Zann Daily Care

Type of visit: Required - 1 Year

On 10/06/23 Licensing Program Analysts (LPAs) Mariana Agban,Huma Rahimi and Leslie Ngo-Castandena, conducted an Annual Required visit and inspection of the facility. Upon arrival, LPAs was greeted by the staff and explained the reason for the visit. A tour of the physical plant was conducted at 9:30 AM. Kitchen: The kitchen appeared clean and the appliances and fixtures functional. LPAs found a sufficient amount of perishable and non-perishable food at the facility; properly stored. LPAs observed that sharp objects were stored in unlocked drawer. Staff immediately locked the drawer. Medications are locked in the hallway cabinet. Medications observed to be locked and inaccessible to clients. LPAs observed fully stocked first aid kit in the hallway cabinet. Bathrooms: There were two (2) bathrooms in the facility. One (1) bathroom in hallway which is the main and one (1) bathrooms in the private bedroom. All bathrooms were clean, properly supplied and had functional fixtures. Water temperatures were: 118.5 and 119.3 degrees Fahrenheit. Bedrooms: There were six (6) bedrooms designated for residents' use. All bedrooms were clean, properly furnished and had sufficient lighting. Common Areas: These included the living room and dining area. The common areas were properly furnished Surrounding Grounds: Entry/exits were free of obstruction.Temperature: Facility maintains a comfortable temperature of 78 degrees Fahrenheit. Fire extinguisher: are located in the dining room, and kitchen observed to be fully charged and was purchased on 07/23/2023 and 06/29/23. Laundry Area-Garage: located in the garage. Appliances observed to be in good repair. Garage door was locked and thus laundry detergents were inaccessible to residents. Backyard Area: a patio table and chairs shaded by a large umbrella for residents use. Patio furniture observed to be in good repair with adequate seating for the residents. There is a pool enclosed by a gate. Gate to the pool observed to be locked and inaccessible to clients. Due to discrepancy of the facility records, this annual will be continued in a another time. Exit interview conducted and deficiencies cited and copy of this report delivered.the state’s words, verbatim · CDSS document, Oct 6, 2023

Allegation investigated: Due to neglect/lack of Care and Supervision. Resident developed multiple Pressure Injuries while in care.

Licensing Program Analyst (LPA) Tihesha Smith made a visit to this facility at 2:40 pm to interview Resident #1 (R1) and to deliver findings. LPA Smith met with facility staff and administrator was contacted. LPA spoke with administrator Ann Slovakyan who revealed is currently picking up (R1) from medical appointment and will be on way to the facility shortly. On 11/07/22 at 12:47 PM (LPA) Smith made a complaint visit to this facility. LPA Smith had a phone conversation with administrator at 12:55 and disclosed purpose of visit revealed administrator at medical facility and unable to come to facility. LPA conducted tour of the physical plant at 1:45 pm and requested copies of documents relevant to the investigation. During initial visit, on 07/19/22, (LPA) Abeye Duguma conducted a physical plant tour at around 09:45 AM and interviewed one staff from 10:00 AM - 11:00 AM. At 11:15 AM LPA requested pertinent documents. (Cont to 9099) Unsubstantiated (Cont forn 9099) Due to neglect/lack of Care and Supervision, resident developed multiple pressure Injuries while in care. It was alleged that due to neglect/lack of care and supervision, resident developed multiple pressure Injuries while in care. To investigate the allegation interviews were conducted with administrator on 07/19/2022, including telephone interviews with administrator on approximately 11/07/22, 03/01/23 and 03/07/23. Documents relevant to the investigation were obtained and reviewed. Telephone interviews also conducted with witness relevant to investigation on 02/15/23. Interview with administrator revealed R1 was assessed upon arrival and any bruising/wound was documented on assessment form on admission.. Administrator also revealed was informed by R1 family that R1 had previously sustained fractures and multiply falls while living at home and in other facility. Interview with witness relevant to investigation revealed that R1 sustained several falls with significant bruising and fall on approximately 05/30/22 resulted in fractures. According to witness paramedics were called to R1s home and R1 was not fully healed due to other health conditions of R1. Review of would assessment document and photos reveal location of shunt and bruising’s on R1s body. The assessment and photos also show 1 (one) small wound on buttocks. Interview with R1 reveal staff treats them fair and do not neglect or mistreat them. R1 revealed they are taken to doctor appointments and they are doing fine at the facility. Based on interviews and documents obtained during this and previous licensing visits there is insufficient pertinent information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.the state’s words, verbatim · CDSS document, Mar 9, 2023 · control 31-AS-20220718165118

