Blue Skies Ranch

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an Annual Required visit and inspection at the facility. Upon arrival, LPA was not able to enter the property, due to the front gate being locked. LPA contacted the Administrator via telephone, who opened the front gate. Administrator Eilene Krakover was informed the reason of the visit. The annual inspection entailed a physical plant of the inside and outside of the facility, which included: common areas, resident rooms and bathroom; living and dining, and kitchen. Smoke alarms and carbon monoxide detectors are hardwired and interconnected. Inside temperature was comfortable and cool. Fire extinguisher were fully charged. Common Areas: These included the living 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. There is a storage space, that is locked at all times, where records, medications, and supplies are maintained. 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, and chemicals were stored in a locked cabinet in the kitchen. Cleaning supplies were maintained and kept locked and inaccessible. Bedrooms: There are three (4) bedrooms designated for residents' use. All resident rooms were properly furnished with appropriate beddings and linens with sufficient lighting. LPA was informed by the Administrator, room #4 is being shared by a staff/caregiver with resident. LPA informed Administrator, that staff are not allowed to sleep in resident's rooms. This is a potential health and safety risk to residents in care. Citation will be issued. (LIC809C cont'd) Bathrooms: There are three and a half (3 1/2) bathrooms designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 110.7 degrees Fahrenheit. Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor use. The backyard has a swimming pool, that is fenced and inaccessible. The outdoor area was free of hazards. Record review: Facility, staff, and resident records reviewed, all documents were in compliance with Licensing requirement. Citation issued, appeal rights provided, and a copy of the report issued.the state’s words, verbatim · CDSS document, Sep 20, 2025

Allegation investigated: Staff do not ensure that resident's hygiene needs are met while in care

On 09/09/24, at 9:50am, Licensing Program Analyst (LPA) Gina Saucedo and Angelica Segovia arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Administrator, Eilene Krakover. LPA explained the purpose of this visit was to gather additional information and deliver findings for this complaint. On 03/05/2024, Licensing Program Analyst (LPA) Tuesday Cabiness initiated the complaint investigation. On 09/09/24, LPA Saucedo and LPA Segovia asked for the census, staff, and resident rosters. On 09/09/24, LPA Saucedo interviewed additional staff and residents, conducted a physical tour, gathered additional information, and delivered findings. LIC 9099C-continued Substantiated Regarding the allegation: Staff do not ensure that resident's hygiene needs are met while in care. It is being alleged that the resident’s care is being neglected. Although four (4) out of four (4) residents confirmed that their hygiene needs are met, LPA reviewed the file of resident #1 (R1) who needed assistance with several hygiene needs and was missing documentation. R1's file did not have a Preplacement Appraisal and Resident Appraisal documentation on file. The Appraisal/Needs and Services Plan states R1 needed help with incontinence, bath/shower, eating, and leg elevation. Physician's report stated R1 was ambulatory but R1 was bedridden and had Traumatic Brain Injury. LPA asked the administrator about hospice care and administrator stated they had six (6) waivers. LPA asked another staff if R1 received hospice care or home health and they stated, "no." According to staff interviews, it was confirmed that R1 did need more hygiene care than other residents. Therefore, based on the LPA's records review, staff and resident interviews, the above allegation(s) above is SUBSTANTIATED at this time. An exit interview was conducted, a citation(s) was issued for the above allegation(s), and a copy of this report was given to the Administrator with the Appeals Right.the state’s words, verbatim · CDSS document, Sep 9, 2024 · control 31-AS-20240228152538

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(d) · Plan of correction due date: Sep 10, 2024

Basic Services-87464(d)A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources.This requirement was not met as evidenced by: Based on the LPA's observation, file review and interviews the administrator did not ensure one out of one file at the facility to have a preappriasal, resident appraisal and correct information on the physician's reportl which poses an Immediate Health, Safety or Personal Rights/risks to persons in care.the state’s words, verbatim · CDSS document, Sep 9, 2024

Plan of correction: Administrator will need to provide the proper hygiene needs to all resident's in care according to their individual needs by trraining all staff. POC Date: 09/10/24

Allegation investigated: Staff leave bedridden resident alone in the facility while in care Staff do not ensure that resident is able to reach them to request assistance as necessary

