Patricia's Elder Care

Type of visit: Required - 1 Year

On 10/03/2023 at 8:58 AM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Required – Annual Inspection and met with David Gener, Administrator/Caregiver. Five (5) residents and two (2) staff were present during this inspection. Facility is licensed to serve six (6) non-ambulatory residents. The facility also has an approved dementia waiver. The facility currently has 5 non-ambulatory residents. The Annual Licensing Fees are current. The home consists of 1 floor level with: 4 resident rooms, 3 bathrooms, 1 staff room, kitchen, dining room, living room, and garage. The administrator accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, and shower was free of mold/mildew. Hot water temperature properly measured at 113.3F in shower and 116F in kitchen. Common areas were clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. One fire extinguisher, last serviced June 15, 2023 was observed in the kitchen area. LPA tested carbon monoxide detectors and smoke detectors. Both devices were functional. 5 staff records were reviewed and had required criminal record clearances or criminal record exemptions. See LIC 859 for details. 2 staff members were interviewed. 5 resident records were reviewed. See LIC 858 for details. 2 residents were interviewed. Deficiencies are being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted, Plans of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and left with David Gener.the state’s words, verbatim · CDSS document, Oct 3, 2023

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Staff did not seek timely medical attention for a resident while in care.

**This report is being amended with correct information and remove deficiencies.** On 07/19/2023 at 8:05 AM Licensing Program Analyst (LPA) David España met with met with Gener David, Administrator and Linda, caregiver to conduct a complaint investigation to address the allegations listed above. LPA España discussed with Gener David, Administrator and explained the purpose of this visit. The investigation consisted of the following: LPA España conducted a tour of the facility grounds. LPA España interviewed staff, clients, witnesses, and reviewed records. LPA España requested and reviewed the following documents: client roster; staff roster; LIC 601 - Identification and Emergency Information; LIC 602A - Physician's Report; LIC 627C - Consent for Emergency Medical Treatment; LIC 625 - Appraisal Needs and Services Plan, and LIC 603A - Resident Appraisal (i.e., All resident files will be submitted to LPA by Friday, July 21, 2023, via email David.espana@dss.ca.gov or fax). The investigation revealed the following: Regarding the allegation “Staff did not seek timely medical attention for a resident while in care.” Unsubstantiated It’s being alleged the facility has not provided a comfortable environment as it relates to medical attention for residents. 1 out of 6 residents interviewed agreed with the allegation. 3 out of 6 residents have denied having any issues that staff has failed to provide a comfortable environment as it relates to medical attention for residents. 2 out of 6 resident was not able to provide interview. 2 out of 2 staff denied the allegation, S1 & S2 denied providing uncomfortable environment as it relates to medical attention for residents: Concerning the allegation “Staff did not seek timely medical attention for a resident while in care.” Based on interviews conducted, record reviews and observation, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Gener David, Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 19, 2023 · control 11-AS-20230717150226

Type of visit: Case Management - Deficiencies

On 07/19/2023 at 8:05 AM Licensing Program Analyst (LPA) David España met with Gener David, Administrator and Linda, caregiver. The purpose of this visit is to document deficiencies observed during investigation of a complaint with complaint control number 11-AS-20230717150226. On 07/19/2023 at 8:05 AM LPA España and Gener David, Administrator observed and interviewed the water heater smelling like gas. LPA and David, Administrator discussed maintenance of water heater, the Administrator could not provide a date for maintenance nor proof of maintenance dated by service provider. LPA noted that the water heater is located between kitchen and living area as specified in approved floor plan. LPA noted with the Administrator that the water heater may have bacteria inside and a licensed service provided needs to check for any detectable gas leaks. LPA España and Gener David, Administrator discussed who the present Administrator was for Patricia's Elder Care: The Administrator stated he has been the Administrator for years at Patricia's Elder Care.LPA explained the purpose of having up to date information with the department, as this complaint visit has showed to suggest Patricia's Elder Care has not updated the Administrator information for years.The licensee’s failure to correct a repeated violation may result in the violation of California Code of Regulations (Title 22, Division 6, Chapter 8), as deficiencies were observed and citations were issued. An exit interview was conducted, plans of correction were developed and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 19, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87406(3)(A-I) · Plan of correction due date: Jul 28, 2023

