Heart of Home Senior Living

Type of visit: Case Management - Annual Continuation

At 9:35 a.m., Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced Case Management - Annual Continuation at the facility today continuing the inspection that began on 06/27/2023. At 10:00 a.m., the Administrator arrived at the facility. RECORD REVIEW: Between 10:10 a.m. and 11:20 a.m., the LPA conducted a file review for all residents and staff regularly scheduled and observed the following: Staff have current first aid and training documentation showing required training completed. All personnel/ staff files were in order. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. The following was noted: one (1) out of four (4) resident files reviewed did not contain a current reappraisal. The Administrator did not reassess and update the reappraisal for Resident #1’s (R1) in the past 12 months (last reappraisal dated 06/26/22). Discussion held with Administrator and the Administrator stated that R1’s reappraisal will be updated. Remaining files reviewed were observed to be in compliance. MEDICATIONS: Between 11:35 a.m. and 12:08 p.m., the LPA conducted a review of medication and medication documentation with the Administrator for four (4) out of four (4) residents and observed the following: R1’s Carvedilol 6.25 mg (take 1 tablet twice a day) had 12 tablets remaining, however the medication was started on 06/28/2023 and the quantity was 60. Resident #2’s (R2’s) Levothyroxine 125 MCG Tablet (take 1 tablet once a day) had 3 tablets remaining, the medication was started on 06/27/2023 and the quantity was 30. Resident #3’s (R3’s) SM Melatonin 5MG (take 1 tablet once a day) had 2 tablets remaining, the medication was started on 06/27/2023 and the quantity was 30. The LPA had a discussion with the Administrator regarding the inconsistencies of R1, R2, and R3s medication and the Administrator stated that facility staff, including himself will be trained on medications. At 12:10 p.m., the LPA toured the physical plant areas inside and outside, with Administrator to ensure there are no health and safety hazards. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8 and California Health and Safety Code the following deficiency was cited (refer to LIC 809-D) Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 28, 2023

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 1:25 p.m., the LPA met with staff and explained the reason for the visit. At 1:40 p.m., the Administrator arrived at the facility. At 1:56 p.m., the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 1:58 p.m., hot water measured at 105.8-degree Fahrenheit. Medications and first aid kits are located in a locked kitchen cabinet. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away inside a kitchen cabinet. BEDROOMS: The facility is a single-story residential home with four (4) bedrooms and two (2) bathrooms for resident's use. The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 2:02 p.m., hot water 110.3-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. Continued on LIC 809-C. OUTDOOR SPACE: At 2:04 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a gate on the side of the house designated for an emergency exit. There are no bodies of water on the premises. At 2:04 p.m., the LPA observed car tires in the backyard. Licensee stated that the car tires will be removed from the facility. The facility has an accessory dwelling unit (ADU) on the side of the facility and is not part of the license. The ADU remains inaccessible to residents. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and last serviced on 11/03/2022. At 2:06 p.m., fire alarms/carbon monoxide detectors were tested and functioned properly. Night lights were present in the hallways and passages. All exits have functioning auditory devices and were operational at the time of the visit. There is a washer and dryer located in one of the hallways. Between 3:08 p.m. and 3:12 p.m., the LPA conducted interviews with two (2) staff. Due to time constraints the LPA will return to complete the annual at a later date. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jun 27, 2023

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a Random Annual two-year Compliance Plan visit. At 10:57 a.m., the LPA met with the Administrator and explained the reason for the visit. This annual had a specific emphasis on physical plant/environmental safety and food services practices and procedures. At 11:45 a.m., the LPA, along with the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:50 a.m., hot water measured at 105.2-degree Fahrenheit. Medications and first aid kits are located in a locked kitchen cabinet. At 11:55 a.m., the LPA observed staff preparing lunch. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 11:41 a.m., hot water measured between 106.6 and 109.6-degree Fahrenheit. The sinks had sufficient liquid soap, and paper towels. At 11:46 a.m., the LPA observed Lysol disinfectant underneath the sink. Once observed, the Administrator locked away the Lysol disinfectant. Continued on LIC 809-C. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguisher to be fully charged and serviced on 11/03/2022. Signs are posted throughout facility to promote handwashing, and cough/sneeze etiquette. At 11:56 a.m., the fire alarms/carbon monoxide detectors were tested and functioned properly. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. OUTDOOR SPACE: At 12:02 p.m., the LPA observed the back patio which has a covered outdoor area for resident use. There is a self-latching gate on the side of the house designated for an emergency exit. There were no bodies of water noted At 12:15 p.m., the LPA confirmed that three (3) out of four (4) residents have dementia. The Administrator understands that disinfectants need to be stored inaccessible to residents with dementia. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 809-D). Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. Report issued, and a copy of the report and appeal rights was provided via email.the state’s words, verbatim · CDSS document, Dec 20, 2022

