Land of Peace 3

Type of visit: Required - 1 Year

At 11:00 a.m. on 1108/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual visit. LPA met with the Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out at 11:15 a.m. No immediate health or safety hazards were observed at the time of this visit. A file review was conducted at 9:30 a.m. today prior to the visit. The facility was last visited on 03/20/2023 for a complaint visit. It is a single story building with 6 bedrooms, 4 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 #6. The facility serves residents with dementia. Approved hospice waivers for 6 residents. The front yard was well maintained. LPA signed in on the visitor log. Staff took LPA’s temperature upon entry. Near the dining room table were postings for resident rights, rights of resident councils, Ombudsman contact, confidential complaints, emergency disaster plan, house rules, neighborhood grievance policy, non-discrimination notice, visitation policy, administrator certificates, and the facility license. The facility has 6 bedrooms. 5 are private and 1 is shared. One private bedroom is designated for staff. The staff bedroom was locked and free of hazards. All bedrooms contained a night stand, storage, and bed with adequate bedding. Five (05) out of six (06) bedrooms contained a chair. The chair in Bedroom #2 was removed per the resident’s preference. All furnishings were clean and in good condition. Emergency evacuation routes were posted in each room and clearly labelled. The facility has 4 bathrooms. All bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can, grab bars near the toilet, shower, and commode, and a non-skid mat in the shower. At 11:40 a.m. LPA measured the water temperature in the bathroom between Bedroom #2 and Bedroom #3 to be 107.1 degrees Fahrenheit. LPA observed an adequate supply of perishable and non-perishable food in the kitchen and garage refrigerators and freezers. The stove hood was clean. Medications were locked by the refrigerator. Sharp objects were locked under the counter top. A washer and dryer in good condition near the dining room. Detergents and cleaners were locked in the bathroom closest to the dining room. At 11:45 a.m. LPA observed a fully charged fire extinguisher near the laundry area. It had a receipt taped to it from 05/03/2022. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. A fireplace was appropriately screened. The house telephone was called and determined functional at 11:50 p.m. Activities, reading material, television and art supplies were observed in the living room. All emergency exit paths were free from obstructions. Three (03) out of three (03) exit gates were unlocked. A ramp with secure hand rails led out from Bedroom #6. At 2:45 p.m. the administrator tested the smoke and carbon monoxide detector to be operational. When tested, three (03) out of three (03) alarms functioned and two (02) out of two (02) fire doors closed automatically. A resident was visiting with family in the covered patio area. Furniture was in good condition. The back yard was maintained. The back yard contained a fountain with no water. A detached unit was locked. LPA reviewed staff and resident files at 12:30 p.m. LPA, administrator, and staff conducted a medication review at 2:50 p.m. LPA interviewed staff and residents at 3:15 p.m. During today's inspection, the facility is in compliance with Title 22 regulations. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Nov 8, 2023

Allegation investigated: Staff did not prevent resident from becoming physical with another resident in care

At 12:50 p.m. on 03/30/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced, subsequent complaint visit. LPA met with the Administrator and disclosed the reason for the visit. Staff did not prevent resident from becoming physical with another resident in care Regarding the allegation above, it was alleged staff did not prevent Resident #1 (R1) from inappropriately touching Resident #2 (R2). On 02/27/2023 between 10:30 a.m. and 4:00 p.m. LPA interviewed the Administrator, toured the facility, and reviewed records and video footage. On 03/30/2023 between 1:15 p.m. and 2:15 p.m. LPA interviewed residents and staff. Video footage of the facility revealed R1 touching R2 in a friendly manner. R1 pinched R2’s cheek three times and stroked R2’s face using the back of R1’s hand. Staff #1 (S1) intervened to stop the behavior. Unsubstantiated Interviews with the Administrator and staff revealed the behavior exhibited by R1 was normal and meant to be affectionate. Staff #1 (S1) stated they were present and supervising R1 and R2 the entire time. S1 stated an additional staff member was also observing R1 and R2. S1 further stated that both S1 and S2 are not verbally proficient, so they typically interact with others through physical touch. At 1:35 p.m. on 03/30/2023, LPA and S1 observed R1 interact with R2 through physical touch of hands. The interaction was friendly and not physical or violent. Record review of R1 and R2’s service plans confirmed the facility should promote their socialization. Based on video footage review, interviews, observations, and record review, the evidence gathered does not support 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, Mar 30, 2023 · control 31-AS-20230217165031

