Global Elderly Care Facility

Allegation investigated: Staff did not provide resident with medications as prescribed.

On 6/16/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted an initial complaint investigation for the allegations listed above. LPA was greeted by House Manager Maricel Campbell. Administrator Teresita Bautista arrived shortly and joined LPA with the visit. LPA explained the purpose of today's visit. The investigation consisted of the following: LPA toured the physical plant with the House Manager. LPA reviewed R1’s service records (Admission Agreement, Physician’s Report, Appraisal, Medication Administration Records, and hospice records. LPA obtained a copy of the resident and staff rosters and R1’s service records. LPA interviewed four staff (S1-S4) and two (R2 and R3) residents. LPA’s attempts to interview three residents (R1, R4 and R5) were unsuccessful due to their medical conditions. LPA was unable to interview one resident (R6) because R6 is currently in the hospital. Evaluation Report continue on LIC 9099-C Substantiated This page has been amended to revise the first paragraph. INVESTIGATION REVEALED THE FOLLOWING: Based on records review, Resident #1 (R1) was admitted to the facility on 5/20/2023. R1’s physician’s report shows R1 is not able to store and administer own medications. R1 is unable to manage own medications but can communicate the need for PRN medications. Allegation: Staff did not provide resident with medications as prescribed. It is alleged that staff did not provide resident with medications as prescribed. It was reported that staff has not been giving R1 a medication prescribed by the doctor. Based on interviews conducted, four staff (S1-S4) and two residents (R2 & R3), denied that staff did not provide resident with medications as prescribed. However, based on LPA’s records review, R1’s medication administration records (MAR) in May 2023 shows none of medications was administered. A record of each dose was not maintained in the resident's record. LPA observed R1’s MAR in May 2023 does not list R1’s nonprescription PRN medications. S2 stated S2 administered all R1’s medications since R1 moved into the facility on 5/24/2023 but S2 admitted that S2 forgot to update R1’s MAR and overlooked to list R1’s nonprescription PRN medications. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has been met; Therefore, the allegation of: Staff did not provide resident with medications as prescribed” is found to be SUBSTANTIATED. According to the California Code of Regulations (Title 22, Division 6, Health and Safety Code), the following deficiency has been observed and citation issued (ref. LIC 9099D). Exit interview was conducted and a copy of the report was provided to Administrator Teresita Bautista. This page has been amended to revise the first paragraph. INVESTIGATION REVEALED THE FOLLOWING: Based on records review, Resident #1 (R1) was admitted to the facility on 5/20/2023. R1’s physician’s report shows R1 is not able to store and administer own medications. R1 is unable to manage own medications but can communicate the need for PRN medications. Allegation: Staff did not safeguard resident’s medication. It was alleged that staff did not safeguard resident’s medication. Based on interviews conducted, four staff (S1-S4) and two residents (R2 & R3), denied that staff did not safeguard resident’s medication. Based on LPA's records review of R1's medication administration records (MAR), R1's medications are centrally stored in a locked cabinet in the facility. Based on LPA's observations, there are no missing medications. Based on information gathered, there is no sufficient evidence to corroborate the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated An exit interview was conducted with Administrator Teresita Bautista, and a hard copy of report was provided.the state’s words, verbatim · CDSS document, Jun 16, 2023 · control 11-AS-20230609141712

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(3) · Plan of correction due date: Jun 17, 2023

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement was not met as evidenced by: Based on LPA’s records review, R1’s medication administration records (MAR) in May 2023 shows none of medications was administered. A record of each dose was not maintained in the resident's record. LPA observed R1’s non-prescription PRN medications are not lised in the MAR for both May and June 2023. S2 stated S2 administered all R1’s medications since R1 moved into the facility on 5/24/2023 but S2 admitted that S2 forgot to update R1’s MAR and overlooked to list R1’s nonprescription PRN medications.the state’s words, verbatim · CDSS document, Jun 16, 2023

Plan of correction: Administrator shall ensure all residents' medication are administered as prescribed and a record of each dose is maintained in the resident's record. Administrator shall conduct a training to staff on Section 87465 of Title 22. POC shall be submitted to CCLD via email to lourdes.montoya@dss.ca.gov.

