A Heavenly Haven, Inc. II

Allegation investigated: Staff inappropriately touch residents

Licensing Program Analyst (LPA) Angela Panushkina, conducted a subsequent visit to deliver final finding. LPA met with the Administrator and LPA explained the reason for the visit. At 10:00 AM, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations During the initial visit made on 07/07/23, LPA Ruiz met with the Administrator and requested client and staff roster. LPA also requested copies of pertinent information which include, but not limited to Physician’s report, Admission Agreement, Appraisal Needs and Services Plan, etc. Between 11:00 AM – 12:15 PM, LPA conducted an interview with the Administrator, two (2) out of four (4) and one (1) out of six (6) residents, who were able to communicate. Continue on LIC9099-C Unsubstantiated Allegation: Staff inappropriately touch residents It was reported that facility "Staff inappropriately touch residents". To investigate this allegation, during the initial visit conducted by LPA Ruiz on 07/07/23, LPA interviewed the Administrator and two (2) staff involved in R1's care and supervision and all denied the allegation and reported no resident ever complained staff touched/handled them inappropriately and also they never seen any staff inappropriately touched R1 and or other residents. During today's visit, Administrator reported that all facility staff received training on how to handle residents and that all residents are being treated with care and respect. Based on inspection, observation and interviews there is no sufficient evidence to support the allegation. Therefore, the allegation is Unsubstantiated at this time. No deficiencies cited. Exit interview conducted, copy of report signed and deliveredthe state’s words, verbatim · CDSS document, Nov 7, 2023 · control 31-AS-20230706094717

Type of visit: Required - 1 Year

At 10:20am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with the Administrator and explained the reason for the visit. At 10:25am LPA conducted a tour of the physical plant and observed the following: Facility is a Residential Care Facility for the Elderly which was licensed for capacity of six (6) of which three (3) non-ambulatory and one (1) bedridden residents. Facility has six (6) bedrooms designated for residents use, four (4) bathrooms and one staff room. Facility has been approved for a hospice waiver for four (4) residents. LPA was able to tour the home and did not observe any immediate health and safety concerns. . Smoke detectors and carbon monoxide monitors were observed to be functional. Facility maintains a temperature of 74°F. LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Sharps, cleaning supplies and medications are centrally stored and are kept locked in various kitchen cabinets and drawers. Bedrooms are appropriately furnished and have appropriate lighting. Bathrooms have soap, paper towels and hand washing signs were observed. The hot water temperature measured at 119.1°F. Extra towels and linens were readily available. The fire extinguisher was observed in the living room area and was last serviced on 03/27/2023. Laundry area is also located by the kitchen area and LPA observed all chemicals and detergents are kept locked and inaccessible to residents. Facility has a permitted Accessory Dwelling Unit (ADU) in the backyard that is fenced all around with a gate and kept locked at all times. LPA also observed a clean covered patio and backyard furniture to accommodate the six (6) residents. Between 11:00am to 12:00pm, LPA reviewed records of three (3) residents and two (2) staff. Resident and staff records appeared to be complete and updated. LPA collected Certificate of Liability Insurance and LIC500. No citations issued during this visit. Exit interview conducted. Copy of report emailed to Licensee.the state’s words, verbatim · CDSS document, Nov 7, 2023

Allegation investigated: Staff forced residents to take cold showers Staff handled residents in a rough manner Staff utilized toilet water to clean residents Staff do not ensure that residents are adequately fed