Type of visit: Required - 1 Year

At 11:27 a.m., Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. The LPA was greeted and screened by staff. The Administrator was not available during the time of the visit. At 11:29 a.m., the LPA spoke with the Administrator on the phone, and the Administrator authorized staff, Tatevik Grigoryan to sign the report. This annual had a specific emphasis on infection control practices and procedures. At 11:35 a.m., the LPA, along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: At 11:35 a.m., the LPA observed the kitchen/dining area. Knives are stored in a locked cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:43 a.m., hot water measured at 105.5-degree Fahrenheit. Medications and first aid kits are located in a locked kitchen cabinet and drawer. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away. At 12:00 p.m., the LPA observed a resident reading a book at the dining table. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed puzzles and books in the common area. The LPA observed the fire extinguisher to be fully charged and last serviced on 05/27/2021. Flashlights were observed throughout the facility. Upon entry, signs are posted to promote handwashing, cough/sneeze etiquette, and physical distancing. At 11:46 a.m., fire alarms and carbon monoxide detectors were tested and functioned properly. The laundry units are located inside a hallway closet. Continued on LIC 809-C. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 11:44 a.m., hot water measured at 112.8-degree Fahrenheit. Night lights were present in the hallways and passages. OUTDOOR SPACE: At 11:39 a.m., the LPA observed the backyard, which has a covered outdoor area for resident use. There is a gate on the side of the house that is single latched designated for an emergency exit. Passageways were free and clear from obstruction. INFECTION CONTROL: During today’s visit, the LPA spoke with the staff regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. LPA observed a 30-day 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 has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. No deficiencies were observed at this time. Exit interview conducted with staff. Report issued and a copy of the report was emailed to the Administrator.the state’s words, verbatim · CDSS document, May 5, 2022

