Four Seasons Assisted Living Center

Allegation investigated: Facility food is not of good quality Resident is being harassed by staff Staff is refusing laundry services.

Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to the above facility. LPA Ascencio met with Ulka Sawghavi at 10:45 a.m. Entrance interview conducted. On 06/16/2023, the Department received a complaint alleging that facility food is not of good quality, resident is being harassed by staff and that staff are refusing laundry services. On 06/19/2023, starting at 4:20 p.m., an interview with Resident #1 (R1) revealed that they do not have any complaints about the food being served. Additionally, the food is always delicious and nurturing. Lastly, R1 states that the food is great on most days, the other days, it is ok. Interview with six (6) residents on 06/26/2023 revealed that the food is good. The food comes from the skilled nursing facility (SNF) and is delivered to the residential dining room. The staff assist with plating the food and can serve the food at a hot temperature most of the time. Continued on LIC 9099 - C Unsubstantiated In addition, resident interviews indicated that they would prefer different variety of foods and meals instead of a rotating schedule. Lastly, although resident interviews indicated that they enjoy the food, other residents indicated that the food is cold, is of low quality and is not known what food item they are eating. That same day, starting at 11:00 a.m., LPA Ascencio conducted a tour of the facility kitchen. The tour revealed a clean and well maintained kitchen area with proper utensils and kitchenware. Additionally, LPA Ascencio observed a variety of perishable and non-perishable goods for resident consumption. During the kitchen tour, an interview with Head Chef revealed that they create a monthly dining calendar for the Assisted Living Facility and SNF. The menus involve a balanced meal consisting of protein, carbohydrates, and vegetables. The Head Chef added that if a resident does not like the food item on the calendar, they have a side menu they can choose consisting of sandwiches or salads. That same day, LPA Ascencio received menus for the month of June 2023 revealing all menus had a balance of protein, carbohydrates and vegetables for lunch and dinner. That same day, when conducting resident interviews, LPA Ascencio observed the lunch meals for 6 residents, which consisted of chicken in a red sauce, mashed potatoes, and cooked squash. Although some resident interviews revealed that they were displeased with the food not being of good quality, observation and additional interviews revealed that the food is of good quality and enjoy what is being served daily. The LPA spoke with Staff Ulka regarding the request of resident wanting different variety and that food should always consists of good quality food types. Thus, based on evidence gathered, the allegation of facility food is not of good quality is deemed unsubstantiated at this time. Regarding the allegation of resident is being harassed by staff. On 06/19/2023, starting at 4:20 p.m., an interview with R1 revealed that they are not being harassed by staff or residents. R1 indicated that they have not had a problem with anyone at the facility and if they do, they can reach out to the staff for assistance. Interview with six (6) residents on 06/26/2023, starting at 11:25 p.m. revealed that no staff member or other resident has harassed them at the facility. Additionally, residents are aware they can reach out to staff or the Administration for assistance if any harassment were to occur. That same day, interview with staff members revealed that they have not seen or heard of any resident being harassed by another staff or resident. Staff members indicated that they could reach out to their Administrator, call the Ombudsman or Community Care Licensing if abuse or harassment were to occur. Based on evidence gathered, the allegation of resident is being harassed by staff is deemed unsubstantiated at this time. Continued on LIC 9099 - C Page 2 Lastly, regarding the allegation of staff is refusing laundry services. On 06/19/2023, starting at 4:20 p.m., an interview with Resident #1 (R1) revealed that they wish to have their own personal laundry service done separately from everyone else. The facilities protocol for laundry services is collecting the dirty laundry from all residents and putting it to wash collectively. Right now, the washer stopped working, so the staff are taking the clothes to the other side, washing them, and drying them on our side. I just don’t want to have all my clothes together. They haven’t lost any clothes, but I don’t want mine with everyone else. That same day, an interview with Staff #1 (S1), starting at 4:30 p.m., confirmed that the washer stopped working, but because the staff have access to the SNF washer, they can continue with laundry services. S1 added that R1 has stated that they want to have their clothes done separately but gave us no reason for it. If R1 would be losing socks, shirts or pants, then maybe we would consider doing laundry service separately, but at this point in time, there is no need. R1 got upset at this gesture but we haven’t had an issue moving forward. Interview with six (6) residents on 06/26/2023, starting at 11:25 p.m. revealed that they do not have a problem with laundry services or services being denied. Additionally, residents confirmed that the washer is not working at the assisted living facility, but the staff have been getting it done on a daily basis. That same day, interviews with various staff members revealed that they do not refuse laundry services for residents. Additionally, staff indicated that the residents can request a specific outfit or clothing item to be washed, and if it is more than that, staff will not refuse and will wash their clothes. Lastly, staff indicated that R1 request their laundry be done separately from everyone else. Although the request was denied, staff indicated that they continue to provide laundry services for R1 and everyone at the facility. Although R1 had requested staff to separate their laundry from the rest of the residents, further interviews with R1 and other residents revealed that the current process of laundry service is working. LPA Ascencio and Ulka spoke regarding the laundry service and reminded that all facility appliances should be fully operational and in good condition. Ulka added that the Maintenance Director is aware of the problem and are currently awaiting parts for repair. Based on evidence gathered through the investigation, the allegation of staff is refusing laundry services is deemed unsubstantiated at this time. Exit interview conducted and a copy of the report was issued. Page 3the state’s words, verbatim · CDSS document, Aug 8, 2023 · control 29-AS-20230616132318

Allegation investigated: Staff did not seek medical attention for resident in care Staff threatened a resident in care Staff spoke inappropriately to a resident in care Staff do not serve nutritious meals

Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to the above facility. LPA Ascencio met with Staff Ulka Sawghavi at 12:45 p.m. Entrance interview conducted. On 06/08/2023, the Department received a complaint alleging that staff did not seek medical attention for resident in care, staff threatened a resident in care, staff spoke inappropriately to a resident in care, and staff do not serve nutritious meals. On 06/26/2023, interview with Resident #1 (R1) starting at 12:12 p.m. revealed that sometime in 2021, R1 was living in the second (2nd) floor, walked up the stairs and had a fall. R1 indicated that the elevator was not working to go up to the second floor. R1 added that when they fell, R1 felt pain in their abdomen and groin area. R1 stated they were not seen by a doctor and that Administrator Melissa Christopher observed the incident and assisted R1 back to their room. Continued on LIC 9099 - C Unsubstantiated Later that day, during R1’s file review, an incident report, dated 02/21/2022, indicated that R1 walked to the top of the stairs and R1 fell/slid at the top of the stairs. Former Administrator Christopher indicated in the incident report that they observed the fall, asked if R1 was ok and if R1 hit their head. R1’s response was that they were ok and did not need any medical attention. Administrator Christopher took R1 to their room in a wheelchair. Additionally, Administrator Christopher added on the report, that Administrator Christopher checked on R1 a few days later and R1 stated feeling ‘OK’ and that they did not need any medical attention. Further file review revealed a discharge summary from the skilled nursing facility on 09/08/2021 indicating that R1 is not a fall risk and had genital complications, a Narrative Charting note, dated 10/11/2021, revealed that R1 requested and was transported to the hospital due to discomfort in genital area, and R1’s Primary Physician note indicating that on 10/21/2021, R1 was experiencing genital pain and abdominal pain due to the genital pain which also includes abnormalities in gait, and muscle weakness and mobility. Additionally, a hospital discharge summary was observed, dated on 02/17/2022, indicating that the reasons for visit was due to a headache and complications of the genital area. No other documentation regarding pain or discomfort was observed. Although the date on the incident report differs from what R1 stated, documentation revealed that there was an incident regarding R1 having a fall while walking up the stairs. The incident report was written by Former Administrator Christopher, who indicated in the report, that they observed R1 falling, assisted R1 to their feet and offered medical attention via paramedics but R1 refused services. Incident reports also indicated that Administrator Christopher, on two (2) separate occasion, spoke to R1 who refused medical attention and stated they did not need medical attention. Moreover, a file review revealed that R1 sought medication attention on various occasion when having discomfort or pain. Additionally, facility staff assisted in obtain that medical attention by calling the paramedics or taking R1 to their primary doctor. Thus, based on evidence gathered, there is not enough evidence to support the allegation that staff did not seek medical attention for resident in care. Therefore, the allegation is unsubstantiated at this time. A similar allegation with the same resident was unsubstantiated on 06/26/2023. Continued on LIC 9099 - C Page 2 Regarding the allegations of: staff threatened a resident in care and staff spoke inappropriately to a resident in care. On 06/13/2023, LPA Ascencio conducted an interview with R1, starting at 1:00 p.m. Interview with R1 revealed similar details to an unsubstantiated complaint dated 05/16/2023. LPA Ascencio asked if R1 had additional information regarding the allegations. R1 stated that LPA Ascencio had all the details from the previous conversation relating to the matter, nothing has changed. Although a new complaint was filed for allegations that were previously unsubstantiated on 05/16/2023, interview with R1 revealed that there is no additional evidence that support the claims that staff threatened a resident in care and staff spoke inappropriately to a resident in care. The following is a summary of the unsubstantiated findings delivered on 05/16/2023. On 05/16/2023, LPA Ascencio conducted an interview with Administrator Punit at 10:15 a.m. Interview with Administrator Punit revealed that Resident #1 (R1) has been living at the facility for over a year and is on the Assisted Living Waiver Program (ALW). Monthly, the ALW program pays a majority of R1's boarding and care fees, while R1 is responsible for what ALW does not cover. Administrator Punit stated R1 has not been paying their portion since moving in last year, raking up a fee of over $15,000. Administrator Punit also mentioned that they have spoke to R1 various time regarding the billing statement and possible eviction for non-payment, but was not mentioned in a threatening way. We did have Staff #1 (S1) last week on 05/12/2023, to speak to R1. Although, I am not sure what was said, we could not hear any yelling or cursing coming from the room. I know that S1 was going to talk to R1 regarding their outstanding balance, and that the eviction topic would not come up. Lastly, R1 has been refusing to pay their portion stating the facility should be charging Medicare and Medi-Cal for their stay at the facility. Later that same day, interview with R1 at 10:40 a.m., revealed that the facility has spoken to R1 various occasion regarding the billing. R1 added a staff person arrived at their room on 05/12/2023 talking about how they want to help me but then started to talk about getting "their money." Afterwards, that staff person began to yell at me and cursed at me, calling me a derogatory, racial slur. Lastly, R1 added that the staff person spoke to them about eviction because I haven’t paid, but R1 reiterated they will not be moving from the facility. Continued on LIC 9099 - C Page 3 That same day, interview with S1, starting at 11:20 a.m. revealed that they spoke to R1 on 05/12/2023 regarding ways the facility can assist R1 in obtained additional resources such as Social Security Income (SSI) funds. S1 stated the conversation was going great, until the topic of money and the outstanding balance came up. S1 added that R1 began to yell and curse at S1. S1 added they left the room not wanting to cause any emotional disturbance to R1. Lastly, S1 stated they were professional and understanding toward R1, and did not threaten R1 with any eviction. Later that day, interview with residents starting at 01:33 p.m. revealed that staff are nice, professional and have not cussed at any resident at the facility. Although the R1 has an outstanding balance of $15,000 for not paying their portion of rent, interview with Administrator Punit revealed that the facility is looking at additional resources to help R1 obtain additional funds to create a payment plan for their balance. Administrator Punit stated they will not be evicting R1 at this moment as the facility wants to provide every resource available to R1 before doing so. Even though R1 stated they were called a racial slur by S1, and S1 stated they were professional and polite when speaking with R1, it is unsure what was said during the conversation between R1 and S1. Thus, there is insufficient evidence to prove that the allegation of Staff threatened resident of eviction and Staff spoke inappropriately to resident occurred. Thus, the allegations are deemed unsubstantiated at this time. LPA Ascencio and Administrator Punit reviewed policies and procedures regarding the eviction process. Similar allegations regarding the same resident were unsubstantiated on 05/16/2023. Lastly, regarding the allegation of staff do not serve nutritious meals. Interview with six (6) residents on 06/26/2023 revealed that the food is good. The food comes from the skilled nursing facility (SNF) and is delivered to the residential dining room. The staff assist with plating the food and can serve the food at a hot temperature. In addition, resident interviews indicated that they would prefer a different variety of meals instead of a rotating schedule. Lastly, although resident interviews indicated that they enjoy the food, other residents indicated that the food is cold, is of low quality and is not known what food item they are eating. That same day, starting at 11:00 a.m., LPA Ascencio conducted a tour of the facility kitchen. The tour revealed a clean and well-maintained kitchen area with proper utensils and kitchenware. Additionally, LPA Ascencio observed a variety of perishable and non-perishable goods for resident consumption. Continued on LIC 9099 - C Page 4 During the kitchen tour, an interview with Head Chef revealed that they create a monthly dining calendar for the Assisted Living Facility and SNF. The menus involve a balanced meal consisting of protein, carbohydrates, and vegetables. The Head Chef added that if a resident does not like the food item on the calendar, they have a side menu they can choose consisting of sandwiches or salads. That same day, LPA Ascencio received menus for the month of June 2023 revealing all menus had a balance of protein, carbohydrates and vegetables for lunch and dinner. That same day, when conducting resident interviews, LPA Ascencio observed the lunch meals for 6 residents, which consisted of chicken in a red sauce, mashed potatoes, and cooked squash. Although some resident interviews revealed that they were displeased with the food not being of good quality, observation and additional interviews revealed that the food is of good quality and enjoy what is being served daily. Thus, based on evidence gathered, the allegation of facility food is not of good quality is deemed unsubstantiated at this time. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 8, 2023 · control 29-AS-20230608083803

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Illegal eviction

Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to the above facility. LPA Ascencio met with Interim Administrator Aaron Mayes at 10:00 a.m. Entrance interview conducted. On 06/13/2023, the Department received a complaint alleging that an illegal eviction had occurred. On 06/13/2023, LPA Ascencio conducted Staff #1 (S1) interview starting at 2:24 p.m. Interview with S1 revealed that Resident #1 (R1) was admitted to the hospital on 06/08/2023 due to having lower abdominal pain. At the facility, R1 was unfortunately becoming more dependent on the caregivers to do all activities of daily living (ADL).R1 needed to improve or move to a skilled nursing facility (SNF). When R1 was at the hospital, we did receive a call from a social worker indicating that R1 was ready for discharge. We recommended R1 go to a SNF, and when R1 is better, they can return to the facility. Lastly, S1 stated they did not issue an eviction notice as R1 is still paying rent until they are discharge from their system, that has yet to happen. Continued on LIC 9099 - C Unsubstantiated LPA Ascencio reviewed the Four Season Assisted Living facility file and did not observe an eviction notice letter for R1. LPA Ascencio attempted various times to communicate with R1 but did not receive a call back. Additionally, LPA Ascencio conducted email and telephone calls to R1’ s hospital social worker but did not get a response. On 08/02/2023, LPA Ascencio conducted a file review on R1 revealing that R1 was discharged from the facility on 06/08/2023. That same day, interview with Interim Administrator Aaron at 12:20 p.m. revealed that any resident that is admitted to the hospital, that day becomes their discharge date. Because we don’t know when or if a resident comes back, that date they leave becomes their discharged date from Four Seasons. Although R1 was admitted to the hospital due to abdominal pain, R1 did not return to the facility once they were discharged from the hospital. According to S1, R1 was admitted to a SNF and chose not to return to Four Seasons Assisted Living, thus moving out. Because of R1 chose not to return, there was no formal eviction notice issued to R1. Thus, based on evidence gathered, there is insufficient evidence to support the claim that an illegal eviction occurred. This allegation is unsubstantiated at this time. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 2, 2023 · control 29-AS-20230613130839

Allegation investigated: Facility elevator in disrepair. Resident was injured while in care.

Licensing Program Analyst (LPA) Angel Ascencio conducted an initial 10-day complaint visit to the above facility. LPA Ascencio met with staff Ulka Sawghavi at 09:45 a.m. Entrance interview conducted. On 06/21/2023, the Department received a complaint regarding the facility elevator is in disrepair and resident was injured while in care. On 06/26/23, starting at 09:50 a.m., interview with Staff #1 (S1) revealed that the elevator stopped working on 06/24/2023. S1 proceeded to call the elevator company who came out that same day and fixed the elevator. While the elevator was inaccessible, facility staff assisted the residents who lived in the second (2nd) floor up and down the stairs. Continued on LIC 9099 - C Unsubstantiated Additionally, the residents on the 2nd floor had the option of dinning in their rooms if they wanted too. Later that same day, interviews with various residents starting at 11:25 a.m. confirmed that the elevator was not working for a few hours but by the end of the day, the elevator was fixed. That same day, starting at 11:45 a.m., LPA Ascencio conducted a facility tour, which included the elevator. LPA Ascencio observed the elevator working properly at the time of visit. Based on evidence gathered throughout the investigation, the allegation of elevator in disrepair is deemed unsubstantiated at this time. Lastly, regarding the allegation of resident was injured while in care. On 06/26/2023, interview with Resident #1 (R1) starting at 12:12 p.m. revealed that sometime in September of 2021, R1 was walking up the stair and fell. R1 stated the elevator was not working at the time and used the stairs to get to their room. R1 added that they felt pain in their abdomen and groin area. R1 stated they were not seen by a doctor and that Administrator Melissa Christopher observed the incident and assisted R1. That same day, a file review was performed for R1 at 12:40 p.m., revealing an incident report dated 02/21/2022. The narrative of R1’s incident reports indicates that R1 walked to the top of the stairs and R1 fell/slid at the top of the stairs. Former Administrator Christopher indicated in the incident report that they observed the fall, asked if R1 was ok and if R1 hit their head. R1’s response was that they were ok and did not need any medical attention. Administrator Christopher took R1 to their room in a wheelchair. Additionally, Administrator Christopher added that they checked on R1 a few days later and R1 stated they were feeling ‘OK’ and they did not need any medical attention. Further file review revealed a discharge summary from the skilled nursing facility on 09/08/2021 indicating that R1 is not a fall risk and had genital complications, a Narrative Charting note, dated 10/11/2021, revealed that R1 requested and was transported to the hospital due to discomfort in genital area, and R1’s Primary Physician note indicating that on 10/21/2021, R1 was experiencing genital pain and abdominal pain due to the genital pain which also includes abnormalities in gait, and muscle weakness and mobility. Additionally, a hospital discharge summary was observed, dated on 02/17/2022, indicating that the reasons for visit was due to a headache and complications of the genital area. No other documentation regarding pain or discomfort was observed. Continued on LIC 9099 - C Page 2 Although the date on the incident report differs from what R1 stated, documentation revealed that there was an incident regarding R1 having a fall while walking up the stairs. The incident report was written by Former Administrator Christopher, who indicated in the report, that they observed R1 falling, assisted R1 to their feet and offered medical attention via paramedics. In the incident reports, Administrator Christopher indicated on two (2) separate occasion that R1 refused medical attention and did not need medical attention. Moreover, a file review revealed that R1 sought medication attention on various occasion during any discomfort or pain and that facility staff assisted in obtain that medical attention by calling the paramedics or taking R1 to their primary doctors. Thus, based on evidence gathered, there is not enough evidence to support the allegation of resident was injured while in care. Therefore, the allegation is unsubstantiated at this time. Exit interview conducted and a copy of the report was issued to Staff Ulka Sawghavi. Page 3the state’s words, verbatim · CDSS document, Jun 26, 2023 · control 29-AS-20230621083720

