Americare Assisted Living of Rolling Hills

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required visit to the above facility. LPA was met by Minda Olila and later spoke with Leia Joaquin, Administrator via telephone and the purpose of today’s visit was explained. There are currently (6) residents in the facility. (2) residents are ambulatory and (4) are non-ambulatory. The facility is a single-story structure located in a residential neighborhood. It has a ramp on the back door. It consists (7) bedrooms, (2) full bathrooms, shaded back yard, front yard, laundry in the attached 2 car garage. LPA and Care giver toured the entire facility inside and out. Documents are posted as mandated by the DPH and CCLD. INFECTIOUS CONTROL PRACTICES - LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap and paper towels in all the bathrooms and additional sanitation supplies are stored in hall closet and garage. LPA observed staff wearing masks, Residents private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing completed for staff, infectious Control Plan posted and/or in folder, Emergency infectious Plan posted and/or in folder, and required postings throughout the facility. Visitor designated area, resident temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days. All resident's and staff are vaccinated and boosted. OPERATIONAL REQUIREMENT - Fire clearances are incompliance. PHYSICAL PLANT ENVIRONMENTAL SAFETY - Bedrooms are occupied by residents and contain the mandated furniture. One staff bedroom. Bathrooms have non skid mats, bars, and are clean and operational. (3) fire extinguishers are fully charged. First Aid kit complete with manual. The water temperature is at 115 degrees Fahrenheit. Linens and personal hygiene supplies are adequate. A comfortable temperature is maintained in the facility. Smoke detectors and carbon monoxide detector are complying and operational. hazardous toxins and/or items are inaccessible to residents. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. Exit, walkways and/or passageways, front yard and back yard are free of debris and/or hazards. The facility is in good repair. STAFFING AND PERSONNEL RECORD TRAINING - 4 staff files are current with valid CPR cards, egress system operational, no volunteers at the facility. RESIDENTS REC - INCIDENT REPORT- 4 Resident files are current along with medications. RESIDENT'S RIGHTS - Internet access along with computer, visitor policy posted, PUB 475 posted. PLANNED ACTIVITIES - shaded area, indoor and outdoor activity area. FOOD SERVICE - Ample supply of perishable and nonperishable food and menu posted. INCIDENTAL M&D – The MARS is updated and complete. Residents medications are being given as prescribed by their physician. DISASTER PREPAREDNESS – The facility has an emergency and disaster plan, staff knows were shut off valves are located, flash lights available along with batteries, cell phones, additional emergency provisions, and conducted fire drill on April 2023. RESIDENT'S W/SHN - The Residents do not have any restricted health condition needing specialized care. No - Technical Advisories (TA) issued. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. Due to technical difficulties (printer not operational) LPA will email reports. An exit interview was conducted with Minda Olila , Care giver and a hard copy of report was provided via email.the state’s words, verbatim · CDSS document, Apr 22, 2023

Allegation investigated: Resident developed multiple pressure injuries while in care. Resident sustained a fracture while in care.

