Brookdale Monrovia

Allegation investigated: Staff did not clean resident's room. Facility is not adequately staffed to meet the needs of the residents in care. Unqualified staff are performing glucose testing for residents in care. Facility staff are not properly trained. Staff did not ensure that a resident was administered medication.

Licensing Program Analyst (LPA) Tao conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Administrator, Logan Harrison. LPA explained the purpose of today’s visit is to discuss the above-mentioned allegations. The investigation consisted of resident interviews, staff interviews, facility tours, and review of facility records. LPA obtained resident roster, staff roster, and residents’ facility files. The investigation revealed the following: In regard to allegation “staff did not clean resident's room," it was alleged that staff did not clean resident’s room who had dog(s). Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Two (2) residents interviewed had a dog and five (5) residents interviewed did not have pets. Resident interviews revealed that staff clean resident's rooms daily and housekeeping staff conducted deep cleaning weekly. (-continued in LIC 9099 C-) Unsubstantiated In regard to allegation “facility is not adequately staffed to meet the needs of the residents in care," it was alleged that facility was understaffed which caused bed bound resident was not properly attended for resident’s need and residents would sit on soiled diaper for long period of time. Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Four (4) of those seven (7) residents interviewed were using briefs or diapers. Residents’ interviews revealed staff provided the cares that residents’ needs, they did not sit on soiled diaper for long period of time, and their cares/needs were met. All six (6) staff interviewed denied the allegation. Administrator stated no resident residing at the facility was bed bound. Staff interviews revealed that no resident was bed bound. Staff would attend to residents who needs assistance and change their soiled diapers in 5 - 10 minutes. LPA toured to residents’ room who using briefs and diapers. LPA did not smell foul odor and was not aware of residents who sit on soiled diapers. Therefore, staff had met residents’ cares and needs. In regard to allegation “unqualified staff are performing glucose testing for residents in care," it was alleged that staff who are not medical professional had conducted glucose testing for residents. Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents would prick their fingers with lancet and drew blood by themselves. Staff would prepare and clean up after residents’ glucose testing. All six (6) staff interviewed denied the allegation. Staff interviews revealed that residents’ glucose testing was conducted by residents and staff only assisted on preparing the set up and clean up after the test. Staff file review revealed facility had policy on medication administration and training on blood glucose monitoring to staff. Therefore, staff did not perform glucose testing for residents. In regard to allegation “facility staff are not properly trained," it was alleged that staff are not properly trained for administer injection medication to resident. Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Resident interviews revealed none of the residents were on injectable medication. All six (6) staff interviewed could not corroborate the allegation. Staff interviews revealed no resident was on injectable medication. Per staff file review, since no resident is on injectable medication, no training on injectable medication was needed. Therefore, facility did not fail to properly trained staff on injection medication. (-continued in LIC 9099 C-) In regard to allegation “staff did not ensure that a resident was administered medication," it was alleged that resident did not receive resident’s injectable medication. Seven (7) out of seven (7) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents did not have injectable medication. All six (6) staff interviewed could not corroborate the allegation. Staff interviews revealed that no resident residing at the facility had injectable medication. File review revealed no resident was on injectable medication. As mentioned above, per staff file review, no training on injectable medication was provided and no resident was on injectable medication. LPA toured to med room and did not observe any injectable medication in place. Therefore, staff did not fail to administer resident’s injectable medication since no resident was on injectable medication. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Administrator. A hard copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 26, 2023 · control 28-AS-20230918163747