*Amendment of 809 delivered on 7/19/23 to add the deficiency page which provide the correct regulations/citations...(3) Submit a completed Application for...sure, certification or other approvals as specified in Sections 87406(b)(3)(B)(i) and (ii). This requirement was not met as evidence by: Based on observation, LPA observed the Administrator has not updated current Administrator as read on facility profile. This presents a health and safety risk to client in care.the state’s words, verbatim · CDSS document, Jul 19, 2023

Plan of correction: Licensee will update Administrator’s information no later than POC due date and provide licensing with proof via fax or email (David.espana@dss.ca.gov).

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a)(b) · Plan of correction due date: Aug 19, 2023

*Amendment of 809 delivered on 7/19/23 to add the deficiency page which provide the correct regulations/citations..(a) The facility shall be clean, safe, sanitary and in good repair at all times... Maintenance shall include provision...(b) A comfortable temperature...(3) Nothing in this section...individual thermostatic... This requirement was not met as evidence by: Based on observation, LPA observed the Administrator has not maintenance water heater. This presents a health and safety risk to client in care.the state’s words, verbatim · CDSS document, Jul 19, 2023

Plan of correction: Licensee will maintenance water heater no later than POC due date and provide licensing with proof via fax or email (David.espana@dss.ca.gov).

Allegation investigated: Staff is not following resident's diet Staff is not providing proper toileting services to resident in care Staff did not properly clean resident's room Staff is interfering with resident's relocation

On 06/23/2023, Licensing Program Analyst (LPA) Perry Scott conducted an initial complaint investigation to address the allegation(s) listed above. LPA Scott met with Gener David, Administrator, and explained the purpose of this visit is to gather information for the complaint. The investigation consisted of the following: On 06/23/2023, LPA Scott interviewed two staff (S1-S2) and three residents (R1-R3). LPA reviewed all resident files and obtained copies of staff /resident roster, admission agreements, physician reports, Id/Emergency information, appraisal/needs and service plan, and preplacement appraisal. The Investigation revealed the following: Regarding allegation #1: Staff is not following resident's diet It was reported that the resident was supposed to be on a diabetic diet and the administrator was not complying with the doctor’s orders. LPA interviewed two staff (S1-S2) and three residents (R1-R3). Both staff denied that they are not following the resident’s diet. S1 and S2 both stated that they are following the menu provided by R1. 2 of 3 residents denied that the facility was not following their diet plan. R2 and R3 both stated that the facility is adhering to their diet plan. Report continued on LIC9099-C Unsubstantiated Based on interviews there is insufficient evidence to support the allegation: Staff is not following resident's diet. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated. Allegation # 2: Staff is not providing proper toileting services to resident in care It was reported that the staff is not providing proper toileting services to the resident. When interviewed both staff (S1-S2) denied the allegation. Both stated that the resident’s portable toilet is emptied more than four times per day or as needed. Staff also stated that R1 has sanitary wipes, and the facility has more than enough for the residents. R1 confirmed that the staff empties the portable toilet four or more times per day. The other resident’s R2-R3 report that they’re not incontinent and don’t require those type of services. Based on interviews there is insufficient evidence to support the allegation: Staff is not providing proper toileting services to resident in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated. Allegation #3: Staff did not properly clean resident’s room It was reported that the resident’s room was very dusty, and mold was in the restroom. Both staff (S1-S2) denied the allegation. Both stated that all residents’ rooms were cleaned daily. 2 of 3 residents interviewed confirmed that the staff cleans their rooms daily. LPA toured the residents’ bedrooms and bathroom, and found them to be clean and had no mold in the bathroom. Based on interviews there is insufficient evidence to support the allegation: Staff did not properly clean resident’s room. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated. Allegation # 4: Staff is interfering with residents’ relocation It was reported that the administrator was interfering with the resident’s relocation. The resident states that the resident has been blackballed by the administrator from finding another facility. When interviewed both staff (S1-S2) denied the allegation. Both stated they were aware of the resident wanting to find a new facility and neither of them has interfered in that process. When interviewed about moving from the facility and staff interfering with that move R1 confirmed that no one was interfering with R1’s moving. R1 stated R1 has been trying to move since March of 2023 but can’t afford anything else. Report continued on LIC9099-C Based on interviews there is insufficient evidence to support the allegation: Staff is interfering with residents’ relocation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are Unsubstantiated. No deficiencies were cited. An exit interview has been conducted and a copy of the Complaint Report was provided to Administrator, Gener David.the state’s words, verbatim · CDSS document, Jul 14, 2023 · control 11-AS-20230621145621

