ office any resident that would not eat or ate minimal. Based on interviews with the administrator, facility residents, and staff, residents were receiving appropriate care, and the facility was ensuring that residents were provided the require nutrition. Therefore, there is insufficient evidence to support the allegation ‘Facility staff are not ensuring that residents are eating and drinking.’ 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, ‘Facility staff are not keeping the facility clean,’ the complainant’s concern is that staff are not cleaning or disinfecting contaminated areas. Continue on LIC-9099C.. During the investigation, LPA Richardson conducted an interview with the administrator. LPA Walker conducted a record review, interviews with facility residents, and staff. Interviews revealed that staff cleaned and disinfected high touch surface areas ‘daily,’ ‘every hour to half an hour.’ Record review confirmed, that the facility staff were disinfecting, and cleaning all high touch surface areas on an hourly basis. Based on record review, interviews with the administrator, facility residents, and staff the facility was following CDC guidelines and cleaning or disinfecting contaminated areas. Therefore, there is insufficient evidence to support the allegation ‘Facility staff are not keeping the facility clean.’ 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. Exit interview conducted and a copy of the report was emailed.the state’s words, verbatim · CDSS document, Apr 11, 2022 · control 29-AS-20201008165626

Allegation investigated: Resident sustained a hip fracture due to a lack of care and supervision.

**This is an amended report to issue a deficiency under the correct regulation section.** Licensing Program Analyst (LPA) Yelena Avetisyan completed a subsequent complaint visit on 01/20/2022 to deliver findings for the allegation above. The LPA met with Georgina Osuna - Med-Tech and explained the reason for the visit. LPA spoke with the administrator Evelina Papazyan via telephone and informed her the findings of the investigation. Ms. Papazyan designated Georgina to sign for the report. Allegation: Resident sustained a hip fracture due to a lack of care and supervision. To investigate this allegation, LPA Nino Santos completed an initial complaint visit and obtained documents from R1 file, staff files, and facility file on 4/22/19. LPA Michael Cava reviewed records on 12/26/19. Records included incident reports, medical assessments, appraisals, and staff training. The file review revealed that R1 had a history multiple falls and was unable to walk without assistance. File documentation stated that staff would provide full care with activities of daily living. LPM Maryjo Schnitzer interviewed Administrator Evelina Papazian on 3/5/20. It was reported that staff were trained on resident care needs including, but not limited to, Fall Precautions, Needs of the Elderly, and Techniques of Personal Care. Substantiated Investigations Branch (IB) Investigator Edward Hector conducted staff interviews on 2/14/20, 2/18/20, and 3/5/20. Staff interviews revealed that staff was present before and after the incident, but not at the time of the fall. Staff admitted to leaving R1 alone while assisting another resident. According to medical records, the fall resulted in a hip fracture. Incident reports submitted to the Woodland Hills North Regional Office confirmed the occurrence of a fall resulting in hip fracture. According to information obtained from staff interviews, file review, and incident report review, there is sufficient information to support the allegation that the resident sustained a hip fracture due to a lack of care and supervision. Therefore, this allegation is substantiated. A $500 immediate civil penalty is assessed today for a violation resulting in injury to R1. The licensee/administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f). Exit interview conducted. Appeal rights given. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 20, 2022 · control 31-AS-20190419115127

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jan 22, 2022

87468.2(a)(4)...In addition to the rights listed… residential care facilities for the elderly shall have all of the following personal rights: To care, supervision, and services that meet their individual needs... This requirement is not met as evidenced by: Based on staff interviews, file review, and incident report review the licensee did not comply with the cited section by not providing proper care and supervision which resulted in R1 sustaining a hip fracture which posed an immediate health and safety and personal rights risk to R1.the state’s words, verbatim · CDSS document, Jan 20, 2022

Plan of correction: licensee/Administrator will obtain vendorized training for staff on regulation 87468.2(a)(4). Verification of scheduled training with the credentials of the trainer will need to be submitted within 24 hours. Licensee/Administrator will submit verification of the the completed training by 2/4/2021

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 9:30 a.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Evelina Papazyan and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The dining room furniture was observed to be in good condition. BEDROOMS: The LPAs observed randomly selected resident rooms, which were furnished appropriately with clean linens, furnishings and sufficient lighting. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Bathrooms are sufficiently stocked with hand liquid soap and paper towels. COMMON SPACES: Common areas include the dining room, activity room, library, theater room, and patio. In the common areas, walls, flooring and furniture were checked for cleanliness and good condition. The fire extinguisher in the hallways were fully charged and was last serviced 3/2021. Required postings were observed throughout the common hallways. The facility has a courtyard equipped with furniture for resident use. There is a fountain, yet it is drained of water. No additional bodies of water noted. There are laundry areas throughout the facility for resident use. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The LPA observed appropriate signage which promoted good hand hygiene, physical distancing, and symptoms of COVID-19. The facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) in storage and the facility is able to obtain additional supplies as needed. The LPA observed resident and staff temperature logs, visitation screening questions, and cleaning log. The facility’s cleaning protocol is sufficient. Staff and residents were observed wearing face coverings. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The LPA and Administrator discussed the recent PIN as it relates to visitation and staff vaccination requirements. No identified staffing concerns. The facility is in compliance regarding the requirements for indoor and outdoor visitation. This facility keeps track of vaccination rates for current staff. The facility’s policies and procedures as it pertains to infection control are adequate. No deficiencies cited. Exit interview conducted. Copies of the resident and staff roster were obtained for the file. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 1, 2021