Ano One Facility for the Elderly

Allegation investigated: Staff failed to administer resident’s medication as prescribed.

Licensing Program Analyst (LPA) Emily Peraldi, conducted an unannounced subsequent visit to deliver findings at this facility. At 1:30 p.m., the LPA met with Administrator and explained the reason for the visit. During the initial visit on 08/17/2021, between 11:25 a.m. and 4:30 p.m., LPA Peraldi toured the facility, reviewed resident records and medications. During a subsequent visit, on 08/25/2021 between 9:30 a.m. to 5:00 p.m., LPA Peraldi and LPA Ashley Smith toured the facility, interviewed four (4) staff, including the Administrator, reviewed records and medications. During a subsequent visit on 05/19/2023 between 12:30 p.m. and 1:45 p.m., LPA Peraldi conducted a brief physical plant tout, conducted interviews with four (4) out of five (5) residents and with one (1) staff. Continued on LIC 9099-C. Substantiated Regarding the allegations: Staff failed to administer resident’s medication as prescribed. It was alleged that staff failed to properly assist residents with the self-administration of medication as prescribed. During a subsequent visit, LPAs Peraldi and Smith conducted a review of medication and medication documentation with the Administrators and observed the following: Resident #2’s (R2’s) Carbidopa-Levodopa (sp) per directions from physician, was to be administered four (4) times a day. However, the Medication Administration Record (MAR) confirmed that the Administrators were assisting with the self-administration of this medication three (3) times a day. The Administrators explained that R2 would refuse one (1) tablet of the medication and would only take the medication three (3) times a day. Based on the observation and record review, the preponderance of evidence standard has been met, therefore the above allegation is deemed Substantiated at this time. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, and California Health and Safety Code the following deficiency were cited (refer to LIC 9099-D). Failure to correct the deficiency may result in civil penalty. Exit interview conducted. A copy of the report and appeal rights were provided. Regarding the allegations: Staff neglect resulting in resident's poor hygiene. Staff are not meeting residents’ incontinence needs. It was alleged that staff neglected Resident #1 (R1) hygiene and are not meeting R1’s incontinence needs. Interviews with staff revealed that residents, including R1 are bathed twice a week. Interviews with staff revealed that majority of residents wear diapers and that staff change resident’s diapers two (2) to three (3) times a day. Interview with Administrator revealed that R1 has a catheter and that R1 is on Home Health services. R1’s Home Health continues to monitor R1’s catheter and staff continue to tend to R1’s catheter within the scope of their care. During the physical plant tour on 8/17/2021, 08/25/2021 and 05/19/2023, residents appeared well groomed. The LPA’s did not smell any odors nor did residents indicate that staff are neglectful. Additionally, resident interviews did not reveal any issues with their incontinence needs. The information obtained during the investigation did not include evidence sufficient to corroborate the allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Regarding the allegation: Staff failed to assist residents with diabetes care. It was alleged that staff failed to assist residents with diabetes care. During the interview with the Administrator, it was revealed that two (2) out of five (5) residents, including R1 require assistance with diabetes care. The Administrator stated that staff supervise and assist the two residents with their diabetes care, including blood sugar check. The Administrator stated that the two residents can inject the insulin pen on their own. Interviews with residents did not reveal any issues with staff neglect towards diabetes care. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 28, 2023 · control 29-AS-20210809155552

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 29, 2023

87465 (a) (4) Incidental Medical and Dental Care...(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation, record review, the licensee did not comply with the section cited above as R2’s medication of Carbidopa-Levodopa (sp) was not being assisted per directions from physician which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 28, 2023