Allegation investigated: Staff caused bruises to resident in care. Staff handles resident in a rough manner.

On 04/26/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced subsequent complaint visit at this facility. LPA was greeted by Administrator David Gener and Caregiver Erlinda Basallo. LPA explained the purpose of the visit. LPA observed two staff and six residents present during the visit. The investigation consists of the following: LPA Montoya interviewed two staff (S1-S2) and five residents (R1-R5). LPA was unable to interview one resident (R6) because he had difficulty staying awake due to medications. LPA interviewed one staff (S3) by telephone. LPA reviewed R1’s service records. A tour of the facility was conducted. Report continued in LIC 9099C Substantiated INVESTIGATIONS REVEALED: Based on LPA’s records review, R1 was admitted to the facility on 2/1/2023. R1 is non-ambulatory, uses a wheelchair and not able to care own toileting needs and to bathe self. R1 is able to manage own prescription medications but prefers help from staff. Regarding allegation: Staff caused bruises to resident in care. Reporting Party (RP) reported staff constantly treat residents roughly, causing bruises. LPA interviewed and obtained information from five out of six residents (R1-R6) and three staff (S1-S3). S1 stated there are four residents in the home that require assistance with activities of daily living (ADLs) either dressing, toileting, or transferring and other hygiene care. S1 stated S1 usually provides assistance to R5 and R6. S1 stated S2 and S3 usually provide ADL assistance to R1 and R3. S1 stated R2 and R4 require only minimal assistance with their ADLs. S1 stated however, any staff may assist any resident if needed. Interview with R1 and R3 revealed two staff (S2-S3) are rough when assisting residents with their incontinence and activities of daily living causing them bruises. S2 and S3 scrub residents’ body roughly until their skin turn red and staff put their weight on residents while changing residents’ diaper or clothes causing them bruises. S2 and S3 admitted they usually provide assistance to R1 and R3 with their ADLs, but they claim they handle them gently. Two other residents (R2-R4) and three staff (S1-S3) denied staff caused bruises on residents in care. R3 stated S2 and S3 cause resident bruises intermittently. LPA did not observe any bruises on R1 and R3 during the visit but based on LPA’s review of a photo taken on March 22, 2023, R1 had a circular light discoloration (bruise) on leg. Based on LPA’s investigation, there is sufficient evidence to prove that staff caused bruise on resident in care. Regarding allegation: staff handles resident in a rough manner. Reporting Party (RP) reported staff constantly treat residents roughly. Staff lean on resident’s body while providing assistance with their activities of daily living, pushing their weight onto the resident. REPORT CONTINUED ON LIC 9099C LPA interviewed and obtained information from five out of six residents (R1-R6) and three staff (S1-S3). S1 stated there are four residents in the home that require assistance with activities of daily living (ADLs) either dressing, toileting, or transferring and other hygiene care. S1 stated S1 usually provides assistance to R5 and R6. S1 stated S2 and S3 usually provide ADL assistance to R1 and R3. S1 stated R2 and R4 require only minimal assistance with their ADLs. S1 stated however, any staff may assist any resident if needed. Interview with R1 and R3 revealed two staff (S2-S3) are rough when assisting residents with their activities of daily living and incontinence care. S2 and S3 scrub residents’ body roughly until their skin turn red and staff put their weight on residents while changing residents’ diaper or clothes. S2 and S3 admitted they usually provide assistance to R1 and R3 with their ADLs, but they claim they handle them gently. Two other residents (R2-R4) and three staff (S1-S3) denied staff handle residents in a rough manner. Based on LPA’s investigation, there is sufficient evidence to prove that staff (S2 and S3) handle residents in a rough manner. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; therefore, the allegations, "Staff caused bruises to resident in care.”, and “Staff handles resident in a rough manner.” are found to be SUBSTANTIATED. According to the California Code of Regulations (Title 22, Division 6, Chapter 1,6), the following deficiencies had been observed and a citation issued (ref. LIC 9099D). An exit interview was conducted and copy of the Complaint Report and Appeal Rights were provided to the Administrator David Gener. INVESTIGATION REVEALED THE FOLLOWING: Regarding allegation: Staff do not provide proper medication assistance to resident in care. Based on LPA’s records review, R1 was admitted to the facility on 2/1/2023. R1 is able to administer own prescription medications but prefers staff to provide assistance. R1 is able to mobilize with the use of a wheelchair. LPA interviewed five (R1-R5) out of six residents and three staff (S1-S3). During interview, four residents (R2-R5) and three (S1-S3) denied the allegation that staff do not provide proper medication assistance to residents in care. R4 administers own medications. R1 stated on 4/7/2023, S1 forgot to administer a medication to R1 but R1 was not able to name the medication. Per LPA's review of R1's medication administration records, there is no indication of a missed dosage on any of R1's medications. R1 is able to manage own medications and therefore, R1 is able to self-assist with medication administration when necessary. Based on information gathered, there is no sufficient evidence to corroborate the above allegation. Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the above allegation is Unsubstantiated. An exit interview was conducted with Administrator David Gener and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 26, 2023 · control 11-AS-20230410130004

