Atkinson Care Home

Type of visit: Required - 1 Year

On 10/21/2023 at 8:45 am Licensing Program Analyst (LPA) David España conducted an unannounced 1-year Annual visit to the facility. Upon arriving at the facility, LPA met with Licensee Muqueet “MD” Dadahboy, who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections. LPA and Licensee toured the physical plant. The facility is located in a residential area. During today’s visit, LPA observed the following: The Residential Care Facilities for the Elderly (RCFE) facility is licensed to operate for six (6) non-ambulatory residents age 60 and above of which six (6) can be hospice residents. The facility is two-story structure located in a residential neighborhood. It consists of the following: four (4) resident rooms, two (2) resident bathrooms, one (1) living area, one (1) dining area, one (1) kitchen, and one (1) outside patio area including two (2) shed for storage and one (1) table with four (4) chairs with shade. The second story of the facility is not accessible to residents and consists of one (1) office space with one (1) restroom and one (1) staff rest/break room with a restroom. There is a total of two (2) refrigerators and two (2) freezers, and the washer and dryer are located in the detached garage also used for storage. There were no bodies of water or obstructions on the premises. There are ramps leading to the backyard for each resident room to exit the front yard. The front yard consists of a white gate separating the sidewalk and the property and a small waterfall on the left side of the house in the corner. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 105.0 F to 120.0 F (i.e., 114.5 F) in the bathrooms and kitchen sink.A comfortable temperature was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days were observed. Freezers and refrigerators are maintaining temperatures. Medication is labeled and inaccessible to clients in dining room cabinet. There is a fully charged fire extinguisher in the kitchen, smoke detectors and carbon monoxide were operable. Medications were stored in a locked cabinet in the kitchen. During the visit, LPA observed the facility infection control practices. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. No deficiencies were cited during this inspection visit. However, one (1) technical violation and one (1) technical assistance were issued. Technical Violation Staffing - Technical Violation: 1569.618(c)(3) Technical Assistance Resident Rights/Information - Technical Assistance: 87468(c)(2)(A) - An exit interview was conducted, and a copy of this report and appeals rights was provided to Licensee, Muqueet “MD” Dadahboy.the state’s words, verbatim · CDSS document, Oct 21, 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: Required - 1 Year

Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Licensee TERESITA CASTANEDA and the purpose of today’s visit was explained. There are currently (3) residents in the facility. (1) residents are ambulatory, (2) are non-ambulatory, (0) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (6) bedrooms, (2) full bathrooms for residents, shaded back yard, front yard, laundry room and detached 2 garage. LPA and Licensee toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1,2, and 4, are occupied by residents bedrooms 3 is vacant, bedroom 6 if for staff, all contain the mandated furniture. The (2) bathrooms have grab bars and non-skid mats and are clean and operational. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. (1) Resident file along with medications are current. (1) Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is within title 22 limits, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (1) fire extinguishers is fully charged. Cont. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap, paper towels, in all the bathrooms and additional sanitation supplies are stored in the garage. LPA observed staff and residents wearing masks, resident private rooms will be converted to isolation rooms (if needed) trash cans with lids, cart for PPE’s, mitigation plan posted and/or in folder, Fit testing was completed for staff per licensee, and required postings throughout the facility. Visitor designated area, facility has internet & for residents to use, resident’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days. All residents and staff are vaccinated and boosted. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time An exit interview was conducted with Back up Administrator Edilberto Bernardino, and a hard copy was provided.the state’s words, verbatim · CDSS document, Nov 29, 2022

Allegation investigated: Facility illegaly evicted resident.

Licensing Program Analysts (LPA) Martessa Brown, conducted an unannounced subsequent complaint visit to deliver findings at Atkinson Care Home regarding the above allegation. LPA met with Leo Sumalponng, Caregiver and was later met by administrator and explained the reason for the visit. During the visit on 3/11/22, LPA toured the home and spoke to assistant administrator. LPA requested the following documents LIC500 resident #1 physician report, appraisals, needs & service, most recent incident reports for R#1 and hospital records be sent by email 3/16/22. The investigation consisted of the following: On 4/22/22 interview was conducted by LPM Hammond. On 6/11/22 LPA conducted interviews with staff #1-2. Investigation revealed the following: Substantiated Allegation: Facility illegally evicted resident. LPM Hammond interviewed the administrator regarding the above allegation. Administrator stated R1 would disturb the staff and other residents. He stated had informed the family that R1’s health was having breathing problems and health was declining. He mentioned to the family about putting R1 in a private room for the same rent amount to meet R1’s need. Administrator stated family refused and informed him they were going to move R1 to another facility. Administrator stated resident was having breathing problems again and was transported to the hospital and hospital kept resident. He stated did not evict R1. LPA conducted interviews with staff #1-2 stated r1 was disturbing staff and residents and was having breathing problems at night that seemed like a panic attack. S1 stated called family to inform R1 had several incidents but family did not was R1 to be transported to the hospital. S1 stated in February 2022 R1 had to be transported to the hospital and family was notified. Staff stated while R1 was in the hospital was told R1 will not be returning to the facility. On 6/11/22 LPA reviewed R1’s incident report that stated 911 was call and resident was transported to the hospital. Based on documentation and interviews administrator did not have R1 re-evaluated in order to notify family of r1’s needs. Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit Interview Conducted, appeal rights were explained, and a copy of this report was furnished. to Leo Caregiver.the state’s words, verbatim · CDSS document, Jun 13, 2022 · control 11-AS-20220307103756

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Jun 23, 2022

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This Requirement was not met as evidence by: Based on observations and interviews conducted, Licensee did not have R1 re-evaluated to determine if the facility was the appropriate place for resident to continue living in the home. This is a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Jun 13, 2022

Plan of correction: Licensee will review eviction procedures and will outline a plan on how he will adhere to eviction procedure and re-evaluate residents to reflect Title 22. Licensee will send copy by poc due to LPA M. Browns attention.

