Walnut Garden Too

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christine Yee conducted an unannounced case management visit to deliver the amended complaint reports LIC9099, LIC9099-C, LIC9099-D and :LIC421M - Immediate Civil Penalty Assessment - Immediate $500 and Repeat Violations. LPA Yee met with Izhak Ilouz, Administrator. and the reason for today's visit was explained. The investigation for complaint #29-AS-20230721162950, received on 7/21/23, was conducted by LPA Angel Ascencio on 7/28/23. Based on LPA Ascencio's investigation, the allegation that the facility was operating over capacity was substantiated. The facility is licensed for 5 Non-Ambulatory and 1 bedridden resident based on the fire clearance approved by the fire department. The Licensee took on the 7th resident and placed them in a converted alternate dwelling unit(ADU) located at the same address as the facility. The ADU was not inspected by the fire department and a fire clearance was never obtained for the ADU to be used as a bedroom. On 7/28/23 the facility was cited for this deficiency under Title 22, Section 87468.2(a)(1) - Additional Personal Rights of Residents in Privately Operated Facilities (a)(1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. The citation was corrected and cited under: Fire Clearance: All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Exit interview was conducted with the Administrator, Appeals Rights discussed and a copy was given.the state’s words, verbatim · CDSS document, Oct 31, 2023

Allegation investigated: Licensee operating overcapacity

******THIS LIC9099 SUPERSEDES AND AMENDS THE LIC9099 REPORT ISSUED ON 07/28/23 AND CORRECTS THE TITLE 22 SECTION NUMBER INCORRECTLY CITED.***** Licensing Program Analyst (LPA) Angel Ascencio conducted an initail complaint visit to the above facility. LPA Ascencio met with Administrator Izhak Illouz at 10:00 a.m. Entrance interview conducted. On 07/21/2023, the Department received a complaint alleging that the licensee is operating overcapacitiy. on 07/28/2023, LPA Ascencio conducted a facility tour at 10:10 a.m. During the tour, the LPA observed one (1) resident in the dinning room, 1 resident in the living room, and five (5) residents in their private bedrooms. Upon futher review of the Fire Inspection Report, dated 01/17/2020, the Licensee is licensed only to operate at a capacity of six (6). Administrator Illouz indicated that the other resident/tenant, Individual #1 (I1) lives in the addtional dwellingling unit (ADU) in the back of the property. They are not responsible for Substantiated care of this person, but the family pays Licensee to house the tenant in the ADU. The private caregiver called and stated they were running late and our staff assisted the resident this morning. Additionally, moving forward, Administrator Illouz stated they will house the residents and tenants separately. Administrator understood that no care or supervision by the facility should be made available for this additional person if person is only a tenant. That same day, interviews with staff members confirmed that there is an additional person at the home that lives in the ADU. Most days, I1 stays in their room, other times, they come to the home and be part of our facility. Additionally, staff interviews confirmed I1 has a private 24hr caregiver that family is paying for. However, interviews also revealed that family pay for private caregivers at night only while facility staff conduct all activities of daily living (ADL) to the resident during day time hours. Although Administrator Illouz stated that I1 is a tenant in the ADU, Administrator Illouz admitted that I1 was in the facility and that the facility assisted I1 this morning due to the private caregiver being late. Furthermore, although some staff interviews indicated that staff dont assist with ADL's, additional staff interviews confirmed that I1 is being assisted with all ADL's by facility staff. 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. Failure to correct the deficiencies may result in civil penalties. An Immediate Civil Penalty Assessment of $500.00 has been issued today 07/28/2023 for Fire Clearance. Civil penalties will be assessed against any facility that fails to take corrective action within described time periods. Exit interview conducted. A copy of the report and appeal rights were provided via email to Administrator. Lastly staff interviews stated they do not have a problem when showering residents, as they have to turn on the faucet before to warm up the water. Although, staff indicated that they have problems with hot water taking too long for it to come out, interviews indicated that they always have hot water available. Temperature readings of all faucets available at the home indicated that hot water is available and within normal range of 120 degree F. Thus, the allegation is deemed unsubstantiated. Regarding the facility has pest.On 07/28/2023, LPA Ascencio conducted a facility tour at 10:10 a.m. During the tour, the LPA observed various kitchen cabinets and storage areas that did not contain any evidence of pest. Interview with staff members stated that because of the summer time being hot, there are very few pest at night but are taken care of by Terminex Pest control company. Additionally, LPA Ascencio obtained a copy to the Terminex service logs that indicate they are coming every 3 months for servicing. Although Administrator Illouz and staff indicated that they have seen pest in the kitchen area, during facility tour, LPA did not observe any evidence or signs of pest. Thus, the allegation is deemed unsubstantiated at this time. LPA Ascencio spoke to Administrator Illouz regarding the hot water fluctuation and possible pest being observed. Administrator Illouz indicated clear understanding and stated Terminex will continue to fumigate and service the home, remodel the kitchen and update the water heater to mitigate hot water fluctuations. Exit interview conducted and a copy of the report was issued to Administrator.the state’s words, verbatim · CDSS document, Jul 28, 2023 · control 29-AS-20230721162950