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Angel Ascencio arrived at the facility unannounced to conduct a required Annual visit. The LPA met with Staff Ulka Sawghavi and explained the reason for the visit. This is an annual continuation that was first conducted on 05/16/2023. The LPA toured the physical plant areas inside and outside, with Staff Ulka Sanghavi to ensure there are no health and safety hazards. Staff Files: At 10:30 a.m., LPA Ascencio reviewed five (5) staff files. Staff files were observed to be complete with the necessary documents. Resident Files: At 11:20 a.m., LPA Ascencio reviewed five (5) resident files. At 11:22 a.m., Resident #1 (R1) and R2, review of file revealed a missing LIC 602, Physician's Report. R1 was missing their Tuberculosis results in their file. Medication Audit: During medication audit review at 1:45 p.m., R3 had an empty bottle of Folic Acid 1mg and an empty bottle of Docusate Sodium 100 mg. LPA observed a routine medication order for both Folic Acid 1mg and Docusate Sodium 100 mg. Medications was not at facility during audit. Folic Acid 1mg has not been given since 03/11/2023 and Docusate Sodium 100 mg has not been given since 05/25/2023. Additionally, R1 and R4 did not have multiple PRN medication on file, such as Lorazepam 0.5mg, Robafen 5-10-100, , Seroquel 25 mg, Senna 8.6 mg, Loperamide 2mg, Milk of Magnesia, Tylenol 325 mg. Due to the facility not having their “as needed” medication at the facility, if R1 and R4 requested additional PRN medication, the facility would not be able to assist R1 and R4. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties Exit interview conducted and a copy of the report and appeal rights were issued to staff Ulka Sawghavi.the state’s words, verbatim · CDSS document, Jun 19, 2023

Allegation investigated: Facility has bed bugs/roaches

Licensing Program Analyst (LPA) Angel Ascencio conducted an initial complaint visit to the above facility. LPA Ascencio met with Staff Member Ulka Sawghavi at 1:00 p.m. Entrance interview conducted. Administrator Clarizze Punit was not available as Administrator is on leave. On 06/08/2023, the Department received a complaint alleging that the facility has bed bugs/roaches. On 06/13/2023, LPA Ascencio conducted interview with Staff #1 (S1) at 1:00 p.m. Interview with S1 revealed that a fumigation company comes in once a week for routine pest control. The pest control company ask if we have any active bed bug cases or cockroaches, but we haven’t had any in a while. Later that same day, interviews with five (5) residents, starting at 1:20 p.m. revealed that residents have not seen or had bed bugs in their room, but they have seen cockroaches. Interviews stated the cockroaches come and go but every now and then, they are seen in the hallway, on their wall, or in their dresser. Continued on LIC 9099 - C Substantiated Interview with Resident #1 (R1), beginning at 01:37 p.m. revealed that the top drawer in their room is infested with roaches. Additionally, R1 mentioned there was an incident where a cockroach was crawling on R1 while asleep. During R1 interview, LPA Ascencio received permission from R1 to open top drawer of R1’s dresser. LPA Ascencio observed one (1) cockroach in the corner of the drawer. Upon moving a folder paper in the drawer, an additional 4 – 7 cockroaches were observed. That same day, interview with Maintenance Director (MD) at 2:15 p.m. revealed a pest company come in two (2) times a month to fumigate the facility. When we find any pest activity, the pest company comes in and fumigates the room and the following two (2) adjacent rooms to stop the spread. I made the pest company aware of pest activity that LPA found and will have them treat the rooms the next day. Thus, based on observation and interviews, the allegation of the facility has bed bugs/roaches is deemed substantiated at this time. 1 citation was issued during today’s visit. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Exit interview conducted and copy of the report and appeal rights provided to Staff Ulka.the state’s words, verbatim · CDSS document, Jun 13, 2023 · control 29-AS-20230608083803

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 23, 2023

87303 Maintenance and Operations (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement is not met as evidenced by: Based on interviews and observation, the licensee did not comply with the section above as various resident stated observing cockroaches additionally the LPA observed cockroaches in a R1's room which poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 13, 2023

Plan of correction: Administrator will have outside company fumigate the entire building and target specific rooms were interviews were conducted. Administrator will submit invoice of fumigation to CCL by 06/23/2023.

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.

Allegation investigated: Staff threatened resident of eviction Staff spoke inappropriately to resident

Licensing Program Analyst (LPA) Angel Ascencio conducted an initail 10-day complaint investigation to the above facility. LPA met with Administrator Clarizze Punit at 10:12 a.m. Entrance interview conducted. On 05/12/2023, the Department received a complaint regarding staff threatened resident of eviction and staff spoke inappropriately to resident. On 05/16/2023, LPA Ascencio conducted an interview with Administrator Punit at 10:15 a.m. Interview with Administrator Punit revealed that Resident #1 (R1) has been living at the facility for over a year and is on the Assisted Living Waiver Program (ALW). Monthly, the ALW program pays a majority of R1's boarding and care fees, while R1 is responsible for what ALW does not cover. Administrator Punit stated R1 has not been paying their portion since moving in last year, raking up a fee of over $15,000. Administrator Punit also mentioned that they have spoke to R1 various time regarding the billing statement and possible eviction for non-payment, but was not mentioned in a threatening way. Continued on LIC 9099 - C Unsubstantiated We did have Staff #1 (S1) last week on 05/12/2023, to speak to R1. Although, I am not sure what was said, we could not hear any yelling or cursing coming from the room. I know that S1 was going to talk to R1 regarding their outstanding balance, and that the eviction topic would not come up. Lastly, R1 has been refusing to pay their portion stating the facility should be charging Medicare and Medi-Cal for their stay at the facility. Later that same day, interview with R1 at 10:40 a.m., revealed that the facility has spoken to R1 various occasion regarding the billing. R1 added a staff person arrived at their room on 05/12/2023 talking about how they want to help me but then started to talk about getting "their money." Afterwards, that staff person began to yell at me and cursed at me, calling me a derogatory, racial slur. Lastly, R1 added that the staff person spoke to them about eviction because I havent paid, but R1 reiterated they will not be moving from the facility. That same day, interview with S1, starting at 11:20 a.m. revealed that they spoke to R1 on 05/12/2023 regarding ways the facility can assist R1 in obtained additional resources such as Social Security Income (SSI) funds. S1 stated the conversation was going great, until the topic of money and the outstanding balance came up. S1 added that R1 began to yell and curse at S1. S1 added they left the room not wanting to cause any emotional disturbance to R1. Lastly, S1 stated they were professional and understanding toward R1, and did not threatened R1 with any eviction. Later that day, interview with residents starting at 01:33 p.m. revealed that staff are nice, professional and have not cussed at any resident at the facility. Although the R1 has an outstanding balance of $15,000 for not paying their portion of rent, interview with Administrator Punit revealed that the facility is looking at additional resources to help R1 obtain additional funds to create a payment plan for their balance. Administrator Punit stated they will not be evicting R1 at this moment as the facility wants to provide every resource available to R1 before doing so. Even though R1 stated they were called a racial slur by S1, and S1 stated they were professional and polite when speaking with R1, it is unsure what was actually said during the conversation between R1 and S1. Thus, there is insufficient evidence to prove that the allegation of Staff threatened resident of eviction and Staff spoke inappropriately to resident occurred. Thus, the allegations are deemed unsubstantiated at this time. LPA Ascencio and Administrator Punit reviewed policies and procedures regarding the eviction process. Exit interview conducted and copy of the report was issued to Administrator Punit.the state’s words, verbatim · CDSS document, May 16, 2023 · control 29-AS-20230512112322

