Liebelove Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 9:45 a.m. The LPA met with Administrator Galina Melkonyan and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Knives and chemicals were locked inaccessible in the kitchen cabinets. Appliances were in operable condition. The facility had a sufficient supply of perishable and non-perishable food. BEDROOMS: Bedrooms were furnished appropriately; beds were observed with clean linens and rooms had sufficient lighting. All direct exits were clear, and no obstructions were noted. RESTROOMS: Restrooms were clean and sanitary with grab bars and non-skid surfaces. At 10:00 a.m., water temperature measured at 115.5 F. Restrooms were fully stocked. Hand-washing signs were observed in all restrooms. FILES: The LPA reviewed resident files at 10:05 a.m. All resident files were in order at the time of the visit. The LPA reviewed staff files at 10:35 a.m. All staff files were in order at the time of the visit. COMMON SPACES: There was a hallway closet with extra linens and towels. Smoke and common monoxide detector were tested at 11:00 a.m. and were operable at that time. Fireplace in the living room was covered. Medications and files were locked and inaccessible in the kitchen cabinet. Fire extinguisher was fully charged. The backyard had furniture and a covered area for resident use. The garage was attached but is kept locked. The washer and dryer were in the garage, along with additional supplies. INFECTION CONTROL: There was a central entry point for screening and temperature checks. The LPA was appropriately screened upon entry into the facility. Staff were wearing appropriate face coverings. Infection Control signs were observed at the entrance into the facility. The facility’s cleaning protocol was sufficient. There was record of staff and resident vaccinations. The LPA discussed changes around testing, visitation and vaccine requirements. The facility's procedures as it pertains to infection control are adequate. No deficiencies issued at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Nov 28, 2022

Allegation investigated: Facility failed to properly evaluate R1 prior to admission, resulting in the facility retaining a resident with a prohibited health condition