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: May 5, 2023

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. Based on observations, record review and interviews, S2 and S3 handle residents roughly causing them bruises. R1 had a bruise on leg while R3 claimed staff cause bruises on R3 intermitently due to rough treatment of staff during ADL care. This poses a potential health, safe and/or personal rights risk to residents in care,the state’s words, verbatim · CDSS document, Apr 26, 2023

Plan of correction: Administrator shall review Section 87468.1 of Title 22 and shall give staff an in-service training. POC shall be submitted to CCLD via email to lourdes.montoya@dss.ca.gov.

Allegation investigated: Staff do not assist resident with incontinence needs.

On 04/18/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced 10-day complaint visit at this facility. LPA was greeted by Administrator David Gener. LPA explained the purpose of the visit. LPA observed two staff and six residents present during the visit. The investigation consists of the following: LPA Montoya interviewed two staff (S1-S2) and five residents (R1-R5). LPA was unable to interview one resident (R6) because he had difficulty staying awake due to medications. LPA interviewed one staff (S3) by telephone. LPA reviewed R1’s service records. A tour of the facility was conducted. Report continued in LIC 9099C Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Regarding allegation: Staff do not assist resident with incontinence needs. Based on LPA’s records review, R1 was admitted to the facility on 2/1/2023. R1 is non-ambulatory, uses a wheelchair and not able to care own toileting needs. Based on LPA’s interview, five out of six residents have incontinence needs. During interview, R1 stated S3 told R1 that the schedule to clean and change resident’s diaper is three times a day, every after meal. R1 stated since R1 moved into the facility, S3 had always refused to assist with incontinence needs outside the aforementioned schedule. R1 stated, on 4/7/2023 S1 refused to provide assistance with incontinence needs. S1 and S2 stated that R1 always wants immediate incontinence assistance. S1 and S2 stated when they are busy with other residents, they inform R1 to wait for 10-15 minutes but R1 yells and insists that staff assist R1 right away. Interview revealed S3 assists R1 every time R1 asks for help with incontinence needs. Based on LPA’s Interview, three staff (S1-S3) and three residents (R3-R5) denied the allegation that staff do not assist resident with incontinence needs. R2 stated “I don’t know”. “I don’t have incontinence needs”. R4 revealed staff provide timely incontinence assistance whenever R4 needs help. Based on information gathered, there is no sufficient evidence to corroborate the above allegation. Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the above allegation is Unsubstantiated. An exit interview was conducted with Administrator David Gener and a copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 18, 2023 · control 11-AS-20230410151824

