Heritage Senior Home Care

Allegation investigated: Staff did not meet resident's care needs resulting in resident hospitalized for pneumonia, bacteria in blood and septic shock. Resident sustained pressure injuries while in care. Staff did not seek medical attention for resident in a timely manner. Staff placed resident on hospice care without resident's POA's approval. Staff did not ensure resident was fed. Staff did not ensure resident was administered medications. Staff did not ensure resident is involved with resident activities/Staff isolated resident in care. Staff did not allow resident visitors.

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Ronell Lopez caregiver. Administrator Michelle Navarro arrived 10 minutes later, and LPA explained the reason for the visit. The investigation consisted of the following: On 12/12/22 LPA Flores conducted a 24-hour Health and Safety Check visit and requested copies of R1's file which include: Physician's Report, Medication Sheets, Identification and Emergency sheet form, Power of Attorney, Hospice evaluation letter and others. On 12/12/22 investigator Laura Garcia from the Investigation Bureau Department (IB) investigated the first allegation. On 8/24/23 LPA Flores conducted interviews with residents #1-#3(R1-R3), staff #1-3 (S1-S3), responsible parties for residents #4 and #5(R4-R5), requested visitor's logs for September to November 2022, and delivered findings for the allegations. (CONTINUED ON LIC 9099C) Unsubstantiated The investigation revealed the following: Regarding allegation: Staff did not meet resident's care needs resulting in resident hospitalized for pneumonia, bacteria in blood and septic shock. It is alleged R1 was diagnosed with double pneumonia, bacteria in the blood, and in septic shock. R1 was admitted to the facility on 8/5/20 upon admission R1 did not have hospice services. Caremore Health provided services to R1 from 6/15/22 to 10/17/22. On 9/12/22 Caremore Health ordered a chest x-ray for R1 due to cough. On 9/15/22 a plan was noted for treatment provided for R1’s pneumonia. On 10/17/22 Caremore Health nurse ordered a chest x-ray and urinalysis exams, and physician provided a referral for hospice evaluation. On 10/18/22 R1 initiated hospice services with Medplus Hospice Services. The reason for admission to hospice was due to overall decline, need for maximum assistance, and increased confusion and aphasia. On 11/8/22 R1 was admitted to the hospital per R1’s representative request. Upon admission to the hospital R1 was diagnosed with failure to thrive, septic shock, aspiration pneumonia, bacteremia, and other diagnosis. Although, R1 was diagnosed with the previously listed diagnoses, there is no evidence to support that the facility staff was neglectful in care. R1 was receiving home health care services and was admitted to hospice care. The facility and hospice nurse followed R1’s representative wishes when the decision to hospitalize R1 was made on 11/8/22. 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 allegation is UNSUBSTANTIATED. Regarding allegation: Resident sustained pressure injuries while in care. It is alleged R1 developed two bed sores on R1’s coccyx and family member were never told about them. Caremore Health provided services to R1 from 6/15/22 to 10/17/22. Prior to being admitted to the facility on 8/5/20 R1 was at a skill nursing facility. Per skill nursing notes R1 had disorder of the skin and subcutaneous tissue. On 7/15/22 Caremore Health noted R1 had a small skin tear on the left buttock and provided care. On 7/28/22 a follow up visit was conducted for the wound which appeared to be healed. On 9/2/22 R1 was evaluated, and an assessment and plan were noted for a stage 2 pressure injury on left buttocks and sacrum by Caremore Health. On 9/6/22, 9/9/22, 9/15/22, and 10/6/22 R1 was provided wound care by Caremore Health. On 9/16/22 a referral for wound supplies was made by Caremore Health. On 11/8/22 hospital noted skin was dry. Interviews conducted with responsible party, and staff revealed R1 was visited once a week by a nurse from Caremore Health. Although R1 did developed wounds while in care. R1 was receiving care by a home health agency which was providing wound care for R1 at the time the wounds developed. 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 allegation is UNSUBSTANTIATED. Regarding allegation: Staff did not seek medical attention for resident in a timely manner. It is alleged Responsible party had asked the administrator to call 911 and administrator did not call 911 and told responsible party to call the hospice nurse instead. R1 received services from Caremore Health per records reviewed from 6/15/22 to 10/17/22. On 10/17/22 Caremore Health physician provided a referral for hospice care. On 10/18/22 R1 initiate hospice care with Medplus Hospice Services. Interview conducted with hospice nurse revealed, R1’s representative was made aware that R1 would be provided comfort care for the existing diagnosis. Responsible party was also made aware that hospice services will end if R1 was send out to the hospital. Interview with administrator revealed all changes in condition were promptly reported to the hospice nurse and Caremore nurse when observed. On 11/3/22 nurse visited R1 due to shortness of breath and comfort care was provided. On 11/8/22 R1 hospice nurse contacted R1’s responsible party, during that called nurse learned that responsible party had requested facility staff to call 911. At that time nurse contacted 911 and R1 was transfer to the hospital. Due to R1 being on hospice care, a hospice nurse was providing care from 10/18/22 to 11/8/22 and both the facility staff and hospice nurse were following hospice protocols. 