Just Like Home II

Type of visit: Office

An Informal Conference was conducted today in the Woodland Hills North Adult and Senior Care Regional Office. The purpose of this Informal Conference is to discuss deficiencies cited in complaint control #29-NP-20211202105836. Present at today's meeting included licensee representatives Alexandra Vartapetova, and Administrator Marat Davidian, Licensing Program Manager (LPM) Jeralyn Pfannenstiel, and Licensing Program Analyst (LPA) Sandra Urena. The informal conference process was explained to the Administrator. The Administrator was also informed that this Informal Conference is a part of the administrative action process and that further citations may result in a Non-Compliance Conference, which could lead to a referral for Administrative Review by the Department. Brief History: The facility was first licensed in 12/14/2015, for a capacity of six residents. LPM Pfannenstiel discussed deficiencies that were cited during the past three years. This included the complaint investigation, with allegations of failure to notice a resident’s change in condition, and retaining resident in the facility with a prohibited health condition, stage 4 pressure injury. In addition, the facility staff was providing wound care and were not appropriately skilled professionals, where deficiencies were issued on 09/15/2022 on a case management visit. At this time, the licensee has cleared the Plan of Corrections in a timely manner. All parties discussed the complaint investigation and potential ramifications of the complaint findings.the state’s words, verbatim · CDSS document, Mar 2, 2023

Type of visit: Required - 1 Year

On 10/18/2022, Licensing Program Analyst (LPA) Sandra Urena, arrived at the facility unannounced to conduct a required annual inspection. This visit had an emphasis on infection control. LPA Urena arrived at the facility at 10:26 a.m., and met with administrator Marat Davidian. The purpose of the inspection was discussed with the administrator. Infection Control: Upon entry, the facility has a sign in book, and sanitizing gel. Infection Control signage was visible at entrance. Temperature was taken by caregiver, before allowing LPA Urena enter the premises. Temperature was recorded in sign in sheet. From 10:36 a.m. to 11:14 a.m., LPA Urena, and the administrator conducted a tour of the inside, and outside of the facility to ensure there are no health and safety hazards, and the facility is in compliance with Title 22 Regulations. Common Areas: LPA Urena, and administrator toured the common areas (living room and dining room). The walls and flooring were checked for cleanliness and were observed to be in good condition. Furniture was observed to be clean, appropriate, and in good condition. Room temperature was recorded at 75 degrees Fahrenheit. Kitchen: At 10:55 a.m., it was observed by the LPA, and administrator that the knives were stored in an unlocked kitchen drawer. At 10:58 a.m., chemicals were observed to be unlocked under the sink cabinet. 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. Fire extinguisher was observed to be serviced within the last year. The administrator was advised to mount the fire extinguisher for easy, and safe access in case of a fire emergency. Continues on LIC 809C... Bedrooms: The facility has six bedrooms with single occupancy, each bedroom has a private bathroom. Bedrooms were furnished appropriately with appropriate furnishings, bed linens, and sufficient lighting. Bathrooms: Each of the six (6) bathrooms were observed to be clean; shower area was in clean condition with grab bars and a non-skid mat available. Paper towels were available for drying hands. Hand washing sign was displayed, and sufficient amounts of soap, and paper products in each restroom. The facility has a staff/visitor bathroom in the hallway. Hallway: Medications were observed to be locked away in the closet area, and were inaccessible from residents. Outdoor Space: Backyard has a shaded outdoor area equipped with outdoor furniture in good repair for residents’ use. There were no bodies of water noted. Passageways were free of obstruction. Pantry: An adequate supply of emergency food for six residents and two staff was available. Garage Area: Diapers, and Personal Protection Equipment (PPE) is adequate, and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. The facility’s policies and procedures as it pertains to infection control are adequate. Citations were issued at this time. Exit interview was conducted, a copy of the report and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Oct 19, 2022

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Oct 24, 2022

87309(a) Knives, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as knives were accessible in an unlocked kitchen drawer, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 19, 2022

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Oct 24, 2022

87309(a)Disinfectants, cleaning solutions, knives, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as disinfectants and cleaning solutions were accessible in an unlocked kitchen cabinet, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 19, 2022

Allegation investigated: Resident sustained pressure injuries while in care. Facility did not seek timely medical treatment for changes in resident's health.