At approximately, 12:30pm Licensing Program Analyst (LPA), Angela Panushkina arrived to this facility in response to the above mentioned allegations. LPA met with the Administrator and explained the reason for the visit. LPA conducted a physical plant walk through, at approximately 12:40pm, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPA did not observe any immediate health and safety issues during the visit. LPA conducted interview with the Administrator, three (3) staff members, four (4) out of six (6) residents, who were able to communicate, between 12:45pm to 2:10pm and reviewed facility records. LPA also obtained copies of pertinent documents relevant to the investigation. Continue on LIC9099-C Unsubstantiated Allegation:Staff forced residents to take cold showers To investigate this allegation, LPA conducted an interview with the Administrator and three (3) staff members and was informed that the facility provides showers every other day (in the morning 7:00am). LPA was informed that before the shower is provided, the staff has to adjust the water temperature and that all residents get showers with warm water. In addition. In addition, LPA conducted an interview with four (4) out of six (6) residents, who were able to communicate, and all four (4) residents confirmed that the facility provides warm showers every other day. Lastly, LPA tested the hot water temperature at 2:00pm and it was measured at 120°F. Based on information obtained through interviews this allegation is deemed Unsubstantiated. Allegation: Staff handled residents in a rough manner To investigate this allegation, LPA conducted an interview with the Administrator and three (3) staff members and was informed that the staff always takes care of their residents with dignity and respect. All staff denied ever taking care of the residents in a rough manner. In addition, interviews with four (4) out of six (6) residents revealed that they are being treated very well and staff handles them with care. Based on information obtained through interviews this allegation is deemed Unsubstantiated. Allegation: Staff utilized toilet water to clean residents Interview with the Administrator and three (3) staff members revealed that the facility never utilized toilet water to clean residents. All staff members informed LPA that in case of an accident the resident will be provided with the shower from waist down (inside the shower) and or full shower, as needed. In addition, four (4) out of six (6) residents denied ever being cleaned with a toilet water. Based on information obtained through interviews this allegation is deemed Unsubstantiated. Continue on LIC9099-C Allegation: Staff do not ensure that residents are adequately fed Regarding the allegation that staff do not ensure that residents are adequately fed, LPA conducted interviews with four (4) out of six (6) residents, who were able to communicate, and was informed by four (4) residents that they believe they are adequately fed. LPA record review and observation also revealed that the facility provides complete meal with fruit and vegetable servings on every meal and staff interview revealed that the staff responsible for cooking also customize food being served upon resident's request. Moreover, LPA was informed that the weekly menu may vary and daily menu provides options and alternate option for the residents to choose. Based on the information gathered during this visit, this allegations is deemed Unsubstantiated at this time. No deficiencies issued during todays visit. Exit interview conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Feb 17, 2023 · control 31-AS-20230216151634

Allegation investigated: Staff records are not accurate.

On 12/12/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct an unannounced subsequent complaint investigation. Upon arrival LPA met with administrator and the purpose of the visit was explained. Allegation: Staff records are not accurate. It is alleged that the facility is still using former staff records. To investigate this allegation LPA conducted interview with Administrator Fransicsca on 11/08/22. Interview revealed that facility does not use records from former staff. Records are archived at the facility which according to regulations files need to be retained for three years after termination. LPA observed former staff files in a cabinet that were archived, and current staff files where located in a separate location in the office area. LPA collected staff file and a current Personnel Report (LIC 500) Based on interview, this allegation is deemed Unsubstantiated. Exit interview conducted. Report signed and delivered. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 12, 2022 · control 31-AS-20221103152702

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff yell at residents Staff withhold water from residents Staff handle residents in a rough manner Staff force feed residents Staff did not seek medical attention based on observed change of condition Staff do not properly maintain records of centrally stored medication

On 11/08/22 Licesning Program Analsyt (LPA) Joscelyn Martinez arrvied at the facility to conduct a subsequent complaint visit .Upon arrival LPA was met by Administrator Francisca Recede and the purpose of the visit was explained. Initial visit was conducted on 10/26/22. Allegation: Staff yell at residents Allegation: Staff withhold water from residents Allegation: Staff handle residents in a rough manner Allegation: Staff force feed residents Allegation: Staff did not seek medical attention based on observed change of condition It is alleged that staff have yelled at the residents, withheld water, forced fed, handled residents in a rough manner and that staff did not seek medical care in for a resident's change of condition. To investigate these allegations, LPA conducted interviews with three staff and one resident . Unsubstantiated Interviews with three (3) out of three (3) staff revealed that there has never been in a time in where staff have yelled at residents, withheld water, handled residents in a rough manger, force fed residents or failed to provide medical attention to residents. Staff stated they have not witness another staff doing any of these allegations. LPA attempted to interview all five (5) residents. Due to resident's medical condition only one (1) resident was able to provide answers to the interview. Interview with resident (R1) stated they have never been a victim of the allegations mentioned above. R1 also stated they have not witness staff yell at residents, withhold water from residents, treat resident in a rough manner, force fed residents, or failed to provide medical attention. R1 stated all of the staff goes above and beyond for everyone and the administrator is very active in the facility. R1 stated residents are treated with respect and are taken care of very well by staff. Based on interviews these allegations are deemed Unsubstantiated at this time. Allegation: Staff do not properly maintain records of centrally stored medication It is alleged that facility does not properly maintain records of centrally stored medication. To investigate this allegation, LPA collected all five (5) residents' Centrally Stored Medication and Destruction Records (LIC 622). Document review revealed that facility is properly maintain records of resident's centrally stored medication. Interviews with three (3) out of three (3) staff revealed facility does maintain an updated LIC 622. Interview with administrator stated every time medication is delivered or picked up, LIC 622 is updated for the resident. Based on document review and interviews, this allegation is deemed Unsubstantiated at this time. No deficiencies cited. Exit interview conducted. Report signed and delivered.the state’s words, verbatim · CDSS document, Nov 8, 2022 · control 31-AS-20221019120003

Allegation investigated: Staff records are not accurate.