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angel Ascencio arrived at the facility unannounced to conduct a required Annual visit. The LPA met with Administrator Clarizze Punit and explained the reason for the visit. The LPA toured the physical plant areas inside and outside, with Administrator Assistant Ulka Sanghavi to ensure there are no health and safety hazards. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedrooms were observed to be single and double occupancy. RESTROOMS: Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. The LPA observed the appropriate poster in common restrooms. Restroom hot water were measured in resident restroom and common restroom between 105.0 and 120.0 degrees Fahrenheit between 10:40 a.m. and 02:18 p.m. KITCHEN: At 12:50 p.m. the LPA observed the kitchen/dining area. Knives are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. The facility has a pre-set menu however offers the option for residents to choose from a variety of different options if menu choices are not to their taste. COMMON and OUTDOOR AREAS: At 1:00 p.m. the LPA observed the outdoor area. A small patio area is adjacent to the building and is accessible to residents. A shaded area with furniture is accessible to visitors and residents to visit. The common areas included a front lobby area, downstairs entertainment area and upstairs activity room. Continued on LIC 809 - C All areas were accessible for resident use with appropriate furnishings. The LPA observed cameras in all common spaces.All areas were clean, sanitary and in good repair. Smoke detectors are hardwired and interconnected. Fire alarm system and extinguishers were last serviced by the fire alarm company on 05/01/2023. The LPA observed required postings on the hallway walls and reminded the administrator to ensure that the Department Provider Notices are displayed appropriately. Flooring was checked for cleanliness and appeared in good condition. Infection Control: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility had a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time. The facility’s policies and procedures as it pertains to infection control are adequate. Exit interview conducted and copy of the report were issued.the state’s words, verbatim · CDSS document, May 16, 2023

Allegation investigated: Facility elevator is in disrepair Resident's medical device is inaccessible

Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for an initial complaint visit for the above allegations. The LPA met with Administrator Clarizze Punit and explained the reason for the visit. During today's visit, the LPA conducted a brief facility tour at 10:40 a.m., interviewed administrator at 11:00 a.m., interviewed residents at 11:10 a.m., 2:35 p.m. and 2:37 p.m. interviewed staff at 12:20 p.m. and 2:05 p.m. and reviewed documents at 2:30 p.m. Unsubstantiated Regarding the allegation: Facility elevator is in disrepair It was alleged that the facility elevator had not worked since September 2021. The LPA conducted a physical plant tour on 7/27/22 at 10:40 a.m. and observed one elevator in the facility that gives access to the 2nd floor. The facility also has a staircase with access to the 2nd floor. The LPA observed and used the elevator and confirmed that the elevator was functioning appropriately at the time of the visit. As previously addressed in Complaint # 29-AS-20211223133434, information obtained from interviews at the time revealed that the facility had previously been actively working on repairing the elevator that had not been operable since 11/19/2021. The administrator reveled at time that the elevator had challenges in the past and the facility began the process of acquiring an elevator company to modernize the elevator and signed an agreement on 10/20/2021. Although the elevator modernization project was due to begin in January 2022 the facility received an email from the elevator company on 12/17/21 indicating that materials wouldn’t be available for 5 to 6 weeks. The elevator modernization was completed, and the elevator was fully functional effective 7/18/2022. Interviews conducted today revealed that communication regarding the working elevator was not received by all residents on the day it was working again but that as of 7/26/22 those who had not known were advised. Based on the information obtained, whereas the elevator had not been working, the facility elevator was restored to fully working order as of 7/18/2022 and all residents have been notified. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: Resident’s medical device is inaccessible It was alleged that a power chair had been delivered to the facility however it was left on the 1st floor. The LPA conducted interviews with Staff #1 (S1) and resident #1 (R1) which confirmed that a power chair had been delivered weighing about 200 lbs in April 2022. The facility was undergoing an elevator modernization at the time which resulted in the chair having to be left downstairs as it was too heavy to lift. S1 communicated to the resident that the chair would be temporarily stored in a room on the 1st floor, to which R1 agreed as it was confirmed that R1 was able to use the power chair at their request when needed. It was additionally communicated that R1 personally ordered this power chair for their own personal use. A review of documentation further revealed that R1 was able to ambulate with a walker or a wheelchair and could utilize the power chair on the 1st floor if needed. Absent of this power chair resident could still ambulate with a walker or a wheelchair. It is noted that the facility is cleared for ambulatory only on the 2nd floor and based on the fact that resident ambulates with a walker R1 was relocated to the 1st floor, mid May 2022. Based on interviews which were conducted, there is insufficient evidence to support the allegation that the resident’s medical device is inaccessible. Although the allegation may have happened or is valid, there is insufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Jul 27, 2022 · control 29-AS-20220720134605

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required Annual visit. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Melissa Christopher and explained the reason for the visit. The LPA toured the physical plant areas inside and outside, with Administrator Assistant Ulka Sanghavi to ensure there are no health and safety hazards. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings, and sufficient lighting. Bedrooms were observed to be single and double occupancy. RESTROOMS: Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. The LPA reminded the Administrator to ensure that bathrooms displayed appropriate hand-washing signs. Restroom hot water measured between 114.0 and 119.8 degrees Fahrenheit between 10:29 a.m. and 10:46 a.m. KITCHEN: At 10:09 a.m. the LPA observed the kitchen/dining area. Knives are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has enough supply of perishable and non-perishable food. Freezer and refrigerator are stocked with a variety of foods. The LPA was able to speak with chef to discuss menu choices. The facility has a pre-set menu however offers the option for residents to choose from a variety of different options if menu choices are not to their taste. COMMON and OUTDOOR AREAS: At 10:05 a.m. the LPA observed the outdoor area. A small patio area is adjacent to the building and is accessible to residents. A shaded area with furniture is accessible to visitors and residents to visit. The common areas included a front lobby area, downstairs entertainment area and upstairs activity room. All areas were accessible for resident use with appropriate furnishings. The LPA observed cameras in all common spaces. All areas were clean, sanitary and in good repair. Smoke detectors are hardwired and interconnected. Fire alarm system and extinguishers were last serviced by the fire alarm company on 4/14/22. The LPA observed required postings on the hallway walls and reminded the administrator to ensure that the Department Provider Notices are displayed appropriately. Flooring was checked for cleanliness and appeared in good condition. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator Melissa Christopher regarding the facility’s infection control practices. The Administrator was advised that they need to ensure that visitors upon entry are signing in at a central entry point for symptom screening, temperature checks, and sanitation. The LPA also advised the Administrator to ensure staff continue wearing face masks at all times. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time and the LPA reviewed facility’s policies and procedures as it pertains to infection control. The Administrator advised the LPA that the elevator is still under repair and is currently waiting on a confirmed date of completion. The facility is expecting elevator inspections in upcoming weeks and will update licensing on the progress of the elevator repair. At this time the Administrator indicated that all the residents residing on the 2nd floor are able to access the 1st floor either unassisted or by escort. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided via Email.the state’s words, verbatim · CDSS document, May 16, 2022

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff are not providing a safe enviornment for residents Staff yelled at resident Staff are not treating resident's with respect

Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit to deliver the findings for the above allegations. The LPA met with Med Tech Socorro Rosas and explained the reason for the visit. The LPA contacted the Administrator via telephone and also explained the reason for the visit. The Administrator authorized Med Tech Socorro Rosas to sign for the report. During the initial visit on 1/19/22 the LPA interviewed the administrator at 3:45 p.m. and reviewed documents. The LPA conducted a subsequent visit on 4/1/22 and interviewed staff at 9:35 a.m., 1:00 p.m., 1:45 p.m., 1:57 p.m., and 2:20 p.m. The LPA reviewed documents at 9:40 a.m., conducted a brief plant tour at 10:40 a.m. and interviewed residents at 11:15 a.m. and 11:50 a.m. During the subsequent visit on 4/11/22 the LPA interviewed staff at 10:25 a.m., 10:48 a.m., 11:15 a.m.,11:38 a.m., 3:00 p.m., 3:33 p.m. and 3:48 p.m. The LPA interviewed residents at 1:05 p.m., 1:10 p.m., 1:25p.m., 1:30 p.m., 2:00 p.m., 2:15 p.m., 2:42 p.m. and 2:50 p.m. Substantiated Regarding the allegation: Staff are not providing a safe environment for residents It was alleged that staff have had inappropriate interactions with residents, which has created an unsafe environment. For example, it was alleged that a staff threw a tray at a resident. To investigate, the LPA conducted interviews with residents and staff. Staff and residents confirmed that they have observed, overheard, or experienced elevated behavior from Staff #1 (S1). For example, interviews with staff and residents revealed that Staff #1 (S1) threw an insulin pen at a resident. It was mentioned that S1 was upset and responded in that manner because S1 was no longer allowed to help the resident administer the insulin injection. Staff #2 (S2) admitted to becoming frustrated with residents when they have had trouble being understood by the residents. This has prompted S2 to stop interacting with those residents to eliminate disagreements or further conflict. Interviews further revealed that S1 will display unwillingness to assist residents with requests when they are bothered. Staff interview revealed that Staff #3 (S3) has inappropriately handled residents when waking them, by taking off their blankets and forcing them up when they are not ready. Based on the investigation, there is sufficient evidence to support the claim that staff are not providing a safe environment for residents. This allegation is deemed Substantiated at this time. Regarding the allegations: Staff yelled at resident AND Staff are not treating residents with respect It was alleged that staff yelled at residents. In addition, it was alleged that staff are demeaning and have no respect for the residents. To investigate, the LPA conducted interviews with residents and staff. In particular, it was mentioned that S1 and S2 have yelled at residents. Interviews revealed that due to staff having difficulty in communicating with residents, staff are not always able to transmit information or directions in a compassionate manner. Interviews confirmed that S1 and S2 have trouble communicating with English only speakers as their English may be fragmented and incomplete, because the staff’s knowledge of the vocabulary isn't as robust as an English speaker. This has presented a conflict between staff and residents as the resident’s perception of information received is taken as rude and disrespectful. Interviews further revealed that both staff and residents have observed, overheard, or experienced this behavior from staff, interviews from Residents confirmed that they have been yelled at by staff. Additionally, resident interviews confirmed that they will avoid requesting anything from S2 because they believe S2 is rude, and residents do not like how they are treated or talked to by S2. Both S1 and S2 have displayed inappropriate behavior, as they often offend residents and staff with her aggressive personality. Based on the investigation, there is sufficient evidence to support the above mentioned claims. The allegations “Staff yelled at resident” and “Staff are not treating residents with respect” are Substantiated at this time. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Exit interview conducted. A copy of the report, and appeal rights, were issued.the state’s words, verbatim · CDSS document, Apr 15, 2022 · control 29-AS-20220114163908