Allegation investigated: Failure to provide adequate care and supervision

Licensing Program Analyst (LPA) Ashley Smith initiated a subsequent complaint investigation to issue findings for the above allegations. The LPA met with Administrator Kajo Movsesian and issued the findings. On 04/26/2021, the Department received a complaint which alleged that due to lack of care and supervision, Resident #1 (R1) developed multiple untreated injuries which led to R1 being hospitalized. Thereafter, R1 passed away. It was further alleged that the facility failed to provide adequate food service and poor incontinent care. Community Care Licensing Division’s Investigations Branch (IB) Investigator Lorraine Patterson was assigned to the case. The initial visit was conducted on 04/27/2021 from 10:00 a.m. to 12:00 p.m. by LPA Eva Miller, in which LPA Miller toured the facility, interviewed three staff members and three residents, and obtained documents. Investigator Patterson reviewed hospital and home health records on 6/30/2021 and conducted the following interviews: interviewed a responsible party for R1 on 05/20/2021 at 4:31 p.m., interviewed R1’s family member on 06/14/2021 at 1:22 p.m.; interviewed staff on 05/20/2021 at 5:08 p.m., on 9/16/2021 at 5:00 p.m. and 6:31 p.m.; and, interviewed a resident on 9/16/2021 at 6:20 p.m. Substantiated Regarding the allegation: Failure to provide adequate care and supervision It was alleged that upon admission to the hospital, R1 was found with multiple pressure injuries. Prior to admission to this facility, a review of R1’s medical assessment dated 9/30/2020 and R1’s discharge paperwork from the skilled nursing facility dated 10/02/2020 did not mention wounds and/or pressure injuries outside of the healing surgical wound on R1’s left hip. The assessment conducted by home health, dated 10/3/2020 indicated that R1 had no additional pressure injuries. However, further review of the home health notes revealed that during the 10/03/2020 initial visit, staff were allegedly provided information on ‘skin and diabetic foot care’, yet additional information was not discovered as to the staging or presence of wounds. The home health visit conducted on 10/06/2020 documented that R1 had a ‘pressure ulcer/injury’ on the left heel, right heel, and coccyx with black surrounding tissue, yet there was no information regarding staging of the wounds. Intervention notes claimed that the nurse educated facility staff on the ‘diabetic precautions and management’. The final home health visit on 10/10/2020 was documented as ‘missed’; the visit notes claimed that when home health called the facility on 10/10/2020, the caregivers claimed that they did not need another ‘teaching visit’ as it related to R1’s care. Subsequently, R1 was discharged from home health services on 10/10/2020. The Administrator admitted that due to COVID-19, an in-person assessment was not conducted of R1 prior to R1 being admitted to the facility. Instead, the Administrator reviewed R1’s medical assessment and information from the skilled nursing facility, which neither document indicated the presence of wounds. The Administrator admitted that upon arrival to this facility, an assessment was conducted on R1 and R1 was observed to have ‘minor skin breakdowns’ on the left and right heels, and a wound on the coccyx. The Administrator was under the impression that home health would provide wound care for R1’s heels, yet the home health agency discharged R1 on 10/10/2020 and did not address the dark spots on R1’s heels. The Administrator also admitted that R1 had a ‘normal’ pressure injury on the coccyx area that was noted with redness and had started to open. The Administrator noted that R1’s heels worsened in condition, which resulted in the Administrator reaching out to R1’s primary care physician and R1’s family on approximately 10/27/2020. The Administrator reiterated that they communicated their concerns to the appropriate parties but noted that they had not received a timely response to their increasing concerns. Yet interviews with staff whom also provided care to R1 denied claims that R1 had the presence of ‘dark spots’, claimed that R1 lower body extremities were ‘good’, and appeared unaware to the fact that R1 had any wounds. After a tele-health visit was conducted on 10/27/2020, R1’s primary care physician re-authorized R1 to be evaluated by home health for the hip incision and the wounds on R1’s feet. On 11/01/2020, a home health nurse evaluated R1’s wounds. The assessment conducted by home health indicated that R1 had an unspecified open wound to the left foot and an unstageable pressure injury of the right heel. R1 was admitted to the hospital on 11/02/2020 at 5:06 p.m. due to a change of condition. Hospital admission paperwork dated 11/02/2020 indicated that R1 was admitted with a urinary tract infection, sepsis, septic shock, diabetes, end stage renal disease, hypertension, dyslipidemia, anemia, chronic kidney disease, malnutrition, hypoalbuminemia, hypokalemia, multiple pressure injuries, blindness in the left eye, and deep vein thrombosis. Furthermore, the nursing assessment conducted in the hospital revealed that R1 had a stage 4 pressure injury in the sacral-coccyx area, right heel deep tissue injury, and left heel deep tissue pressure injury. R1 was also found to have bilateral heel gangrene, and that the wounds were infected. Per the National Pressure Injury Advisory Panel, “…if necrotic tissue, subcutaneous tissue, granulation tissue, fascia, muscle or other underlying structures are visible, this indicates a full thickness pressure injury (Unstageable, Stage 3 or Stage 4).” As such, due to the necrotic tissue that developed on the heels, the deep tissue pressure injuries are further noted as unstageable. On 11/04/2020, R1 had to undergo a procedure where wound debridement of necrotic tissue of the left heel was removed. On 11/07/2020, R1 passed away in the hospital. The hospital discharge summary further noted that R1 developed respiratory failure with hypoxia and that R1’s condition was deemed dire in light of multi-organ failure. The cause of death, per the Death Certificate, was noted as sepsis, urinary tract infection, diabetes, end stage renal infection. Based on the information obtained, R1 was admitted to this facility on 10/02/2020 and assessed to have ‘discoloration’ on R1’s heels. Whereas R1 was under the care of home health, documents demonstrated that it was only for R1’s surgical wound on R1’s left hip. At the appearance of the discoloration on R1’s heels and the wound on R1’s coccyx, the staff should have sought the guidance of an appropriately skilled professional to specifically assess and treat R1’s heels. Whereas the Administrator claimed to have communicated their concern to multiple parties prior to reaching out to R1’s primary case physician on 10/26/2020, the Administrator could not provide supporting documentation or record of wounds, body checks, or logs to indicate when they consulted with home health or R1s family. The Administrator maintained the belief that R1’s dark spots were related to the diabetes, as they consulted with a home health nurse (whom was not assigned to R1) and they noted that the dark spots were likely due to R1’s diabetes diagnosis. In conclusion, the facility failed to properly assess R1’s skin condition and seek proper medical care. When R1’s wounds were properly evaluated at the hospital, R1 was found to have multiple pressure injuries, which were presumed to be infected. In addition, R1’s wound(s) on R1’s lower extremities were not monitored and treated by an appropriately skilled professional between 10/06/2020 and 11/01/2020. Lastly, the pressure injury on R1’s coccyx progressed to a stage 4 pressure injury. The allegation ‘Failure to provide adequate care and supervision’ is Substantiated at this time. Per California Code of Regulations (CCR), Title 22, see LIC 9099-D for deficiencies cited. An immediate civil penalty of $500 is also assessed. The licensee was informed that a civil penalty might be assessed based on the Health and Safety Code 1569,49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f). Exit interview conducted. A copy of the report was issue, along with appeal rights. Regarding the