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 allegation is UNSUBSTANTIATED. Regarding allegation: Staff placed resident on hospice care without resident's POA's approval. It is alleged R1 was placed on hospice without the power of attorney (POA)'s consent. Interview with POA revealed that due to not knowing much about hospice, POA refused when advice by administrator that R1 may need hospice care. POA "relented and agreed to hospice". POA acknowledge to singing consent forms for hospice initiation. On 10/17/22 Caremore health physician provided a referral for hospice evaluation. Interview conducted with administrator revealed, Caremore health requested a hospice evaluation. Administrator stated to have advice POA that R1 was declining, and a hospice evaluation may be necessary. Upon POA inquiring for recommendations of hospice agencies, administrator provided different hospice agencies choices. Interview with Hospice Nurse revealed that POA signed R1 into hospice care. Per documents reviewed on 10/18/22 POA signed the informed consent and treatment authorization for hospice services. On 11/8/22 POA signed a hospice revocation. 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 allegation is UNSUBSTANTIATED. Regarding allegation: Staff did not ensure resident was fed. It is alleged facility staff did not ensure R1 was fed. Interviews conducted with residents revealed 3 out of 3 residents stated facility staff provide three meals and ensure they eat their meals, as well as provide additional options of meals when requested. Interviews with family members revealed facility ensures their family members eat by providing a meal the resident requested. Administrator also notifies family, who choose to bring something they know the resident likes. Interviews with staff revealed 3 out of 3 staff interviewed stated to provide meals to residents, to follow physician’s recommendations for meals, and to provide ensure drink when physician recommends as a substitute for a meal as needed. 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 allegation is UNSUBSTANTIATED. Regarding allegation: Staff did not ensure resident was administered medications. It is alleged facility staff did not ensure R1's medications was administered. Interviews conducted with residents and family members revealed facility provides their medication as prescribed and had no concerns regarding medication provided. Interviews with staff revealed staff provide medication as prescribed and noted in a medication sheet. Per documents reviewed, On 10/18/22 power of attorney was notified there were no changes in medication by hospice nurse. On 11/7/22 hospice nurse visited R1 and discuss with POA the need for comfort medications. On 11/8/22 hospice nurse visited and informed POA of medications administer to R1 on that day. Medication logs for August 2022 to November 2022 were reviewed, staff initialed each dose provided per day, no refused or skipped medication were noted. 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 allegation is UNSUBSTANTIATED. Regarding allegation: Staff did not ensure resident is involved with resident activities and Staff isolated resident in care. It is alleged staff did not ensure R1 joins the other residents in the dining hall or involved in resident activities and was always left alone. Interviews with residents and family members revealed residents spend time in the dining room, and facility staff either take residents on walks in the neighborhood or provide time in the backyard. (CONTINUED ON LIC 9099C) Interviews with staff revealed residents like to spend time in the living room and in the back yard and are in their rooms only when they choose to have some quiet time. Documents reviewed revealed, that on 10/20/22 a hospice social worker visited the facility and observed R1 sitting in the TV room. On 11/3/22, R1 was observed sitting in a chair, awake and alert by hospice nurse. 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 allegation is UNSUBSTANTIATED. Regarding allegation: Staff did not allow resident visitors. Responsible party was never allowed inside the facility until just recently. Interviews with residents and family members revealed, residents receive visits at the facility and have not been denied entry to the facility. Interviews with staff revealed visitors are allowed at the facility and there are different areas indoor and outdoor in the facility for families to visit the residents. Staff stated that in 2022 facility was allowing visitors and only asking families to self-assess for COVID symptoms prior their visit. Documents reviewed revealed, on 11/7/22 POA was present during a visit from hospice. Visitor log showed R1's representative visited on 9/15/22, 9/23/22, 10/7/22, 10/16/22, 10/19/22, 10/22/22, 10/26/22. Facility keeps a visitors log from 2021 to present. 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 allegation is UNSUBSTANTIATED. Exit interview was conducted with Nino Navarro and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 24, 2023 · control 28-AS-20221209132559