Type of visit: Case Management - Deficiencies

On 6/16/2023, Licensing Program Analyst (LPA) Lourdes Montoya conducted a case management - deficiency visit. During today's unrelated complaint visit, LPA observed the garage is full of clutters. LPA took photos of used clothes, lamps, boxes, black plastic bags, cardboards, old mattresses, etc. LPA observed the garage had molodorous smell. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. Exit interview conducted and a copy of the appeal rights were given at the time of the visit to Administrator Teresita Bautista.the state’s words, verbatim · CDSS document, Jun 16, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 23, 2023

(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 was not met as evienced by: During an unrelated complaint visit, LPA observed the garage is full of clutters. LPA took photos of used clothes, lamps, boxes, black plastic bags, cardboards, old mattresses, etc. LPA observed the garage had molodorous smell. This poses a potetial health, safety and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jun 16, 2023

Plan of correction: Administrator shall ensure the garage is clean, in order and sanitary. Administrator agreed to clean the garage. POC shall be submitted to lourdes.montoya@dss.ca.gov by the POC due date.

Type of visit: Required - 1 Year

On 2/16/23 Licensing Program Analyst Alfonso Iniguez conducted an unannounced visit to this facility. The purpose of today’s visit was to conduct an Annual inspection. LPA met with Joel Morales/ Administrator. Facility is licensed for (6) non-ambulatory residents and (1) bedridden resident. The facility has an approved hospice waiver for (4) residents. The facility currently has (4) non-ambulatory residents, who are residing in the facility. There are (3) residents diagnosed with mild Dementia residing in the facility. There is (1) Hospice resident at the facility. The facility does not handle residents’ cash resources. LPA toured the facility. The facility consists of (4) resident bedrooms, (3) bathrooms, living room, dining room, kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Bathrooms are clean, sanitary, and fixtures are working properly, the bathrooms grab bars are secure and non-skid mats in place. The facility water temperature properly measured at 118 F°. Resident bath towels, toiletries, and personal hygiene supplies were adequately stocked. Common areas were clean and hazard free. All doorways were free of obstructions. The kitchen is clean, sanitary, and observed to be within Title 22 regulations. The facility currently has a sufficient supply of perishable as well non-perishable food items. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors and Carbon monoxide detectors were tested and found to be operating properly. Outside grounds were toured and no bodies of water were observed. All walkways around the home were clear of hazards. LPA observed a sign-in/sanitation station at the facility entry. There is hand sanitizer and masks in all rooms in this facility. Facility has screening process for all visitors, sanitizer/soap, paper towels, and additional PPE supplies are stored inside the garage. The facility is prepared to provide a private room for isolation if needed. The facility mitigation plan was approved by CCL on 5/10/2021. According to the Infection Control Tool LPA observed the following Technical Violation at the facility: Section 107 of the Infection Control Practices Tool- No signs regarding Covid 19 policies and procedures were posted on facility entrance. POC: Administrator will ensure signs are posted at facility entrance with updates to visitor policy to notify of policies and procedures. Administrator corrected TV during LPA's visit An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to the Administrator Joel Moralesthe state’s words, verbatim · CDSS document, Feb 16, 2023

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 Marisel Campbell, Lead Staff and later met with Joel Morales, administrator and the purpose of today’s visit was explained. There are currently (5) residents in the facility. (3) residents are ambulatory and (2) are non-ambulatory. The facility is a single story structure located in a residential neighborhood. It consists (4) bedrooms, (3) full bathrooms, shaded back yard, front yard, shaded front porch, laundry room in the detached 2 car garage. LPA and Marisel toured the entire facility inside and out. Documents are posted as mandated. Bedrooms are occupied by residents and contain the mandated furniture. The (3) bathrooms 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. Resident Medications and file are current. Staff file is current. Ample supply of perishable and nonperishable food, hot water temperature is 112 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 2 fire extinguisher is 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 are logged and temperature checked, sanitizer/soap in the staff bathroom and additional additional supplies in the garage. LPA observed staff and residents wearing masks, resident private rooms will be converted to isolation rooms (if needed.) Share rooms will change Covid positive resident to designated isolation room in the back of the house. Required postings throughout the facility. The residents temperature's are checked and logged once a day. 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. An exit interview conducted with Joel Morales, Administrator and copy of report provided.the state’s words, verbatim · CDSS document, Feb 17, 2022