Type of visit: Required - 1 Year

At 9:45 a.m. on 06/20/2022, 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 05/06/2022 for a complaint visit. It is a single story building with 6 bedrooms, 4 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 #6. The facility serves residents with dementia. Approved hospice waivers for 6 residents. The facility uses surveillance cameras inside. Entry: The front yard was well-maintained. Signs were posted at the main entrance for the facility’s COVID policies. Near the dining room table were postings for resident rights, resident councils, Ombudsman contact, confidential complaints, and Emergency Disaster Plan. A sign showing “Oxygen in Use – No Smoking” Hung on the rear entrance door. Screening: LPA was screened for infectious disease upon entry. The screening station contained a digital thermometer and a visitor log. The visitor log tracked contact tracing information, symptoms, and temperature. LPA advised staff to also track proof of vaccination or a negative COVID test. Bedrooms: The facility has 6 bedrooms. 5 are private and 1 is shared. One private bedroom is designated for staff. The staff bedroom was locked and free of hazards. Bedroom #1 remains locked by resident preference. Bedroom #4 is the shared bedroom and has a divider. Bedroom #5 was locked, but staff unlocked the room during the visit. All bedrooms contained a chair, nightstand, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Emergency evacuation routes were posted in each room and clearly labelled. Bathrooms: The facility has 4 bathrooms. 2 out of 3 bathrooms contained liquid soap, paper towels, handwashing instruction sign, trash can, grab bars near the toilet and shower, and a non-skid mat in the shower. Due to residents with dementia and a lack of hazard awareness, the facility provides paper towels and soap when residents use the bathroom. Kitchen: LPA observed an adequate supply of perishable and non-perishable food. The facility also stores more food in a garage near the main office. The stove hood was clean. Medications were locked by the refrigerator. Sharp objects were locked by the sink. Cleaning solutions were locked by the refrigerator. Staff kept the keys with them. Laundry: LPA observed a washer and dryer in good condition near the dining room. Common Areas: Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. A fireplace had an appropriate covering. 2 residents were observed sitting and watching television. 1 resident played a game with staff. Safety: All emergency exit paths were free from obstructions. 2 exit gates were unlocked and led to the main street. At 10:18 a.m. staff opened the sliding exit door in Bedroom #5. LPA heard the auditory alarm function. Ramps with secure hand rails led out from Bedroom #5 and Bedroom #6. At 10:37 a.m. LPA tested the smoke and carbon monoxide detector to be operational. When tested, the fire door by Bedrooms #3, #4, and #5 closed automatically. At 42 a.m. LPA observed a fully charged fire extinguisher near the laundry area. It had a receipt taped to it from 05/03/2022. LPA observed a sufficient First Aid Kit in the kitchen. Outdoor areas: LPA observed a safe walkway in the back yard free of tripping hazards. A covered patio area contained furniture in good condition. A detached garage was locked. 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, Jun 20, 2022

Allegation investigated: Staff unlawfully evicted a resident while in care

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with the administrator and explained the reason for this visit. It is alleged that the facility is refusing to accept resident #1 (R1) back into the facility after being hospitalized. Regarding the allegation LPA conducted interviews with the administrator and facility staff regarding this allegation from 1:10-1:45pm. Information from interviews reveal that R1 was admitted to the facility on 4/29/22. On 5/3/22 R1 went to the hospital due to having a wound. After being hospitalized it was found that R1 has a prohibited health condition to which R1 could not be accepted back without being on hospice care. While at the facility LPA spoke with R1's responsible party who confirmed that R1 just secured hospice services. LPA spoke with administrator who confirmed they are accepting R1 back into the facility and was just awaiting for R1 to retain hospice services to treat R1's wounds. LPA also spoke with staff at the hospital R1 is staying at and confirmed that R1 had a prohibited health condition and is being discharged back to the facility with hospice services. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time. Exit Interview conducted. Unsubstantiatedthe state’s words, verbatim · CDSS document, May 6, 2022 · control 31-AS-20220506125935