Licensing Program Analyst Sandra Urena conducted an unannounced subsequent visit to deliver the findings for the above allegations. The LPA arrived at the facility at 9:30 a.m. Staff contacted administrator via phone. Administrator arrived at 10:15 a.m. LPA Urena met with the administrator Marat Davidian and explained the reason for the visit. On 12/2/2021, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day complaint investigation visit regarding the above allegations. LPA Urena reviewed facility records beginning at 11:45 AM, and conducted an interview with the responsible party for one resident and the administrator between 12:00 p.m. and 12:15 p.m. Continues on LIC 9099C... Substantiated Resident sustained pressure injuries while in care. On the allegation of ‘Resident sustained pressure injuries while in care’, it is alleged that Resident #1 (R1) was admitted to the hospital with a wound on their left heel, and a sacral stage four (4) pressure injury. To investigate this allegation, LPA Urena requested hospital records and Home Health Services records for review. On 12/08/2021, the LPA reviewed the hospital records. Hospital wound care consultation records confirmed that R1 was admitted to the Emergency Room (ER) with a sacral stage 4 pressure injury, and a left heel wound. On 07/27/2022, the LPA requested Home Health Care Services (HHCS) records and conducted the record review on 08/05/2022. On 12/02/2021, at 12:00 p.m., the LPA interviewed the administrator about the allegations. Per the administrator, R1 started receiving Home Health Care Services (HHCS) in June 2021 due to a surgical wound. At 12:06 p.m., the LPA interviewed the Responsible Persons (RP) for R1 about the physical condition of R1. The RP reported that they knew a nurse was providing care to R1 for a surgical wound but was not aware of the pressure injury. On 07/27/2022, the LPA interviewed representatives from the HHCS agency about the care provided to R1, and the communication with the facility’s staff in regard to R1’s condition. Per the HHCS representatives, services were provided to R1 from 6/30/2021 to 11/26/2021. Services for R1 were started due a surgical wound, and not for the sacral pressure injury. Furthermore, the HHCS staff reported that the RP, and facility staff were informed of the sacral pressure injury, which developed while R1 was in care. Continues on LIC 9099C... The LPA conducted HHCS record review, which revealed that on 11/09/2021, HHCS staff reported that upon R1’s skin assessment, it was observed that R1 had developed ‘redness in the sacral area’. R1’s physician was informed, and per the physician’s orders, HHCS staff were to educate facility staff on the prevention of pressure injuries. HHCS record review revealed that HHCS staff instructed, and demonstrated to facility staff, the changing of R1’s position every 15 minutes (or not more than two hours), while on the bed, and sitting on the wheelchair to prevent pressure injuries. HHCS staff instructed facility staff to roll R1 to their sides to relieve pressure on the back, putting pillows in-between R1’s knees, and ankles to prevent pressure injuries when R1 was in bed. HHCS staff also instructed facility staff to assist R1 with sit-up exercises to help relieve R1’s pressure on the buttock area, while R1 was sitting on the wheelchair. On 08/29/2022 at 10:32 a.m., staff interviews revealed that they were repositioning R1 every two hours, and as needed. Staff stated that they moved R1 from the bed to the wheelchair, and from the wheelchair to the sofa, and vice versa. Staff did not state whether they were assisting R1 with sit-up exercises. Staff stated that they ensured R1’s was kept dry by changing R1’s diaper every two hours or more often if needed. On 11/017/2021, HHCS records review revealed that HHCS staff reported that upon R1’s skin assessment, it was observed that there was an open wound on the sacral area with a diameter of 2cm. x 3cm. The physician ordered wound care for R1. HHCS staff provided the wound care per the physician’s orders, and instructed facility staff to observe the wound, and provide wound care regimen daily. Continues on LIC 9099C... The LPA was concerned what type of “wound care” the staff was providing, as only