Toluca Lake Manor Senior Assisted Living II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection at 10:00 a.m. This annual inspection had an emphasis on infection control practices and procedures. LPA Urena met with Administrator Mariana Romano at 10:05 a.m., and explained the reason for the visit. At 10:15 a.m., the LPA and Administrator 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: Kitchen appliances were found to be in operable condition. The emergency non-perishable food for six residents, and three staff was found to be sufficient. The fresh food supply was found to be appropriate for the five residents currently residing at the facility. Kitchen knives are stored and locked in a kitchen drawer. The LPA observed two fire extinguishers in the kitchen area to be fully charged and operational. BEDROOMS: There are five (5) bedrooms currently occupied as single occupancy. Bedrooms were supplied with sufficient bedding and linens, and there were no visible hazards. Lighting and room temperature were found to be appropriate. BATHROOMS: There are five (5) bathrooms. Each bedroom has a bathroom. The bathrooms were found to have hand washing signs, personal grooming supplies, and paper towels. See LIC 809C... COMMON AREAS: Common areas included the Living Room and Dining Room. All common areas were appropriately furnished to accommodate a maximum capacity of six (6) residents. There were no visible hazards. SURROUNDING GROUNDS: The property is fenced. The LPA and Administrator observed a large water fountain in the front courtyard area with running water, however the water fountain is filled with stones so that the water is leveled with the stones in the fountain. There is furniture appropriate for outdoor use, and shade available for residents’ use. LPA Urena 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’s policies and procedures as it pertains to infection control are adequate. Exit interview was conducted with Administrator. The report was reviewed with the Administrator, and signatures were obtained. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jan 27, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility unannounced to conduct a required annual inspection at 1:30 p.m. This annual inspection had an emphasis on infection control practices and procedures. LPA Urena met with Administrator Mariana Romano at 1:45 p.m., and explained the reason for the visit. At 2:00 p.m., the LPA and Administrator 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: Kitchen appliances were found to be in operable condition. At 2:20 p.m., during the tour of the kitchen, the LPA, and Administrator observed that the facility’s supply of perishable fresh vegetables was found to be insufficient for five residents and three staff. The supply of fresh vegetables were observed today to be two tomatoes, three heads of lettuce, seven small potatoes, approximately five small onions, a butter squash, and an eggplant. The emergency non-perishable food for six residents, and three staff was found to be insufficient, additionally, many of the can and dry foods found in the emergency pantry were found have expiration dates ranging from 2018 to 2021. The LPA observed two fire extinguishers in the kitchen area to be fully charged and operational, last check date was April of 2021. See LIC 809C... BEDROOMS: There are five (5) bedrooms currently occupied as single occupancy. Bedrooms were supplied with sufficient bedding and linens, and there were no visible hazards. BATHROOMS: There are five (5) bathrooms. Each bedroom has a bathroom. The bathrooms were found to have hand washing signs, personal grooming supplies, and paper towels. COMMON AREAS: Common areas included the Living Room and Dining Room. All common areas were appropriately furnished to accommodate a maximum capacity of six (6) residents. There were no visible hazards. SURROUNDING GROUNDS: The property is fenced. The LPA and administrator observed a large water fountain in the front courtyard area, containing standing/running water, not fenced, which poses an immediate health, safety or personal rights risk to persons in care. There is furniture appropriate for outdoor use and shade available for residents’ use.Based on observation, the licensee as LPA Urena 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’s policies and procedures as it pertains to infection control are adequate. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited, (Please refer to LICs 809-D). Citations were issued today. Exit interview was conducted with Administrator. The report was reviewed with the Administrator, and signatures were obtained. A copy of the report and appeal rights were provided via email.the state’s words, verbatim · CDSS document, Feb 8, 2022

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff left resident in soiled diaper for extended period of time