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Jose Villalobos and Ashley Calderon conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Executive Director Logan Harrison. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. COVID-19 screening is no longer in place. The facility has submitted a COVID-19 Mitigation Plan and Infection Control Plan. Operational Requirements: A current Plan of Operation was reviewed. The Infection Control Plan has been added to the Plan. The facility does not have a Dementia Waiver in place. A Hospice Waiver for 10 is approved. A fire clearance for 75 residents of which (34) may be non ambulatory; 0 may be bedridden. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place. Physical Plant/Environment Safety: The facility does not have Dementia residents. Facility is a 3-story building consisting of 65 resident rooms, 2 activity rooms, beauty salon, dining room, laundry room, and a courtyard patio area. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. On 6/15/23, The sprinkler system, alarms, fire connections, and kitchen hood system were inspected. The facility has fully charged fire extinguishers. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. LPA tested rooms #103 , #106 , #107, #116, #124, #125, #221, #225, #228, and #231. Continued on LIC 809-C Staffing: A total of 42 staff members provide care and supervision to the clients. Personnel Records/Staff Training: Administrator on record is not current. Documents are pending. Staff have criminal background clearance and training. Seven (7) staff files were reviewed. Proof of staff training, health clearance, and 1st Aid/CPR training was observed. Resident Records/Incident Reports: A total of seven (7) resident files were reviewed. They contained admission agreements, Physician's Reports, Appraisal, TB clearance, Functional Capability Assessment, Physician's Orders, medical consent, and medication records. RCFE complaint poster and Personal rights were observed posted. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. An activity calendar was reviewed Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies observed. Physician orders for modified diets are on file. Sanitation practices and kitchen cleanliness was observed. Incident Medical and Dental: Six (6) centrally stored resident medications were reviewed. Medical and dental transportation is provided. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. Residents with Special Health Needs: There are currently (5) residents on Hospice and (8) on Home Health No half bed rails for mobility assistance were observed in resident rooms. Individual Service Plans and Appraisals are on file. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, NO deficiencies were cited. Exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 26, 2023

Allegation investigated: Staff is not properly trained. Facility has pests. Resident's personal items poses a hazard for resident in care.

Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegations listed above. LPA met with the Administrator of the facility Logan Harrison and explained the reason for the visit. The investigation consisted of the following: during the initial visit conducted on 04/14/2022, LPA Joe Katrdzyhyan interviewed two (2) Staff Members, three (3) Residents, toured the room of Resident #1 (R1), and obtained copies of the Course Completion History, Training Hours and Work Schedule for Staff #1 (S1). During today's visit, LPA Zaragoza reviewed these documents and also obtained an updated Staff and Resident Roster list, Physician Reports for Residents #3 - 5 (R3 - R5) along with Resident #8 (R8), and also obtained records of trainings for Staff #3 - 7 (S3 - S7). LPA Zaragoza also interviewed S2 - S7, and also Residents #2 - 8 (R2 - R8). LPA attempted to interview R1, however R1 no longer lives in the facility. Unsubstantiated The investigation revealed the following: in regards to the allegation "Staff is not properly trained", it is alleged that staff at the facility are not trained properly and do not have the time necessary to complete the tasks outlined in their training materials. During interviews with the staff along with review of the staff training records, none of the staff members corroborated the allegation that they are not properly trained. S3 - S5 explained that they are all required to perform initial when hired which is facility by computer courses, and afterwards receive in-person known as "Shadowing" in which they work in conjunction with other seasoned staff before they are allowed to work independently. S2-S6 all indicated that annual training is conducated as well to ensure they retain knowledge of proper protocols and procedures. Record reviews of the staff training revealed that they had updated training on CPR along with completed online courses in medication management, policies, and techniques on caregiving as well. In regards to the allegation "Facility has pests", it is alleged that R1's room contained pests including bugs that crawled over R1's body in bed. During interviews with the residents, none of them were able to corroborate the allegation that there has been a problem with pests within the facility. R2, R7, and R8 stated that occasionally a fly, gnat, or small insect will enter the facility if a door is left open however it has not been a major problem within the facility. During interviews with the staff members of the facility, none of them corroborated the allegation that pests have been an issue in the past. S2, S4, and S5 all claimed that if there was any evidence of an issue with pests at the facility, they work with Ecolab for pest control services to address any potential problem. In regards to the allegation that "Resident's personal items poses a hazard for resident in care", it is alleged that R1 had been hoarding an excessive amount of personal items in their room which was causing a fire hazard at the facility. During interviews with the residents, seven (7) out of eight (8) residents have never heard of residents hoarding items within their rooms. R2 - R7 all claimed that they have witnessed any potential hazards within the facility while living here, and that they believe it is safe living at the facility. During interviews with the staff, none of them corroborated the allegation that residents have been living in hoarding conditions in their rooms. S3 stated that if a residents room became cluttered to the extent that it became a fire hazard, the facility would ensure to assist the resident in removing unnecessary items to avoid any potential hazards. LPA toured five (5) different resident rooms and none of them were observed to have excessive amounts of clutter that would pose a fire hazard. Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided. Regarding the allegation "Glucose testing is being administered by Med Techs and not an appropriately skilled professional", it is alleged that only nurses are supposed to be conducting blood sugar testing for diabetic residents, however it is alleged that Med Techs were conducting the testing as well each were doing the tests differently. During interviews with residents, one (1) out of eight (8) residents interviewed corroborated the allegation. R3 explained that S7 has been conducting the blood sugar testing, including pricking her finger with the lancet, in order to get a reading on her blood sugar levels. During an interview with S7, S7 explained that they do prick the finger of R3 in order to draw blood so that they can get a reading of R3's blood sugar levels. Record review of R3's physician report, dated 5/27/2023, revealed that R3 is not able to perform their own glucose testing. According to Title 22 Regulations, 87101(a)(10), by definition an appropriately skilled professional is "an individual that has training and is licensed to perform the necessary medical procedures prescribed by a physician. This includes but is not limited to the following: Registered Nurse (RN), Licensed Vocational Nurse (LVN), Physical Therapist (PT), Occupational Therapist (OT) and Respiratory Therapist (RT). These professionals may include, but are not limited to, those persons employed by a home health agency, the resident, or facilities and who are currently licensed in California." Based on LPAs interviews conducted with the clients and staff, the preponderance of evidence standard has been met for the above allegation, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 3 are being cited on the attached LIC9099D. Exit interview held and a copy of the report and appeal rights was provided to the administrator Logan Harrison.the state’s words, verbatim · CDSS document, Aug 31, 2023 · control 28-AS-20220407091359