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angelica Rea conducted the unannounced required annual inspection on today's visit. LPA met with Licensee/Administrators, Nino Navarro and Michelle Navarro who assisted with the visit. The facility serves residents 60 and older. Facility is a single story home located in a residential area consisting of 4 private rooms, one shared room and 1 staff room, 3 bathrooms, living room(s), dining room, backyard patio area with shade, and attached garage. The last fire drill was completed on 3/8/23. Administrator(s) certificate(s) expire on 05/04/24, and 4/10/24, respectively. The following were observed/inspected: Four (4) resident rooms, 1 staff room, common areas, bathrooms, and outdoor physical plant was inspected. Three (3) centrally stored client medication records were reviewed. Sufficient supply of perishable for 2 days & non-perishable foods for 7 days were observed. All required postings were observed. PPE supplies were observed. Smoke Detectors and carbon monoxide detectors, tested and operating. Staff and resident files were reviewed during today's visit. Cleaning supplies, and toxins are stored in a locked cabinet in the laundry area. Water was tested in kitchen and 3 bathrooms. Water temperature measured between 112.2 degrees F and 113.4 degrees F in all faucets measured. Designated area for centrally stored medication is located in locked kitchen cabinet. A first-aid kit has been inspected and has the following : thermometer, tweezers, scissors, antiseptic, bandages, gauze and current first aid manual, which are stored in locked kitchen cabinet. There are no deficiencies issued today. The exit interview was held. A copy of this report was given to Michelle Navarro..the state’s words, verbatim · CDSS document, Jun 2, 2023

Allegation investigated: Staff are not providing residents a safe and healthful environment. Facility does not have adequate staffing to meet resident's needs. Facility has mold. Facility is in disrepair.

On 03/02/2023 at 9:05 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted a subsequent complaint visit to investigate the allegations listed above. LPA met with administrator Michelle Navarro and explained the reason for the visit. The initial complaint visit was conducted on 11/21/2022. During the initial visit LPA toured the facility with the Administrator, obtained resident/ staff roster, staff schedule, text correspondence between Administrator and Family member of resident# R5. LPA also received a copy of claim acknowledgement and correspondence with nationwide dated 10/11/2022 and took photos of facility flooring. LPA interviewed administrator, staff#1 (S1) and Staff#2(S2). Residents # R1 through R3 is nonverbal. LPA attempted to interview resident# R4, but due to communication limitations, LPA was not able to continue with the interview. Report Continued on 9099C Unsubstantiated During today’s visit LPA reviewed resident files and obtained R1-R4 physician’s report, and resident roster. LPA interviewed facility Insurance broker and obtained a copy of claim acknowledgement from the insurance broker. LPA and the Administrator toured the facility to ensure no signs of molding. Prior to the visit LPA received a report from All state with results of facility inspection. The investigation reveals the following: Regarding “Staff are not providing residents a safe and healthful environment” it is alleged that the facility is producing contaminated air ventilation. During the visit LPA toured the facility and observed no indication of air pollution. Staff interview revealed that they do not have signs and symptoms of illness/sickness caused by air pollution. LPA reviewed resident files and did not find any resident with pneumonia. The Administrator confirmed that a former resident moved out abruptly and had pneumonia. The Administrator further stated the resident had a history of pneumonia and confirmed that all current residents was never hospitalized for pneumonia. The investigation reveals the following: Regarding “Facility does not have adequate staffing to meet resident's needs”. It is alleged the facility has insufficient staffing. Upon arrival LPA observed two (2) caregivers in the facility during visit and on the initial visit dated 11/21/2022. Staff interviews revealed that the facility always have 2 staff working and sometimes the administrator will also be present. Staff further stated that they do not feel the facility is short staffed. The Interview with the administrator, revealed that 2 staff and 2 administrators are schedule Monday through Fridays, and 1 caregiver is scheduled to the night shift. LPA reviewed staff schedules and observed Monday through Fridays the facility has 2 staff scheduled to work during the day and 1 staff scheduled for the night shift. Report Continued on 9099c The investigation reveals the following: Regarding “Facility has mold”. It is alleged the facility has mold throughout the facility. During the visit LPA toured the facility and observed no signs of molding or white oozing substance. LPA did observe white substance on lining on one floorboard that was hard. interviews with the Administrator revealed that the facility has never had mold. Interviews with staff revealed that they have never seen mold while working at the facility. LPA also consulted with another LPA who was at the facility for another investigation on 12/12/2022, and confirmed mold was not observed during their visit. The investigation reveals the following: Regarding “Facility is in disrepair”. It is alleged the facility floors are buckled. During tour of the facility LPA did observe buckled floors with possible signs of water damage. During the interview with the administrator, it was revealed the floor buckled in October and the facility is in contact with their insurance company to repair the floors. The administrator presented LPA with an email proving that an insurance claim was filed on 6/26/2022 and correspondence between the facility and the insurance company. On 11/22/2022 The facility sent LPA a report of findings from the insurance company citing the damaged floors was due to the house being built without the perimeter gap between the floors. The facility proceeded with a private contractor and repaired the floors prior to LPA’s next visit. LPA received photos from the administrator on 12/20/2022 showing the repaired flooring. During today’s visit LPA confirmed the flooring was repaired by the facility. The Administrator stated the claim was not submitted on 6/26/2022 as the document stated and provided the insurance broker information. Interview with the insurance broker confirmed the date was a mistake and the claim was filed 10/10/2022. Based on LPA's observation, interviews, and file review the investigation revealed: 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. Exit interview conducted with Administrator Michelle Navarro and a copy of this record provided.the state’s words, verbatim · CDSS document, Mar 2, 2023 · control 28-AS-20221115090235