allegation: Questionable Death It was alleged that R1 sustained an untimely death due to lack of care and supervision. Interviews and records review revealed that on approximately 9/18/2020, R1 fell and suffered a left hip fracture. R1 underwent hip surgery and was transferred to a skilled nursing facility for rehabilitation on 9/22/2020. After rehabilitation, R1 was admitted to this facility on 10/02/2020 with orders for home health for the surgical hip wound and physical therapy services. R1’s medical assessment, dated 09/30/2020, indicated that R1 had a diagnosis of Type II Diabetes and End Stage Renal Disease. It was further noted that R1 received hemodialysis three times a week. Record review confirmed that R1 had a healing surgical wound on the left hip and documents did not mention other wounds and/or pressure injuries. The assessment conducted by home health, dated 10/3/2020 indicated that R1 had no additional pressure injuries. Records revealed that R1 was visited by home health on 10/03/2020 and 10/06/2020 and a ‘Missed Visit’ was noted on 10/10/2020. The 'Missed Visit’ notes claimed that when home health called the caregivers, the caregivers claimed they did not need another ‘teaching visit’ to care for R1. As such, R1 was discharged from home health services on 10/10/2020. R1 received visits from a physical therapist on 10/03/2020, 10/06/2020, 10/08/2020, 10/13/2020, and 10/15/2020. R1 was discharged from physical therapy services on 10/20/2020 with discharge notes claiming that R1 was unable to ‘clear the bed’ during multiple sit-to-stand attempts and noted that R1 displayed a significant amount of fear with standing. Further discharge notes stated that R1 could benefit from outpatient physical therapy services with access to parallel bars. During interviews with the Administrator, the Administrator admitted that R1 had dark spots on their legs, feet, and heels. The Administrator communicated their dissatisfaction with the agency assigned to care for R1, as they did not address R1’s heel wounds. A review of the home health admission paperwork dated 10/03/2020 confirmed that the services was for R1’s surgical wound only and had no mention of wound care for R1’s feet. As a result, the Administrator noted that R1’s heels worsened in condition. The Administrator consulted with a home health nurse (whom was not assigned to R1) and they noted that the dark spots were likely due to R1’s diabetes diagnosis. Sill, the wounds were not monitored by an appropriately skilled professional. Records review revealed that a tele-health visit was conducted with R1’s primary care physician on 10/27/2020, in which the Administrator requested a new home health referral to treat R1’s wounds. In addition, the Administrator advocated for R1’s feet to be elevated when R1 was at the dialysis facility, as R1 received dialysis three times a week for several hours at a time. R1’s primary care physician re-authorized R1 to be evaluated by home health for the hip incision and the wounds on the feet. On 11/01/2020, a home health nurse evaluated R1’s wounds. The assessment conducted revealed multiple wounds, one of which that was deemed unstageable on R1’s right heel. Interviews and medical records review confirmed that on 11/02/2020, while receiving dialysis treatment, dialysis staff noted that R1 had a change of condition. R1 was sent back to the facility and later that evening, 9-1-1 was called and R1 was admitted to the emergency room on 11/02/2020 at approximately 5:06 p.m. Hospital admission paperwork dated 11/02/2020 indicated that R1 was admitted with a urinary tract infection, sepsis, septic shock, diabetes, end stage renal disease, hypertension, dyslipidemia, anemia, chronic kidney disease, malnutrition, hypoalbuminemia, hypokalemia, multiple pressure injuries, blindness in the left eye, and deep vein thrombosis. Regarding the pressure injuries, R1 was observed to have a stage 4 pressure injury on the sacral-coccyx area upon admission to the emergency room. In addition, R1 was also found to have bilateral heel gangrene, deep tissue pressure injuries on the left and right heel, and that the wounds were infected. On 11/04/2020, R1 had to undergo a procedure where wound debridement of necrotic tissue was removed from R1’s left heel. On 11/07/2020, R1 passed away at the hospital. The hospital discharge summary further noted that R1 developed respiratory failure with hypoxia and that R1’s condition was deemed dire in light of multi-organ failure. The cause of death, per the Death Certificate, was noted as sepsis, urinary tract infection, diabetes, end stage renal infection. Staff interviews revealed that staff were attentive in providing R1 with adequate care, which included regular body checks, providing wound care, repositioning R1, and providing R1 with a bath three times per week on average. The Administrator claimed to have cared for R1’s wounds with over-the-counter ointment and implemented additional preventative measures such as keeping R1’s legs elevated, utilizing compression socks, and regularly repositioned R1. The Administrator confirmed that at the sign of any changes, they consulted with home health, R1’s family, and R1’s primary care physician. Staff believed that R1 did not need urgent medical attention, and promptly called 9-1-1 when R1 had a change of condition. Based on the information obtained, there is insufficient evidence to support the claim that R1 sustained an untimely death due to lack of care and supervision. Interviews with R1’s family member revealed no suspicion of neglect or lack of care from the facility staff. Due to challenges with R1’s medical insurance coverage, R1’s insurance did not cover services that R1 needed prior to being at this facility. Further review by the Department Clinical Consultation confirmed that R1 had multiple comorbidities, which placed R1 at a higher risk of decline. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: Failure to provide adequate quality and quantity of food It was alleged that R1 was served food of poor quality and little variety. A review of the skilled nursing discharge summary dated 10/02/2020 noted that as R1 was diagnosed with End Stage Renal Disease, R1 was on a renal diet, which is a diet low in sodium, phosphorous (a mineral which in high dosages can contribute to bone weakness), and protein. Information obtained from interviews supported claims that R1 received food specific to their dietary restrictions. In addition, interviews with R1’s family member revealed that the food served to R1 was nutritional and of good quality, and no concerns were communicated regarding food service. In addition, information obtained from interviews with residents and staff did not corroborate claims that food served at the facility was of poor quality nor an insufficient amount. Based on the information obtained, there is insufficient evidence to support the claim that the facility failed to provide adequate quality and quantity of food. The allegation is deemed Unsubstantiated at this time. Regarding the allegation: Failure to provide adequate incontinent care It was alleged that R1 would stay wet ‘for hours’ before staff would change R1. Staff interviews supported claims that R1 was regularly repositioned and changed. Interviews with residents whom were incontinent denied claims that incontinent care was inadequate. It was during a diaper change that staff discovered that R1’s urine was discolored and felt that it was best to send R1 to the hospital. Interviews with R1’s family member revealed no suspicion of neglect or lack of care from the facility staff. A review of medical records from when R1 was hospitalized did not reveal that R1 was brought to the hospital in soiled clothing, which would have indicated poor incontinent care. A review of home health records revealed no documented concerns regarding the incontinent care that R1 received from the facility staff. Home health records did not indicate suspicions pertaining to neglect or lack of care. Based on the information obtained, there is insufficient evidence to support the claim that the facility failed to provide adequate incontinent care. The allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Mar 2, 2022 · control 29-AS-20210426111448