Type of visit: Case Management - Other

Licensing Program Analysts (LPA) Tihesha Smith and Tuesday Cabiness made a Case Management visit to this facility on 10/06/22. LPAs met with Ann Solakyan at 10:15 am and explained the reason for this visit. LPAs conducted interview with administrator to obtain additional information per Legal Division recommendation for Case: 31-AS-20190723103029 Date:07/22/2019. Exit interview conducted/copy of report given.the state’s words, verbatim · CDSS document, Oct 6, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced Annual Required/infection control visit to this facility at 10:19 am. LPA Smiths’ temperature taken upon entry and Covid symptoms follow-up questions on sign-in sheet. LPA informed staff the purpose of this visit. The administrator was called. Administrator authorized caregiver Svetlana Tumanyan to sign report in administrators absence. LPA conducted a tour at 11:00 AM of the physical plant to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. LPA was escorted to the living and dining combination area and observed adequate seating for residents. Staff confirmed there are six (6) clients in the home. The living area had furnishings, sufficient lighting and the area was clean. Smoke alarms and carbon monoxide detectors were present and function properly. The two (2) fire extinguishers located in kitchen on counter and in dining room attached to wall observed to be charged. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the six (6) clients currently residing there. Two (2) days of perishable fruits, vegetables, milk, and eggs observed with juice. The freezer is stocked with meats and extra water/juice stored in hall closet #1.. Sharps observed to be locked in lockbox stored in bottom kitchen cabinet and observed to be inaccessible to clients. All the toxins, cleaning solutions and disinfectants are stored in locked garage and observed to be in accessible to clients. Laundry area located in garage. Appliances observed to be in good repair. Medications are locked in hall closet #2. Medications observed to be locked and inaccessible to clients. LPA observed fully stocked first aid kit locked in medication closet with facility, staff, and client files (Cont to 809C) (Cont. from 809) There are six (6) bedrooms. A tour of the client’s bedrooms, bathrooms, personal accommodations, and common areas (all resident bedrooms toured had the required furniture for residents’ comfort and safety). Common areas were observed for the ability to safely serve the needs of residents, including cleanliness, skid materials, locks, grab bars, and comfortable temperatures. LPA observed a sufficient supply of linens and PPEs in garage. There are two (2) bathrooms: one (1) bathroom in hallway near front of house and one (1) bathroom in room #5. Each bathroom has posted “wash your hands” sign and the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for the two (2) bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 110- and 111.8-degrees Fahrenheit. The backyard has the following: a patio table and chairs shaded by a large umbrella for clients use including a 2nd sitting area on the side of house. Patio furniture observed to be in good repair with adequate seating for the residents. There is a pool enclosed by a gate. Gate to the pool observed to be locked and inaccessible to clients. There were no immediate health and safety risks observed during the day of inspection. There are no deficiencies to report. Exit interview conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Sep 26, 2022

Allegation investigated: Staff leaves residents unattended.