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Jul 31, 2023

Fire Clearance: All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by: the licensee accepted a 7th resident(R1) that exceeded the maximum capacity approved by the fire clearance granted for 6 non-ambulatory residents. The resident was also placed in a converted alternate dwelling unit located on the premises, that was never fire cleared for use as a bedroom.the state’s words, verbatim · CDSS document, Jul 28, 2023

Plan of correction: The Licensee will work with the family of the 7th resident (R1) in relocating the resident to another licensed facility that has vacancies or a location that is more appropriate to meet the needs of the resident, ASAP. The licensee will also provide the Department with a copy of the permits and the approved Ceritificate of Occupancy for the converted Alternate Dwelling Unit by no later than 11/15/23. *** Resident #1(R1) was relocated by famiily on 10/19/23****

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit. LPA Ascencio met with Administrator Arlene Ceballos at 10:15 a.m. and explained the reason for the visit. The LPA toured the physical plant areas inside and outside, with Administrato rArlene Ceballos at 10:25 a.m., to ensure there are no health and safety hazards. BEDROOMS: There are (6) six bedrooms designated for resident use and (1) one bedroom designated for staff use. Bedroom #3 Bedroom #4 and Bedroom #5 have a direct exit to the exterior. The facility has furnished each room with clean linens, appropriate furnishings, and sufficient lighting for resident use. RESTROOMS: Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. The restrooms hot water measured between 105.0 and 120.0 degrees Fahrenheit. KITCHEN: Kitchen appliances were in operable condition. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The facility has a sufficient supply of perishable and non-perishable food. Knives, medications, and chemicals were locked and inaccessible. Kitchen sink hot water measured 118.2 degrees Fahrenheit. Continued on LIC 809-C COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. The facility smoke alarm system is hardwired and operated normally at the time of visit. Medications were observed to be locked in a closet by the kitchen and contained at least 30 days of worth of medication. The backyard has a covered outdoor area equipped with furniture for resident use. There were two water fountains noted. Both fountains are surrounded with plants and lawn ornaments which make the fountains inaccessible. The LPA observed a storage unit containing additional incontinent supplies, personal protective equipment, and seasonal decorations. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility had a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed 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 a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time. The facility’s policies and procedures as it pertains to infection control are adequate. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. At 11:30 a.m., during resident file review, LPA observed 5 out of 6 residents did not have their Appraisal or Reappraisal signed by resident representative. At 11:40 a.m., during resident file review, LPA observed 1 resident file that did not have a Tuberculosis exam results. Continued on LIC 809 - C At 11:47 a.m., during record review, LPA observed 2 staff files that did not have a completed Health Screening Form and their Tuberculosis exam results. At 1:30 p.m., during medication audit, LPA did not observed Acetaminophen 325 mg to be at the facility for resident per doctor's order. Exit interview conducted and copy of the report and appeal rights were issued to Administrator.the state’s words, verbatim · CDSS document, Jun 1, 2023

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required Annual visit. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Izhak Illouz at 3:00 p.m. and explained the reason for the visit. The LPA toured the physical plant areas inside and outside, with Administrator Izhak Illouz and assistant Arlene Ceballos at 3:10 p.m., to ensure there are no health and safety hazards. BEDROOMS: There are (6) six bedrooms designated for resident use and (1) one bedroom designated for staff use. Bedroom #3 Bedroom #4 and Bedroom #5 have a direct exit to the exterior. The facility has furnished each room with clean linens, appropriate furnishings, and sufficient lighting for resident use. RESTROOMS: Resident restrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. The LPA observed accessible cleanser, over-the-counter topical medications and disinfectant in Bathroom #4. Restroom hot water measured between 109.7 and 116.2 degrees Fahrenheit between 3:20 p.m. and 3:28 p.m. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Knives, medications, and chemicals were locked and inaccessible. Kitchen sink hot water measured 118.2 degrees Fahrenheit at 3:10 p.m. Continued on LIC 809-C COMMON SPACES: The common spaces included the living room and dining area and open laundry area. The LPA observed a screened fireplace in the living room. All areas were clean, sanitary and in good repair. Smoke detectors are hardwired and interconnected, there is a Carbon Monoxide detector installed at the facility. The LPA tested the fire alarm system at 3:30 p.m. and observed the system to be operating at the time of the visit. The fire extinguisher was observed to be full and last serviced on 11/1/21. The LPA observed required postings on the wall at the entrance. At 3:30 p.m. the LPA observed disinfecting wipes accessible. Flooring was checked for cleanliness and appeared in good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. BACKYARD: The backyard has a covered outdoor area equipped with furniture for resident use. There were two water fountains noted. Both fountains are surrounded with plants and lawn ornaments which make the fountains inaccessible. The LPA observed a storage unit containing additional incontinent supplies, personal protective equipment, and seasonal decorations. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator Izhak Illouz regarding the facility’s infection control practices. The Administrator was advised that they need to ensure that visitors upon entry are signing in at a central entry point for symptom screening, temperature checks, and sanitation. The facility has a sufficient amount of Personal Protective Equipment (PPE). The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility does not have a confirmed case of COVID-19 at this time and the LPA reviewed facility’s policies and procedures as it pertains to infection control. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided via Email.the state’s words, verbatim · CDSS document, May 18, 2022

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.