Plan of correction: Within 24 hours, the Licensee will notify LPA when training will be completed. Licensee agreed to do a complete medication audit for the facility and training for all medication staff and submit documentation to CCL.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management - Annual Continuation at the facility today continuing the inspection that began on 08/16/2023. At 9:30 a.m., the LPA met with the Administrators and explained the reason for the visit. RECORD REVIEW: Between 9:45 a.m. to 11:10 a.m., the LPA reviewed resident records for five (5) out of five (5) residents. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, and consent forms. All files were in order. The LPA conducted a personnel file review for all staff regularly scheduled and reviewed for, but not limited to: personnel records, health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. At 3:00 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for five (5) residents and observed that all medications were properly documented. Copy of valid liability insurance and Facility Emergency Plan was provided to the LPA during the visit. No deficiencies cited at this time. Exit interview conducted. A copy of the report of provided.the state’s words, verbatim · CDSS document, Sep 28, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 2:16 p.m., the LPA met with staff and explained the reason for the visit. At 2:30 p.m., the Administrator arrived at the facility. At 2:45 p.m., the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 2:46 p.m., hot water measured at 108.5-degree Fahrenheit. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away inside a kitchen cabinet. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms and three (3) bathrooms for resident's use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 2:52 p.m., hot water measured between 108.6 and 115.8-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Continued on LIC 809-C. OUTDOOR SPACE: At 2:56 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. There are no bodies of water on the premises. Passageways were free and clear from obstruction. The facility has an accessory dwelling unit (ADU) at the back of the facility and is not part of the license. The ADU remains inaccessible to residents. Laundry units are located inside the ADU. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 07/18/2023. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. Exits have functioning auditory devices. At 3:00 p.m., fire alarm/ carbon monoxide detectors were tested and functioned properly. Medications and first aid kits are located in a locked hallway closet. The LPA observed cameras in the common areas, and throughout the exterior perimeter of the facility. Night lights were present in the hallways and passages. Between 3:05 p.m. and 3:16 p.m., the LPA conducted interviews with three (3) staff and one (1) resident. Due to time constraints the LPA will return to complete the annual at a later date. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 16, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:23 a.m., the LPA met with staff and explained the reason for the visit. At 10:35 a.m., the LPA spoke with the Administrator, Artur Atoyan via telephone, and the Administrator authorized staff Armine Tagaryan, to sign the report. The Administrator was unavailable during the time of the visit. This annual had a specific emphasis on infection control practices and procedures. At 11:02 a.m., the LPA, along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:05 a.m., hot water measured at 116.9-degree Fahrenheit. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 09/13/2021. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. Exits have functioning auditory devices. At 11:37 a.m., fire alarms and carbon monoxide detectors were tested and functioned properly. Medications and first aid kits are located in a locked hallway closet near the kitchen area. The LPA observed cameras in the common areas, and throughout the exterior perimeter of the facility. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 11:08 a.m., hot water measured between 109.3 and 111.5-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Continued on LIC 809-C. OUTDOOR SPACE: At 11:12 a.m., the LPA observed the back patio which has a covered outdoor area for resident use near the garage. There is a gate on the side of the house designated for an emergency exit. Passageways were free and clear from obstruction. The garage is detached from the house and remains locked and inaccessible to residents. Laundry units are located inside the garage. INFECTION CONTROL: During today’s visit, the LPA spoke with the staff regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. The LPA observed a 30-day 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 not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. No deficiencies were observed at this time. Exit interview conducted with the staff. Report issued and a copy of the report will be provided via email.the state’s words, verbatim · CDSS document, Aug 2, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Emily Peraldi and Ashley Smith conducted an unannounced Case Management-Deficiencies inspection visit at the facility today due to deficiencies observed during the investigation of complaint control # 29-AS-20210809155552. At 11:36 a.m., LPA Peraldi toured the facility. The LPA observed accessible chemicals in the bathroom cabinets. During a previous visit conducted on 08/17/2021, the LPA toured the facility and observed over the counter medications and disinfectants accessible in restrooms. Items were secured upon observation. At 11:41 a.m., the LPAs interviewed Administrator ARTUR ATOYAN. Administrator stated that Resident #1 (R1) went to a skilled nursing facility a few months ago. Per record reviews, R1 was sent to the hospital and transferred to a skilled nursing facility from 06/10/2021 to 06/29/2021. The facility did not send an Incident Report for either unusual incidents. During a previous visit conducted on 08/17/2021, staff mentioned to LPA Peraldi that Resident #2 (2) had passed away a few weeks ago. LPA Peraldi asked Administrator about the death and Administrator stated that R2 passed away on 08/08/2021. The death was never reported to the Department. LPA Peraldi requested for a copy of the death report. Administrator stated that they believed that the time frame to submit a death report was ten (10) days. LPA pointed out that the death report states to submit the written report within seven (7) days of occurrence. At 11:31 a.m., LPA Peraldi observed a camera in Resident #3’s (R3) room. Per interviews, Administrator confirmed that the camera is there for additional oversight. 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, Aug 25, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Aug 25, 2021

87705 (f)(2)Care of Persons with Dementia The following shall be stored inaccessible to residents with dementia: Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances ... This requirement is not met as evidenced by: Based on observations, the licensee did not comply with the section cited above, as medications and disinfectants were accessible, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 25, 2021

Plan of correction: These items were secured upon observations. Plan of correction met.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.2(a)(1) · Plan of correction due date: Aug 25, 2021

87468.2 (a)(1) Additional Personal Rights of Residents in Privately Operated Facilities. Residents...shall have the following personal rights: To have a reasonable level of personal privacy in accommodations, medical treatment, personal care... This requirement is not met as evidenced by: Based on observations and interview, the licensee did not comply with the section cited above, as there was a camera in one out of four resident rooms (R3), which poses an immediate personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 25, 2021

Plan of correction: During todays visit, the licensee removed the camera. Plan of correction met.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 25, 2021

87211(a)(1)(D) Reporting Requirements. A written report shall be submitted to the licensing agency ... within seven days of the occurrence: Any incident which threatens the welfare, safety or health of any resident. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above, as an incident report was not submitted for R1's hospitalization or R2's death in a timely manner, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 25, 2021

Plan of correction: The Administrator agreed to the following: Submit incident report for R1 and updated death report for R2 by 08/30/2021.