This is an amended report. On 12/13/2021, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent complaint visit and met with the Administrator at 9:30 a.m. LPA Urena explained the reason for the visit. The reason of the visit was to issue an amended report which was originally issued on 08/05/2021. Regarding the Allegation: It is alleged that staff left residents in soiled diapers for an extended period of time; that residents are not being changed during the night, and residents are left in wet diapers and dried excrement all night. Substantiated On 08/05/2021, LPA Urena interviewed staff #1 (S1) and staff #2 (S2) and asked about the diaper change schedule for residents. S1 covers the day shift and stated that the diapers are changed beginning at 7:30am and two hours thereafter throughout the day. S2 covers the evening shift and stated that diapers are changed at 7:30pm and at 11:00pm, before S2 goes to bed. As a result, residents do not receive diaper changes, if needed, between the hours of 11:00 p.m. and 7:30 a.m. Based on the interviews with staff and their answers, this allegation is found to be Substantiated at this time. Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiencies are cited (Please refer to LIC 9099-D) The Allegation’s finding issued on the 08/05/2021 Report, is being amended from Unsubstantiated to Substantiated. Exit interview conducted. Today's reports, and appeal rights were reviewed with Administrator. Report was issued via email.the state’s words, verbatim · CDSS document, Dec 13, 2021 · control 29-AS-20200921083222

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87625 · Plan of correction due date: Dec 17, 2021

87625- Incontinence Care-The licensee shall... accept or retain a resident who has a manageable ...incontinence condition: (b)The licensee shall be responsible for ...: (2) Ensuring that incontinent residents are checked, including during the night. This requirement is not met as evidence by: Based on interviews, the Licensee did not ensure residents are checked during the night for incontinence, which poses a health and safety, and personal risk to persons in care.the state’s words, verbatim · CDSS document, Dec 13, 2021

Plan of correction: Licensee agrees to set up a schedule to ensure sufficient incontinent checks during the night and a way to ensure that the incontinent care has been completed. Staff will need to fill out an incontinent care log. Deficiency was corrected on todays's date 12/13/2021.

Allegation investigated: Failure to arrange for or provide transportation Failure to manage resident cash resources

This report has been amended due to formatting issues, there is no change in the findings. Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent complaint investigation regarding the above allegations. The LPA met with the Administrator at 10:30am and explained the reason for the visit. On 08/05/2021 at 10:00 a.m., the LPA reviewed a copy of the admission agreement. On 08/05/2021 at 10:30 a.m., the LPA conducted interviews with the facility administrator. On 08/05/2021 at 11:30 a.m., the LPA conducted interviews with facility residents. On 08/05/2021 at 12:00 p. m., the LPA conducted interviews with facility staff. Unsubstantiated Regarding the allegation: Failure to arrange or provide transportation It is alleged that the facility failed to arrange or provide transportation to appointments for residents. In review of the specifications of the Admission Agreement, the monthly payment only covers the basic board and care services for residents. No other services are noted in the admission agreements for residents. As per regulations, the facility is only responsible for arranging for transportation, if not stated otherwise in the admission agreement. Interviews with staff # 1 (S1), staff #2 (S2), and staff #3 (S3) revealed that residents are offered transportation services by staff; however, residents may accept or decline such transportation services. Additionally, transportation is offered to residents through the Mobile Physician Associates services. The administrator stated that they only refused to provide transportation on one occasion as the location exceeded the acceptable travel radius. Resident interviews confirmed that such transportation is offered; however, though they do not always accept those services. Therefore, based on the information gathered through interviews, and records review, the allegation is deemed to be UNSUBSTANTIATED at this time. Regarding the allegation: Failure to manage resident cash resources. It is alleged that the facility failed to manage residents’ cash resources; specifically, that the facility is not paying for resident #1’s (R1’s) phone bill. The LPA conducted records review, resident and staff interviews. According to the Admission Agreement, the facility is responsible for providing basic board and care services. On page #3 of the Admissions Agreement, it specifies that residents can ask for additional optional services: Incontinent Care Products, and Long-Distance Calls (as needed). Staff # (S3) was interviewed about the cash management for residents. S3 stated that the facility does not manage residents’ cash. LPA Eva Miller interviewed the administrator on 11/9/2020 and was informed that R1 has two cell phones with two different carriers. The administrator has taken R1 to pay for the bills, but in the past, there were occasions when R1 waited until the bill was overdue before letting the administrator know that it needed to be paid. However, the phone bill was not the responsibility of the facility. Based on the information gathered through interviews, and records review, the allegation: Failure to manage resident cash resources; is deemed to be UNSUBSTANTIATED at this time. Exit interview conducted with Administrator Mariana Romano. No citations issued. Report was issued via email.the state’s words, verbatim · CDSS document, Dec 13, 2021 · control 29-AS-20201029182646

