Prime Residential Senior Care

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Evelin Rios and Michael Cava conducted an unannounced case management visit - deficiencies visit in conjunction to complaint control number 31-AS-20230623141817. The purpose of this visit was explained to administrator Sofya Kechikyan. During complaint investigation conducted on 06/30/2023 LPA observed the following: a room converted from the living room utilized for an additional dwelling. Review of facility sketch does not indicate that their is a room created in the living room area for an additional occupant. Interview with administrator revealed occupant is a relative and is living in the created bedroom. Furthermore administrator states, this occupant is not receiving elements of care and supervision from facility staff. LPA review of records revealed that the occupant has fingerprint clearance.the state’s words, verbatim · CDSS document, Jul 20, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a)(7)(A) · Plan of correction due date: Jul 28, 2023

...Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:(7) Sketches, showing dimensions, of the following: Building(s) to be occupied, including a floor plan that describes the capacities of the buildings... This requirement is not met as evidenced by: Based on LPA's observation on 06/30/2023 there was an additional room created by the Licensee which was not reflected on the facility sketch during the application process, which posed a potential health and safety issue for residents in care.the state’s words, verbatim · CDSS document, Jul 20, 2023

Plan of correction: Licensee aggress to submit and LIC200 and updated facility sketch indicating a change in facility floor plan by or before POC due date.

Allegation investigated: Staff did not keep resident(s) free from punishment, humiliation, intimidation, abuse or other acts of a punitive nature. Staff was negligent while assisting resident(s) while transferring to/from bed Staff did not provide adequate required incontinent care to resident(s).

On 06/30/2023 at 9:45 a.m. Licensing Program Analyst (LPA) Evelin Rios made an unannounced 10-day complaint visit to this facility to investigate the above allegations. LPA Rios met with facility administrator Sofya Khechikyan and an entrance interview was conducted, the purpose of this visit was explained. At approximately 10:00 a.m. LPA and Administrator Sofya toured the physical plant of the facility. LPA did not observe any health and safety issues at this time. From 10:41 a.m. to 11:25 a.m. LPA conducted interviews with residents and staff including the Administrator. At 11:25 a.m. LPA requested records for current residents and previous residents from the last year. Records review revealed resident in question/resident #1 (R1) does not and did not reside at this facility. Interview with the administrator revealed they have never admitted R1 to this facility. At 12:25 p.m. LPA contacted family member of R1 and determined R1 was residing at a different facility. (LIC9099-C Continued on to next Page) Unfounded (LIC9099-C Continued) Additionally Sofya provided LIC500, LIC9020. LIC9020 Register Of Facility Clients/Residents and resident records corroborates that R1 does not reside at this facility or has ever resided at this facility. Furthermore, an LIC500 confirms that the staff in question, does not work at this facility. Based upon the information obtained, this agency has investigated Allegation #1: Staff did not keep resident(s) free from punishment, humiliation, intimidation, abuse or other acts of a punitive nature, Allegation #2: Staff was negligent while assisting resident(s) while transferring to/from bed and Allegation 33: Staff did not provide adequate required incontinent care to resident(s). We have found that the complaint was Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Therefore, the allegation will be deemed UNFOUNDED at this time.the state’s words, verbatim · CDSS document, Jun 30, 2023 · control 31-AS-20230623141817

Allegation investigated: Resident was overmedicated while in care. Due to staff neglect resident developed multiple Urinary Tract Infections. Resident was placed on hospice while at the facility without consent of resident's representative. Staff did not seek medical attention for resident in care in a timely manner. Staff did not ensure that resident in care received follow-up medical attention.