Type of visit: Case Management - Deficiencies

On 04/18/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted a case management - deficiency visit at this facility. LPA was greeted by Administrator David Gener. LPA explained the purpose of the visit. LPA observed two staff and six residents present during the visit. During an unrelated visit, LPA observed the following deficiencies: 1. Kitchen and garage are cluttered, the kitchen floor is filthy. 2. Scissors and a knife on the kitchen counter accessible to residents. 3. Three hand rakes in the backyard accessible to residents. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. Appeal rights and a copy of this report was provided to Administrator David Gener.the state’s words, verbatim · CDSS document, Apr 18, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(1) · Plan of correction due date: Apr 19, 2023

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement was not met as evidenced by: During LPAs visit, LPA observed a pair of scissors and a knife on the kitchen counter accessible to residents. LPA also observed three hand rakes in the backyard accessible to residents. This poses an immediate health, safety and/or personal rights risk to residents with dementiathe state’s words, verbatim · CDSS document, Apr 18, 2023

Plan of correction: Administrator moved the scissors, knife and hand rakes to a locked drawer. This was corrected during the visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Apr 24, 2023

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement was not met as evidenced by: LPA observed the kitchen and the garage are cluttered, the kitchen floor is filthy. This poses a potential health, safety and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 18, 2023

Plan of correction: Administrator shall clean and organize the kitchen and the garage. Administrator shall submit a POC to CCLD via email to lourdes.montoya@dss.ca.gov

Type of visit: Required - 1 Year

On 9/17/2022, Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced annual required visit. Upon arrival, LPA Montoya called the Administrator and the Licensee twice but no answer. LPA left messages but no reply. LPA proceeded to the facility's front door and asked Staff Erlinda Bassalo who opened the door. LPA conducted a risk assessment and based on Staff Bassalo's response, the facility is clear of Covid-19 infection. LPA explained the purpose of today’s visit. Staff Bassalo assisted LPA with the visit. This facility consists of a kitchen, dining area, four (4) resident bedrooms, one (1) bedroom for awake staff (bedroom#3), three (3) bathrooms (one bathroom is in bedroom#1 and bedroom#4 & #5 shared bathroom), indoor patio, garage (washer/dryer located in garage). LPA toured the single-story facility with Staff Erlinda Bassalo. LPA observed there were no bodies of water or obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured at 101.1 degree Fahrenheit in the bathroom located in the hallway near bedrooms #1, #2 and #3. The water temperature in the bathroom between resident bedrooms #4 and #5 measured at 100.2 degree Fahrenheit. A comfortable temperature was maintained in the facility. LPA observed the facility to be appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food supplies. The facility has (2) fire extinguisher that was charged and last serviced on 7/3/2022, smoke detectors, and carbon monoxide were operable. The facility conducted a Fire/Safety Drill on 9/8/2022. A working telephone (310) 530-8946 remains available. Evaluation Report Continues on LIC 809-C During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for residents, staff and visitors, and sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. The facility has an approved Mitigation Plan Report on file with CCLD. Technical Assistance Advisory Issued. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. Appeal rights and a copy of this report was provided to Staff Erlinda Bassalo.the state’s words, verbatim · CDSS document, Sep 17, 2022