On 09/09/24, at 9:50am, Licensing Program Analyst (LPA) Gina Saucedo and Angelica Segovia arrived at the facility to conduct an unannounced, subsequent complaint visit and was greeted by Administrator, Eilene Krakover. LPA explained the purpose of this visit was to gather additional information and deliver findings for this complaint. On 03/05/2024, Licensing Program Analyst (LPA) Tuesday Cabiness initiated the complaint investigation. On 09/09/24, LPA Saucedo and LPA Segovia asked for the census, staff, and resident rosters. On 09/09/24, LPA Saucedo interviewed additional staff and residents, conducted a physical tour, gathered additional information, and delivered findings. LIC 9099C-continued Unsubstantiated Regarding the allegation: Staff leave bedridden resident alone in the facility while in care. It is being alleged that the resident is left in bed all day. LPA's interviewed four (4) out of four (4) residents that confirmed that they are not left in bed all day and/or alone in the facility while in care. LPA's also confirmed with resident #2 (R2) who is bedridden if they are left alone in the facility while in care and R2 stated, "no, staff is always here." LPA's interviewed two (2) staff that confirmed that residents are able to leave their room whenever they want and ask for assistance if they want to leave their room and our never left alone in the facility. During the visit, LPA's were able to confirm that there were two (2) staff present and working. Therefore, based on the LPA's records review, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time. Regarding the allegation: Staff do not ensure that resident is able to reach them to request assistance as necessary. It is being alleged that there is no way of communication between staff and resident for help. LPA's interviewed four (4) out of four (4) residents that confirmed they can request help at any time and as necessary. LPA confirmed with resident #2 (R2) who is bedridden the means of requesting assistance and R2 stated, "I have a bell." LPA's interviewed two (2) staff that confirmed they regular check in with the residents to see if they need any assistance. During the visit, LPA's observed assistance being provided to the residents. Therefore, based on the LPA's records review, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time. An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Sep 9, 2024 · control 31-AS-20240228152538

Type of visit: POC

LPA Mariana Agban conducted a Plan of Correction (POC) Visit subsequent to citations issued during the Complaint 31-AS-20230703161605 conducted on 07/22/24. LPA Agban met with Administrator Eilene Krakover. An entrance interview was conducted. 87468.1(a) & 87468.1(a)(8) - Personal Rights of Residents POC: Administrator agreed to email LPA a statement of understanding this section of CCR by the POC date and Administrator will hire a licensed vendor to train all staff on Basic Services Regulations. POC Date: 07/22/24 / Correction Completed / POC Cleared on 08/01/24. LPA obtained copies of the statement of understanding and staff training certificates. 87625 (b)(3) -Managed Incontinence POC: Administrator agrees to hire a licensed vendor to train all staff on Managed Incontinence POC Date: 07/22/24 / Correction Completed / POC Cleared on 08/01/24. LPA obtained copies of staff training certificates. 87555(b)(5) - General Food Services POC: Administrator agrees to hire a licensed vendor to train all staff on General Food Services POC Date: 07/22/24 / Correction Completed / POC Cleared on 08/01/24. LPA obtained copies of staff training certificates. 87468.1(a)(11) - Personal Rights of Residents POC: Administrator agrees to hire a licensed vendor to train all staff on Personal Rights POC Date: 07/22/24 / Correction Completed / POC Cleared on 08/01/24 LPA obtained copies of staff training certificates.the state’s words, verbatim · CDSS document, Aug 9, 2024

Allegation investigated: Staff administered resident medication without consent Staff leaves resident in bed for an extended period of time. Staff left resident in soiled for an extended period of time. Staff did not provide adequate food service to resident in care. Facility does not have adequate staff to care for residents. Staff did not allow resident visitors.

