Bassett Residential Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sandra Urena arrived at the facility to conduct the annual inspection year Required inspection of the facility. LPA met with administrator Emma Arutiunian and explained the reason for the visit. The LPA and the administrator conducted a tour of the physical plant at approximately 10:30 a.m. There are (6) bedrooms for residents and (1) bedroom for staff use only. Smoke alarms and carbon monoxide detector were not functioning at time of the visit. The administrator stated that the smoke and carbon monoxide alarm started emitting a sound at night and that could not be resolved by staff. The administrator contacted an alarm company to resolve the issue and stated that the company was going to resolve the issue same day of the visit later in the afternoon. The LPA observed all required postings in the entry area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Fire extinguisher was fully charged and purchased in May 23, 2023. KITCHEN: The kitchen appeared clean and the appliances and fixtures functional during the time of visit, sharp objects are stored in lock box that was kept on the kitchen counter. The LPA observed box to be locked at this time. Some cleaning supplies and disinfectants were observed stored inaccessible to residents under the sink. The LPA observed a sufficient amount of perishable and a seven-day supply of non-perishable food at the facility properly stored, however the facility lacked a water supply. The administrator stated that the water will be purchased by the end of the day and pictures of the water supply will be emailed to LPA by 07/27/2023. BEDROOMS: The residents’ bedrooms were properly furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate and clean bedding and linens such as sheets, pillowcases, and blankets. Continues on LIC 809C... BATHROOMS: The LPA observed all bathrooms were clean, properly supplied and had functional fixtures. LPA observed grab bars and non-skid mats in the bathroom. Residents have sufficient amounts of supplies for personal hygiene properly stored inaccessible to residents. The hot water was measured in each bathroom during physical plant tour. Hot water measured within the required limit of 105-120 degrees Fahrenheit. COMMON AREAS: The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Laundry room is located right outside the hallway pass bedrooms #5 and #6. The LPA observed laundry room to be inaccessible to residents in care at this time. Cleaning supplies were stored in cabinets above washer and dryer. LPA observed cabinets to be locked at this time. There is an attached garage accessible from the outside and the laundry room. LPA observed garage to store an extra fridge and freezer for perishable foods. Extra medical supplies and furniture was also observed in the garage. SURROUNDING GROUNDS (Outdoors): Exit passageways were clear of hazards and obstructions. There was an area with proper furniture for outdoor use in the area located outside of living room to the left of the property, however the outdoor area lacked shade. The LPA informed the administrator that some form of shade (patio umbrella), must be provided for the comfort of residents and family members if they wish to meet outdoors. There are no bodies of water on the premises. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate 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 isolate residents in their private bedrooms. The facility’s policies and procedures as it pertains to infection control are adequate at this time. RECORDS: Records review began at 12:00p.m. Residents’ records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All records were in order. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 1:12 p.m., medications are centrally stored and locked in a cabinet in the hallway; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications; however, the dates of bottles did not match the Centrally Store Medication and destruction record as of the time of the visit. An audit of two out of two medication bottles: Quetiapine (250mg, and 500mg) did not have the correct amount of tablets left in the bottles, as prescribed. Citations were issued. Exit interview conducted. Report issued and sent via email.the state’s words, verbatim · CDSS document, Jul 26, 2023

