Granada Golden Years

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator, Mariam Balasanyan and explained the reason for the visit. At approximately 11:18am, with the assistance of the administrator, LPA took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms and carbon monoxide detector is dual and are hardwired. There is a fully charged fire extinguisher is located near the dining room. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Bedrooms: There are four (4) bedrooms designated for residents' use. The bedrooms, in use by residents were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms. One bathroom designated for residents, and one designated for staff. The bathrooms used by residents were properly supplied and had functional fixtures. Hot water temperature was measured at 105 degrees Fahrenheit. There were no cleaning supplies observed in the bathrooms. Common Areas: These included the living room, family room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Medications and medication records are kept locked in a closet located at the living room. Staff and resident records are also maintained there. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The outdoor area was free of hazards. The laundry area is located by the kitchen. There is a locked cabinet by the laundry area where detergents and cleaning supplies are kept. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were review for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a Copy of the Report Issued.the state’s words, verbatim · CDSS document, Nov 3, 2023

Allegation investigated: Facility is in disrepair Staff forced residents to discard used toilet paper in the trash can Staff did not report an incident as required

Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above allegations. The LPA was made aware of all issues prior to receiving this complaint and all allegations were addressed during a Case Management visit on 11/7/2022. The LPA was able to speak to staff and the administrator regarding this visit. Allegation 1. Facility is in disrepair On 11/7/2022 the LPA conducted a case management visit to the home. The LPA was able to interview staff, the administrator and the residents regarding this issue. Staff and the administrator confirmed that a plumbing issue had occurred and that the resident restroom was not functional for about 2 days. While touring room number 3, the LPA also observed that the floor next to the door had buckled and was preventing the door from closing. Based on LPA observation, this allegation is deemed substantiated. The LPA issued a deficiency for this allegation on 11/7/22 and the floor was corrected on 11/13/22 and has since been cleared. Substantiated Allegation 2. Staff forced residents to discard used toilet paper in the trash can LPA was able to interview staff, residents and the administrator regarding this allegation on 11/7/2022 during a case management visit. Staff interviewed confirmed that they had told residents not to throw used toilet paper in the toilet after use and to use a trash can. The administrator also confirmed that they had requested that residents use the trash can because the pipes in the house were old and this would prevent the pipes from clogging up. Residents also stated that they were told not to discard toilet paper in the toilet and to use the trash can for the waste. This allegation is deemed substantiated. Deficiencies were issued during the case management on 11/7/2022 and the Plan of Corrections have been received. Allegation 3. Staff did not report an incident as required The LPA was able to interview the administrator regarding this allegation on 11/7/2022 during a case management visit. The administrator admitted that she did not submit an incident report regarding the the broken pipe issues or the damage to the floor. The facility was issued a deficiency on 11/7/2022 and the plan of correction has since been submitted. Based on the admission from the administrator, this allegation is deemed substantiated at this time. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Nov 18, 2022 · control 31-AS-20221115135709

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the home in response to a notification that the facility toilet had not been functioning properly. The LPA was able to tour the home, interview staff, and interview residents. LPA toured the home and observed that both facility toilets were functioning properly. Interview with staff and residents did confirm, that about 2 weeks ago the toilet had been clogged and it took a few days for the issue to be corrected. While touring room number 3, the LPA did observe that the floor boards in the room had been warped due to water damage for the blocked toilet. The door to room 3 will not close and the resident is unable to close the door properly. Interviews with staff and residents also indicated that the facility is not allowing residents to flush used toilet paper in the toilet and are directing them to throw it in a trash can. Facility staff stated that residents are asked to do this as a precaution, so that the toilets will not overflow. A review of the facility incident reports also indicated that a report was not submitted for the broken toilet or the repair. The LPA was able to discuss the issues over the phone with the administrator. Exit interview conducted, deficiencies cited and report issued.the state’s words, verbatim · CDSS document, Nov 7, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468(a)(1) · Plan of correction due date: Nov 8, 2022