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Apr 22, 2022

87468.2 (a)(4)... Personal Rights of Residents in All Facilities,... shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as it was communicated that staff lack the sufficient skills to communicate in English, which poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2022

Plan of correction: The Administrator has agreed to do the following: 1. Administrator is going to talk to all staff to assess personal rights protocols and develop a plan to ensure that residents and staff are able to communicate effectively and efficiently. Communicate plan to CCLD by 4/22/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Apr 22, 2022

87468.1(a)(1) Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as it was communicated that residents were being yelled at in the facility by staff, which poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2022

Plan of correction: The Administrator has agreed to do the following: 1. Administrator is going to talk to all staff to assess personal rights protocols and develop a plan to ensure that residents and staff are able to communicate effectively and efficiently. Communicate plan to CCLD by 4/22/2022.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Elsie Campos conducted an unannounced Case Management-Deficiencies inspection visit at the facility today due to deficiencies observed during the investigation of complaint control # 29-AS-20220114163908. During the investigation, the LPA conducted interviews and determined that staff have administered insulin injections to resident. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, today's reports and appeal rights were reviewed and issued.the state’s words, verbatim · CDSS document, Apr 15, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87629(a) · Plan of correction due date: Apr 29, 2022

87629(a) Injections. The licensee shall be permitted to accept or retain a resident who requires intramuscular, subcutaneous, or intradermal injections if the injections are administered by the resident or by an appropriately skilled professional. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as staff have administered insulin injections to residents, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2022

Plan of correction: The Administrator has agreed to do the following: 1. Review Regulation 87629 and submit a Statement of Understanding no later than 4/18/2022 2. Administrator is going to conduct an in-service with staff regarding the administration of medications. Submit confirmation that all staff have been retrained to CCL no later than 4/29/2022.

Allegation investigated: Lack of supervision results in verbal abuse and bullying amongst residents.

Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit to deliver the findings for the above allegation. The LPA met with Social Worker/Administrator Assistant Ulka Sanghavi and explained the reason for the visit. During the initial visit conducted on 12/28/2021, LPA’s Salia Walker and Elsie Campos conducted a brief facility tour at 10:22 a.m., interviewed administrator at 10:36 a.m., interviewed staff at 11:05 a.m., interviewed resident at 11:25 a.m. and reviewed documents at 12:20 p.m. During a visit conducted on 3/30/2022, LPA Elsie Campos conducted an interview with the administrator at 12:20 p.m., collected documents at 12:50 p.m. and reviewed documents at 2:15 p.m. During a visit conducted on 4/1/2022, LPA Campos interviewed staff at 9:35 a.m., 1:00 p.m., 1:45 p.m., 1:57 p.m., and 2:20 p.m., reviewed documents at 9:40 a.m., conducted a brief plant tour at 10:40 a.m. and interviewed residents at 11:15 a.m. and 11:50 a.m. Continued on LIC 9099-C Unsubstantiated Regarding the allegation: Lack of supervision results in verbal abuse and bullying amongst residents. It was alleged that Resident #1 was bullying and verbally abusing other residents at this facility due to lack of supervision. To investigate, the LPA conducted interviews with residents and staff. Interviews revealed that staff interact appropriately with residents at this facility and take effective action when there is knowledge of any conflicts between residents. Interviews negated claims that staff was not supervising residents and failed to act when residents required intervention. Interviews revealed that staff will attempt to resolve any disagreements between residents when there is knowledge of such behavior before taking any action, such as moving a resident out of a shared living space and into another space. The administrator did reveal that in the occasion where residents were not able to come to an agreement regarding their differences and living in the same room was no longer an option, they would take effective action to ensure that the residents are separated and their needs are met. Interviews revealed that staff intervened when they gained knowledge that R1 was interacting inappropriately with residents. Attempts by staff and the Administrator were made to diffuse escalating conflicts between R1 and other residents. Interviews with residents indicated that while they have witnessed some residents acting disorderly, that behavior is not common among residents. Interviews further revealed that R1 was assisted in bringing resolution to the ongoing conflicts between R1 and the other residents. Based on the information obtained, there is insufficient evidence to support the claim that Lack of supervision results in verbal abuse and bullying amongst residents. This allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 6, 2022 · control 29-AS-20211223133434

Allegation investigated: Facility staff are financially abusing resident

Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit to deliver the findings for the above allegation. The LPA met with Social Worker/Administrator Assistant Ulka Sanghavi and explained the reason for the visit. During the initial visit conducted on 1/19/2022, LPA Elsie Campos conducted an interview with the administrator at 3:45 p.m. The LPA reviewed and obtained copies of documents pertinent to the investigation. During a visit conducted on 4/1/2022, LPA Campos interviewed staff at 9:35 a.m., 1:00 p.m., 1:45 p.m., 1:57 p.m., and 2:20 p.m., reviewed documents at 9:40 a.m., conducted a brief plant tour at 10:40 a.m. and interviewed residents at 11:15 a.m. and 11:50 a.m. Continued on LIC 9099-C Unsubstantiated Regarding the allegation: Facility staff are financially abusing the resident The complainant was concerned that the facility had taken thousands of dollars from Resident #1 (R1), and invoices were red flags. During the investigation, a record review revealed, that the facility has provided the resident with monthly invoices showing the correct amounts due for rent. The record review further revealed that the resident is past due however, all payments and invoices reflect the adequate amounts due since the resident’s admission into the facility. Interviews revealed that the resident was previously at a skilled nursing facility where they were undergoing financial hardship. Interviews with staff and the administrator indicated that all residents are provided alternatives to payment when residents are unable to meet their financial obligation. Staff and administrator negated any complaints or active matters regarding financial abuse. Based on the information obtained, there is insufficient evidence to support the claim, that facility staff are financially abusing the resident. This allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Apr 6, 2022 · control 29-AS-20220113145359

Allegation investigated: Facility failed to have a working elevator. Facility did not provide written notice to the resident for rate increase.

Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit for the above allegations. The LPA met with Administrator Melissa Christopher and explained the reason for the visit. During the initial visit conducted on 12/28/2021, LPA’s Salia Walker and Elsie Campos conducted a brief facility tour at 10:22 a.m., interviewed administrator at 10:36 a.m., interviewed staff at 11:05 a.m., interviewed resident at 11:25 a.m. and reviewed documents at 12:20 p.m. Today, the LPA interviewed the administrator at 12:20 p.m., collected documents at 12:50 p.m. and reviewed documents at 2:15 p.m. Continued on LIC 9099-C Unsubstantiated Regarding the allegation: Facility did not provide written notice to the resident for rate increase The complainant was concerned that staff raised their rent without written notification. During the investigation, a record review revealed, that the facility provided a notice on 12/8/21 informing residents that the Department of Social Services had increased Social Security Income (SSI) and State Supplementary Payment (SSP) payment standards. In addition, the facility provided residents whom needed further explanation a copy of the Provider Information Notice (PIN) 21-23-CCLD, which describes the estimated SSI rate increase (Described as PIN 21-23-CCLD ESTIMATED SSI/SSP PAYMENT STANDARDS EFFECTIVE JANUARY 1, 2022). Per regulation, licensees are required to provide residents with at least a sixty (60) day notice regarding any rate increase or rate structure change. However, facilities are not required to provide a sixty (60) day notice when it pertains to SSI rate changes. Thus, the Provider Information Notice (PIN) was issued on 11/19/2021, informing licensees that the rate change would be in effect 1/1/2022. That change would be in effect under sixty (60) days. The facility is required to notify residents as soon as the licensee is notified of SSI/SSP rate changes. Record review revealed that on 12/8/2021 residents received the notice of the rate increase. Based on the information obtained, there is insufficient evidence to support the claim, that the facility did not provide written notice to the resident for rate increase. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: Facility failed to have a working elevator It was alleged that the facility elevator had not been working for two months. LPA's conducted a physical plant tour on 12/28/21 at 10:22 a.m. and observed one elevator out of order in the facility. The plant tour further revealed that this was the only elevator in the facility and access to the 2nd floor is only via the staircase. Information obtained from interviews revealed that the facility had previous knowledge of the elevators need for repairs. Per interviews, the administrator reveled that the elevator had challenges in the past and the facility began the process of acquiring an elevator company to modernize the elevator and signed an agreement on 10/20/2021. At the time the agreement was signed the elevator was still functioning however, on 11/19/2021 the facility discovered that the elevator was inoperable. Although the elevator modernization project was due to begin in January 2022 the facility received an email from the elevator company on 12/17/21 indicating that materials wouldn’t be available for 5 to 6 weeks. The administrator received a notification that the project would commence April 4, 2022. Based on the information obtained, whereas the elevator is currently not working the facility was aware of it and was actively working to remedy it. The administrator confirmed that the residents on the 2nd floor are able to use the stairs and any residents needing assistance can be escorted by staff. This allegation is deemed Unsubstantiated at this time. Continued on LIC 9099-Cthe state’s words, verbatim · CDSS document, Mar 30, 2022 · control 29-AS-20211223133434

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.

