Simla Villas, Redondo Beach

Type of visit: Required - 1 Year

On 10/30/2023 at 1:00 PM, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced required – annual inspection and met with Jennifer Bobadilla, Administrator. Five (5) residents and two (2) staff were present during this inspection. Facility is licensed to serve six (6) non-ambulatory residents. The facility currently has 5 non-ambulatory residents. The facility is a two-story structure located in a residential neighborhood. It has a ramp going alongside front of home. The 1st floor is the facility and 2nd floor is for staff. 1st floor It consists (6) bedrooms, (3) full bathrooms, 1/2 bathroom. Sun room, book/activities area, living room/office area, dining room, kitchen/office area, ramp alongside of living room & dining room also ramp alongside of hallway to bedrooms, shaded back yard, front yard, gazebo, laundry room and 2 car garage. Staff accompanied LPA inside and outside the facility during this inspection. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. There are no security bars or weapons on the premises. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Resident bath towels and toiletries were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. LPA toured the kitchen area and observed a two-day supply of perishable and a seven-day supply of non-perishable food. Knives and toxics were kept in locked storage cabinet. First Aid kit was available. LPA observed one fire extinguisher last serviced August 16, 2023. 5 staff records were reviewed, 5 out of 5 staff records had required criminal record clearances. 2 staff were interviewed. 5 resident records were reviewed and, 5 out of 5 resident records had Admission Agreements, Medical Assessments, and Needs & Services Plans. 3 resident medication records were reviewed. 2 residents were interviewed. Deficiencies are not being cited based on LPA observation, interviews conducted and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted. A copy of this report was left with the Administrator.the state’s words, verbatim · CDSS document, Oct 30, 2023

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Facility staff did not adequately supervise resident resulting in resident wandering from the facility on more than one occasion. Facility staff did not reset door alarm to prevent residents from leaving without notification on more than one occasion. Resident sustained a fracture while in care. Facility staff are not adequately trained.

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the Simla Villas Redondo Beach facility on 01/27/2023 at around 09:00 AM and was greeted by Administrator (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation. Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10-day visit on 01/27/2023 approximately around 09:00 AM. LPA Calderon initiated an investigation for the above-mentioned allegation and conducted a face-to-face interview with Administrator (S1). On 01/23/2023 LPA Calderon interviewed W1 for complaint. On 01/27/2023 LPA Calderon requested copies of the following: Staff and Resident rosters, Needs and Service Plan, Physician Report, MAR, Dementia Training, and video for R1. On 01/27/2023 LPA Calderon reviewed medical records for R1. On 01/27/2023 LPA Calderon interview R2-R4 for complaint. On 01/27/2023 LPA Calderon interviewed S2-S3 for complaint. On 01/27/2023 LPA Calderon reviewed medical records for R1. Substantiated Regarding Allegation #1: Facility staff did not adequately supervise resident resulting in resident wandering from the facility on more than one occasion. On 01/23/2023 LPA Calderon interviewed W1 for complaint. W1 states that resident has wandering behaviors and left the facility on 12/17/2022 and was found on Inglewood Blvd by unknown witness who called 911. W1 states that resident was transported to the hospital. W1 states that staff did not properly supervise resident and allowed resident to leave the facility. On 01/27/2023 LPA Calderon interviewed S1 who states she was advised by staff that resident had wandered and left the facility and was found on Inglewood Blvd. On 01/27/2023 LPA Calderon interviewed S2 who states that a guest was visiting the facility and left the front door unlocked. S2 states that staff was aware that resident had wandering behaviors and S2 could not find resident. S2 states that staff searched and 20 to 30 minutes later found resident on Inglewood Blvd, but 911 had been called and fire department took resident to the hospital. On 01/27/2023 LPA Calderon interviewed S3 who states that resident had wandering behavior and had left the facility. S3 states that S3 was told that a guest had left the front door unlocked when they left, and that resident followed the guest out the front door. On 01/27/2023 LPA Calderon reviewed resident facility paperwork to include physician report, needs and service plan and hospital records. Resident was noted to have wandering behavior by staff, but reports do not support this behavior. On 01/27/2023 LPA Calderon attempted to interview R1-R4 but due to communication issues residents were not able to answer any questions. Regarding Allegation #2: Facility staff did not reset door alarm to prevent residents from leaving without notification on more than one occasion. On 01/23/2023 LPA Calderon interviewed W1 for complaint. W1 states that on two separate occasions resident had left the facility and staff had not secured the front door by locking the door or making sure the door alarm was working. On 01/27/2023 LPA Calderon interviewed S1 who states that a unknow guest left the facility and staff did not lock or alarm the front door one time, but resident who has wandering behaviors left the facility. On 01/27/2023 LPA Calderon interviewed S2 who states that a unknown guest left the front door unlocked and staff did not follow up and make sure the front door was locked and alarmed. On 01/27/2023 LPA Calderon interviewed S3 who states that the responsibility to make sure the front door is locked is the guest. On 01/27/2023 LPA Calderon attempted to interview R1-R4 but due to communication issues residents are not able to answer any questions. Regarding Allegation #3: Resident sustained a fracture while in care. On 01/23/2023 LPA Calderon interviewed W1 for complaint. W1 states that resident has wandering behavior and had left the facility and was found on Inglewood Blvd by unknown witness who called 911. Resident was transported to the hospital and evaluated with a right fracture ankle due to a unwitnessed fall. On 01/27/2023 LPA Calderon interviewed S1 who states that resident was found on Inglewood Blvd, was transported to the hospital, and evaluated with a right ankle fracture. On 01/27/2023 LPA Calderon interviewed S2 who states that resident was found on Inglewood Blvd and was taken to the hospital with a right ankle fracture. On 01/27/2023 LPA Calderon reviewed hospital records for resident and resident was evaluated with a right ankle fracture. Regarding Allegation #4: Facility staff are not adequately trained. On 01/23/2023 LPA Calderon interviewed W1 for complaint. W1 states that resident had wandering behaviors and staff had not been trained to deal with a resident with this behavior and had no training as to how to secure the front door to prevent a resident from leaving. On 01/27/2023 LPA Calderon interviewed S1 who states that no formal training had been given for staff to deal with a resident with wandering behaviors. On 01/27/2023 LPA Calderon interviewed S2-S3 who state that they were aware of resident wandering behaviors but were not given formal training. On 01/27/2023 LPA Calderon reviewed dementia training given on 12/19/2022, only 2 staff of 10 signed the sign in sheet and not clear as to what training was given. No training could be found regarding securing the front door or use of alarm. Based on LPA Calderon observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegations “facility staff did not adequately supervise resident resulting in resident wandering from the facility on more than one occasion” “facility staff did not reset the door alarm to prevent residents from leaving without notification on more than one occasion” “resident sustained a fracture while in care” “facility staff are not adequately trained” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 are being cited on the attached LIC 9099D. An exit interview was conducted and copy of the Complaint Report and Appeal Rights were provided to the Administrator (S1).the state’s words, verbatim · CDSS document, Jan 27, 2023 · control 11-AS-20230119162436