Licensing Program Analyst (LPA) Ana Soto conducted a subsequent investigation visit to deliver decisions and findings for the allegations listed above. LPA met with Norberto Batongbakal, House Manager and the purpose of the visit was explained. The investigation consisted of the following: Licensing Program Analyst (LPA) Ulysses Coronel initiated the complaint and obtained copies of staff and resident records The complaint was referred the Department of Social Services Investigation Branch and was assigned to Investigator (IB) Dennis Seng. Investigator Seng conducted record review, review of medical records and conducted staff, resident and witness interviews. The investigation revealed the following: Regarding the allegation “Resident developed multiple pressure injuries while in care.” Record reviews conducted by IB indicate that 08/12/2021 R1 was given a body check during hospital discharge and no pressure injuries were observed on R1’s body. Substantiated Record reviews also indicate that 09/17/2021 during hospital admission, R1 was observed with an Unstageable Pressure Injury to the Let Hip / Greater Trochanter ~7.5 x 6 x 0 cm, a Stage 3 Pressure Injury to the Sacrum extending to right buttock ~6 x 6 x 0.1 cm, a Stage 2 Pressure Injury on the Left Buttock ~2 x 3 x 0 cm and Stage 1 Pressure Injuries to Right Medial Great Toe ~1 x 1 x 0 cm & Left Heel ~2 x 4 x 0 cm. On 10/27/2021 the administrator told IB that:” Around early August of 2021 R1 suffered a stroke. Unfortunately, R1 wasn't the same after this. R1 became harder to care for as R1 became more confused, physically frailer, and it became more difficult for R1 to sit or stand.“ Caregiver S1 told IB that “On 08/27/2021, R1 woke up screaming in pain when we tried to tum R1 from side to side to change R1’s diaper. After that it just got so bad that I didn't want to move or transfer R1 because R1 was in so much pain. R1 screamed when we moved them to wheelchair, turned them, any transfer that we did R1 screamed. On 09/06/2021 I noticed the pressure sores on R1’s body. I reported this to home health on 09/08/21 and they said R1 needs to go to the hospital.” Caregiver S2 stated “When R1 screamed, I didn't want to move R1 anymore, so R1 stayed in bed. On 09/06/2021 I noticed R1 developed the sores on their body. I think R1 got the sores because when we moved R1, R1 screamed, and we didn't want to cause R1 more pain, so we left R1.” Regarding the allegation “Resident developed multiple pressure injuries while in care.” Based on interviews which were conducted and the records that were reviewed by IB, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D Regarding the allegation: “Resident sustained a fracture while in care.” Record reviews conducted by IB on 10/27/2021 indicate that during hospital admission on 09/17/2021 x-ray results showed that R1 had a fracture on the right hip femoral neck. On 10/27/2021 the administrator stated:” Around early August of 2021 R1 suffered a stroke. Unfortunately, R1 wasn't the same after this. R1 became harder to care for as R1 became more confused, physically frailer, and it became more difficult for R1 to sit or stand.” Caregiver S1 stated: “It was actually on 08/26/2021 that R1 fell. R1 didn't verbalize any pain. R1 didn't have any head injuries that I could see. I did a body check and saw no cuts or bruises on their body. There was nothing that I saw that was alarming to me. I gave R1 some Tylenol and I called their family to tell them what happened. I thought R1 needed an x-ray after the next day R1 screamed. On 08/27/22021 we arranged a portable x-ray, but R1’s insurance declined it.” Caregiver S2 stated “I didn't see R1 fall because I was assisting R2 in the bathroom. S1 was in the other bathroom helping out another client.” On 11/01/2021 witness W1 stated: “This fracture occurred on 08/26/2021 and she wasn't taken here until three weeks later. The facility still should have stepped in and forced their hands because family didn't seem to know better.” Regarding the allegation: “Resident sustained a fracture while in care.” Based on interviews which were conducted and the records that were reviewed by IB, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(e)(1)(A) “Serious Bodily Injury” as defined in Section 243 of the Penal Code that states, a serious physical condition, including, but not limited to, the following: loss of consciousness; concussion; bone fracture; protracted loss or impairment of any bodily member or organ; a wound requiring extensive suturing; and serious disfigurement.” At this time a $500 Civil Penalty is assessed. An exit interview was conducted, plans of corrections were developed. A copy of this report and appeals rights were provided.the state’s words, verbatim · CDSS document, Oct 20, 2022 · control 11-AS-20210921093903

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(5) · Plan of correction due date: Oct 27, 2022

Personnel Requirements – General. All personnel shall be given on the job training or have related experience in the job assigned to them....This requirement was not met as evidenced by: Based on record reviews and interviews conducted by Investigator (IB) Dennis Seng the licensee failed to ensure that staff had the knowledge necessary in order to recognize early signs of illness and the need for professional help. Staff S1 and S2 recognized R1 having pressure sores but failed to seek professional help even after being told to by R1’s home health agency which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 20, 2022

Plan of correction: Licensee shall ensure all staff receive training on Emergency Procedures/ Care for Elderly Residents and submit sign in sheet, training materials and instructor information to Licensing by the POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Oct 27, 2022

87615(a)(1) Prohibited Health Conditions. Persons who require health services for or have a health condition including, but not limited to,..... This requirement was not met as evidenced by: Based on record reviews and interviews conducted by Investigator (IB) Dennis Cheng the licensee failed to ensure that residents with stage 3 pressure injuries are not retained at the facility, R1 developed Stage III pressure injuries on left sacrum and right buttocks while in care which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 20, 2022

Plan of correction: Licensee shall review Title 22 regulations regarding Prohibited Health Conditions and submit a statement confirming review of the regulations and acknowledging understanding.

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

Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. ....This requirement was not met as evidenced by: Based on record reviews and interviews conducted by Investigator (IB) Dennis Cheng the licensee failed to ensure that observation of unmet needs are brought to the attention of the resident's physician, staff failed bring R1’s complaints of pain and pressure sores to attention of R1’s physician which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 20, 2022

Plan of correction: Licensee shall ensure all staff receive training on observation of the residents and submit sign-in sheet, training materials and instructor information to Licensing by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Antonio Bayco, Care giver and later met Leia Joaquin with administrator and the purpose of today’s visit was explained. There are currently (3) residents in the facility. (2) residents are ambulatory, (1) are non-ambulatory, (0) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (7) bedrooms, (2) full bathrooms, The front has a ramp and Bedroom #7 has a ramp outside of French doors, and the French living room doors have a ramp outside also. Kitchen, living room, dining room, shaded back yard, front yard, laundry room in the attached 2 car garage. LPA and Antonio toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1, 2, & 5 are occupied by residents and contain the mandated furniture. Bedroom 3, 4, & 6 are vacant. Bedroom 7 is a staff bedroom. The (1) bathrooms are clean and operational. 2nd bathroom is a staff bathroom. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (1) Resident file along with medications are current. (1) Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is between 105 - 120 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (2) fire extinguisher is fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked. Sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in the garage. LPA observed staff wearing masks, resident private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing completed for staff, and required postings throughout the facility. Visitor designated area, facility has internet & Computers for residents to use, resident’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. No Technical Advisory (TA) issued An exit interview conducted with Leia Josquin, Administrator and a hard copy of report provided.the state’s words, verbatim · CDSS document, Aug 27, 2022