Allegation investigated: Facility is discriminating against resident #1 (R1) by being rude to R1. Facility administrator is violating resident #1's rights by not allowing R1 to obtain a copy of their medication log to share with R1's physician during their medical appointment. The administrator is not qualified.

Licensing Program Analyst (LPA) Salia Walker arrived unannounced for a subsequent complaint visit to deliver the investigation findings for the above allegations. The LPA met with administrator Melissa Christopher at 09:10 a.m. and explained the reason for the visit. During today’s visit, the LPA conducted a physical plant tour with the administrator from 9:40 a.m. until 9:45 a.m. to ensure there are no health and safety hazards. From 9:13 a.m. until 9:39 a.m., the LPA conducted an interview with the administrator. From 9:46 a.m. until 9:51 a.m.; and between 11:25 a.m. until 11:38 a.m., the LPA conducted interviews with staff. From 9:58 a.m. until 11:09 a.m., the LPA conducted interviews with residents. From 11:15 a.m. until 11:24 a.m., the LPA reviewed and obtained copies of documents pertinent to the investigation. Continue on LIC9099C.. Unsubstantiated On 09/07/21, LPAs Sandra Urena and Salia Walker conducted an initial complaint visit at 4:45 p.m. Between 5:00 p.m. and 5:35 p.m., the LPAs conducted interviews with residents. The LPAs determined, at that time, that further investigation was required. Regarding the allegation, ‘Facility is discriminating against resident #1 (R1) by being rude to R1’, the complainant’s concern is that they believe that the administrator is racist. The complainant stated that R1 feels harassed and targeted because of R1’s race. During the investigation, LPA Walker conducted interviews with the complainant, R1, the facility residents, and staff, to determine whether or not they have observed the administrator being rude to any facility resident, regardless of their race. Interviews with residents revealed that the residents have ‘never witnessed or observed the administrator being rude to anyone’, ‘race is not an issue’, the administrator ‘takes care of business’, ‘everyone here is treated equally, like family.’ Staff were interviewed as to whether or not they have observed the administrator being rude to any facility resident, regardless of their race. Interviews with staff revealed that ‘doesn’t matter what race,’ they have ‘never seen the administrator be rude to residents,’ the administrator ‘always listens to everyone and meets their needs,’ and ‘the residents are happy here.’ The LPA also interviewed the administrator who revealed that the facility has a ‘Zero Tolerance Policy’ regarding discrimination, ‘and if there is any discrimination between staff towards residents, staff will be reprimanded.’ The administrator did acknowledge that ‘there are times the office door is closed due to being in conference meetings at least once a week.’ The administrator also stated that she still ‘socializes with all the residents.’ The administrator stated the facility has ‘coffee with the administrator’ where the administrator sits with the residents to get to know each other and address any concerns the residents have.’ The LPA interviewed R1 to find out if R1 believes that the administrator is rude to R1 and what that entailed. R1 stated the administrator ‘has not said or done anything to R1 directly, but was informed by another resident the administrator picked on that resident.’ R1 did not give further information as to whether or not the administrator was observed by R1 being rude to any facility residents, regardless of their race. R1 only provided the information given to R1 by the other facility resident. Based on interviews with the complainant, R1, facility residents, staff, and the administrator, there is insufficient evidence to support the allegation ‘Facility is discriminating against resident #1 (R1) by being rude to R1.’ Therefore, this allegation is deemed Unsubstantiated at this time. Continue on LIC9099C.. Regarding the allegation, ‘Facility administrator is violating resident #1's (R1’s) rights by not allowing R1 to obtain a copy of their medication log to share with R1's physician during their medical appointment’, the complainant’s concern is that R1 asked staff to provide R1 with their medication log sheet to share it with R1’s doctor. According to R1, the staff requested R1’s medication log sheet from the administrator to give to R1, and the administrator refused to provide it. During the investigation, LPA Walker conducted interviews with R1, and the administrator. The LPA also conducted a record review and obtained copies of documents pertinent to the investigation. The interview with R1 revealed that the administrator asked for R1’s doctor to request R1’s medication log in order for the administrator to release it, versus it just coming from R1. During the interview with the administrator, it was revealed that R1 was requesting a copy of R1’s medication log containing internal facility information; and, that the administrator provided such copy requested by R1 with the internal facility information concealed. The administrator provided the example to the LPA of how she concealed the internal facility information. According to the administrator, ‘R1 wanted the controlled narcotics sheet reflecting staff signatures.’ The administrator provided a copy of the received letter and email from R1 specifying that R1 wanted the dates that the facility staff provided medication assistance. Based on interviews with resident and the administrator, there is insufficient evidence to support that the allegation ‘Facility administrator is violating resident #1's rights by not allowing R1 to obtain a copy of their medication log to share with R1's physician during their medical appointment. Therefore, the finding is deemed Unsubstantiated. Regarding the allegation, ‘The administrator is not qualified’, the complainant’s concern is whether the administrator ‘is the right person for this spot.’ During the investigation on 09/07/21, LPAs Urena and Walker conducted an interview with the complainant. The interview with the complainant revealed that according to the complainant, they ‘never said [the administrator] was not qualified.’ The complainant stated, they ‘don’t know if she is qualified,’ and they don’t feel ‘she is the right person for this type of facility.’ The complainant believes the administrator ‘is not a people person’ because ‘she keeps her door closed,’ and the complainant believes the administrator ‘should come out of her office and get to know the residents.’ Continue on LIC 9099C.. To conduct the investigation, the LPAs reviewed the administrator’s ‘Certificate of Completion’ which reflected eighty (80) Hours of Residential Care Facility for the Elderly Initial Certificate Training Program completion. The LPAs also reviewed documentation regarding any other training that the administrator has received. The administrator provided a copy of the email by The Administrator Certification Section (ACS) congratulating on passing the Administrator Certification Exam as of 09/27/21. The LPA’s also interviewed facility staff and residents who viewed the administrator to be competent to do the job. Based on record review, interviews with the complainant and the administrator, there is insufficient evidence to support that the allegation ‘The administrator is not qualified.' Therefore, the finding is Unsubstantiated. Exit Interview conducted, a copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 28, 2021 · control 29-AS-20210902165549

Type of visit: Case Management - Other

Licensing Program Analyst conducted an unannounced case management visit to conduct additional interviews related to complaint # 29-AS-20200810165320. Between 9am - 11am, LPA also reviewed and obtained copies of pertinent documents relevant to the investigation. LPA did not observe and immediate or potential health and safety concerns at this time. Exit interview conducted. Report issued and sent via email.the state’s words, verbatim · CDSS document, Sep 28, 2021

Allegation investigated: Resident does not feel safe at the facility Staff failed to provide a safe and comfortable environment for residents in care

This is an amended report. Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint investigation visit regarding the above noted allegations. During the initial visit on August 30, 2021 at 10:00 a.m., LPA Urena conducted a brief facility tour, and interviewed some residents in care. On this subsequent visit, Licensing Program Analyst (LPA) Sandra Urena, arrived at the facility at 1:30 p.m., and at 1:45pm, the LPA met with Administrator Melissa Christopher. LPA Urena explained the reason for the visit. LPA Urena conducted interviews between 11:00 a.m. and 3:00 p.m. with a random selection of residents and staff. In addition, the LPA requested minutes for the Residents Council Meetings, which were later reviewed.Regarding the allegation, ‘Resident does not feel safe at the facility’, it is alleged that the facility recently accepted two (2) male residents who have been heard making violent threats against other residents. One (1) of the two (2) new male residents allegedly made threats against facility staff as well and was allegedly removed from the facility. To investigate this concern, LPA Urena conducted interviews with residents who stated that they do not feel safe at the facility due to two (2) residents making threats against other residents; and, that these two (2) residents continue to reside at the facility. Unsubstantiated LPA Urena also interviewed a random selection of residents regarding whether or not they felt safe in the facility. The residents’ interviews revealed that they have not heard other residents making threats, nor have they witnessed residents being aggressive towards other residents. Additionally, randomly interviewed residents stated that they feel safe at the facility, in their rooms, and in the common areas of the facility; and, if they felt unsafe at the facility, they would bring it up to the administration. The staff’s interviews revealed that they have not witnessed any acts of threats or aggression between resident to resident or between residents to staff. Based on the investigation, there is insufficient evidence to support the claim that the facility is unsafe, which would lead residents to not feel safe at the facility. Therefore, the allegation is deemed Unsubstantiated at this time. Regarding the allegation, ‘Staff failed to provide a safe and comfortable environment for residents in care’, it is alleged that on an unknown date, the facility held a resident council meeting with the residents. In this meeting, the complainant alleges that the alleged violent resident said in front of everyone that “if anyone goes to their room, they would kill or shoot them”. To investigate this allegation, LPA Urena conducted interviews with staff and a random selection of residents about the resident in question making threats during the Resident Council meeting. The residents interviewed revealed that they have not heard other residents making threats, nor have they witnessed anyone being aggressive at the Resident Council meeting. The residents stated that the Resident Council meetings are held in the dining room area with an open-door policy; and, the meetings dates are posted in the monthly calendar. The staff interviewed about the Resident Council meeting revealed that they have not heard residents making threats during the meetings. The staff stated that some residents tend to talk louder than other residents, but staff has not witnessed or heard threats from resident to resident. Staff reported that staff is present at the Resident Council meetings for support; and, to hear residents’ opinions and recommendations as a group. LPA Urena received a copy of the Resident Council Meeting Minutes for the month of August 2021. Upon review of these minutes, it was observed that the minutes did not reflect any notes addressing the allegation that the resident in question made threats to other residents during the Resident Council meeting. Resident council minutes are taken and recorded by council meeting officers attending the meeting. The council meeting officers are elected residents residing in the facility. The facility staff was not able to provide a sign-in sheet for the Residents Council minutes provided. Based on the investigation, there is insufficient evidence to support the allegation that staff failed to provide a safe and comfortable environment for residents in care. The allegation is deemed Unsubstantiated at this time. No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was issued via email.the state’s words, verbatim · CDSS document, Sep 21, 2021 · control 29-AS-20210825134726