Allegation investigated: Facility staff failed to issue a refund

Licensing Program Analysts (LPA) Martessa Brown, conducted an unannounced subsequent complaint visit to deliver findings at Atkinson Care Home regarding the above allegation. LPA met with Leo Sumalponng, Caregiver and was later met by administrator Dadaboy and explained the reason for the visit. During todays visit LPA toured the facility and obtained the following document R1's Admissions Agreement. LPA conducted interview with the administrator and Staff S1. The investigation revealed the following: Allegation: Facility staff failed to issue a refund LPA conducted interview with the administrator. He stated R1 did not return to the facility per the hospital stated R1 could not return to the facility therefore refund was not due. LIC9099-C is on the next page Substantiated He stated the resident items was place in the garage and family was notified around 2 weeks after around March 2022 the hospital to pickup belongings. LPA interviewed s2, stated resident did not return to the facility due breathing complications and hospital kept the resident. S2 stated they had moved out residents belonging 2 weeks after the hospital and son had picked up r1's belongings. LPA reviewed R1 admissions agreement stated under payment provisions, section B the billing and payment policies and procedures are no monthly invoicing, non-refundable processing fee of $500 and non-refundable assessment fee of $500. Based on review the administrator charged R1 to separate fees preadmission fees instead of one. Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit Interview Conducted, appeal rights were explained, and a copy of this report was furnished to Leo Caregiver.the state’s words, verbatim · CDSS document, Jun 13, 2022 · control 11-AS-20220608115956

From the deficiency page — Deficiency type: Type B · Section cited: CCR 1569.651(b)(d) · Plan of correction due date: Jun 23, 2022

1569.651 Preadmission fee or deposit for elderly at residential care facilities; written statement describing costs and stating whether fee is refundable; conditions for refund; refund rate schedules (b) If a licensee charges a preadmission fee, the licensee shall provide the applicant or his or her representative with a written admission fee is refundable..(d) Any fee charged by a licensee of a residential care facility ...This requirement was not met as evidence by: Based on observations and interviews conducted, Licensee charged R1 one 2 Pre-Admission fee instead of one and did not describe the associated fee or that it was refundable. This is a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Jun 13, 2022

Plan of correction: Licensee will develop a plan on how he is going to comply with regulation and not charging 2 pre-admissions fees and submit a new admissions agreement for the facility to LPA Brow by POC due date.

Type of visit: Case Management - Other

On 6/13/22, Licensee Program Analyst (LPA) Martessa Brown was investigating a complaint allegation at the above facility and met with Muqeet Dadaboy. During today’s investigation LPA notice the following health and safety concerns. At 11:30 AM during today’s visit LPA observed construction work being done in the facility’s living room, hallways and kitchen area. At 11:30 AM LPA observed there was no stove, refrigerator and cabinets in the kitchen area. LPA went outside of the home and the refrigerator; toaster oven and other kitchen appliances was outside. LPA noticed the refrigerator, rice cooker and a hot plate with a pot sitting on the counter and was plug into a socket located outside. Administrator stated construction was done around 5/13/22 and did not notify CCLD, Ombudsman and the fire department. He stated construction will be finish in a month. During today’s visit LPA discussed the with the Administrator plan of corrections and due dates. Deficiencies cited on California code of regulations title 22, division 6, chapter 8. An exit interview was conducted and a copy the report and the appeal rights were discussed and provided to Leo-Cargiver.the state’s words, verbatim · CDSS document, Jun 13, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 8277(a)(D) · Plan of correction due date: Jun 23, 2022

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(D) Any incident which threatens the welfare, safety... This requirement was not met as evidence by: Based on LPAs observation construction work was being done inside of the home and Licensee did not notify the proper departments. This is a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Jun 13, 2022

Plan of correction: Licensee will outline a plan on how he will ensure the health and safety of the residents in care while construction work is being done. He will also complete/notify CCLD, Ombudsman and the fire depart by POC due date.

Type of visit: Required - 1 Year

On 11/23/2021, Licensing Program Analyst (LPA) Don Senaha conducted an unannounced annual required visit with a primary focus on Infection Control measures using the new CARE Inspection Tool. LPA met with Licensee Muqueet Dadahboy and explained the purpose of today’s visit. The facility is licensed to operate for six (6) non-ambulatory residents age 60 and above of which six (6) can be hospice residents. The facility is two-story structure located in a residential neighborhood. It consists of the following: four (4) resident rooms, two (2) resident bathrooms, one (1) living area, one (1) dining area, kitchen, and outside patio area including a shed for storage and a table with shade. The second story of the facility is not accessible to residents and consists of an office space with a restroom and a staff rest/break room with a restroom. There is an additional refrigerator and freezer and the washer and dryer in the detached garage used for storage. LPA and Licensee toured the physical plant. There were no bodies of water or obstructions on the premises. There are ramps leading to the backyard for each resident room to exit the front yard. The front yard consists of a white gate separating the sidewalk and the property and a small waterfall on the left side of the house in the corner. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. The water temperature measured between 105.0 F to 106.8 F in the bathrooms and kitchen sink. A comfortable temperature was maintained in the facility. Evaluation Report Continues on LIC 809-C LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. There is a fully charged fire extinguisher in the kitchen, smoke detectors and carbon monoxide were operable. Medications were stored in a locked cabinet in the kitchen. During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. No deficiencies were cited during this inspection visit. An exit interview was conducted and a copy of this report was provided to Licensee Muqueet Dadahboy.the state’s words, verbatim · CDSS document, Nov 23, 2021