Mountain View Cottages - I

Allegation investigated: Facility is in disrepair.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with Staff, Octavia Lapalonga. The purpose of the visit was explained. Administrator, Jasbindar Singh, arrived shortly thereafter to assist with the visit. The investigation consisted of the following: LPA obtained copies of the staff roster, resident roster, and interviews held with the Administrator, 3 Staff, 2 residents, and a plumber. A tour of the facility was also conducted. For allegation – Facility is in disrepair. It is alleged a pipe burst, causing mold, and the water was turned off. Facility staff indicated the water leak occurred approximately 2 weeks ago. The incident was reported to the owner right away. Due to obtaining cost and securing a plumber, the repair began this past Saturday, 2/11/23 and the anticipated completion date is on 2/17/23. Substantiated LPA toured the facility and observed the walls striped apart in the bathrooms, laundry area, and hallway to repair the pipes. LPA did not see any mold, but the water was turned off. Staff indicated that they were instructed to keep the water off for the time being and to turn on only when showering, using the toilet, or washing hands. Per the Administrator, several gallons of water are being refilled so that residents and staff could use for washing things. Residents interviewed were not aware of the water pipe bursting and causing leaks. Based on interviews and observation, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted. The Plan of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Feb 13, 2023 · control 28-AS-20230210100952

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 20, 2023

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The requirement is not met as evidenced by: Based on interviews conducted, the water was turned off due to the water pipes being in disrepair which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 13, 2023

Plan of correction: The Administrator shall submit proof of repair for the bathrooms, laundry area, and hallway by POC due date 2/20/23.

Allegation investigated: Facility has pests. Facility is not maintained in a clean and sanitary condition.

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegations. LPA met with Jasbindar Singh (Administrator) and explained the reason for the visit. The investigation consisted of the following: LPA Mora obtained copies of the resident and staff rosters, interviewed Administrator, Staff 1 - Staff 2 (S1 – S2), Resident 1 - Resdient 4 (R1 – R4) and conducted a tour of the facility. The investigation revealed the following: regarding the allegation "facility has pests”, it is alleged that cockroaches were observed crawling in the facility's kitchen. Interviews with Administrator and staff revealed that they are aware of the cockroaches and have bought Hot Shot Roach Spray and AdvionAnt gel to kill the cockroaches. Administrator also stated that the last pest control service was done in October 2022 because the person that provides the services has been out of the country. (CONTINUED TO LIC 9099C) Substantiated Residents interviewed could not corroborate with the allegation. During the tour, the LPA observed multiple cockroaches crawling in the kitchen's cabinets. Regarding the allegation "facility is not maintained in a clean and sanitary condition”, it is alleged that there is a layer of unknown residue on the top of the stove and a dead insect was observed attached to a web. Interview with Administrator revealed that a new stove was bought and will be delivered on 12/29/2022 because they are unable to remove the grease/oil residue from the stove. Best Buy receipt was observed by the LPA. Administrator also stated that the kitchen walls and cabinets will be cleaned and the walls will be painted. Residents interviewed could not corroborate with the allegation. During the tour, the LPA observed that the stove had a layer of oil/grease on the top part of it, the kitchen cabinets, walls and ceiling were stained with grease, roach droppings were observed inside the corners of the cabinets, and there was a dead insect attached to a web under the kitchen wall cabinets. Based on LPA's interviews and observations, the preponderance of evidence standard has been met, therefore the allegations are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D. Exit interview held and a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Dec 12, 2022 · control 28-AS-20221205092329

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 26, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: Based on observation the licensee did not ensure the kitchen is free of cockroaches which poses a potential risk to the health, safety, or personal rights of the persons in care.the state’s words, verbatim · CDSS document, Dec 12, 2022

Plan of correction: Administrator is to ensure facility is maintain free of cockroaches at all times, will contact pest control services and create a plan that will eliminate the cockroaches in the kitchen and submit the new plan to the CCLD by 12/26/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Dec 26, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: Based on observation the licensee did not ensure that the kitchen's walls, cabinets and stove are clean which poses a potential risk to the health, safety, or personal rights of the persons in care.the state’s words, verbatim · CDSS document, Dec 12, 2022

Plan of correction: Administrator is to ensure that the facility is maintain clean, sanitary and in good repair at all times, will replace the stove and clean kitchen's walls and cabinets. Pictures to CCLD will be submitted by 12/26/22 *The administrator showed the LPA a receipt for a new stove & will be delivered on 12/29/22*