Licensing Program Analyst (LPA) Mariana Agban arrived at the facility to conduct an unannounced subsequent complaint investigation based on further information obtained for this complaint. Upon arrival, LPA was greeted by the administrator, and the purpose of the visit was explained. Today's investigation consisted of an interview with the Administrator, and obtaining additional documents. Allegation: Staff administered resident medication without consent It was alleged that staff administered Seroquel to R1 from April 20, 2023, to April 23, 2023, without consent from R1's responsible party. Records review and interviews revealed that the administrator didn't notify R1's responsible party regarding R1's change of condition and the new medication prescription. Administrator did administer Seroquel medication on April 20, 2023, before getting consent from the R1 responsible party. Based on information obtained the allegation is deemed Substantiated at this time. (Conintue on 90099C) Substantiated Allegation: Staff leaves resident in bed for an extended period of time. It was alleged that Staff left R1 for extended period of time in bed. Interviews with W2 and W6 confirmed that staff left R1 for an extended time. Both direct witnesses confirmed that staff would only move R1 out of bed when there was a visitor in the facility or when W2 requested another staff assistance to move R1 out of the bed. W2 stated that R1 was left alone without food and no changed clothes. The administrator didn't deny the allegation. Based on information obtained the allegation is deemed Substantiated at this time. Allegation: Staff left resident in soiled for an extended period of time. It was alleged that staff left R1's soiled in their diapers for an extended period of time. Interview with W2 revealed that the facility is understaffed and thus staff would use multiple diapers on one resident so staff won't change R1 as often. However, Interviews with the Administrator and staff revealed that R1 would never notify them that they need to use the restroom or when they want to change their diaper. R1's medical records indicated that R1 needs assistance with incontinence care. The administrator didn't deny the allegation. Based on information obtained the allegation is deemed Substantiated at this time. Allegation: Staff did not provide adequate food service to resident in care. It was alleged that staff left R1 in their dark bedroom without food. The administrator denied the allegation. However, interviews with direct witnesses confirmed that staff did not provide adequate food service to residents in care. W2 stated that R1 stayed until 11:00 AM without breakfast, and staff wouldn't offer an alternative option when R1 did not like the food. W6 noted that residents would eat only one meal daily without any snacks. W6 mentioned that staff would tell residents to wait so they could combine breakfast and lunch meals. Based on information obtained the allegation is deemed Substantiated at this time. Allegation: Facility does not have adequate staff to care for residents. It was alleged that facility doesn't have enough staff to meet residents needs. Interviews with direct witnesses revealed that the facility had 4 residents with only one staff and the Administrator. Direct witnesses confirmed that the Administrator would leave the residents with one staff to run errands. W1 stated that the Administrator had called for assistance to left up from the bathroom floor. W2 stated that the facility has been always understaffed and the administrator was aware and didn't act on it. Based on information obtained the allegation is deemed Substantiated at this time. Allegation: Staff did not allow resident visitors. It was alleged that Administrator did not allow visitors for R1. RP stated that on 6/21/23, the Administrator asked RP via text message to not visit R1. Although, the Administrator stated that her residents had visitors the other day. The administrator didn't deny the allegation. Based on information obtained the allegation is deemed Substantiated at this time. Exit interview conducted, citations issued, appeal rights given and a copy of this report deliveredthe state’s words, verbatim · CDSS document, Jul 22, 2024 · control 31-AS-20230703161605

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Aug 5, 2024

§ 87468.1 - Personal Rights of Residents (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by: Administrator didn't notify R1's responsible party regarding the new medication perscribed and administred.This pose a potential health & safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: Administrator will email LPA a statement of understanding this section of CCR by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(a) · Plan of correction due date: Aug 5, 2024

(a) The services provided by the facility shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care. Such persons shall be encouraged to participate as fully as their conditions permit in daily living activities both in the facility and in the community. This requirement was not met as evidenced by: Based on direct witnesses Staff left R1 in bed for an extended period of time. This pose a potential health & safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: Administrator will hire a licensed vendor to train all staff on Basic Services Regualtions. Administrator will email LPA the vendor number, and attendance log. Training and certification must be submitted to the licensing agency by 08/05/24

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Aug 5, 2024

87625 Managed Incontinence (b) (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidenced by: Based on interviews and direct witnesses R1 was left in soiled for an extended period of time. This pose a potential health & safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: Administrator will hire a licensed vendor to train all staff on Managed Incontinence. Administrator will email LPA the vendor number, and attendance log. Training and certification must be submitted to the licensing agency by 08/05/24

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(5) · Plan of correction due date: Aug 2, 2024

General Food Services (5) Meals shall consist of an appropriate variety of foods and shall be planned with consideration for cultural and religious background and food habits of residents. This requirement was not met as evidenced by: Based on interviews and direct witnesses R1 was left without food or provided an alternative options. This requirement was not met as evidenced by:the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: Administrator will hire a licensed vendor to train all staff on General Food Services. Administrator will email LPA the vendor number, and attendance log. Training and certification must be submitted to the licensing agency by 08/05/24

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Aug 5, 2024

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on interviews and direct witnesses facility does not have adequate staff to care for residents. This pose a potential health & safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: Administrator will email LPA LIC500 showing adequate staff coverage by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Aug 5, 2024