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Sep 1, 2023

87268 Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing (...) or has it administered by an appropriately skilled professional. The requirement is not met as evidenced by: Based on interview and record review conducted with residents and staff, LPA determined that R3 is getting their blood sugar level tested by S7. Additionally, R3's physician report indicates that R3 cannot test their own glucose levels, which poses an immediate risk for clients in care.the state’s words, verbatim · CDSS document, Aug 31, 2023

Plan of correction: Administrator shall ensure that only appropriate skilled professionals administer medicaiton through injection or assist residents with glucose testing while in care. During record review and interviews, it was determined that R3 is not able to test her own glucose levels. (Cont.) Additionally it was revelaed that S7 does the glucose testing for R1 even though theyare not a skilled professional. Administrator to submit a written plan indicating how facility will meet regulation 87628 moving forward.

Allegation investigated: Resident sustained fall due to lack of supervision Staff did not answer resident's call button in a timely manner Resident did not receive hot meals

Licensing Program Analyst (LPA) Erik Zaragoza conducted a follow up complaint investigation regarding the allegations listed above. LPA met with Mia Nakamatzu Business Office Manager of the facility and explained the reason for the visit. Administrator Logan Harrison arrived shortly thereafter. The investigation revealed the following: during the initial visit conducted on 08/03/2022, LPA Joe Katrdzyhyan interviewed the Administrator, four (4) staff members, five (5) residents, and also obtained copies of Resident #1's (R1) Unusual incident/injury reports, Physician Report, Personal Service Plan, DIscharge Report, Residents/Staff Roster, and Facility Progress notes. During today's visit, LPA Zaragoza reviewed these documents and also obtained an updated Staff and Resident Roster list. LPA Zaragoza also interviewed Staff #1 - 6 (S1 - S6), and also Residents #2 - 9 (R2 - R9). LPA attempted to interview R1, however R1 no longer lives in the facility. Unsubstantiated The investigation revealed the following: in regards to the allegation "Resident sustained fall due to lack of supervision", it is alleged that R1 had sustained a fall while living at the facility due to a lack of care and supervision. During interviews with the residents, four (4) out of eight (8) stated that they have either fallen themselves personally or have heard of other residents falling in the facility, but that it was not due to lack of supervision. R3 stated that when they fell that the facility quickly called paramedics to assist R3, and R6 along with R9 have heard of residents sustaining falls within the facility but also that they were promptly assisted. In interviews with Staff five (5) out of six (6) could not corroborate the allegation that residents have fallen due to lack of care and supervision. S3 and S5 explained that while falls have occurred within the facility, staff have never been negligent in assisting the residents when they do fall. In regards to the allegation "Staff do not answer call button in a timely manner", it is alleged by R1's family that they attempted to call staff to her room during the night shift and that it look 30 - 42 minutes for a caregiver to come to R1's room to provide assistance. During interviews with the residents of the facility, none of them could corroborate the allegation that the staff at the facility do not answer their call light requests in a timely manner. R6 and R8 explained that they usually get assistance when they use their call lights quickly within five (5) to ten (10) minutes, and if there ever is a delay it is because the caregivers are busy assisting other residents, and that it is never because they are neglecting to answer the call lights. None of the staff members corroborated this allegation, and S4 explained that once the call light signal request is sent by a resident, their computer system is immediately notified and all caregivers and Medical Technicians are paged directly once it is received informing them of the name of the resident and where they are located within the facility. LPA tested the call light system in one of the resident rooms, #124, and was able to see that the signal was related to their computer system immediately, and observed the pagers emitting their sound signal to the caregivers, which allowed them to respond to the room in approximately three (3) minutes. In regards to the allegation that "Resident did not receive hot meals", it