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to issue findings for the above allegation. Administrator Galina Melkonyan was not available at the time of the visit; however, the LPA met with Ida Fahimi and explained the reason for the visit. On 07/12/2021, the Department received a complaint alleging that due to staff neglect, Resident #1 (R1) developed an unstageable pressure injury. The complaint was referred to the Community Care Licensing Investigation's Branch (IB) and it assigned to Investigator Robert Kujawa. On 07/13/2021, the LPA toured the facility at 9:10 a.m., conducted a file review at 9:15 a.m., interviewed the Administrator at 9:36 a.m., and collected documents. Investigator Kujawa interviewed facility staff on 9/14/2021 at 3:25 p.m., and on 12/16/2021 at 11:25 a.m., 11:45 a.m., 12:15 p.m.; interviewed a resident on 12/16/2021 at 12:25 p.m.; attempted to interviewed R1’s family members on 10/12/2021; interviewed hospital staff on 1/18/2022 at 3:02 p.m.; interviewed a home health representative on 12/20/2021 at 11:37 a.m.; and, reviewed home health and hospital records on 12/22/2021, 1/5/2022, and 1/21/2022. Substantiated Interviews and records review revealed that R1 was admitted to this facility on 7/6/2021 and was discharged on 7/10/2021. Prior to being at this facility, R1 was in a skilled nursing facility from 6/25/2021 through 7/6/2021 due to a fracture. The Physician’s Report, dated 7/5/2021, noted that R1 had discoloration on the left and right heel. The review of the skilled nursing discharge paperwork did not note any wounds; however, there were instructions regarding wound care for both heels. R1 was not receiving hospice care services. Interviews with the Administrator revealed that the Administrator was aware of R1’s pressure injuries upon admission to the facility but was unaware of the exact staging. The Administrator claimed that R1 was receiving home health services yet stated that they did not communicate with home health regarding the status of R1’s condition, nor did staff receive training regarding proper wound care. The Administrator admitted that R1 was ’heavy’ and that staff had difficulty repositioning R1 as frequently as needed. The Administrator claimed that R1 was moved ‘more than twice a day’. Staff interviews revealed that at least one staff whom cared for R1 during R1’s stay was unaware of any pressure injuries but claimed R1 was repositioned when R1 was being cleaned. Staff whom did not provide care for R1 denied receiving training on proper wound care but claimed knowing that residents should be repositioned every two hours. A review of facility charting notes revealed that upon admission on 7/6/2021, it was noted that R1 had discoloration on both heels, yet it was written as follows; ‘No instruction yet from doctor/nurse for heel treatment’. Notes revealed that on 7/8/2021, a home health nurse came to evaluate R1, and that R1’s heels were treated with iodine and covered in gauze. However, an interview with a home health representative and a review of home health notes revealed that R1 was only evaluated on 7/8/2021 yet never received care. Charting notes revealed that staff applied iodine on both heels and changed the dressing, noting that R1 was in pain. However, on 7/10/2021, R1 became unresponsive and 9-1-1 was called. A review of medical records revealed that on 7/1/2021, R1 was bought into an emergency department due to increased confusion. Yet upon admission to the hospital, it was documented that R1 had unstageable bilateral heel pressure injuries. Based on the information obtained, staff did not conduct a proper assessment prior to admitting R1 to this facility, resulting in this facility retaining a resident with a prohibited health condition. In addition, staff admitted to not having instruction for proper wound treatment for R1. R1 was admitted to the hospital on 7/10/2021, and the injuries to both the left and right heel were unstageable bilateral pressure injuries. There is sufficient evidence to support the claim that the staff did not conduct a proper assessment prior to admitting R1 to this facility, thus retaining R1 with a prohibited health condition. This allegation is deemed Substantiated at this time. The LPA reviewed the findings with Ms. Fahimi. Ms. Fahimi communicated that they were not comfortable signing the report due to the contents of the report, and felt it was best for Administrator Galina Melkonyan to sign. Ms. Fahimi allegedly spoke with Administrator Melkonyan over the phone, whom disagreed with the findings and instructed Ms. Fahimi to not sign the report. Ms. Fahimi communicated to the LPA that had Ms. Melkonyan been available to receive the report, that Ms. Melkonyan would also refuse to sign the report. The LPA explained that signing the report indicates that the report was received by the Facility Representative, not that the Facility Representative agreed with the contents of the report. The LPA stated that the facility could still exercise their appeal rights. Ms. Fahimi communicated understanding, yet claimed that they did not want to sign the report. A Civil Penalty in the amount of $500 was assessed during today's visit, due to admitting and retaining a resident with a prohibited health condition. The prohibited health condition was not cared for by an appropriately skilled professional while at this facility. 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 conducted. Facility Representatives refused to sign the report. A copy of the report and appeal rights were provided to Ms. Melkonyan via email.the state’s words, verbatim · CDSS document, Feb 14, 2022 · control 29-AS-20210712165319

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Feb 16, 2022

87615(a)(1) Prohibited Health Conditions. (a) Persons who require health services for or have a health condition including... those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as R1 was retained at this facility with unstageable pressure injuries, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 14, 2022

Plan of correction: The Administrator agreed to do the following: 1. Schedule a training regarding Prohibited Health Conditions and Pressure Injuries. Verification of scheduled training with the trainers credentials will need to be submitted by 2/16/2022 and completion of training must be submitted no later than 3/2/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87457(c) · Plan of correction due date: Feb 16, 2022

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 the investigation, the licensee did not comply with the section cited above, as a pre-admission appraisal was not conducted prior to accepting R1, as R1 was accepted with a prohibited health condition, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 14, 2022