Personal Rights of Residents in All Facilities-To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: The licensee did not allow residents to flush toilet paper in the toilet and had them throw it in the trash can, which posed an immediate health and safety risk to the residents in carethe state’s words, verbatim · CDSS document, Nov 7, 2022

Plan of correction: The administrator will put in writing their understanding of this regulation and submit it to the LPA by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Nov 9, 2022

Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing...within seven days of the occurrence of any events specified in The licensee did not submit an incident report regarding the broken toilet, which posed a potential health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Nov 7, 2022

Plan of correction: The administrator agrees to submit an incident report and submit it by the POC date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80087(a) · Plan of correction due date: Nov 14, 2022

80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by: Based on LPA observation, the licensee did fix a residents floor causing a resident to not be able to close the door, which poses a potential risk to the resident in carethe state’s words, verbatim · CDSS document, Nov 7, 2022

Plan of correction: Administrator will have the floor fixed and submit pictures of the correction by the POC date

Allegation investigated: Staff uses illegal drugs while providing care and supervision Staff behavior poses as a risk to the residents Residents are being over medicated while in care

Licensing Program Analyst arrived at the facility in order to complete these complaint allegations. The LPA was greeted by facility staff and explained the reason for the visit. Allegation 1. Staff uses illegal drugs while providing care and supervision LPA was able to speak with staff, residents and the administrator regarding this allegation. All residents confirmed that they have never seen a staff member under the influence of drugs or alchohol. A review of associated staff members indicated that the staff member in question is not associated to this facility and has never worked for this facility. The LPA was able to interview the back-up administrator who also confirmed that she has never suspected any of her staff of doing drugs, nor has she ever received a complaint of a staff member acting intoxicated at work. Based on interviews and review of the facility documents, this allegation is deemed to be unsubstantiated. Continues on LIC 9099-C Unsubstantiated Allegation 2. Staff behavior poses as a risk to the residents LPA was able to interview all residents and staff in order to come to a finding for this allegation. All residents interviewed are verbal and cognizant of their surroundings. None of the residents interviewed felt as though the staff behavior ever posed a risk to their well being. All residents confirmed that staff are helpful and professional. An interview with the administrator assistant also confirmed that there has never been any complaints regarding the staffs behavior and the staff member in question does not work at this facility. Based on interviews with staff and residents, this allegation is deemed unsubstantiated. Allegation 3. Residents are being over medicated while in care LPA was able to interview staff, residents and go through resident medications in order to come to findings for this allegation. All residents in the home are cognizant of their surroundings and their feelings. All residents confirmed that they have all been given their medications as prescribed and that they have never been drugged or over medicated. Facility staff also confirmed that all medications are given as prescribed and that all medications are correct. Medications for two residents were inspected by the LPA and were observed to be correct. Based on interviews and a medication review, this allegation is deemed unsubstantiated. Exit interview conducted and report issued,the state’s words, verbatim · CDSS document, Sep 7, 2022 · control 31-AS-20220803093341

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility and was greeted by facility staff. Staff took the LPA's temperature before allowing the LPA to enter the home. Staff was observed to be wearing a mask. The home has 4 bedrooms and two bathrooms. The smoke alarms appeared to be functional, as well as the carbon monoxide detector. The fire extinguisher was purchased on 5/19/2021 and appeared to be functional. Hand sanitizer, masks and gloves were also observed in the entry of the facility. The facility is currently following their mitigation plan and no deficiencies were observed during todays visit. Exit interview conducted and report issued.the state’s words, verbatim · CDSS document, Jun 7, 2022

Allegation investigated: Neglect/Lack of Supervision: Staff neglected Resident #1 (R1) resulting in severe dehydration and multiple pressure injuries. Resident was placed on hospice without the consent of the responsible party. Facility staff did not ensure resident received physical therapy. Staff ordered medical equipment through the resident's insurance without consent. Facility staff overmedicated resident.

Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an unannounced subsequent complaint visit to deliver findings for the above allegations. LPA Guzman Chavez met with Administrator, Sevak Arutyunyan and explained the reason for the visit. On 05/22/2020, the Department received a complaint regarding an allegation of Neglect/Lack of Supervision. It was alleged that the Granada Golden Years staff neglected Resident #1 (R1) resulting in hospitalization with a diagnosis of severe dehydration and multiple pressure injuries. On 05/27/2020, from 9:45am to 11:15am., LPA Richardson conducted the initial complaint visit and met with staff Naira Alikhanyan and Administrator Sevak Arutyunyan at 9:45am. The LPA conducted a physical plant tour with staff Alikhanyan and at 10:30am reviewed and obtained copies of pertinent documents relevant to the investigation. No immediate health and safety hazards were observed. The LPA briefly discussed the allegations with the Administrator and explained that further investigation was needed. ...Continued on LIC 9099C... Unsubstantiated ...Continued from LIC 9099... The complaint was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Christine Ferris on 05/26/2020. Investigator Ferris conducted interviews with staff, residents and witnesses on 07/14/2020, 07/20/2020, 07/26/2020, and 08/05/2020. Investigator Ferris obtained copies of R1’s medical records from Northridge Hospital Medical Center on 06/24/2020; from Kaiser Permanente Panorama City on 06/18/2020; from Physician’s Preferred Hospice Care on 07/14/2020; from Omni Wound Physicians on 07/29/2020; and Astoria Nursing and Rehabilitation Center on 07/30/2020. On 07/15/2019, R1 was admitted to Astoria Skilled Nursing Facility due to multiple falls and non-compliance with medication regimen and home safety recommendations. R1 lived in own home prior to being admitted and refused to transition out of home or hire caregivers. A report for self-neglect was filed for R1 in January 2019 and again on 07/15/2019. R1 was discharged on 08/19/19 with diagnosis of right heel deep tissue injury and admitted to the Granada Golden Years facility. Information in the Hospice records indicated R1’s start of hospice care was 08/30/2019 and end of care date was 10/04/2019, the day R1 was admitted to the hospital. Hospice nurses provided wound care to R1 every 3 to 4 days. It was also noted that R1’s family were in communication with the hospice agency and aware R1 was receiving hospice services. Information reviewed in the OMNI Wound Physicians report indicated on 09/11/2019, R1 was treated for chronic wound to bilateral posterior heels as R1 was unable to move both lower extremities; left heel, pressure ulcer stage 3-chronic; pressure ulcer stage 4-chronic. A bilateral vascular study of the lower extremity arteries was performed for signs and risk faction of peripheral vascular disease (PVD). The study indicated non-compressible arteries on both extremities. High complexity, treatment course is prolonged due to sustained inflammation vascular factors-immobility. Staging care due to poor wound progression. R1 was seen again on 09/17/2019 where left buttock pressure ulcer stage 3 was added to the diagnoses and treatment plan. R1 was seen again by the wound care nurse on 09/24/2019 and 10/01/2019. ...Continued on LIC 9099C... ...Continued from LIC 9099C... On 10/04/2019, R1 was taken to the Northridge Hospital Medical Center Emergency Room due to R1 was noted to have altered mental status. During the ER visit, R1 was diagnosed with severe sepsis, acute parotitis, acute kidney injury, hypernatremia, and acute encephalopathy secondary to metabolic derangement. On 10/04/2019, R1 was transferred from the ER and admitted to Kaiser Permanente Panorama City for assessment. During the hospital stay, a speech pathology clinical swallow assessment was completed. The assessment results found that R1 demonstrated mild oral dysphagia with reduced mastication and swallow functional for soft foods with no signs of aspiration evidenced. The discharge summary dated 1019/2019, stated R1 was on hospice prior to admission and had a history of stroke, diabetes mellitus type 2, severe malnutrition, chronic kidney disease, and admitted 10/04/2019 for metabolic encephalopathy with severe hypernatremia, dehydration, acute chronic kidney failure, sepsis with MRSA bacteremia likely due to skin/decubitus ulcers and new onset atrial fibrillation. R1 was receiving hospice care during residency at the facility and per the hospice nurse, R1 was properly cared for by facility staff as they adhered to the instructions given to care for R1, communicated