is alleged that whenever R1 asked for food to be delivered to their room, it always arrived cold. During interviews with residents, seven (7) out of eight (8) could not corroborate the allegation that they have been served cold food. Most explained that they have never been served cold food, and R7 explained that if food is ever served cold the staff have fixed it by either heating up the food or providing a new plate of food. During interviews with staff, none of them corroborated the allegation that food has been served cold to the residents. LPA interviewed S2 who used to work in the kitchen area along with S6 who currently works as part of the kitchen staff, and when asked how they ensure that food is kept warm when delivering it to the rooms of the residents, they explained that once they know the residents that are requesting food to be delivered to their rooms, the kitchen staff make sure they are the first trays that are sent out so that they are still warm by the time they get delivered to the resident's room. Additionally both S2 and S6 stated that they wrap the warm food tightly in saran wrap and also cover the food as well so that it stays warm for as long as possible. Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2023 · control 28-AS-20220928101305

Allegation investigated: Facility failed to re-filled Prescription for resident Facility fail to inform responsible party prescription was not filled

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced initial 10 days complaint visit and LPA met with Business Office Manager Mia Nakamatzu who allowed the entry of the facility and explained the reason of the visit. Shortly after, the Executive Director Danny Vera arrived and assisted with the visit. The investigation consisted of the following: On today's visit, LPA interviewed Executive Director, three staff (S1-S3)in the facility and one staff via telephone and six residents (R2-R7) in the facility and obtained Resident#1 (R1) documents including face sheet, admission agreement, Medication Admin Adult Report (Jan to March, 2023), Physician Report dated on 05/06/2021, Personal Service Plan dated on 06/25/2022, Progress Notes (June 2022 to Feb 2023) and LPA reviewed three residents' medication in the facility. (See LIC 9099C for continuation) Unsubstantiated The investigation revealed of the following: Allegation#1 "Facility failed to re-filled Prescription for resident" LPA interviewed six residents and all denied the allegation and reported they never missed any medication in the facility and staff never forgot to refill their medication. LPA interviewed staff and reported they usually would assist resident to refill the medication when they have about 7 days medication left , they would either call the pharmacy to refill the prescription or family/responsible party about residents' medication are running low and request them to bring the medication to the facility . If family did not answer, they would leave a message and continue to call the responsible party everyday. The staff also stated that if it is an emergency and they would call the facility pharmacy to refill the medication and the pharmacy can deliver the medication within the same day. The staff stated that R1's routine medication which is through the facility pharmacy Omnicare and R1's PRN medication (Carbidopa Leveodopa) is through Kaiser which R1's family handle it. R1's family would assist R1 to refill the medication/prescription and deliver the medication to the facility. The facility has no interaction with Kaiser. Facility staff would remind family to refill R1's prescription when the medication is running low. LPA also inspected 3 residents medication and all residents medication are updated and current. Allegation#2 "Facility fail to inform responsible party prescription was not filled" LPA interviewed residents and all denied the allegation and reported the facility is very good at contacting their family members or responsible party for any related medical issues. LPA interviewed staff and reported they did contact R1's family/daughter when R1's medication was running low or when the medication is ready to pick up. Staff did leave a message to R1's family. LPA also reviewed the facility nursing department communication log /progress notes for R1 and it indicated that nurse did remind R1's family to pick up R1's PRN medication and left message to R1's family that R1's PRN medication was ready to pick up. Based on the interviewed conducted with residents and staff and record reviewed, Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided to the Executive Director Danny Verathe state’s words, verbatim · CDSS document, Mar 14, 2023 · control 28-AS-20230310090010