Allegation investigated: Questionable Death

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint investigation visit to deliver the final findings for the allegation listed above. Upon arrival, LPA met with staff and explained the reason for the visit. Administrator Emma Arutiunian arrived shortly after. On 10/24/2022, the initial complaint visit was conducted between approximately 9:30 a.m. - 2:30 p.m. During the visit, LPA conducted physical plant, interviewed staff as well as reviewed and obtained copies of pertinent documents relevant to the investigation. On 11/07/2022, LPA conducted a subsequent visit between approximately 11:30 a.m. - 12:30 p.m. and conducted physical plant, interviewed staff and responsible parties. LPA has attempted to contact reporting party on 10/24/2022 at 10:00am and 10:58am, 06/12/2023 at 11:40am and 06/12/2023, at 4:00pm, but was unsuccessful. LPA also subpoenaed and reviewed ABC Hospice records on 06/12/2023. It was reported that facility staff expedited Resident #1 (R1) death by administering medication such as Morphine. It was further stated that an individual would arrive at the facility to administer the medication to R1, and that R1 was active prior to the start of the medication. Unsubstantiated Continued from 9099 Information gathered during the course of the investigation reflected that R1 was admitted to the facility on 08/24/2021, after previously residing at a skilled nursing facility. Upon admission to the facility, R1 was also assessed and admitted into ABC Hospice. Based on the Comprehensive Nursing Assessment completed by hospice staff on 08/24/2021, R1 was noted to be bed bound, with a primary diagnosis of Alzheimer’s disease and secondary diagnosis of restlessness, agitation, chronic pain syndrome, dyspnea, and hypertension. Additionally, R1 was further noted to be awake, but lethargic, minimally responsive, and disoriented. R1 was pulse was also noted to be regular but weak with labored respirations. Per the hospice assessment reviewed, R1’s family was present during the visit and a Physician Orders for Life-Sustaining Treatment (POLST), which indicated Do Not Resuscitate (DNR) was signed by the family of R1. The assessment further reflected that, R1 was actively dying, due to R1 being lethargic, and non-responsive to verbal and touch stimuli. R1 was placed on comfort care and were prescribed Morphine Sulfate, as needed (PRN) along with Acetaminophen (PRN), Amlodipine Pesylate, Lorazepam (PRN), Olmesartan Medoxomil and Quetiapine Fumarate (PRN). The hospice care visit notes for 08/25/2021, reflected that per facility caregivers, R1 was not drinking any fluids or taking any meals. Therefore, new orders were received from R1s hospice physician, and R1 was given Normal Saline (NS) via intravenous injection (IV). Per hospice records, R1 was given non-pharmacological methods to control pain on both 08/25/2021 and 08/26/2021. At approximately, 5:20 p.m. on 08/26/2021, hospice conducted an unscheduled visit after receiving a call from facility caregiver who reported that R1 was non-responsive to verbal, touch stimuli and had severe shortness of breath. Upon nurse assessment, R1 was cold to touch, had no pulse, respiration, and pupils were not reacting to light. R1 was pronounced deceased at 5:20 p.m. in comfort. Interviews conducted with R1’s family indicated that R1 was rapidly declining and actively dying upon admission to the facility and the family did not have any concerns of neglect or foul play by the facility. Based on information gathered throughout the course of the investigation, the Department does not have sufficient evidence to determine that R1’s death was expedited by facility staff. Therefore, the above allegation “questionable death” is deemed UNSUBSTANTIATED at this time. Exit interview conducted/ No citations issued/ A copy of report provided to administrator.the state’s words, verbatim · CDSS document, Jun 16, 2023 · control 29-AS-20221021163242

Allegation investigated: Covid-19 masking protocols are not being followed.

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent complaint visit to investigate the allegation listed above. Upon arrival LPA met with facility staff and explained the reason for the visit. Administrator Emma Arutiunian arrived shortly after. On 02/14/2022, the initial complaint visit was conducted between approximately 10:29 a.m. - 1pm. During the visit, LPA conducted physical plant, interviewed staff, residents, resident families, as well as reviewed and obtained copies of pertinent documents relevant to the investigation. It was alleged that facility is not following COVID-19 masking requirements. Regional office received information from a credible witness that while visiting the facility, they observed that staff were not wearing masks. During the time of the complaint, COVID-19 Ongoing Requirements from Public Health required the use of face masks inside the facility. On 02/14/2022, upon arrival to the facility, LPA observed staff wearing mask however, Substantiated Continued 9099 LPA interview with the staff revealed they recently had a visit from an outside agency who observed Staff 1 (S1) and Staff (S2), not wearing a mask while working with the residents. Based on information gathered throughout the course of the investigation, the Department has sufficient evidence to determine that facility staff were not using face coverings at all time while inside the facility. Therefore, the above allegation that COVID-19 masking protocols are not being followed is deemed SUBSTANTIATED at this time. Citations Issued. See LIC 9099-D. Appeal Rights discussed and copy of report issued to Administrator. Continued from 9099 Interviews conducted with families and responsible parties of residents over the course of the investigation revealed that each party did not express any immediate or potential concerns of facility staff not answering their calls or keeping them up to date with their resident in care. Based on information obtained throughout the course of the investigation, LPA could not find sufficient evidence to indicate the allegation had occurred. Therefore the allegation of Communications to the facility are not being answered in a timely manner is deemed Unsubstantiated at this time. It was alleged that facility does not have a designated administrator. Interviews conducted and records reviewed revealed , at the time of the complaint, Hripsime Tavitian was listed as Licensee and Administrator. Caregiver / House Manager Emma Arutiunian was designated on Licensing form LIC 308 as the staff authorized to receive any documents including reports of inspections and consultations, accusations and civil and administrative processes on the behalf of the Administrator in the event of their absence. Interviews conducted with families of residents in care confirmed Hripsime as Administrator during the time of the complaint. Based on information obtained throughout the course of the investigation, there is not sufficient evidence to confirm the allegation occurred. Therefore, the allegation that facility does not have a designated administrator is deemed Unsubstantiated at this time. Exit interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Jun 16, 2023 · control 29-AS-20220208161249