Licensing Program Analyst (LPA) Tihesha “Lynn” Smith conducted an unannounced complaint investigation visit at 9:45 am at this facility. LPA met with Administrator Ann Solakyan at 10:35 am. Administrator states census is five (5). Administrator provided LPA with resident files and revealed she had to return to the hospital for client #5 status (C5) and to take(C5) to other medical appointments if not under hospital observation. Concerns were that staff leaves residents unattended. During investigation on 07/08/2022 between 12:15pm - 12:45pm, LPA Smith interviewed facility staff. Interviews revealed that there is a live-in caregiver onsite, and administrator coordinates coverage with on call staff to provide additional coverage as needed. During todays visit LPA reviewed facility files at 10:40 am and obtained copies of pertinent documents at 1:55 pm. LPA interviewed three (3) of the five (5) clients present in the facility starting at 12:40 pm. Interviews revealed that all three (3) clients are enjoying their residency at the facility. (Cont to 9099C) Unsubstantiated (Cont from 9099) The clients revealed the staff are pleasant and are always available when they need assistance or have questions. C1 revealed that Staff # 1 (S1) is always in facility and very busy assisting everyone and it’s five (5) of them and one (1) of her at times. LPA observed (S1) making snacks, lunch, providing assistance, and answering clients’ questions during this visit. Based on interviews and information obtain during the course of the investigation the allegation is deemed UNSUBSTANTIATED at this time. Exit interview conducted. Copy of report printed.the state’s words, verbatim · CDSS document, Jul 11, 2022 · control 31-AS-20220203090149

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility 1130am to conduct an unannounced infection control inspection/visit. Upon arriving, LPA was greeted by caregiver, who allowed LPA to enter the facility. There have not been any active or past COVID cases at the facility, and (3) staff and (5) residents have been vaccinated. The current census is (5). Administrator Ann Solakyan arrived shortly after, and was informed the reason of the visit. .LPA temperature was taken, and LPA observed the visitors sign in sheet and cleaning table, with hand sanitizer. COVID-19, CDC, Department of Public Health, and Licensing postings on the walls throughout the facility. The infection control inspection began with the Administrator, who escorted LPA throughout the facility. The facility has (7) private bedrooms; with (1) room for staff, and all bedrooms were properly furnished. The common areas were observed to be clean, including bathrooms, with soap and towels, and hand washing signs visually posted. LPA conducted a mitigation plan review with the Administrator to obtain information on how the facility has implemented the department's mitigation plan. The Administrator reported to LPA, the facility has documentation of all vaccination records and other pertinent information pertaining to COVID-19, in staff and resident files. All new employee hires and new resident admits, will be properly screened, and provided a negative COVID test, prior to entering the facility. Administrators reported to reading the departmental emails and continues to provide and conduct training to staff in relation to COVID-19. There is currently no paid sick leave policy in place. LPA discussed with the Administrator, that even though, everyone in the facility has been vaccinated, there needs to be a sick leave policy in place for staff, that is flexible and not punitive. The facility does have staffing issues, but Administrator has a plan in place, and is currently hiring and reviewing applicants for new employees. There are designated rooms for potential positive COVID residents because the facility has private rooms. PPE supplies were inspected, and Administrator reported to LPA that the supplies are kept in the garage area. It's replenished as often as needed, based on the request of staff. Chemicals, cleaning supplies, paper products were observed and locked and secured in the garage. Administrator informed LPA that they continue to implement the best practices for their facility, which has kept them COVID-19 free. The facility is aware to report any changes with residents and staff to Licensing and there LPA, pertaining to positive COVID-19 cases. Exit interview conducted and copy of report was provided.the state’s words, verbatim · CDSS document, Sep 9, 2021

Allegation investigated: Facility staff neglect resulted in Resident #1 (R1) sustaining multiple pressure injuries – SUBSTANTIATED

Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an unannounced subsequent complaint visit to the above facility. The purpose of the visit is to conclude an investigation initiated by LPA D. Perera on 07/24/2019. Upon arrival, LPA met with Administrator Ana Solakyan. Entrance interview conducted and the reason for the visit was explained. On 07/24/2019, LPA Perera conducted an initial 10-day visit, at which time copies of pertinent documents from Resident #1 (R1) facility file was obtained and reviewed. On 07/24/2019 at 8:55am, LPA conducted a tour of the physical plant and interviews were conducted with administrator and staff at 9:10am. During the course of the investigation, LPA also obtained medical records pertaining to R1 from Northridge Hospital Medical Center and Top Choice Home Health. On 07/23/2019, LPA conducted an interview with the responsible party of R1. Continued on LIC 9099c Substantiated Continued from LIC 9099 On 09/12/2019 and 09/16/2019, LPA conducted interviews with various personnel, including but not limited to Wound Specialist, Emergency Room (ER) nurse, and Social Worker from Northridge Hospital Medical Center. Additionally, on 09/11/2019 and 09/19/2019, interviews were conducted with various Top Choice Home Health personnel, including but not limited to Director of Nursing, Nurse Practitioner (NP) and Registered Nurse (RN). On 11/04/2019, LPA also conducted an interview with West Coast Wound and Skin personnel. Medical records were reviewed by LPA on 08/26/2019, 09/09/2019 and 09/10/2019. This case was referred to the Community Care Licensing Divisions (CCLDs) Program Clinical Consultant (PCC) for further review. It was alleged that facility staff neglect resulted in R1 sustaining multiple pressure injuries. Information gathered and reviewed revealed that R1 was admitted to the facility on 06/18/2019. On 06/21/2019, R1 was evaluated by a Nurse Practitioner (NP) who assessed that R1 had a possible recurrent urinary tract infection (UTI), dementia, gait abnormality, was wheelchair bound and had Stage 2 pressure ulcers at left hip, right hip, right ankle along with other comorbidities. Home Health (HH) was ordered for assistance with Activities of Daily Living (ADLs) and wound management. On 06/24/2019, a Registered Nurse (RN) from HH conducted a nursing assessment and wound care to R1. Documents reflected R1 had a stage 2 pressure injury to the left hip only. Per physicians’ orders, R1 was provided wound care by HH from 06/25/2019 to 06/30/2019. However, HH documents did not reflect other pressure injuries on right hip and ankle. R1 was transferred to Northridge Hospital due to generalized weakness, shortness of breath and cough on 06/30/2019. Per hospital records, R1 was admitted to the hospital for Sepsis and acute respiratory failure. Furthermore, the nursing assessment from the hospital indicated multiple pressure injuries as follows: bilateral hips (stage 2), right ischium (stage 1), left shoulder (stage 1), bilateral ankles (stage 1), left lateral foot (stage 1), right heel/right medial foot (stage 1), right knee (stage 2) and right buttock. On 07/08/2019, the hospital wound care consultation was conducted. Per hospital records, the family of R1 did not want R1 discharged to a skilled nursing facility (SNF). Therefore, wound care treatment was ordered and R1 was discharged back to the facility on 07/08/2019. Continued on LIC 9099c Continued from LIC 9099c HH resumed its services for R1 on 7/9/2019. Per nursing assessment, the following injuries were noted: Right ankle (stage 2), left hip (stage 2), right hip (stage 2), right knee (stage 2), and right lateral foot (stage 1). R1 received wound care from HH on 07/09/2019, 07/11/2019 and 07/13/2019. Per HH records, HH nurses reported a new stage 2 pressure injury on the coccyx on 07/13/2019. R1 was further evaluated by a wound care clinic on 07/16/2019, which documented as follows: left hip acute stage 2 pressure injury; coccyx, acute full thickness skin tear; right hip, acute partial thickness skin tear; right knee, acute full thickness skin tear and right ankle, acute deep tissue pressure injury. Information gathered revealed on 07/19/2019, R1 had a change in condition including extreme weakness and lethargy. On 07/09/2019, R1 was visited at the facility by the NP due to R1’s change in condition. Per interviews, the NP was aware of R1s pressure injuries to the left hip however, facility staff did not inform NP of the additional pressure injuries. Per the NPs expert opinion, all signs directed towards a possible wound infection therefore, Emergency Medical Services (EMS) were contacted and R1 was transported to Northridge Hospital at approximately 7:40pm. On 07/20/2019, at approximately 1:00am, R1s wounds were assessed and R1 was reported to have an unstageable pressure injury on the left 2nd toe, stage 2 on the right knee, stage 2 on the left inner thigh, unstageable on right lower shin, unstageable on left upper shin, stage 2 on right lateral buttock, stage 2 on coccyx, deep tissue injury on right malleolus, two (2) deep tissue injury right lateral foot, stage 1 on right achilles and unstageable on left hip. Interviews with facility staff revealed that they would put ointment on R1s wounds, if needed and would reposition every hour or two. However, based on expert opinion, it was revealed that R1s wounds on the hips significantly worsened and was possibly due to R1 not being repositioned for extended periods of time. Based on all information gathered during the course of the investigation, the above allegation, “Facility staff neglect resulted in Resident #1 (R1) sustaining multiple pressure injuries” is deemed SUBSTANTIATED at this time. A $500 immediate civil penalty is assessed today. The licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f). Pursuant to Title 22, California Code of Regulations, the following deficiency will be cited (refer to LIC 9099-D Exit interview conducted, civil penalty issued, appeal rights discussed, and a copy of this report has been issued.the state’s words, verbatim · CDSS document, Jul 22, 2021 · control 31-AS-20190723103029