Plan of correction: The Administrator agreed to do the following: 1. Review Regulation 87457. Once reviewed, submit a Plan of Action, indicating how the facility will maintain compliance with the regulation. Submit Plan of Action no later than 2/16/2022, end of day. A civil penalty in the amount of $500 has been issued due to admitting and retaining a resident with a prohibited health condition. The prohibited health condition was not cared for by an appropriately skilled professional while at this facility.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Ashley Smith and Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 9:30 a.m. When the LPAs arrived, there were two staff and three residents present. The LPAs were greeted by staff and informed them of the reason for the visit. Administrator Galina Melkonyan arrived shortly thereafter. At 10:40 a.m., the LPAs toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPAs began the inspection in the kitchen/food service area. At 10:44 a.m., knives were observed a cabinet with the lock disengaged. At 10:45 a.m., the LPAs observed an accessible lighter, knife sharper, multi-purpose swiss army knife, and pizza cutter in the drawer. At 10:46 a.m., cleaning supplies were accessible in a cabinet with the lock disengaged. At 10:48 a.m., the LPAs observed the medication cabinet, with a disengaged lock. At 10:49 a.m., medications were found accessible in a kitchen drawer. At 10:51 a.m., non-perishable goods were observed to be poorly packaged. At 10:54 a.m., accessible medications were observed in the fridge. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:55 a.m., the hot water temperature was measured in the kitchen at 106.2 degrees Fahrenheit. COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is covered and inaccessible. The facility maintained a comfortable temperature of 69 degrees. Smoke detector(s) and carbon monoxide detector were tested at 11:12 a.m. and were operational at the time of the visit. The fire extinguishers were fully charged yet were purchased 11/2019. All exits have functioning auditory devices, however they were not on during today’s visit. At 10:58 a.m., accessible medications were located in an unlocked hallway closet. At 11:08 a.m., accessible medications were observed in the dresser located in the activity room. The LPAs observed required postings in the foyer. Cameras were observed in the common spaces. The backyard has a covered outdoor area equipped with furniture for resident use. There is a side gate for resident usage and is single-latched. There are no bodies of water noted. The garage is only accessible from outside the facility and is accessible via a garage opener. The washer and dryer are in the garage. BEDROOMS: The LPAs observed the single-occupancy resident bedrooms, which were furnished appropriately with clean linens, furnishings and sufficient lighting. At 11:09 a.m., accessible medications were noted in Bedroom #4. There was a linen closet in the hallway with extra towels and linens. The LPAs reminded the Administrator that staff cannot sleep in common spaces (ie. living room). RESTROOMS: The resident restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The restrooms were sufficiently stocked with supplies and paper towels. Accessible cleaning supplies were observed in all restrooms. At 11:00 a.m., the LPAs observed that the common hallway restroom required additional lighting. At 11:01 a.m., the hot water temperature measured in the hallway restroom at 110.3 degrees Fahrenheit. RECORDS: Personnel records review began at 11:30 a.m. and records were reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. The following was noted: one out of three staff (S2) needs an updated tuberculosis test. Two out of three staff (S1, S2), need a completed Criminal Record Statement. The LPAs were unable to verify the required forty (40) hours of training for Staff #3 (S3), nor the twenty (20) hours of annual training for S2. The Administrator’s Certificate expires 12/21/2022. Resident records review began at 12:10 p.m.; resident records were reviewed for, but not limited to: appraisals, medical records, admissions agreement, consent forms. The appraisals for Resident #1 (R1) and Resident #2 (R2) were not signed by the responsible party. The following documents for R2 were either blank or incomplete: admission’s agreement, consent forms, personal rights form. Resident #3 (R3) is on hospice, yet there was no hospice care plan on file. MEDICATIONS: Medications review began at 4:00 p.m.; medications are centrally stored and locked in a cabinet in the living room; medications are labeled and checked for expiration dates. Medications are not properly documented on the centrally stored medications and destruction record. The Administrator is preparing medications for residents more than twenty-four hours in advance and the LPAs were unable to successfully complete a medication audit. INFECTION CONTROL: Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. The facility has 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 has up-to-date vaccination records for all staff and residents. The facility’s policies and procedures as it pertains to infection control are adequate. The Administrator was reminded of the policy for mask wearing and noted that staff needed to wear masks at all times. 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.the state’s words, verbatim · CDSS document, Dec 6, 2021

The state marks this report as 14 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.