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alberto Lopez conducted a site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA met with Danny Vera, Executive Director and explained the purpose of the visit. The facility is licensed to serve 75 residents (41 Ambulatory and 34 Non-Ambulatory only) ages 60 and above. Non-ambulatory to be housed on second floor only. No Bedridden allowed. The facility has an approved Hospice Waiver on file for ten (10) Residents. Brookdale Monrovia does not have an approved Dementia Care Plan in their plan of operation and does not accept or care for residents with dementia. During today's visit, LPA used the infection control domain to complete the Required - 1 Year inspection. The following were observed/inspected: · COVID-19 signs are posted at the entrance. Visitors are screened in the main entrance and a log is kept. · LPA was not screened for this visit. · Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote handwashing, cough/sneeze etiquette, and physical distancing. · Facility does not have designated isolation room as residents all have private rooms. · 6 client rooms, common areas, bathrooms, and outdoor physical plant was inspected. · 6 client rooms were equipped with alcohol based hand sanitizer. · Four (4) centrally stored client medication records were reviewed. · Staff responsible for direct care and supervision were observed wearing masks. · Clients were not observed wearing masks but adhering to public health social distance guidelines. · Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed. Deficiencies cited, please see 809D for details Exit interview conducted with Danny Vera, Executive Director and copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, Feb 13, 2023

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Joe Katrdzhyan and Alberto Lopez conducted a site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPAs met with Business Office Manager / Diana Marquez and were later joined by the Assistant Administrator / Danny Vera who assisted with the visit. The facility is licensed to serve for a capacity of 75 residents (41 Ambulatory and 34 Non-Ambulatory only) ages 60 and above. Non-ambulatory to be housed on second floor only. No Bedridden allowed. The facility has an approved Hospice Waiver on file for ten (10) Residents. Brookdale Monrovia does not have an approved Dementia Care Plan in their plan of operation and does not accept or care for residents with dementia. During today's visit, LPAs used the infection control domain to complete the Required - 1 Year inspection. Also, the physical plant was toured, medication and food supplies reviewed. 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. The ground floor consists of a dining room, living room/activity room, laundry room, employee break room and a kitchen. The middle floor consists of resident rooms, an outside patio, library, exercise room, beauty shop, medication room and a laundry room. The upper floor consists of resident rooms and a laundry room. The garage is located on the ground floor. LPA toured a random selection of resident rooms on each floor. Resident rooms were furnished appropriately. Each resident room has their own restroom. The bathrooms were observed to be clean and operational w/grab bars. The resident rooms have signal systems located in each room/restroom and facility phones to call the front desk. The signal system was tested in various locations and is operable. The hot water temperature was tested throughout the facility. The facility has central air and heating accommodations. The kitchen was observed. There was a sufficient amount of perishable and non-perishable food supplies and perishable food was stored in covered containers at the appropriate temperatures. No pesticides or poisons were stored in the food areas. Storage areas for cleaning solutions, toxics, knives, and hazardous items were secured and made inaccessible to Residents. The fire extinguishers were observed to be fully charged and in compliance. The facility has carbon monoxide detectors in each resident room. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. The outdoor area was enclosed and no large bodies of water were observed. A shaded area with chairs is provided in the outside patio, located on the middle floor. Medications are centrally stored in the locked medication room located on the middle floor. A random selection of medications were reviewed to ensure they are being administered as prescribed and prescription and non-prescription PRN medications have signed and dated written orders from the physician. The first-aid kit is fully stocked w/First-aid Manual. The following deficiencies were observed during today's visit; The hot water temperature in the rooms listed below were not in compliance with Title 22 Regulations: At 11:12am, Room #105 kitchen - measured at 124 degrees F. & bathroom - measured at 122.2 degrees F. At 11:19am, Room #131 kitchen - measured at 124.9 degrees F. & bathroom - measured at 123.1 degrees F. At 11:38am, Room #234 bathroom - measured at 123.1 degrees F. At 11:45am, Room 208 kitchen - measured at 121.2 degrees F. At 11:52am, Room #218 kitchen - measured at 98.5 degrees F., bathroom #1 - measured at 97.2 degrees F. & bathroom #2 - measured at 68.1 degrees F. At 12:04pm, LPAs observed the wooden fence located by the east walk way was in disrepair. The fence had broken pieces and was leaning forward (towards the facility). At 11:07am, LPAs observed the wall near the entrance of room #112 was in disrepair. There was a hole on the corner of the wall. At 11:12am, LPAs observed the kitchen top drawer (next to the sink) located in room #105 was in disrepair and would not open or close properly. The following deficiencies were observed to be in violation of California code of Regulations, Title 22, Division 6 (refer to 809D) An exit interview was conducted and a copy of this report was provided along with the Appeals Rights.the state’s words, verbatim · CDSS document, Dec 9, 2021