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jun 19, 2023

Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations... This requirement is not met as evidenced by: Based on interviews, the Licensee did not ensure the personal rights of persons in care to live in a safe, healthy, and comfortable home as staff did not wear face coverings at all times while inside the facility, which poses an immediate health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Jun 16, 2023

Plan of correction: The Licensee agreed to advised staff on wearing masks at all times inside the facility when required and to conduct a training on CA Dept of Public Health Guidance for the use of face coverings and COVID-19 screening protocols and submit proof to LPA via email by end of day 06/19/2023.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Brian Balisi conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20220208161249). The purpose of the visit is to issue a citation for deficiencies observed during the complaint investigation. During the complaint investigation, the following deficiency was observed: A Ring camera was observed installed on the ceiling of Resident 1 (R1). Administrator stated the responsible party installed the camera to keep in touch with R1. During the visit, Administrator called the responsible party over the phone and informed them they are required to remove the camera today. Responsible party agreed to visit facility today and remove camera. LPA did not observe cameras installed in the rooms of other residents in care. Citations Issued. See LIC 809-D. Appeal Rights discussed and copy of report issued to Administrator.the state’s words, verbatim · CDSS document, Jun 16, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Jun 23, 2023

Living accommodations and grounds shall be related to the facility's function... privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply This requirment was not met as evidenced by: During physical plant, LPA observed camera installed in R1's room. This poses as a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 16, 2023

Plan of correction: During the visit, The reponsible party agreed to uninstall the camera today. Administrator agreed to review section cited and submit statement of understanding to LPA via email by POC date. Administrator will also send picture to LPA via email once camera is removed.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived to this facility today to conduct a One (1) year Required inspection of this facility with emphasis on infection control practices and procedures. LPA met with Caregiver Sona Hakobyan and explained the reason for the visit. LPA spoke with Administrator Hripsime Tavitian over the phone who stated it was okay for Sona to sign for the report. A tour of the physical plant was conducted with Sona approximately between 2:30pm - 4pm LPA inspected facility for Fire Safety, Personal Accommodations and Services, and Food Service. The following was noted: There are (6) bedrooms for residents and (1) bedroom for staff use only. Smoke alarms and carbon monoxide detector were tested and functioned properly during time of visit. LPA observed all required postings in the entry area. The facility serves residents with dementia, the auditory alarms on the exit doors were tested and functioned properly at the time of visit. Fire extinguishers were fully charged and purchased in April of 2022. Kitchen: The kitchen appeared clean and the appliances and fixtures functional during the time of visit. LPA observed a sufficient amount of perishable and non-perishable food at the facility properly stored; Sharp objects are stored in lock box that was kept on the counter. LPA observed box to be locked at this time. Some cleaning supplies and disinfectants were observed stored inaccessible to residents under the sink. Bedrooms: The resident bedrooms were properly furnished with at least one chair, night stand and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. Continued from 809 Bathrooms: LPA observed all bathrooms were clean, properly supplied and had functional fixtures. LPA observed grab bars and non-skid mats in the bathroom Residents have sufficient amounts of supplies for personal hygiene properly stored inaccessible to residents. The hot water was measured in each bathroom during physical plant tour. Hot water measured within the required limit of 105-120 degrees Fahrenheit. Common Areas: These included the family area by entry way, dining area and living room located between kitchen and hallway to the bed rooms. The common areas were checked for cleanliness and furniture was checked for functionality during time of visit. Laundry room is located right outside the hallway pass bedrooms #5 and #6. LPA observed Laundry room to be inaccessible to residents in care at this time. Cleaning supplies were stored in cabinets above washer and dryer. LPA observed cabinets to be locked at this time. There is an attached garage accessible from the outside and the laundry room. LPA observed garage to store an extra fridge and freezer for perishable foods. Extra medical supplies and furniture was also observed in the garage. Surrounding Grounds (Outdoors): This facility shares a lot with Bassett Assisted Living #197609920. Exit passageways were clear of hazards and obstructions. There is a storage unit located in the far right corner of the property. LPA observed unit to store medical supplies, extra furniture and home maintenance tools. There was a shaded area with proper furniture for outdoor use in the area located outside of living room to the left of the property. There are no bodies of water on the premises. The property is gated was observed to be open at this time. Once the gate is closed, the lock on the entry gate appeared to be single action and inaccessible from the street into the property. At 3pm, LPA observed staff making snacks for the residents. The LPA spoke with Sona and Hiripsimi via phone regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate 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 to isolate residents in their private bedrooms, if the facility has a confirmed case of COVID-19. COVID-19 testing is conducted weekly if anyone shows any symptoms. The facility’s policies and procedures as it pertains to infection control are adequate at this time. Exit interview conducted. Report issued and sent via email.the state’s words, verbatim · CDSS document, Jul 12, 2022