Type of visit: Case Management - Incident

At 11:30 a.m. on 05/05/2022 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with Administrator and disclosed the reason for the visit. The reason for the visit comes from an incident report submitted on 05/04/2022. Resident #1 (R1) was admitted on 04/29/2022 with pressure injuries on the buttocks and left heel of unknown stages. During a 04/28/2022 hospital visit, a Kaiser physician informed the R1 and R1’s family that the wound on the heel would not prohibit admission to a board and care. The physician did not disclose the size or stage of the wounds but arranged a 05/05/2022 podiatry appointment. Home health also evaluated the wounds on 05/03/2022, but additional follow up was required for staging and treatment. Regional Office has requested a full investigation by the Investigations Branch. The referral is currently pending. At approximately 12:30 p.m. LPA interviewed Administrator. At 12:51 p.m. LPA conducted a record review. LPA obtained copies of the register of facility residents, personnel report, staff training records, and medical assessment. Administrator will send additional information through email later today. At 1:20 p.m. LPA and 2 Administrators conducted a physical plant tour with Administrator. R1 was in bed in an elevated position. R1 was safe and in good health. Administrator and staff redressed the wound. 2 photographs of the wound were taken. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, May 5, 2022

Type of visit: Required - 1 Year

At 3:42 p.m. Licensing Program Analysts (LPAs) Melissa Ruiz, Angela Panushkina and Licensing Program Manager (LPM) Nichelle Gillyard conducted an unannounced annual inspection at the facility mentioned above. Team met with caregiver Martha Maria Reyna who granted access to the home. This is a 6-bedroom, 4-bathroom single story residence that includes a living room, dining area, kitchen, and dining area. LPA toured the entire facility with the Administrator Sona Muradyan who arrived at approximately 3:50 p.m. and observed the following: Infection control: LPA reviewed approved facility mitigation plan to make sure licensee was following current infection control recommendations. Upon arrival, the team was not screened by the caregiver and was not asked any infection control questions. Staff was unable to take LPAs temperatures. The team had to prompt and guide the caregiver through the screening process. Food Inspection: LPA conducted a food inspection tour. Currently the licensee has a offsite food waiver in which a outside food vendor provides meals for the residents. LPA observed there to be insufficient stock of one-week non-perishable foods. Frozen foods are properly wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Garbage cans have tight fitting covers in the kitchen. Smoke detectors were checked and are hardwired throughout the facility. Smoke detectors and carbon monoxide are observed to be operational. Resident rooms: There are 6 bedrooms designated for resident use and have sufficient lighting. One bedroom is designated for live-in staff. All bedrooms are properly furnished, cleaned and have appropriate bedding and linens. Auditory alarms are placed on each door. The facility has dementia residents in care. Bathrooms: LPA toured resident bathrooms and checked to make sure bathrooms were clean and in good repair. The hot water temperature measured at 117.3F. LPA observed appropriate hand washing signs posted in each bathroom, grab bars and non-skid mat. Towels and washcloths are not shared. Residents have sufficient amounts of supplies for personal hygiene which is provided by the Licensee. At 4:05 p.m. LPA observed cleaning products/chemicals accessible to residents. Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. There are no bodies of water which is unsecured. The garage is detached to the home and is kept locked inaccessible to clients. Laundry service: There is enough linen available to change weekly or more if need. Medications are in a centrally stored and locked. Care and supervision: Team observed one staff to 6 residents on duty. One staff is tasked with providing care and supervision, which include by not limited to changing residents, assisting residents with toileting needs, assistance with medications, tranfers, etc. Staff are also tasked with screening visitor as they come into the facility. One staff is unable to meet all of these needs and keep any eye on everyone. A resident voiced a concerned that staff does not respond when needed at night after calling several times. Therefore additional staffing is needed. Administrative: LPA collected the Administrators certification, Sample food menu and license from outside food vendor, certificate of liability insurance and LIC 500. Annual fees are current. Deficiencies and Civil penalties were issued per CA code of Regulations Title 22 or Health and Safety Code. See 809D's included with this report. Appeal rights issued. Exit interview conducted.the state’s words, verbatim · CDSS document, Jul 22, 2021