At 11:00 a.m. on 03/11/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced subsequent complaint visit. LPA met with the Administrator and disclosed the reason for the visit. Initial investigation visit was conducted by the LPA Wendell Smith on 08/26/2022. At the time of visit between 9:30am and 11:00am, LPA Smith conducted a physical plant tour and interviewed the administrator. The case was later referred to the Investigation’s Branch (IB) and an investigation was continued by the IB Investigator Seng. LPA Reed reviewed Investigator Seng’s report at 5:00 p.m. on 01/03/2023 and at 9:50 a.m. on 01/13/2023. Regarding the allegation “Resident was overmedicated while in care”, it was alleged Resident #1 (R1) was overmedicated with antipsychotic medication. At the time of investigation, R1 was no longer at the facility. R1 moved to another location on 09/19/2022. Unsubstantiated During investigation, between 09/20/22 and 11/29/22 IB investigator Seng conducted interviews with R1’s hospice and palliative care physician, facility Administrator, other staff, residents, witnesses, and a family member. The facility staff indicated that they assisted R1 with all prescribed medications, which included medications prescribed by the Hospice doctor. R1’s family member was unaware that since R1’s admission to hospice care on 07/07/2022, R1 was prescribed with additional medications. As per hospice physician, the medications prescribed to R1 were ineffective and therefore could not have been used as chemical restraints. A review of R1’s medication record conducted by LPA Reed on 01/13/2023 at 9:50am, revealed that in addition to R1’s medication prescribed by R1’s regular physician, resident was receiving other medication prescribed by the hospice doctor. The information revealed from record review verified the information received from staff interviews. Based on interviews and record review, there is not sufficient information to support the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Due to staff neglect resident developed multiple Urinary Tract Infections”, it was alleged R1’s multiple UTIs were caused by overmedication and staff removing R1’s catheter. From interviews of medical professionals, facility staff, and residents and review of medical records conducted by IB Investigator Seng between 09/20/22 and 11/29/22, R1’s medications would not have caused a UTI or constipation. R1’s UTIs and constipation were likely the result of dehydration, and the irritation of a UTI was a probable cause for R1 removing their catheter. Staff noted multiple attempts to keep R1 hydrated. R1 admitted to removing their catheter several times from July 2022 to September 2022 due to discomfort. Based on interviews and record review, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Resident was placed on hospice while at the facility without consent of resident's representative”, it was alleged R1 was placed under hospice care without consent from their responsible person. From record review of facility files conducted on 01/13/2023 at 9:50 a.m., R1 was admitted to the facility with no responsible person. R1’s medical assessment showed no legal representative either. R1’s admission was contracted through the Department of Mental Health. R1 signed their own hospice paperwork on 07/07/2022. From IB Investigator Seng’s interview of the facility Administrator on 09/20/2022, the facility did not receive any paperwork identifying family member as a designated Power of Attorney (POA) for R1. The information revealed from R1’s records verified the information received from the Administrator. Based on record review and interviews, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff did not seek medical attention for resident in care in a timely manner”, it was alleged the facility did not immediately attend to R1’s medical needs. From record review conducted on 01/13/2023 at 9:50 a.m. R1 was hospitalized three times while at the facility. Staff Interviews conducted by IB Investigator Seng on 09/20/2022 revealed that R1 was in poor health upon arrival, but staff did their best to care for R1. While in care, R1 was hospitalized few times. In each instance, the facility notified R1’s case workers, hospice agency, primary care physician, and Community Care Licensing. 9-1-1 was called immediately thereafter. Based on interviews and record review, the allegation is deemed UNSUBSTANTIATED at this time. Regarding the allegation “Staff did not ensure that resident in care received follow-up medical attention”, it was alleged R1’s overmedication led to their bowel blockage and staff did not provide required medical attention. From staff interviews conducted on 09/20/2022 by IB Investigator Seng, the hospice care was recommended for R1 due to their chronic pain and constipation. In addition, staff attempted to hydrate R1 on an hourly basis. From record review conducted on 01/13/2023 at 9:50 a.m. by LPA Reed, R1 had a history of chronic constipation. The facility’s sign-in sheet showed multiple visits each month from case managers and hospice nurses visiting R1 to address chronic health problems. Based on interviews and record review, the is an insufficient information and evidence to support the allegation, Therefore, the allegation is deemed UNSUBSTANTIATED at this time. No immediate health and safety issues were noted during this visit. Exit interview conducted. Appeal rights discussed. Copy of report provided.the state’s words, verbatim · CDSS document, Mar 11, 2023 · control 31-AS-20220825154325

Allegation investigated: Staff are not following guidelines to prevent the spread of COVID-19