Type of visit: Case Management - Deficiencies

Licensing Program Analyst(s) (LPA) conducted a case management visit during a complaint investigation visit due to observed deficiencies. LPA met with Nino Navarro administrator and explained the reason for the visit. On 12/12/22 LPA Flores conducted a tour of the facility to conduct a health and safety check. During the tour LPA observed the kitchen area and observed the following; cleaning spray was observed on top of the window sill, upon LPA explaining the cleaning spray must be lock staff placed it in cabinet under the sink and did not lock the cabinet. LPA observed the a drawer with utensil and sharps (knives) were observed, drawer was unlock at the time of the visit. Caregiver stated to be using cleaning solution and sharps. Deficiencies are noted on LIC 809D under Title 22 Regulations. Exit interview was conducted with Nino Navarro administrator and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Dec 12, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Dec 13, 2022

87309 Storage Space: (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidence by: Based on observation licensee did not ensure staff maintained cleaning supplies, and knives at all times which poses a immediate risk to the health, safety, or personal rights of the persons in care.the state’s words, verbatim · CDSS document, Dec 12, 2022

Plan of correction: Administrator will ensure all cleaning supplies, knives are locked at all times. Staff locked items during the visit and administrator certified on LIC 9098 on 12/12/22. Deficiency cleared as of 12/12/22.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alberto Lopez and Bennette Pena conducted an unannounced Required- 1 year visit focusing on COVID-19 Infection Control Practices. LPAs met with Licensee/Administrator Nino Navarro and Administrator Michelle Navarro and explained the purpose of the visit. Facility serves residents 60 and older. Facility is a single story home located in a residential area consisting of 4 private rooms, one shared room and 1 staff room., 3 bathrooms, living room, dining room, backyard patio area with shade, and attached garage. The last fire drill was completed on March 1, 2022. Administrator certificate expires 05/04/22 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. · Infection control signs and other COVID-19 signs are posted throughout the facility in the bathrooms, kitchen, and hallway to promote hand washing, cough/sneeze etiquette, and physical distancing. · Facility has one designated isolation room. · Three (4) resident rooms, common areas, bathrooms, and outdoor physical plant was inspected. · All client rooms were not equipped with alcohol-based hand sanitizer but available through out the facility · 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. · A posted Emergency Disaster Plan was observed. · PPE's were observed. · Staff and resident files were not reviewed during today's visit. Water temperture was within range of 105-120 degrees F and Deficiencies cited. (see 809 for details) Exit interview was conducted with Administrator Nino Navarro and Co Administrator Michelle Navarro. A copy of the report was provided.the state’s words, verbatim · CDSS document, Apr 13, 2022

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