appropriately skilled professionals (Licensed Vocational Nurse [LVN] or higher) are allowed to provide wound care for pressure injuries. Staff interviews revealed that they kept the wound area clean, by irrigating the wound with the cleaning solution, applying ointments around the wound area and covering the wound with a dry dressing. The administrator’s interview revealed that they were aware of the change in condition and stated that staff was instructed to only change the dressing and apply moisture cream around the sacral wound. However, since only appropriately skilled professionals are allowed to care for pressure injuries, this issue will be addressed on a case management visit. Based on the information gathered, interviews, and records review, the resident sustained pressure injuries while in care. Although facility staff received instructions from HHCS staff on how to prevent pressure wounds, R1 developed pressure injuries, specifically in the sacral area, which started as ‘skin redness’, and progressed to a stage four (4) sacral pressure injury, and a wound on the left heel, while R1 was in care at the facility. Therefore, the allegation that ‘Resident sustained pressure injuries while in care’ is deemed SUBSTANTIATED at this time Facility did not seek timely medical treatment for changes in resident's health. On the allegation of ‘Facility did not seek timely medical treatment for changes in resident's health’, it is alleged that the facility staff did not seek timely medical treatment for Resident #1 (R1) when it was observed that R1’s health condition had changed; consequently, R1 developed a stage four (4) sacral pressure injury. To investigate this allegation, the LPA conducted records review and staff interviews. Continues on LIC 9099C... The Home Health Care Services (HHCS) record review revealed that the HHCS staff reported R1’s changes in condition on 11/09/2021 and 11/16/2021. On 11/09/2021, the HHCS staff reported that upon R1’s skin assessment, it was observed that R1 had developed ‘redness in the sacral area’. On 11/16/2021, HHCS staff reported that upon R1’s skin assessment, it was observed that there was an open wound on the sacral area with a diameter of 2cm. x 3cm. The HHCS staff provided wound care regimen per physician’s instructions. Facility staff were instructed to continue wound regimen daily. Staff interviews revealed that they kept the wound area clean by irrigating the wound with a cleaning solution, applying ointments around the wound area, and covering the wound with a dry dressing. As noted on the previous allegation, this will be addressed on a case management visit, as only appropriately skilled professionals may provide care to pressure injuries. The HHCS record review revealed that on 11/20/2021, a conversation with R1’s responsible party (RP) was held; the HHCS recommended for a wound specialist to see R1; however, the RP declined a wound specialist visit; and, any invasive wound treatment. As a result, the facility staff did not seek any further treatment for R1; though they should have elevated the HHCS concerns to the resident’s physician and sought a higher level of care for R1 versus retaining R1 in the facility with a prohibited health condition. Based on the information gathered, and records review, the facility staff did not seek timely medical treatment for changes in resident's health. Although the HHCS staff informed the facility staff of the deterioration of the skin of the sacral area, the facility staff did not notify R1’s physician so that they further the resident in seeking timely medical treatment. As a result, the pressure injury progressed to a stage four (4) while in care. Therefore, the allegation that the Facility did not seek timely medical treatment for changes in resident's health is deemed SUBSTANTIATED at this time. Continues on LIC 9099C... The following deficiencies are observed (See LIC 9099-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. An immediate $500 civil penalty is being assessed today. Citations were issued. Exit interview conducted with the administrator, and signatures were obtained. A copy of the report, and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Sep 15, 2022 · control 29-NP-20211202105836