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Feb 3, 2023

87411 Personnel Requirements - General: A Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interviews, observations and records the licensee failed to adequately supervise staff to prevent wandering behavior. This poses a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 27, 2023

Plan of correction: Licensee will provide training to all staff regarding resident wandering behaviors. POC will be done by 2/3/23

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Feb 3, 2023

87411 Personnel Requirements - General: A Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interviews, observations and records the licensee failed to adequately train staff regarding locking and alarming the front door. This poses a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 27, 2023

Plan of correction: Licensee will provide training to all staff regarding securing /locking and alarming the front door to stop wandering behavior. POC will be done by 2/3/23

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(b) · Plan of correction due date: Feb 3, 2023

87211 Reporting Requirements: B Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on interviews, observations and records the licensee failed to adequately supervise residents to prevent wandering behavior and serious injuries. This poses a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 27, 2023

Plan of correction: Licensee shall provide training to alll staff regarding dementia and wandering behaviors to prevent serious injury. POC will be done by 2/3/23

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Feb 3, 2023

87411 Personnel Requirements - General: A Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on interviews, observations and records the licensee failed to adequately train staff to prevent wandering behavior and serious injuries. This poses a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 27, 2023

Plan of correction: Licensee shall provide training to alll staff regarding dementia care by POC date of 2/3/23

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Lyn bacos and later met with Simla Mehta, Administrator and the purpose of today’s visit was explained. There are currently (5) residents in the facility. (1) resident is ambulatory, (3) are non-ambulatory, (1) bedridden. The facility is a two story structure located in a residential neighborhood. It has a ramp going along side front of home. The 1st floor is the facility and 2nd floor is for staff. 1 st floor It consists (7) bedrooms, (3) full bathrooms, 1/2 bathroom is in room #7. Sun room, book/activities area, living room/office area, dining room, kitchen/office area, ramp along side of living room & dining room also ramp along side of hallway to bedrooms, shaded back yard, front yard, gazebo, laundry room is part of bathroom #1 and an attached 2 car garage. LPA and Lyn toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1 is vacant, Bedroom 2-6 are occupied by residents and contain the mandated furniture. Bedroom 7 is a staff bedroom. The (3) bathrooms are clean and operational. (1/2) bathroom is in staff bedroom #7. First aid kit is fully stocked with manual; smoke detectors and carbon monoxide detector were in compliance and operational. Facility had the smoke detectors and fire alarm system checked March 2022 and provided documents. The system is inter-connected and its connected with the Fire Department. 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 between 105 -120 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, (3) fire extinguisher are fully charged. 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 wearing masks, resident private rooms will be converted to isolation rooms (if needed.) trash cans with lids, No cart for PPE’s, mitigation plan posted and/or in folder, No fit testing completed for staff, and required postings throughout the facility. Visitation designated area, facility has internet for residents use, resident’s temperatures are checked and logged (once a day). Emergency contacts updated and posted; PPE's are enough for 30 days. 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. Technical Advisory(TA) was issued: 1. No fit testing completed for staff. An exit interview conducted with Mehta Simla, Administrator and a hard copy of report provided.the state’s words, verbatim · CDSS document, Aug 27, 2022

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.