To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement was not met as evidenced by: Based on information obtained Staff did not allow resident visitors. This pose a potential health & safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: Administrator will hire a licensed vendor to train all staff on Personal Rights Regulations. Administrator will email LPA the vendor number, and attendance log. Training and certification must be submitted to the licensing agency by 08/05/24

Type of visit: Case Management - Deficiencies

In conjunction to the complaint number 31-AS-20230703161605 Licensing Program Analyst (LPA) Mariana Agban conducted a case management- Deficiencies visit. During the complaint investigation, LPA asked for R1 hospice records and Administrator had lost Hospice records for R1. LPA advised Administrator to keep all residents records for 3 years. Exit interview conducted, citations issued and copy of this report delivered.the state’s words, verbatim · CDSS document, Jul 22, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80070(f) · Plan of correction due date: Aug 5, 2024

Original or photographic reproduction of all client records shall be retained for at least three years following termination of service to the client. This requirement was not met as evidenced by: Based on interview, Administrator lost hospice records for R1. This pose a potential health & safety risk to the residents in care.the state’s words, verbatim · CDSS document, Jul 22, 2024

Plan of correction: Administrator will email LPA a statement of understanding this section by the POC date.

Type of visit: Required - 1 Year

At 1:10 p.m. on 07/10/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with administrator and disclosed the reason for the visit. LPA and administrator toured the facility inside and out. The facility was last visited on 03/05/24 for a complaint visit. It is a single story building with four (04) bedrooms, four (04) bathrooms, kitchen, common areas, and outdoor areas. It has an approved fire clearance for six (06) nonambulatory residents, of which one (01) may be bedridden. The facility serves residents with dementia. Approved hospice waivers for six (06). At the main entrance, LPA observed a maintained front area and driveway. Postings were observed inside for confidential complaint contacts, emergency contacts, Ombudsman contacts, rights of family and resident councils, personal rights, employee rights, facility license, and facility sketch with evacuation routes clearly labelled. Walls, floors, windows, screens, and blinds were clean and in good repair. At approximately 1:30 p.m. LPA measured the room temperature to be 72 degrees Fahrenheit. A storage room was locked and contained confidential files and medications. The living room contained board games, activities, an appropriately grated fireplace, puzzles, and a television. Three (03) residents were observed eating a meal together. LPA observed an adequate supply of perishable and non-perishable foods in the kitchen. At approximately 1:45 p.m. the refrigerator and freezer temperatures were measured to be 38 degrees Fahrenheit and -2.2 degrees Fahrenehit. The stove hood was clean. Appliances were in good condition. Sharps were locked below the counter. Cleaning solutions were locked in a cabinet near the washer and dryer. A laundry area near the kitchen contained a washing machine and dryer in working order. Detergents were locked in a cabinet next to the appliances. The facility has four (04) bedrooms. Three (03) bedrooms are private and one (01) is shared. All bedrooms contained a chair, lamp, nightstand, storage, and a bed with adequate bedding. All furnishings were clean and in good condition. Bedroom #2 had a sign posted for “No smoking – Oxygen in Use”. Bedroom #1 and Bedroom #3 have private bathrooms. There is a shared bathroom outside of Bedroom #2 and a half bathroom near the laundry area. All bathrooms contained liquid soap, paper towels, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At approximately 2:10 p.m. LPA measured the water temperature in the shared bathroom to be 108.9 degrees Fahrenheit. LPA observed a covered patio area in the rear of the facility. A mosquito net covered the sliding glass door separating the living room from the outside area. The patio was shaded and contained furniture in good condition and had a gardening area. The emergency exit path and ramp leading out were free of tripping hazards. The exit gate was unlocked with an inward facing, self-closing latch. The pool in the back yard was fenced, locked, and inaccessible. A storage shed in the area contained gardening supplies and was also inaccessible. Auditory alarms were turned on and functioning. At approximately 2:30 p.m., smoke and carbon monoxide detectors were tested and operational. At approximately 3:00 p.m. LPA observed a fully charged fire extinguisher in the laundry area. At 3:05 p.m. LPA reviewed resident and personnel files. Two (02) out of two (02) staff had First Aid/CPR certifications which had expired on 06/08/2024. A deficiency is issued on the attached LIC 809-D page. No immediate health and safety risks were observed during today’s visit. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 10, 2024