Type of visit: Case Management - Deficiencies

At 8:30am, Licensing Program Analysts (LPAs) Sandra Urena and Salia Walker conducted an unannounced Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint control # 29-AS-20210902165549). Upon arrival, LPAs were greeted at the door by Activities Director Ulka Sanghaui. The LPAs met with Administrator Melissa Christopher at approximately 09:00 a.m. and explained the reason for the visit. During today’s visit, the LPAs reviewed files for twenty (20) out of thirty (30) residents between 08:30 a.m. and 04:00 p.m. Resident files were reviewed for admission agreements, medical assessments, appraisals, consent forms and medication records. Upon review of residents' files, it was observed that twenty (20) out of twenty (20) residents did not have an LIC 603A Re-appraisal nor an updated LIC 625. Therefore, based on records reviewed the following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. Signatures obtained. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 7, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Sep 7, 2021

(a)The pre-admission appraisal shall be updated.. as frequently as necessary.. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition.. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above, as twenty (20) out of twenty (20) residents’ files did not have a reappraisal, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 7, 2021

Plan of correction: The Licensee has agreed to do the following: 1. Submit proof of all residents’ documents LIC 603A/LIC 625 by 09/17/2021.

Allegation investigated: Resident does not feel safe at the facility Staff failed to provide a safe and comfortable environment for residents in care

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day complaint investigation visit regarding the above noted allegations. At 10:00am, the LPA arrived at the facility. At 10:15am, the LPA met with Activities Director, Ulka Sanghaui. Administrator Melissa Christopher was out on this day. Starting at 11:00am, the LPA interviewed residents. The following narrative addreses the allegations above. Regarding the above allegation: Resident does not feel safe at the facility Residents stated that they feel safe at the facility. If at anytime they dont feel safe they would address it and speak their mind. Residents feel safe at the facility, in their rooms and common areas. Unsubstantiated Regarding the allegation: Staff failed to provide a safe and comfortable environment for residents in care Residents stated that they feel safe and comfortable at the facility. Residents stated that they have a new Activities Director and the Activities Director has new and fun activities for them. The residents stated that the food has improved, and overall the facility is safe. The front door is locked at all times, and visitors have to ring bell to be admitted into facility. Residents have not heard anyone making threats, nor have witness anyone being aggressive at Residents' Council meeting. Records Review: The Activities Director left at 3:00pm. The LPA was not able to obtain the Residents’ Council Minutes for July, and August 2021 at time of visit for review. Needs further investigation. An Exit Interview was conducted via telephone with Administrator Melissa Christopher. The report was emailed to the administrator, and the administrator agreed to sign and email the report back within 24 hours.the state’s words, verbatim · CDSS document, Aug 30, 2021 · control 29-AS-20210825134726

Allegation investigated: Facility staff failed to assist Resident #1 with the self-administration of medication Staff #2 inappropriately interacts with residents Facility did not consider food habits of residents in meal planning Facility did not provide proper care to residents Facility did not provide a safe and sanitary enviroment due to a lice outbreak

Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint investigation for the above allegation. LPA met with Administrator Melissa Christopher. During the course of the investigation, LPA conducted a physical plant tour virtually on 08/18/2020 as well as interviewed Administrator. On 5/11/21 LPA conducted interviews with facility staff, residents and other relevant parties. LPA also gathered and reviewed facility documentation pertinent to the allegation. It was alleged that , Facility staff failed to assist Resident #1 with the self-administration of medication, LPA interview with Resident 1 (R1) revealed that they are satisfied with the assistance they receive from staff with medication. R1 did not express any immediate concerns for assistance with medication, and anytime R1 has had any concerns with their medication staff assist R1 with calling their doctor. LPA interview with Staff 1 (S1) revealed anytime R1 refuses to take medication , the Administrator informs R1s doctor. Continued on 9099-C Unsubstantiated (Continued from 9099-C) It was alleged that Facility did not provide proper care to residents. LPA interview with (10) residents revealed that most residents believed they were receiving proper care from staff and most did not express any immediate concerns about the staff or the services they were receiving. LPA also received additional information that a resident in unit #211 was not receiving proper care, but physical plant tour revealed there is no unit #211 on the 2nd floor. Units on the 2nd floor begin at 215A. LPA interview with staff revealed #211 does not exist and the unit numbers that come close to that figure; unit 111 is not currently occupied and the resident in unit 221 does not match the description that LPA received. LPA records review of the facility files of the (4) residents who closest match the description on the 2nd floor revealed to be updated and sufficient at this time. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility did not provide proper care to residents. Therefore the above allegation is UNSUBSTANTIATED at this time. It was alleged that Facility did not provide a safe and sanitary environment due to a lice outbreak, LPA interview with staff and (10) residents revealed that all are not aware of a lice outbreak ever occurring at this facility. LPA records review of pest control invoices revealed the facility has never been treated for a lice. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility did not provide a safe and sanitary environment due to a lice outbreak. Therefore the above allegation is UNSUBSTANTIATED at this time . Exit interview conducted. Report issued and sent via email. (Continued from 9099) LPA interview with (10) residents revealed that all are satisfied with the assistance they receive from staff with their medications. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility staff failed to assist R1. Therefore the above allegation is UNSUBSTANTIATED at this time. It was alleged that , Staff 2 (S2) inappropriately interacts with residents, LPA interview with (10) residents revealed that all residents did not express any concerns with their interactions with S2 All residents interviewed have also never witnessed S2 interact inappropriately with any residents in care. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that S1 inappropriately interacts with residents. Therefore the above allegation is UNSUBSTANTIATED at this time. It was alleged that Facility did not consider food habits of residents in meal planning, LPA reviewed and obtained a copy of the facility menu and observed a variety of foods being served. LPA interview with (10) residents revealed that most believe there is a sufficient variety of food being served. LPA interview with Administrator revealed that kitchen staff have always been open to communication from residents regarding quality of food. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility did not consider food habits of residents in meal planning. Therefore the above allegation is UNSUBSTANTIATED at this time. (continued on 9099-C)the state’s words, verbatim · CDSS document, Aug 19, 2021 · control 29-AS-20200810165320

Allegation investigated: Facility did not provide written notice to the resident for rate increase.

This is an amended report for the report report issued on 07/20/2021. On 7/20/2021, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial complaint investigation regarding the above allegation. LPA met with the Administrator at 1:00pm and explained the reason for the visit. LPA also spoke to the complainant on the same date. Interviews: LPA interviewed Resident 1(R1) about allegation of increased rent fee, and failure from licensee to inform R1 about the rent increase. R1 provided a copy of the letter given by administrator on May 14, 2021 to R1 about the increase in rental fee. The letter is a copy of a Provider Information Notice (PIN) 20-26-CCLD: ESTIMATED SSI/SSP PAYMENT STANDARDS EFFECTIVE JANUARY 1, 2021. The PIN is dated 11/01/2020. The PIN is sent to all Licensees. Additionally, R1 provided LPA with a copy of the Payment Reconciliation Summary which was received by R1 from Business Office Manager on 07/16/2021, which indicates that the rent increase, started on 01/01/2021. Substantiated At 2:20pm, LPA interviewed Administrator about the date of notification given to residents in relation to the rent increase for SSI Recipients. Administrator stated that a PIN was received from Business Office Manager on May 13, 2021, which was to be given to SSI recipient residents. Letter (PIN) was given to residents on May 14, 2021. Records Review: During the record review, at 3:00pm LPA read Admission Agreement found in complainant’s file. Per the agreement, page 4, under Notice of Rate Changes: If the rate change reflects a government fund increase, written notice is required from the licensee as soon as FOUR SEASONS ASSISTED LIVING is notified. Four Seasons Assisted Living received PIN notice of increased funds on 11/02/2020. The facility did not provide a notice to residents of the rent increase as stated in the admission agreement. Residents received an increase rent fee letter on 05/14/2021. Based on the investigation, there is sufficient evidence to support the claim that the Facility did not provide written notice to the resident for rate increase as stated in the Admission Agreement. Therefore, this allegation is deemed Substantiated at this time. Exit interview Conducted. Deficiencies cited, and a copy of report and appeal rights given to Administrator.the state’s words, verbatim · CDSS document, Jul 20, 2021 · control 29-AS-20210716131848

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87567(c)(4) · Plan of correction due date: Jul 27, 2021

ADMISSION AGREEMENTS: Licensee’s failure to provided written notice to resident as stated in admission agreement. New rent increase became effective 01/01/2021. Resident was charged new rent increase as 01/01/2021. Resident received written notice on 05/14/2021.the state’s words, verbatim · CDSS document, Jul 20, 2021

Plan of correction: Licensee will create a formal Notice of Rate Increase letter to be used to provide residents with a written notice as stated in the Admission Agreement. Letter is due to LPA by 7/27/2021.