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Administrator Jasbindar Singh and explained the reason for the visit. The physical plant was toured, medications records were reviewed, and food supply was inspected. Facility is licensed to serve six (6) non-ambulatory residents age 60 and above and may retain six (6) hospice residents. There are currently four (4) residents residing in the home; two (2) are ambulatory and two (2) are non ambulatory. The facility is single story home located on a residential street. The facility has an open front yard and enclosed backyard with an attached patio cover. LPA and Administrator Singh toured physical plant. LPA observed passageways and exits are free of obstruction. During the tour, LPA observed a living room area, kitchen, dining room area, four (4) resident bedrooms, one (1) staff bedroom, and three (3) bathrooms. The water temperature was tested in all resident bathrooms and measured between 108.5 - 112 degrees F which is within the required 105 - 120 degrees F. Bathrooms have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Resident beds have the required linen, and the linen is in good condition. Bedrooms also have sufficient closet space. LPA observed bedroom#1 to have missing/broken blinds. Bedroom#2 is currently empty. Carbon monoxide detectors were tested and observed in the hallway and family room area. Auditory devices were seen on exit doors which are required for dementia residents and were operating at the time of visit. LPA observed 1 fire extinguisher in the kitchen which was fully charged and last inspected in January of 2022. LPA observed the top of the stove, wall located directly behind stove, cabinet above the stove and ceiling located directly under the stove to have caked on grease and food splatter. LPA observed missing/broken blinds in kitchen above sink. Sharps are locked under the kitchen sink and are inaccessible to residents. Cleaning supplies, toxins and hygiene products are locked in a closet in the hallway and are inaccessible to residents. The First Aid kit which is located in a locked closet in the hallway was inspected and is fully stocked with current manual. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Sufficient supply of 2 days perishable & 7 days non-perishable foods was observed in the kitchen. LPA observed missing/broken blinds in living room. CONT 809C Medications, resident files, and staff files are kept in a locked closet in the hallway. The backyard is clean and there is a shaded seating area for the residents. No bodies of water were observed at the facility. LPA reviewed four (4) staff files and observed the following: out of four (4) staff have criminal record clearances and are associated to the facility, four (4) out of four (4) staff files have health screenings with TB information, and four (4) out of four (4) staff have current first aid/CPR certificates. LPA reviewed 4 residents medications and observed the following: 4 out of 4 medications documented properly and given as prescribed. Deficiencies cited on the 809 D. Exit interview conducted and appeals rights provided .the state’s words, verbatim · CDSS document, Dec 1, 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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced annual visit using the Infection Control Evaluation Tool. LPA met with Caregiver Jennifer Discipulo and explained the reason for the visit. The Administrator Jasbindar Singh arrived shortly after. The physical plant was toured, resident files and medications records were reviewed, staff files were reviewed and food supply was inspected. Facility is licensed to serve 6 non-ambulatory residents age 60 and above and may retain one hospice resident. LPA and Caregiver Jennifer Discipulo toured the facility which included the following: family room, living room, kitchen, dining area, 3 bathrooms, 5 resident rooms, 1 staff room, and backyard. Passageways and exits are free of obstruction. The water temperature was tested in the 3 resident bathrooms and measured between 105.1 - 110 degrees F which is within the required 105 - 120 degrees F. The resident bathrooms are clean and have the required grab bars in the shower and near the toilet for non-ambulatory residents. Showers also have non-skid materials. Resident bedrooms have the required furniture such as bed frames, dressers, lamps and chairs. Resident beds have the required linen and the linen is in good condition. Bedrooms also have sufficient closet space. There is a cabinet in the hallway with extra clean linen. Smoke detectors were tested and observed throughout the facility and in each resident room. Carbon monoxide detectors were tested and observed in the hallway and family room area. Auditory devices were seen on exit doors which are required for dementia residents and were operating a the time of visit. LPA observed 1 fire extinguisher in the kitchen which was fully charged. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked under the kitchen sink and are inaccessible to residents. Cleaning supplies, toxins and hygiene products are locked in a closet in the hallway and are inaccessible to residents. The First Aid kit which is located in a locked closet in the hallway was inspected and is fully stocked with current manual. Signs are posted throughout the facility to promote hand washing, cough/sneeze etiquette, and physical distancing. Sufficient supply of 2 days perishable & 7 days non-perishable foods were observed in the kitchen. (CONTINUED TO LIC809C) Medications, resident files, and staff files are kept in a locked closet in the hallway. The backyard is clean and there is a shaded seating area for the residents. No bodies of water were observed at the facility. LPA reviewed 5 staff files and observed the following: 5 out of 5 staff have criminal record clearances and are associated to the facility, 5 out of 5 staff have proof of in-service training, 5 out of 5 staff files have health screenings with TB information, and 5 out of 5 staff have current first aid/CPR certificates. LPA reviewed 4 residents files and medications, and observed the following: 4 out of 4 resident have admission agreements on file, 4 out of 4 have their needs and services plans up to date, and 4 out of 4 have physician's reports on file and TB information, and 4 out of 4 have their medications documented properly and given as prescribed. Per California Code of Regulations, Title 22, and California Health and Safety Code, there was no deficiencies observed during the visit. Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Dec 1, 2021