Allegation investigated: Lack of care and supervision led to resident's death Resident sustained multiple pressure injuries while in care Facility staff did not assist resident with hygiene needs Resident was left in soiled clothing for an extended period of time

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Subsequent Complaint visit at 1:09PM for the purpose of delivering the findings of a complaint investigation conducted by the Department’s Investigation’s Branch (IB) Investigator Laura Garcia. LPA initially met with facility staff Rosana. House Manager Emma Arutiunian, who is authorized to sign reports, arrived at 1:35PM. Administrator Hripsime Tavitian was unavailable at the time of the visit. Entrance interview conducted. On 11/06/2020, LPAs Kelly Dulek and Brian Balisi conducted an initial complaint inspection, during which, between 9:10AM and 10:45AM LPAs conducted interviews with the staff and residents and conducted a physical plant tour. LPAs also obtained copies documentation relevant to the investigation. IB Investigator Garcia then conducted interviews with facility staff, residents, and other relevant parties on the following dates: 12/08/2020, 12/17/2020, 01/26/2021, and 02/02/2021. Document review took place on the following dates: 11/10/2020, 11/18/2020, 01/27/2021, and 10/01/2021. During today's visit, LPA interviewed House Report continued on LIC 9099-C Unsubstantiated Manager at 1:35PM and toured the facility at 1:53PM. The following was then determined: Regarding the allegation: “Lack of care and supervision led to resident’s death:” Resident #1 (R1) who was admitted to the facility on 09/30/2020, had previously resided at another licensed facility and had been under hospice care since 03/15/2020. Interviews revealed that during the three (3) days R1 resided at this facility, R1 was noted to be not eating well. On the morning of 10/03/2020, facility staff indicated R1 appeared to be weak, refusing meals, and having shortness of breath. R1’s hospice provider was contacted, arrived at the facility and called 9-1-1. The resident was then transported to the hospital, where R1 expired the same day. Record review revealed R1’s death was attributed to probable sepsis, chronic pressure wounds, and cardiovascular disease. Interviews confirmed R1 had a long history of self-neglect and the conditions surrounding R1’s passing were aligned with R1’s history of refusal regarding medical care. Medical professionals concurred that there was nothing suspicious or unexpected regarding R1’s expiration. Reports reviewed revealed there was no indication of any abuse or neglect by the facility staff. Based on interviews and records review, at this time there is insufficient evidence to support the allegation that “lack of care and supervision led to resident’s death.” Therefore, this allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Resident sustained multiple pressure injuries while in care:” R1 was admitted to the facility on 09/30/2020 and had been under hospice care since 03/15/2020. Hospice admission documents, as well as facility admission paperwork, indicated the resident had pressure injuries on the sacro coccyx area (Stage IV) and on the buttocks area (Stage III), for which the Hospice agency was responsible for providing appropriate medical care. While the resident was noted to have decubitus sores on the face, interview and record review revealed the sores/marks were consistent with oxygen mask straps. Records confirm the hospice agency was administering oxygen to R1 while R1 was in care at the facility. Additionally, per the interviews with relevant medical professionals, R1 was diagnosed with “senile ecchymosis” – increased fragility to the skin due to aging on the side of R1’s face. Based on interview and record review, there is insufficient evidence to support the allegation at this time. Therefore, the allegation that “resident sustained multiple pressure injuries while in care” is deemed UNSUBSTANTIATED at this time. Report continued on LIC 9099-C Regarding the allegation “Facility staff did not assist resident with hygiene needs:” Interviews revealed facility staff assist residents with hygiene needs four (4) times a day for incontinent residents, or as needed based on resident request or staff observation. Two (2) of two (2) residents interviewed indicated they are changed frequently and staff regularly tend to any additional needs of the residents. While hospital records did indicate “the patient’s gown is soiled,” upon arrival to the Emergency Room, interviews did not reveal any additional information regarding the nature of the soiled gown. Emergency Medical Services (EMS) reports did not indicate a soiled gown or a concern with the resident’s hygiene. There is insufficient evidence to determine when the resident’s gown became soiled or whether the soiled gown was due to lack of hygiene care at the facility. Based on this information, although the allegation may be cause for concern, there is insufficient evidence to support the allegation. Therefore, the allegation that “Facility staff did not assist resident with hygiene needs” is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Resident was left in soiled clothing for an extended period of time:” It shall be noted R1 was receiving hospice services for the entire duration of R1’s residency at this facility. Upon admission to the hospital, nurse notes indicated “the patient’s gown is soiled.” However, interviews revealed residents’ clothing is changed daily. Hospice nurse notes and hospice staff interview did not indicate details of the clothing change. Additionally, the hospice nurse indicated changing the resident’s clothing could either be completed by the facility staff or the hospice care staff. Facility staff indicated they had changed R1’s clothing daily during the 3 days R1 resided at the facility. Record review revealed that the hospice care plan lacked written information on specific duties for facility staff and hospice agency staff, including frequency and responsibility for changing residents clothing. Interviews with hospice staff did not reveal any detail into how long the resident was wearing specific clothing for or details of the alleged soiled clothing. During the facility tour on 11/06/2020, LPAs Balisi and Dulek observed each resident to have multiple clothing items available for use and all residents’ clothing was observed to be clean and regularly laundered. Based on interview, observation, and record review, although the allegation may have happened, at this time there is insufficient evidence to prove a violation occurred. Therefore, the allegation that “resident was left in soiled clothing for an extended period of time” is deemed UNSUBSTANTIATED at this time. Exit interview was conducted and a copy of the report was provided via email. During the initial complaint inspection on 11/06/2020, LPAs Balisi and Dulek attempted to gather information and documents for R1. Facility staff were unable to verbally provide much information to LPAs regarding R1’s medical or care needs. In addition, interview revealed that facility staff do not speak English as their first language and communication can be difficult without lead staff present to translate. During the LPA’s subsequent visit to the facility, when the House Manager was not present, the facility staff and LPA had trouble communicating verbally in English. Interview revealed that the lead caregiver had cared for R1 during their time at the facility and the remaining two (2) of two (2) staff had little knowledge or interaction with R1. Medical transport report from 10/03/2020 indicated no paperwork was provided to the ambulance provider, nor was medical history verbally communicated to the first responders. Additionally, paperwork received by LPA for the resident was dated 10/30/2019 although the resident was admitted to the facility on 09/30/2020 and had a change of condition which initiated R1’s admission to hospice care on 3/15/2020. Hospice records and hospice care notes were unable to be located at the facility during the initial complaint inspection. Medication administration and centrally stored medication records for the resident were found to be maintained by the hospice agency, rather than present at the facility. Based on record review and interview, the allegation that “facility staff did not provide resident’s medical history to emergency personnel” is deemed SUBSTANTIATED at this time. The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Exit interview conducted. A copy of the report and appeal rights were provided via email.the state’s words, verbatim · CDSS document, Feb 23, 2022 · control 29-AS-20201105122427

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87506(a) · Plan of correction due date: Mar 9, 2022

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on record review and interview, records for R1 were not updated when R1 was admitted to the facility although R1 had a change of condition, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 23, 2022

Plan of correction: House manager agreed to complete a training for all staff on resident records maintenance with a qualified vendor and send LPA record of the training to include name of vendor, date held, participants, and topics covered by POC due date.