Land of Peace 5

Allegation investigated: Staff did not provide adequate food service Staff did not assist resident with her medical appointments Staff did not dispense resident’s medication as prescribed Staff did not provide a comfortable environment for resident

At 9:30 a.m. on 08/31/2023 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with Administrator Sona Muradayan and disclosed the reason for the visit. LPA interviewed staff and residents today between 9:40 a.m. to 1:00 p.m., obtained relevant documents at 10:20 a.m., observed food service at 10:30 a.m., toured the facility at 10:45 a.m., reviewed medication logs at 11:00 a.m., and reviewed records at 1:30 p.m. No immediate health and safety concerns were observed. Regarding the allegation “Staff did not provide adequate food service” it was alleged the facility food was poor quality. Interview with the Administrator at 9:40 a.m. today revealed lunch and dinner for the facility is catered every day, and the food is kosher and low in sodium. LPA observed the catered food provided at 10:30 a.m. today. Interview with the caterer at 10:35 a.m. today revealed they adjust the food served to meet resident preferences. Unsubstantiated Interviews with staff between 11:10 a.m. and 11:40 a.m. today revealed that alternate food options are provided if a resident does not like the catered food provided. Interviews with residents between 12:00 p.m. and 1:15 p.m. today confirmed that staff accommodate resident preferences and needs for food service, and residents did not have any concerns about facility food quality. Based on interviews and observations, there is insufficient evidence to confirm the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff did not assist resident with medical appointments” it was alleged Resident #1 (R1) missed medical appointments due to facility fault. From record review at 1:30 p.m. today, R1’s admission agreement stated the facility would provide “basic transportation to and from medical and dental appointments”. From interviews at 9:40 a.m. and 1:15 p.m. today, the Administrator and R1 stated R1 had not missed any medical appointments. Staff and other residents interviewed between 11:10 a.m. and 1:00 p.m. today stated no residents had missed medical appointments. Based on interviews and record review, there is insufficient evidence to confirm the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff did not dispense resident’s medication as prescribed” it was alleged R1 experienced a delay in receiving medications. Interviews with staff, R1, and other residents today between 9:40 a.m. and 1:15 p.m. revealed residents had no issues with missing medications. Medication log review today at 11:00 a.m. indicated none of R1’s medications were missed. Based on interviews and record review, there is insufficient evidence to confirm the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff did not provide a comfortable environment for resident” it was alleged R1 did not have enough space to maneuver their wheelchair around their shared bedroom. From LPA’s facility tour at 10:45 a.m. today, LPA observed sufficient space for a wheelchair to move about the room. R1 and other residents interviewed today between 12:00 p.m. and 1:15 p.m. stated they had no issues using wheelchairs throughout the facility. Based on interviews and observations, there is insufficient evidence to confirm the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Aug 31, 2023 · control 31-AS-20230825095056

Type of visit: Required - 1 Year

At 1:40 p.m. on 07/31/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. 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 07/23/2021 for an annual visit. It is a single story building with 6 bedrooms, 3 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 6 residents, of which 5 may be non-ambulatory and 1 may be bedridden in Bedroom #5. The facility serves residents with dementia. Approved hospice waivers for 6. The facility uses surveillance cameras inside and out. Entry: Upon entry, LPA observed a maintained front yard. A posting for the facility’s visitation policy hung on the front door. LPA observed postings for ombudsman contact, confidential complaints, administrator certificate, facility license, Emergency Disaster Plan, resident rights, and resident councils. Screening: LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer and visitor log. LPA advised to include columns for symptoms and vaccination records in the visitor log. Bedrooms: The facility has 6 bedrooms. 5 are private and 1 is shared. Bedroom #1 has a sign posted: Oxygen in use – No smoking. Staff was observed providing care for resident. Bedroom #3 is designated for staff. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Evacuation routes were clearly labelled and posted in each room. Bathrooms: The facility has 3 bathrooms. All bathrooms contained paper towels, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. Liquid soap is provided with each use due to residents with impulse control. At 2:01 p.m. LPA measured the water temperature in Bathroom #1 to be 105.0 degrees Fahrenheit. Kitchen: LPA observed an adequate supply of perishable and non-perishable food. Sharps were locked near the stove. Medications were locked near the counter. Laundry: LPA observed 2 functional appliances. Detergents were locked near the appliances. Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. LPA observed linen closets in the hallways with sufficient fresh linens. Flashlights were available in the hallways as well. Safety: All emergency exit paths were free from obstructions. Exit gates were unlocked. Emergency Disaster Plan posted. At 1:45 p.m. LPA tested the dual-functioning smoke and carbon monoxide detector to be operational. LPA observed a fully charged fire extinguisher in the kitchen with a receipt from 05/03/2022 attached. LPA detected 3 out of 3 auditory alarms functioning during visit. Outdoor areas: LPA observed a covered patio with extra wheelchairs. The back yard was maintained. During today's inspection, the facility is in compliance with Title 22 regulations. No citations issued. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 31, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility at 11:25am to conducted a One (1) year Required Infection Control visit. LPA meet with the designated staff kelvin and explained the purpose of this visit. A tour of the physical plant was conducted at 11:30am and the following was observed: The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing). The PPE screening station is located at the front door on an end table equipped with sufficient PPE readily accessible a thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit. Visitors are not allowed in the facility at this time. The Fire Extinguisher is located on the wall in the laundry room purchase dated May 13, 2021. The fire alarm system is hard wired and inter connected. The facility has five bedrooms (5) one (1) room is designated for Staff. Three bathrooms (3) one (1) of the bathrooms are located in room five (5). The facility has an approved mitigation plan on file. Medication: The medication is located in the kitchen cabinet which was observed to be locked and inaccessible to residents. Kitchen: The kitchen was observed to be clean and an inadequate supply of perishables and non-perishable food, currently the licensee has a off site food waiver in which a outside food vendor provides meals for the residents. The perishable, non-perishable and emergency food is stored in one (1) central location off site on the sister property of the facility. Breakfast is prepared in the facility, lunch and dinner are catered by the off site vendor. Sharps were observed to be locked and inaccessible to residents. (Continued on LIC 809C) Resident rooms: There are six (6) bedrooms and one (1) is designated for staff which is located across from room one (1) and room two (2). All bedrooms observed to be clean with adequate furniture, appropriate bedding, linens and sufficient lighting. Bathrooms: LPA observed three (3) bathrooms in which one (1) is located in room five (5) to be clean and in proper operation with appropriate hand washing signs posted in each bathroom. LPA observed the appropriate grab bars in and around the toilet and shower and non-skid mats located in the shower area. At 12:11pm the hot water temperature measured in range of 105.5 to 111.4. Towels and washcloths are not shared. Residents have sufficient amounts of supplies for personal hygiene which is provided by the Licensee. Outside areas: LPA toured the outside area of the facility which provides a covered patio area with appropriate outdoor furniture for residents also located in front yard of the facility under a shaded tree. There are no bodies of water located on the premises. Laundry Room: At 12:25pm LPA observed toxins, laundry soap and other cleaning supplies locked in a cabinet located in the laundry room adjacent to the kitchen. There is enough linen available to change weekly or more if needed. Administrative: LPA collected the Administrators certification, Sample food menu, certificate of liability insurance and LIC 500. Annual fees are current. Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, Jul 23, 2021