On 11/08/22 Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct an unannounced complaint investigation. Upon arrival LPA met with administrator and the purpose of the visit was explained. Allegation: Staff records are not accurate. It is alleged that the facility is still using former staff records. To investigate this allegation LPA conducted interview with Administrator Fransicsca. Interview revealed that facility does not use records from former staff. Records are archived at the facility which according to regulations files need to be retained for three years after termination. Based on interview, this allegation is deemed Unsubstantiated. Exit interview conducted. Report signed and delivered . Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 8, 2022 · control 31-AS-20221103152702

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility is not kept clean Staff store food items with cleaning solutions Facility's air conditioner is in disrepair Staff are not ensuring that the facility is free of pests Staff are not ensuring that medications are centrally stored Staff do not properly maintain records of centrally stored medication

Licensing Program Analyst(s) Wendell Smith and Joscelyn Martinez conducted an initial complaint visit to investigate the allegations above. LPA met with facility staff and explained the reason for this visit. Administrator was contacted and joined the visit shortly thereafter. Facility is not kept clean It is alleged that the facility is dirty and unkempt. LPA's conducted a physical plant tour from 9:45-10:30am. During the physical plant tour LPA's observed the facility to be clean and in good order. Interviews were conducted with staff regarding this allegation. Based on information obtained through observation this allegation is deemed Unsubstantiated at this time. Staff store food items with cleaning solutions Regarding this allegation LPA's conducted a physical plant walk through. LPA's observed cleaning solutions and food items to be stored separately. LPA observed cleaning solutions to be locked away and inaccessible from residents. Based on information obtained through observation this allegation is deemed Unsubstantiated. Unsubstantiated Facility's air conditioner is in disrepair It is alleged that the facility's air conditioner does not work. During the physical plant inspection LPA's checked and observed the air conditioner to be working properly. LPA's also spoke with staff regarding the air conditioner. Based on the information obtained through observation and interviews this allegation is deemed Unsubstantiated at this time. Staff are not ensuring that the facility is free of pests It is alleged that facility has an issue with roaches. During the physical plant walk through LPA's did not observe any roaches or pest in the facility. Interviews were conducted with residents and staff regarding this allegation. Based on the information obtained through observation and interviews this allegation is deemed Unsubstantiated at this time. Staff are not ensuring that medications are centrally stored It is alleged that resident#1 (R1) has medications stored in their room when they are not supposed to. LPA checked R1's room during the physical plant walk through and observed that R1 did have medication in their room. LPA's checked R1's physician report which indicated that R1 was able to handle their own medications. Based on the information obtained through record review this allegation is deemed Unsubstantiated at this time. Exit Interview conducted. Copy of report issued.the state’s words, verbatim · CDSS document, Oct 26, 2022 · control 31-AS-20221019120003

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.

Type of visit: Required - 1 Year

On 06/21/22 at 1:00 p.m Licensing Program Analyst (LPA) Joscelyn Martinez arrived at the facility to conduct an unannounced annual inspection. Upon arrival LPA met with staff and then met with Administrator Francisca Recede. The purpose of the visit was explained. Entrance interview conducted. A physical plant tour was conducted at 1:05 p.m and the following was observed: Infection Control: Covid-19 infection control signage were observed outside of the facility. Proper signage was also observed inside in the common areas. Staff took LPA’s temperature upon arrival. Facility has sufficient PPE supplies for more than 30 days. Food Inspection/Kitchen: LPA observed there to be sufficient stock of one-week non-perishable foods and two-day perishable foods. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers in the kitchen. Sharps are centrally stored in a locked area. Medication are centrally stored in a locked cabinet in the kitchen area. Smoke detectors/carbon monoxide are located throughout the facility and are dual hardwired. Smoke detectors and carbon monoxide detectors were tested at approximately 1:20 p.m. and appear to be functional. Fire extinguisher has a purchase date of 03/29/22. Common Areas: All common areas were observed to be clean and properly furnished. Resident Rooms: Facility has seven (7) bedrooms which of six (6) are designated for resident use. Facility has no live-in staff. The 7th bedroom is used for a staff break/rest area. All seven (7) bedrooms were toured and appear to be clean and properly furnished. LPA observed additional bedding and linens sufficient for all of the residents. All rooms have adequate lighting and furniture. Continue on 809-C Bathrooms: There are three (3) bathrooms in the facility of which all three are designated for resident’s use. LPA observed all bathrooms to be cleaned. The hot water was tested and measured at 138.9F. LPA informed staff that the water had to be correct immediately as it does not fall in regulation. All trash cans located in the bathrooms had tight fitting lids. Outside: LPA toured the outside area and observed appropriate outdoor furniture with a shaded covered area for residents. There are no bodies of water. Garage: There is a detached garage area that is being used for additional storage. LPA observed two rooms inside the garage. Both rooms contained beds and personal items belonging to staff. Administrator stated that no one is sleeping in the rooms. LPA also observed a bathroom in the garage with personal items such as toothbrushes and other toiletries. The following deficiencies were observed and cited per Title 22 see attached LIC 809D Exit interview conducted. Report signed and delivered.the state’s words, verbatim · CDSS document, Jun 21, 2022