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Mar 4, 2022

87615(a)(1) Prohibited Health Conditions. (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained...: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as R1 was retained with a stage 4 and unstageable pressure injuries, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 2, 2022

Plan of correction: The Administrator agreed to do the following: 1. Schedule a training regarding Pressure Injuries and Healing Wounds. Verification of scheduled training with the trainers credentials will need to be submitted by 3/04/2022 and completion of training must be submitted no later than 3/21/2022. A civil penalty in the amount of $500 has been issued due to retaining a resident with a prohibited health condition. The wounds were not cared for by an appropriately skilled professional while at this facility.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87631(a)(1) · Plan of correction due date: Mar 4, 2022

87631(a)(1) Healing Wounds. ... The licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: When care is performed by or under the supervision of an appropriately skilled professional.. This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as R1 had wounds on the heels and coccyx that were not treated by an appropriately skilled professional, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 2, 2022

Plan of correction: The Administrator agreed to do the following: 1. Schedule a training regarding Pressure Injuries and Healing Wounds. Verification of scheduled training with the trainers credentials will need to be submitted by 3/04/2022 and completion of training must be submitted no later than 3/21/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Mar 4, 2022

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities. Residents shall have all of the following....: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on the investigation, licensee did not comply with the section cited above, as R1 did not receive the appropriate care and supervision, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 2, 2022

Plan of correction: The Administrator agreed to do the following: 1. Submit a Plan of Action, explaining the steps the facility will follow to ensure that the care needs of all residents are met. Submit Plan of Action no later than 3/4/2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Mar 4, 2022

87465(g) Incidental Medical and Dental Care. 9-1-1 shall be telephoned immediately if an injury or other circumstance has resulted in an imminent threat to a resident’s health, including an apparent life-threatening medical crisis. This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as the facility failed to ensure that R1 received timely medical attention pertaining to R1's wounds, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 2, 2022

Plan of correction: The Administrator agreed to do the following: 1. Submit a Statement of Understanding, explaining the steps the facility will follow to avoid similar issues from happening again and to ensure compliance to Title 22 Regulations regarding emergency medical assistance.