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Dec 10, 2021

Maintenance and Operation. Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of 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: The hot water temperature in the rooms listed below were not in compliance with Title 22 Regulations: At 11:12am, Room #105 kitchen - measured at 124 degrees F. & bathroom - measured at 122.2 degrees F. At 11:19am, Room #131 kitchen - measured at 124.9 degrees F. & bathroom - measured at 123.1 degrees F. At 11:38am, Room #234 bathroom - measured at 123.1 degrees F. At 11:45am, Room 208 kitchen - measured at 121.2 degrees F. At 11:52am, Room #218 kitchen - measured at 98.5 degrees F., bathroom #1 - measured at 97.2 degrees F. & bathroom #2 - measured at 68.1 degrees F. This poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 9, 2021

Plan of correction: and #218 (kitchen, bathroom #1 and bathroom #2). POC must be submitted to CCL by the POC due date.

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Dec 16, 2021

Maintenance and Operation. 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 is not met as evidenced by: At 11:07am, LPAs observed the wall near the entrance of room #112 was in disrepair. There was a hole on the corner of the wall. At 11:12am, LPAs observed the kitchen top drawer (next to the sink) located in room #105 was in disrepair and would not open or close properly.the state’s words, verbatim · CDSS document, Dec 9, 2021

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Jan 10, 2022

Maintenance and Operation. 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 is not met as evidenced by: At 12:04pm, LPAs observed the wooden fence located by the east walk way was in disrepair. The fence had broken pieces and was leaning forward (towards the facility). This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 9, 2021

Allegation investigated: Resident mistreated by staff Facility staff did not safeguard resident's personal property

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Executive Director / Alison Pastores who assisted with the visit. LPA explained the purpose of today’s visit is to discuss the above mentioned allegations of "Resident mistreated by staff" and "Facility staff did not safeguard resident's personal property". During today's visit, LPA interviewed Resident #1 (R1), Staff #1 (S1) and former Executive Director / Ralph Balbin (via telephone). The investigation revealed the following; Allegation: Resident mistreated by staff. The details of this allegation states that R1 is sickened by how he was treated, and cries at night because of the treatment he received from former Executive Director / Ralph Balbin. During the interview with R1, R1 denied being abused by any staff members. The allegation of R1 being Unsubstantiated mistreated and crying at night is in reference to former Executive Director / Ralph Balbin not keeping his promise by reimbursing the alleged missing money to R1. During the interview with former Executive Director / Ralph Balbin, LPA learned that there was never a written agreement created between the Facility and R1 and no promises were made indicating that the Facility would be responsible for refunding R1 for the missing money. Former Executive Director stated that Facility agreed to provide R1 with half of the missing money ($350.00) in the form of rent credit as a measure of good faith but facility was not admitting guilt in doing so. On 6/5/19 and 6/6/19, R1 received a total of $350 in rent credit. Facility conducted an internal investigation and cooperated with law enforcement in hopes of finding R1's missing money, but efforts were unsuccessful. Based on interviews conducted, there is insufficient evidence to support the allegation of "Resident mistreated by staff". Allegation: Facility staff did not safeguard resident's personal property. This allegation was already investigated and addressed by LPA David Sicairos on 11/21/2019 on Complaint #28-AS-20190924174431. The findings were delivered as Unsubstantiated. Please refer to Complaint #28-AS-20190924174431 for additional information. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted and a copy of this report was provided to the Executive Director.the state’s words, verbatim · CDSS document, Aug 4, 2021 · control 28-AS-20210729090721