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Jun 22, 2022

87303 Maintenance and Operation (e)(2) 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 Based on observation, the licensee did not comply with the section cited above in ensuring the water temperature was kept within regulation for residents' use which poses immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 21, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Jun 28, 2022

87305(b) Alterations to Existing Building or New Facilities. The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement is not met as evidenced by Based on observation and interviews, licensee failed to ensure proper permits were acquired prior to having the non permitted garage use, which poses a potential health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Jun 21, 2022

Allegation investigated: Residents is not treated with dignity or respect Resident is forced to fulfill duties of staff in the facility Staff handled residents in a rough manner Facility is not kept clean Staff did not safeguard resident's personal items Staff yelled at residents Staff ignores resident call for assistance

At 10:00 a.m., Licensing Program Analysts (LPA's) Melissa Ruiz and Angela Panushkina conducted an unannounced complaint visit to the facility mentioned above. LPAs were greeted by the Administrator Francisca Recede and explained the purpose for the visit. Entrance interview conducted. At 10:15 a.m., LPAs conducted a walk through and LPAs did not observe any immediate health and safety issues or concerns. During today's visit, LPAs requested files and conducted file review at 10:25 a.m. File review consists of but is not limited to review of physicians report, appraisal needs and services, etc. LPAs conducted interviews with the Administrator, two out of two staff, and three out of six residents from 11:00-12:00 p.m. Allegations: Residents is not treated with dignity or respect Staff handled residents in a rough manner Staff yelled at residents Unsubstantiated Interviews conducted with three out of six residents, who were able to communicate, stated that staff treat residents with dignity or respect. Additionally, they have never witnessed staff yell at residents. R1 stated staff speak loudly only when they speak to R6 due to R6 having a hard time hearing. Three out of six residents indicated that staff has never handled them in a rough manner. In fact, R1 stated that all staff are wonderful and very caring. R6 stated that all staff provide good service to them. Two out of two staff and the Administrator stated they always treat residents with respect, they handle residents in a gentle manner and only when they need help or ask for assistance. Lastly the Administrator stated staff never yell, they only speak louder when talking to R6. Allegation: Resident is forced to fulfill duties of staff in the facility. At 11:20 a.m., LPA interviewed R1 regarding the allegation mentioned above. R1 stated they have never provided care to the other residents in the facility. R1 stated they sometimes vocalize that they may need water or assistance. Additionally, R1 stated that they have voluntarily asked to help water the plants and cook because they love to cook but that when staff notice R1 getting tired, staff redirect her to get rest. The interview with the Administrator revealed R1 advocates to help with some tasks such as cooking and watering plants because R1 enjoys those hobbies. Allegation: Facility is not kept clean. During today's visit and upon further inspection, LPAs observed the facility to be clean and in good repair. LPAs observed the Administrator cleaning the kitchen area after meal prepping. Additionally, R1 stated that the facility is always nice and clean. Allegation: Staff did not safeguard resident's personal items . An interview with R1 revealed that back in October 2021, $100.00 and a debit card went missing. In result, the Administrator drove them to the bank where it was revealed that the debit card was delivered to the wrong address. R1 stated that the $100.00 were still missing. During the interview with the Administrator it was revealed that when R1 has cash, it is being spent on cigarettes. The Administrator drives R1 to make the purchases, however no receipts are kept. LPAs advised the Administrator to keep a log of cash purchases done by all residents. Interviews with two other residents (R2 and R6) revealed that they have had no issues with personal belongings being lost or stolen. Allegation: Staff ignores resident call for assistance. Interviews conducted with three out of six residents indicate that staff assist residents promptly when a request for assistance is made. Interviews with the two staff members and the Administrator indicate that assistance to residents is done in a timely manner, regardless of the time. Lastly, he Administrator stated that residents are checked on periodically throughout the day and night. Although allegations may have occurred or are valid, there is not a preponderance of evidence to prove that alleged violations did or did not occur, therefore the above seven allegations are UNSUBSTANTIATED at this time. No deficiencies issued. Exit interview conducted and a copy of this report was delivered to the Administrator.the state’s words, verbatim · CDSS document, Dec 22, 2021 · control 31-AS-20211221112018