Allegation investigated: Staff failed to keep facility free of pests Staff failed to provide appropriate care and supervision

Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent complaint investigation regarding the above allegations. LPA me with the Administrator at 9:00am, and explained the reason for the visit. It is alleged that the facility failed to keep facility free of pests. RP states that R1 collects recyclables, and garbage that R1 brings into the residential facility. RP states that the actions of R1, has resulted in vermin running in and out of the garage and into the alley. Additionally, RP states that RP witness bedbugs in the facility. LPA conducted a detailed tour of the facility rooms and beds to look for signs of bedbug infestation, and none was found. Every mattress in each of the six bedrooms has a plastic mattress cover. LPA was vigilant to look for vermin droppings and none was found. Based on the physical observation of the facility bedrooms, beds, and garage, this allegation is deemed UNSUBSTANTIATED at this time. Unsubstantiated Regarding the allegation: Staff failed to provide appropriate care and supervision It is alleged that the facility failed to provide care and supervision for R1 who wanders in the mornings at 5:30 am in inappropriate attire, collecting garbage and recyclable materials daily and especially on Wednesdays, which is trash day. After reviewing R1 file, LPA noted that R1 had the habit to wake up in the early mornings, and collect recyclable materials the day before trash day. Administrator provided pictures of the recyclable materials collected by R1, which piled up on the patio. Per R1 file, R1 was mobile and able to leave facility as needed. R1 last day at facility was June 30, 2021. Based on the review of R1 file and interview with Administrator and staff, this allegation is deemed UNSUBSTANTIATED at this time. Exit interview conducted/ No citations issued/ Report was issued.the state’s words, verbatim · CDSS document, Aug 6, 2021 · control 29-AS-20201019113014

Type of visit: Required - 1 Year

On 08/06/2021 at 11:00 am, Licensing Program Analyst (LPA) Sandra Urena arrived to facility, introduced herself and explained the reason for the visit. LPA conducted an unannounced required annual inspection visit. INFECTION CONTROL: Upon entry, the facility has a sign in book and sanitizing gel. Infection Control signs were visible at entrance. At 11:15 am 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. Bedrooms: At 11:45am, LPA observed the Residents’ bedrooms. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Mattresses had plastic mattress covers. Bathrooms: At 11:50 am, LPA observed the Residents’ restrooms. Restrooms were clean, shower area was in clean condition with grab bars and non-skid mat available. Paper towels were available for drying hands. Hand washing sign was displayed. Kitchen: At 12:00 pm, LPA observed the kitchen/dining area. Knives are stored in a locked cabinet drawer. 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. Emergency food supply is adequate for six residents and two staff. Outdoor Space: At 12:10 pm, LPA observed the Outdoor space. A shaded patio is available for residents to visit with family members. Side gate is unlocked. Facility Records: At 12:30 pm LPA reviewed staff and residents’ records. All flies are in good order, and meet requirements. 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’s policies and procedures as it pertains to infection control are adequate. No deficiencies were cited at this time. Exit interview conducted. Signatures obtained. A copy of report was issuedthe state’s words, verbatim · CDSS document, Aug 6, 2021

Allegation investigated: Failure to arrange for or provide transportation. Failure to manage resident cash resources.

This is an amended report. Please refer to report issued on 12/13/2021. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 5, 2021 · control 29-AS-20201029182646