well concerning R1’s condition, and there was no concern for neglect or abuse. Per hospice records, R1 was receiving wound care by hospice nurses and OMNI Wound Physicians and R1’s decline was due to R1’s medical condition and not contributed to by facility staff. Based on the information and documentation obtained and reviewed, the Department does not have sufficient evidence to support the allegation of Neglect/Lack of Supervision. Therefore, the above allegation is deemed Unsubstantiated at this time. Also, it was alleged that Resident #1 (R1) was placed on hospice without the consent of the responsible party. Interview with R1’s family member revealed that the facility had mentioned to family member that R1 was on Hospice ‘indirectly’, but they did not know R1 was actually signed up with hospice care. However, interviews with the Physician’s Preferred Hospice Licensed Vocational Nurse (LVN) revealed that they personally called and spoke with R1’s family and explained what hospice entailed, the services provided, the care provided, the explanation of benefits, and the medical equipment. Interviews with hospital personnel also revealed that the primary skilled nurse was receiving phone calls from R1’s family concerning R1’s condition. ...Continued on LIC 9099C... ...Continued from LIC 9099C... Furthermore, interviews with staff revealed that R1’s family had contacted the hospice agency and approved the hospice services. Record review revealed that R1 signed themselves into hospice as they were able to make decisions on their own. Also, on page six of the Physician’s Preferred Hospice, Inc. Comprehensive Nursing Assessment, the narrative and disease trajectory states, “…services by Hospice MSW… were explained and offered to the family and the patient.” Additionally, on the RN Prognosis Summary of the Physician’s Preferred Hospice Care medical records stated, “…the family wishes no further aggressive treatment and has now opted for hospice care for symptoms management and comfort care only…services were discussed in detail with patient’s son and all consents for hospice care were signed.” Based on interviews and record review, the Department does not have sufficient evidence to support the allegation of “resident was placed on hospice without the consent of the responsible party”. Therefore, the allegation is deemed Unsubstantiated at this time. It was further alleged that staff did not ensure Resident #1 (R1) received physical therapy. Interviews with staff revealed that R1 was to receive physical therapy through Kaiser Home Health upon admission to the facility. However, facility staff reported that R1 refused physical therapy shortly after. Additionally, interviews with staff revealed that R1 refused to allow Kaiser Hospital Home Health to touch R1 and the physical therapy discontinued. Furthermore, interviews with staff revealed that R1 was ‘cognitive but non-compliant’. Based on interviews, the Department does not have sufficient evidence to support the allegation of “staff did not ensure resident received physical therapy”. Therefore, the allegation is deemed Unsubstantiated at this time. It was also alleged that staff ordered medical equipment through the resident’s insurance without consent. It was reported that an oxygen machine was ordered for R1 without the approval from R1’s family members. Record review revealed that in the Physician’s Preferred Hospice Care Plan for R1 dated 8/30/2019 to 10/04/2019, the hospice doctor had prescribed under ‘medical equipment’ an A-1 Oxygen machine. Subsequently, through the Hospice Care Plan, the oxygen machine was ordered as it was considered to be necessary for R1’s health. Based on the information and documentation obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “staff ordered medical equipment through the resident’s insurance without consent”. Therefore, the allegation is deemed Unsubstantiated at this time. ...Continued on LIC 9099C... ...Continued from LIC 9099C... Also alleged was facility staff over medicated resident. Review of medical documents revealed that R1’s was admitted to hospice on 8/30/2019 with a primary diagnosis of atherosclerotic heart disease of native coronary artery without angina pectoris and other comorbidities which included but not limited to: shortness of breath, wheezing, depression, anxiety, agitation, generalized body weakness, legal blindness, paralysis due to stroke, and DMII with moderate kidney disease stage three. Due to R1’s medical condition, the Hospice Doctor prescribed nine different medications to be taken by R1 once back at the facility. Interviews with staff revealed that R1 was ‘actively declining’. Also, interview with the Hospice Nurse revealed that there were no concerns regarding staff neglecting or abusing R1 as they would have ‘reported it’. Furthermore, the Hospice Nurse reported that staff was attentive and R1 was well cared for. Based on interviews and record review, the Department does not have sufficient evidence to support the allegation of “facility staff over medicated resident”. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. No citations issued. A copy of this report has been issued. ...Continued from LIC 9099C... The complaint was referred to Community Care Licensing Investigations Branch (IB) and assigned to Investigator Christine Ferris on 05/26/2020. Investigator Ferris conducted interviews with staff, residents and witnesses on 07/14/2020, 07/20/2020, 07/26/2020, and 08/05/2020. Investigator Ferris obtained copies of R1’s medical records from Northridge Hospital Medical Center on 06/24/2020; from Kaiser Permanente Panorama City on 06/18/2020; from Physician’s Preferred Hospice Care on 07/14/2020; from Omni Wound Physicians on 07/29/2020; and Astoria Nursing and Rehabilitation Center on 07/30/2020. On 07/15/2019, R1 was admitted to Astoria Skilled Nursing Facility due to multiple falls and non-compliance with medication regimen and home safety recommendations. R1 lived in own home prior to being admitted and refused to transition out of home or hire caregivers. A report for self-neglect was filed for R1 in January 2019 and again on 07/15/2019. R1 was discharged on 08/19/19 with diagnosis of right heel deep tissue injury and admitted to the Granada Golden Years facility. It was noted that Kaiser Hospital Home Health was scheduled to perform physical therapy but R1 refused and physical therapy was discontinued. R1 was not conserved and made own decisions regarding medical care. Information in the Hospice records indicated R1’s start of hospice care was 08/30/2019 and end of care date was 10/04/2019, the day R1 was admitted to the hospital. Hospice nurses provided wound care to R1 every 3 to 4 days. It was also noted that R1’s family were in communication with the hospice agency and aware R1 was receiving hospice services. R1 was given insulin injections daily by a nurse, either hospice or home health, as noted in the medication log from 09/29/2019 to 10/04/2019. The hospice nurse stated that R1 was properly cared for by facility staff as they adhered to the instructions given to care for R1 and communicated well concerning R1’s condition. Information reviewed in the OMNI Wound Physicians report indicated on 09/11/2019, R1 was treated for chronic wound to bilateral posterior heels as R1 was unable to move both lower extremities; left heel, pressure ulcer stage 3-chronic; pressure ulcer stage 4-chronic. A bilateral vascular study of the lower extremity arteries was performed for signs and risk faction of peripheral vascular disease (PVD). ...Continued on LIC 9099C... ...Continued from LIC 9099C... The study indicated non-compressible arteries on both extremities. High complexity, treatment course is prolonged due to sustained inflammation vascular factors immobility. Staging care due to poor wound progression. R1 was seen again on 09/17/2019 where left buttock pressure ulcer stage 3 was added to the diagnoses and treatment plan. R1 was seen again by the wound care nurse on 09/24/2019 and 10/01/2019. On 10/04/2019, R1 was taken to the Northridge Hospital Medical Center Emergency Room due to R1 was noted to have altered mental status. During the ER visit, R1 was diagnosed with severe sepsis, acute parotitis, acute kidney injury, hypernatremia, and acute encephalopathy secondary to metabolic derangement. On 10/04/2019, R1 was transferred from the ER and admitted to Kaiser Permanente Panorama City for assessment. The discharge summary dated 1019/2019, stated R1 was on hospice prior to admission and had a history of stroke, diabetes mellitus type 2, severe malnutrition, chronic kidney disease, and admitted 10/04/2019 for metabolic encephalopathy with severe hypernatremia, dehydration, acute chronic kidney failure, sepsis with MRSA bacteremia likely due to skin/decubitus ulcers and new onset atrial fibrillation. R1 was receiving constant and consistent medical care through hospice services and OMNI Wound Physicians while residing in the facility. Based on the information obtained, the above allegation is deemed Unfounded at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Exit interview conducted and a copy of this report was reviewed and issued.the state’s words, verbatim · CDSS document, Feb 3, 2022 · control 31-AS-20200522145430