Type of visit: Annual/Required

LPA Fernando Fierros conducted an unannounced annual required visit for 2017 and met with Manager Jasbindar Singh. The purpose of the visit was discussed. During visit LPA Fierros spoke with Administrator Trupti Mody. Manager Jasbindar Singh states the facility has no weapons, ammunition's or bodies of water on premises. Manager Jasbindar Singh states the facility presently has three residents with dementia, no bedridden residents and no residents on Home Health or Hospice. Administrator Trupti Mody states the facility has video surveillance in the common area of the facility has been in use for around one year and is used for monitoring of staff, however, the licensee did not update the plan of operation with licensing in regards to the use an purpose of the Video Surveillance. Administrator states the facility will cease use of video surveillance and submit an updated Plan of Operation to licensing for review. The facility is a single story structure located in a residential area and contains the following: living room, dining room, family room, five resident rooms and one staff room, a kitchen, resident room #2 contains a bathroom with a washbasin, toilet and shower/tub, two common bathrooms with washbasin, toilet; one with a shower/tub and one with a walk-in shower, an outdoor shaded area for resident use in the backyard and a front yard. During visit LPA Fierros along with staff Victoria Montoya toured the physical plant and observed the following: required postings, operating within limits of license, auditory device operational, hallways and door ways clean and free of debris, adequate lighting and comfortable temperature throughout, sample food menu and activities observed, adequate 2 day perishable and 7 day non perishable food supply, see continuation page LIC 809C smoke alarms tested, carbon monoxide alarm tested and operational, sharps and toxins observed,, sufficient cups, plates and utensils, grab bars and anti skid mats in bathroom observed, sufficient linens and hygiene supplies, hot water temperature measured at 110*F in residents common bathroom, MARs reviewed, resident and staff files reviewed. At 09:20 AM, LPA Fierros observed the residents food was locked in the kitchen food pantry. Staff Victoria Montoya states the food is locked at night to prevent residents from getting into the food. Manager Singh states the facility does not have a waiver to lock the food supply. At 10AM, LPA Fierros observed toxins, a plastic container of bleach, powder laundry detergent in an unlocked cabinet in the laundry area and a can of paint and All Purpose Joint Compound in the side of the house in the backyard which is accessible to residents with dementia. Staff Victoria Singh was unable find the key to lock the cabinet and moved all items to an area inaccessible to residents with dementia. At 10:30 AM, LPA Fierros observed resident #1 file did not contain written orders for Vitamin D-3 2000 IU and staff Victoria Montoya gave resident #1 the supplement for the period 02/01/18 through 02/15/18. Staff Montoya could not find a written order to give to LPA Fierros At 10:30AM, LPA Fierros observed staff Victoria Montoya was giving resident #1 vitamin B-12 1000 mcg soft gel once a day for the period 02/01/18 through 02/15/18 and the written order was for B-12 Cyanocobalamin 2500 mcg SL Subl Tab - dissolve under tongue daily. Staff Victoria Montoya states residents family gave her the vitamin B-12 supplement with the dosage of 1000 mcg and in soft gel. At 11:30AM LPA Fierros observed resident #3 medication Latanoprost 0.0005% eye drops were stored in an unlocked refrigerator and accessible to residents with dementia. Manager Singh states she would obtain a lock box for the medication. During visit, Staff Victoria moved resident #3 medication to an area inaccessible to residents with dementia. see continuation page LIC 809C At 10:20 AM LPA Fierros observed common bathroom #3 did not have a grab bar near the toilet. Staff Victoria Montoya stated the wall was recently repaired and the grab bar has not been reattached. At 10:20 AM, LPA Fierros observed the smoke alarm in staff room was non operational. Staff Victoria Montoya did not know why it was not working. Cleared during visit, Staff replace battery and smoke alarm is operational. At 11:10 AM LPA Fierros was informed by Manager Singh and Staff Victoria Montoya that all residents #1-#6 are prepared and stored the day prior for morning, evening and bedtime and stored in a clear cup in a clear plastic box. At 11:20 AM LPA Fierros observed the First Aid Kit did not contain a First Aid Manual from an approved agency. Manager Singh states she is unable to locate the First Aid Manual. . At 09:40AM LPA Fierros observed the wall near bathroom #3 and the wall in bathroom #3 are not painted. The backyard contains debris on the walkway on the side of the house, several mattresses, boxes, a wheelchair, walker and hoyerlift. Deficiency noted on todays visit were cited on the Licensing Report LIC 809 dated 02/16/18 for the Year 2016 per Title 22 Division 6 Chapter 8. Appeal Rights discussed and a copy given during visit. Exit interview conducted with Manager Singh.the state’s words, verbatim · CDSS document, Feb 16, 2018