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with facility staff who contacted the administrator by telephone. LPA explained the reason for the visit to the administrator. LPA conducted a physical plant tour from 9:15-9:25am to ensure no immediate health and safety issues. No health and safety issues were noted. It is alleged that facility staff are not doing a covid-19 screening which include temperature checks on visitors. It is also alleged that staff are not wearing mask while providing care in the facility. Upon entry to the facility staff did not take LPA's temperature or perform a covid-19 screening. During the visit LPA observed home health come to the facility at approximately 9:50am and no covid-19 screening was done. LPA did observe one staff to be wearing a mask while another staff was observed to not be wearing a mask. Based on the information obtained through observation this allegation is deemed Substantiated. Deficiency cited on LIC 9099D. Appeal Rights explained and a copy of report was issued. Substantiatedthe state’s words, verbatim · CDSS document, Jul 26, 2022 · control 31-AS-20220721154956

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jul 28, 2022

Personal Rights of Residents in All facilities-To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Bases on observations facility staff did not ensure the personal rights of persons in care to a safe, healthy, and comfortable home and engaged in conduct inimical to the health, welfare, and safety of persons in care, in that facility staff did not wear a mask, and did not follow COVID-19 guidelines by screening visitors.the state’s words, verbatim · CDSS document, Jul 26, 2022

Plan of correction: Administrator shall have an in-service with all staff on Covid Protocols by POC due date. Copy of sign in sheet shall be sent to LPA by email or fax by POC due date.

Type of visit: Required - 1 Year

At approximately 12:35 PM on 02/03/22, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection using the Infection Control Domain of the Compliance and Regulatory Enforcement (CARE) Tools. LPA met with staff and later Administrator and disclosed the reason for the visit. Entry: LPA observed a sign posted on the front door regarding the facility’s visitation policy and COVID precautions. The walkway and front yard were well maintained. Screening: Staff took LPA’s temperature and requested LPA sign in on the visitor log. LPA recorded name and time of arrival. LPA recommended two additional columns for visitor temperature and symptom check. LPA also observed gowns, N95 masks, surgical masks, surgical masks, gloves, and sanitizer. Beside the visitor log was a binder for daily documentation of resident temperatures. At approximately 12:55 PM, LPA conducted a physical plant tour. Bedrooms: The facility has 6 bedrooms in total. 1 bedroom is shared, and 5 bedrooms are private. All bedrooms were clean and odorless. Furniture was in good repair. Bedroom #1 was the shared bedroom. It contained a secured partition which provided social distance between beds. Bedroom #3 was designated for a bedridden resident, and the emergency exit was free from obstruction. Bedroom #4 also contained a secured partition but contained only one resident. Two other bedrooms were designated for staff and an individual who was fingerprinted and criminal background cleared. LPA observed a locked closet in a hallway amongst Bedrooms #1, #2, and #3. The locked closet contained medication and extra hygiene supplies. Bathrooms: The facility had 3 bathrooms. Bathrooms #1 and #2 were located at the front. They contained paper towels, liquid soap, and trash cans with tight fitting lids. Bathroom #3 was connected to Bedroom #4. It contained liquid soap, paper towels, a lidless trash can, and a shower with grab bars and a non-skid mat. LPA recommended a tight fitting lid for the trash can and a handwashing instruction sign Common Areas: LPA observed a clean living room with furniture in good condition. Couches and seating was arranged to allow for social distancing. Television and board games were provided for entertainment. LPA observed a sink near Bedroom #4 where LPA recommended a handwashing instruction sign. Garage: LPA entered a locked garage and saw cleaning supplies, hazardous liquids, detergents, extra PPE, and a refrigerator for extra food. Outside and Back Yard: LPA toured the two side paths and back yard. Both emergency exit gates were unlocked, and paths were free from debris. The back yard contained a gardening space. LPA observed a resident under a shaded patio area. LPA heard functioning auditory alarms on all exit doors. The facility uses a call system which LPA heard several times. Mitigation: At approximately 1:30 PM, Administrator and LPA discussed the facility’s mitigation plan. In the event of a COVID positive resident, the facility can provide the Staff Bedroom for isolation purposes.the state’s words, verbatim · CDSS document, Feb 3, 2022