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jul 23, 2021

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities. To care, supervision, and services that meet their individual needs and are delivered by staff that are…qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on interviews and records review, licensee did not comply with the above the section by not providing the appropriate care, supervision, and competent staffing to R1 which resulted in R1 sustaining multiple pressure injuries.the state’s words, verbatim · CDSS document, Jul 22, 2021

Plan of correction: The Administrator has agreed to submit a Statement of Understanding, explaining the steps the facility will follow to avoid similar issues from happening again and to ensure compliance to Title 22 Regulations regarding emergency medical assistance on or before 7/23/2021.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an unannounced Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint control # 31-AS-20190723103029). Upon arrival, LPA was greeted at the door by Caregiver Zaruhi. LPA met with administrator Ana Solakyan at 11:25am. The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint. On 07/24/2019, LPA Perera conducted an initial 10-day visit, at which time copies of pertinent documents from Resident #1 (R1) facility file was obtained and reviewed. On 07/24/2019 at 8:55am, LPA conducted a tour of the physical plant and interviews were conducted with administrator and staff at 9:10am. During the course of the investigation, it was revealed that the facility failed to assess Resident #1 (R1) prior to accepting R1 to the facility. Additionally, the facility failed to maintain any records for R1 including but not limited to a care plan, physicians report, needs and services plan and reappraisals. Pursuant to Title 22, California Code of Regulations, the following deficiency will be cited (refer to LIC 9099-D Exit interview conducted, appeal rights discussed, and a copy of this report has been issued.the state’s words, verbatim · CDSS document, Jul 22, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Jul 26, 2021

87457(c) Pre-Admission Appraisal – General. (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs… This requirement is not met as evidenced by: Based on interviews and record review, licensee did not comply with the above section by not completing a pre-admission appraisal for R1 prior to accepting and retaining R1 in the facility, which poses a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jul 22, 2021

Plan of correction: Administrator stated that she will review Section 87457 and provide CCL with a statement of understanding of the regulation on or before 07/26/2021.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(a) · Plan of correction due date: Jul 26, 2021

87506(a) Resident Records. The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on record review, observation and interviews, licensee did not comply with the above section by not maintain a complete file for 1 out of 1 residents (R1), which poses a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jul 22, 2021

Plan of correction: Administrator will provide written documentation of her plan for ensuring that residents' records are readily accessible to staff. Administrator will submit this documentation to CCL on or before 07-26-2021.