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Sep 30, 2022

87615(a)(1) Prohibited Health Conditions. (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained...: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on the information obtained, record review and interviews, the licensee did not comply with the section cited above, as the Resident sustained pressure injuries while in care, and developed a stage four (4) sacral wound, and was retained in the facility with a prohibited health condition, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2022

Plan of correction: The Administrator agreed to do the following: Schedule a training for all staff regarding prohibited health conditions. Verification of scheduled training with the trainer’s credentials will need to be submitted by 9/23/22, and completion of training must be submitted no later than 9/30/22.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Sep 30, 2022

87466-The licensee shall ensure that residents are regularly observed for changes in physical...When changes such as …a physical health condition are observed, the licensee shall ensure that such changes are... brought to the attention of the resident's physician and ... This requirement was not met as evidenced by: Based on the investigation, staff failed to timely observe R1s change in physical health condition, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2022

Plan of correction: Schedule a training regarding the observation of changes in resident health and conditions; and, who to contact when those changes are observed. Verification of scheduled training with the trainer’s credentials will need to be submitted by 9/23/22, and completion of training must be submitted no later than 9/30/22.

Type of visit: Case Management - Deficiencies

On 9/15/2022, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced Case Management Deficiencies visit due to deficiencies observed during the investigation of complaint control #29-NP-20211202105836. LPA Urena met with the administrator Marat Davidian and explained the reason for the visit. During the investigation, the LPA learned while interviewing staff, that staff were providing care for R1’s pressure injury. R1’s pressure injury developed while in the care of the facility. On 11/017/2021, records review of Home Health Care Services revealed that HHCS staff reported that upon R1’s skin assessment, it was observed that there was an open wound on the sacral area with a diameter of 2cm. x 3cm. The physician ordered wound care for R1. HHCS staff provided the wound care per the physician’s orders, and instructed facility staff to observe the wound, and provide wound care regimen daily. The LPA was concerned what type of “wound care” the staff was providing, as only appropriately skilled professionals (Licensed Vocational Nurse [LVN] or higher) are allowed to provide wound care for pressure injuries. On 08/29/2022, staff interviews revealed that staff kept the wound area clean, by irrigating the wound with a cleaning solution, applying ointments around the wound area, and covering the wound with a dry dressing. The administrator’s interview revealed that they were aware of the change in condition, and stated that staff was instructed to only change the dressing and apply moisture cream around the sacral wound. Only appropriately skilled professionals are allowed to care for pressure injuries. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Civil penalties assessed. Citations were issued. Exit interview conducted with the administrator, and signatures were obtained. A copy of the report and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Sep 15, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87631(a)(3)(A)(B) · Plan of correction due date: Sep 30, 2022

87631 (a)(3)(A)(B) Healing wounds: Residents with a stage one or two pressure injury must have the condition diagnosed by a physician… (A) The resident shall receive care for the pressure injury from a physician or an appropriately skilled professional; (B) All aspects of care by... facility staff shall be documented in the resident's file. This requirement is not met as evidenced by: Based on the interviews, staff provided care for pressure injuries, which can only be cared by a skilled professional, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 15, 2022

Plan of correction: Schedule a training regarding the care provided by staff; and, documentation in resident’s file. Verification of scheduled training with the trainer’s credentials will need to be submitted by 9/23/22, and completion of training must be submitted no later than 09/30/2022.

Allegation investigated: Facility does not follow COVID-19 health and safety protocol.

On 08/29/2022, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced visit to investigate the allegation named above. LPA Urena arrived at the facility at 10:30 a.m., met with the administrator Marat Davidian and explained the reason for the visit. At 10:45 a.m., the LPA, and the staff conducted a brief tour of the facility. No deficiencies were noted during the tour of the facility. Continues on LIC 9099 C... Substantiated Regarding the allegation, ‘Facility does not follow COVID-19 health and safety protocol’, it is the concern of the Reporting Party (RP) that the facility has not been safeguarding residents by not practicing proper infection control. At 10:30 a.m., the LPA arrived at the facility and was allowed inside the facility by caregivers without conducting infection control practices. At 10:45 a.m., the administrator and the LPA conducted the tour of the facility, and noticed that at the entrance of the common area , there was a table with an oral thermometer, a sign in book and, and an alcohol bottle. The LPA brought to the attention of the administrator the thermometer, and explained that is was not the correct thermometer for conducting infection control practices. The administrator asked the staff for 'the other thermometer' and the staff brought out of the medication closet, a digital thermometer. The administrator and staff were also instructed to place masks on the table with the other items, in case a visitor came to the facility without a mask/face covering. Additionally, the LPA instructed staff, and administrator to follow current infection control guidelines, which state that all visitors must be screened. Additionally, the LPA asked the staff if an an outside agency had visited the facility recently, and had brought to their attention conducting an initial screening for COVID-19 symptoms of all individuals entering facility? The staff stated that 'yes' an outside agency had visited a few weeks ago. Based on the LPA’s observation, and interview with the administrator, there is sufficient evidence to support the allegation that the 'Facility does not follow COVID-19 health and safety protocol’. Therefore, this allegation is deemed Substantiated at this time. The following deficiencies were observed (See LIC 9099-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 was conducted with facility representative, a copy of the report, and Appeal Rights were issued.the state’s words, verbatim · CDSS document, Aug 29, 2022 · control 29-AS-20220823100236

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Sep 9, 2022

87468.1(a)(2) Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations... This requirement is not met as evidenced by: Based on observation, and interviews conducted, the Licensee did not comply with the section cited above, staff did not conduct initial screening for COVID-19 symptoms of individuals entering facility, while providing care and supervision to residents in care, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 29, 2022

Plan of correction: Submit staff training sign in sheet and supporting documentation on Infection Control Practices- PIN 21-38-ASC regarding masks wearing in the facility to LPA by 09/02/2022.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Angel Ascencio conducted an unannounced case management visit. LPA met with Admin Alexandra Vartapetova and explained the reason for visit. Admin stated she will be proving Mitigation Plan and drop at the Woodland Hills Office by end of 7/7/21. LPA toured the physical plant areas inside and outside at 2:50 PM to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. Exit interview was conducted with Administrator, and a hard copy was provided via email.the state’s words, verbatim · CDSS document, Jul 7, 2021