Allegation investigated: Residents are not allowed access to common areas of facility. Staff do not provide activities for the residents. Staff are not preventing residents from intimidating other residents.

Licensing Program Analyst (LPA) Sandra Urena conducted an announced complaint investigation visit regarding the above noted allegations. At 11:50 am LPA arrived at the facility. At 12:15pm, LPA met with Administrator Melissa Christopher. LPA explained the reason for the visit. Regarding the above allegations, LPA requested the following records to address the allegations from RP: Activity Calendar, Residents Activity Participation Sheet, Residents’ Council sign in sheet. To investigate this allegation, LPA conducted interviews between 11:50 pm to 3:00 pm with the Administrator, RP Activities Director, Ombudsman, and a random selection of residents. Regarding the allegation: Residents are not allowed access to common areas of facility. At 12:30pm, LPA interviewed four residents about the use of the common areas, such as the dining room area, activity area, and outdoor area. Unsubstantiated Residents expressed that areas are open to all residents to use. One of the residents was a resident who smokes. Resident stated that resident uses the patio area at least eight times a day to smoke. Three residents stated that they don’t use the patio area too often, but use the dining room area. Based on the investigation, there is insufficient evidence to support the claim that Residents are not allowed access to common areas of facility.Therefore, this allegation is deemed Unsubstantiated at this time. Regarding the allegation: Staff do not provide activities for the residents. At 2:00 pm LPA interviewed Activities Director. Activities Director provided two Activity Calendars for the months of May and June 2021. Calendars provide information about daily activities such as Socials, Bingo, Monthly Birthday Celebrations, Outings, etc. Additionally, Activities Director provided Resident’s Activity Participation logs for five residents for the months of May and June 2021. Three residents were interviewed about the activities provided by the facility. The residents expressed that in the past they used to have many activities, but they stopped during the COVID outbreak. The activities have begun again, but not as many as before. Residents spoke about the Mother’s Day celebration, and birthday celebrations. They talked about having live music and outings to the park, playing bingo and cards. Based on the investigation, there is insufficient evidence to support the claim that the facility does not provide activities for the residents. Therefore, this allegation is deemed Unsubstantiated at this time. Regarding the allegation: Staff are not preventing residents from intimidating other residents. LPA interviewed four residents in connection to this allegation. The residents interviewed stated that they have not felt intimidated by other residents, however if they did, they would bring it up to the Administrator. The residents expressed they feel comfortable attending activities. At 1:00 PM a Residents Council meeting took place in the dining room area. The Administrator, and the Activities Director were present. The meeting was to address the food complaints by residents. About 12 residents present during this meeting. Based on the investigation, there is insufficient evidence to support that staff are not preventing residents from intimidating other residents. Therefore, this allegation is deemed Unsubstantiated at this time. No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was issued via email.the state’s words, verbatim · CDSS document, Jul 1, 2021 · control 29-AS-20210623152148

Allegation investigated: Facility staff does not give medications as prescribed. Facility staff mishandled resident's medications. Facility does not serve food of the quality needed to meet residents’ needs. Facility is not allowing resident to use a Home Health provider.

This is an amended report. Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint investigation visit regarding the above noted allegations. During the initial visit on May 24, 2021 at 12:45 p.m., LPA Richardson conducted a brief facility tour and interviewed some residents in care. At 1:15 p.m., the LPA reviewed and obtained pertinent documents. At 1:30 p.m., the LPA conducted interviews with staff. On this subsequent visit, LPA Urena arrived at the facility at 10:00 a.m. and met with the administrator, Melissa Christopher and explained the reason for the visit. LPA Urena conducted interviews between 10:15 a.m. and 2:00 p.m. with the administrator, Resident #1 (R1), R1’s primary physician, and a random selection of residents and staff. The LPA also observed meals being served from 12:00-12:30 p.m. in the dining room and delivered to resident rooms on the first floor. In addition, the LPA requested records, residents' files, menu, and medication logs to address the allegations. Unsubstantiated Regarding the allegation, Facility staff does not give medications as prescribed, the complainant’ concern is that they believe that R1 is not getting their blood pressure/heart medications and a medication for R1’s hand/arm as prescribed. To conduct the investigation, LPA Urena interviewed the administrator, facility staff and residents. LPA Urena also conducted a records review of the Centrally Stored Medication (CSM) log for the facility. Upon review of the CSM log and the medication self-administration log, the LPA observed that residents are assisted with self-administration of medication according to the doctor’s instructions. Additionally, the medication self-administration logs also document residents’ refusal to take the medication as prescribed by their doctor and their reason for the refusal. It appears that R1 did refuse medication from time to time. Furthermore, LPA Urena observed communication between the facility staff and R1’s physician, informing the physician of the refusal of medication by R1 and requesting advice. Based on the investigation of records review, and interviews, there is insufficient evidence to support the claim that residents do not receive medications as prescribed. Therefore, this allegation is deemed Unsubstantiated at this time. Regarding the allegation, Facility staff mishandled resident medication, the complainant’s concern is that R1 was not receiving all of the medication that they brought to the facility upon admission. LPA Urena conducted a records review of Centrally Stored Medications and found that medications are being recorded for residents that arrive with medications at facility. The LPA reviewed the medication list in all of the residents’ files, and compared it to the medication log, and it appears that all medications are accounted for. The LPA also interviewed the administrator and facility staff, who confirmed this information as well. Based on the investigation, there is insufficient evidence to support the claim that R1’s medication was mishandled. Therefore, this allegation is deemed Unsubstantiated at this time. Regarding the allegation: Facility does not serve food of the quality needed to meet residents’ needs, the complainant’s concern was that the food was ‘nasty’. When asked for clarification, the complainant stated that they observed that the food appeared dry and there were no condiments available. To investigate this allegation, at 12:00 p.m., the LPA observed lunch being served in the dining room area and being delivered to residents residing on the first floor. Lunch was served according to the menu dated for the week of June 28th through July 4th, 2021. On this day, the food listed for lunch was Salisbury steak with grilled onions, diced fried potatoes, corn with green peppers, fresh green salad, and ice cream for dessert. A vegetarian substitution of grilled Tofu was available. Milk, and tea were part of the meal. Menu items are varied throughout the week. All menu items appear to be components of a balanced meal. The administrator stated that condiments are not kept on the dining room tables due to the varied dietary needs of the residents, but condiments are available upon request. The LPA observed today's lunch meal, the meal was appropriately arranged on the plate and did not appear to be dry. It also included a green salad which appeared fresh. Drinks were available on the same food tray. The meal was served as stated on the menu. Residents were also interviewed regarding the food and stated that food is ok, some days is better than others. Based on the investigation, there is insufficient evidence to support the claim that the facility does not serve food of the quality needed to meet residents’ needs. Therefore, this allegation is deemed Unsubstantiated at this time. Regarding the allegation, Facility is not allowing resident to use a Home Health provider, the complainant’s concern was that they believed that the facility was not allowing R1 to receive home health care services. To investigation the allegation, at 11:15 am, LPA Urena contacted R1’s primary care physician’s office to gather information about Home Health services for R1. Per the conversation with R1’s physician’s office staff, R1 requested Home Health Services and R1’s physician approved the services on 5/19/2021. However, per office staff and according to R1’s records, the Home Health Agency contacted R1 to review their insurance plan, at which time the Home Health Agency informed R1 that the portion to come out of pocket expense for the services would be 20% of the shared cost. At that time R1 declined the services. The Home Health Agency attempted to follow up with R1 but was unsuccessful in contacting R1. LPA Urena interviewed R1 about the information provided by R1’s primary physician’s office regarding the Home Health services and R1 indicated that the information provided was correct. R1 stated that communication has taken place with the insurance company in the last few days and that Home Health services are due to start on July 1, 2021. Based on the investigation, there is insufficient evidence to support the claim that the facility is not allowing R1 to use a Home Health provider. Therefore, this allegation is deemed Unsubstantiated at this time. No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was provided.the state’s words, verbatim · CDSS document, Jun 28, 2021 · control 29-AS-20210519151334