Ataraxis Homes #2

Allegation investigated: Staff confines resident to a wheelchair. Licensee does not ensure that staff has a criminal clearance.

On 10/18/23, at 9:46am, Licensing Program Analyst (LPA) Perry Scott initiated a 10-Day complaint investigation to obtain information regarding the allegations listed above. LPA met with James Buckman and Lori Bucman, Licensees, and explained the purpose of today’s visit. On 10/18/23, the investigation consisted of the following: During today’s visit LPA toured the facility. LPA requested the following records: Resident roster, staff roster, resident record (Physicians report, ID/Emergency Information, Staff training in residents Personal Rights & Medication Administration, Assessment and Needs Plan, and Preplacement Appraisal Plan). LPA interviewed staff (S1-S3) and residents (R1-R5). The investigation revealed the following- Allegation # 1 Staff confines resident to a wheelchair. Report continued on LIC9099-C Unsubstantiated On 10/18/23, from 10:00am-1:00pm, LPA interviewed S1-S3 & R1-R5. It is alleged that staff confines resident R1 to a wheelchair all day and the resident is losing their ability to walk. 3 of 3 staff denied the allegation that Staff confines resident to a wheelchair. All staff stated that R1 is not confined to the wheelchair. R1 can walk around a bit, and they try to keep R1 walking. LPA attempted to interview R1-R5 but was not able to due to cognitive difficulties. LPA observed R1 and did not observe any sign of maltreatment. R1 was in the bed and appeared to be doing well. Based on interviews, record review, and observations, there is insufficient evidence to support the allegation that Staff confines resident to a wheelchair. 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. Allegation # 2 Licensee does not ensure that staff has a criminal clearance. On 10/18/23, from 10:00am-1:00pm, LPA interviewed S1-S3 & R1-R5. It is alleged that the facility has undocumented staff working without a criminal clearance and distributing medication to the residents. 3 of 3 staff denied the allegation that the Licensee does not ensure that staff has a criminal clearance. All staff stated they have had a criminal background and has been cleared. S1 provided LPA with supporting documentation of criminal clearances for all staff and ongoing in-service training for medication, Personal Rights of residents, Dementia Care, and other related training to provide effective care to the residents. LPA attempted to interview R1-R5 but was not able to due to cognitive difficulties. LPA observed that all residents looked well and happy. Based on interviews, and a record review of staff files, there is insufficient evidence to support the allegation that Licensee does not ensure that staff has a criminal clearance. LPA reviewed all staff records and found that all staff has criminal clearances and the appropriate in-service training to work. 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. No deficiencies were cited. An exit interview was conducted, and a copy of this report was given to James Buckman, Licensee.the state’s words, verbatim · CDSS document, Oct 18, 2023 · control 11-AS-20231012112509

Type of visit: Prelicensing

On 3/9/23 Licensing Program Analysts (LPA) Alfonso Iniguez conducted a pre-licensing evaluation for an RCFE facility type. Today’s pre-licensing evaluation was conducted with authorized licensees: Lori and James Buckman.The licensee has applied for a license to serve (6) elderly residents ages 59 and older. The fire clearance is approved for (5) non-ambulatory and (1) bedridden residents. The licensee plans to advertise for Special Care Programs for Dementia Residents.A tour of the Kitchen, Dining Room, Living Room, (5) Bedrooms, (2) Bathrooms, Garage, Storage for all supplies, Back Yard with a fenced body of water and Patio with shaded area. The following was observed during this visit: MEDICATIONS There is a locked centralized storage area for Resident medications. PHYSICAL PLANT Facility is clean, sanitary, and in good repair. Protective devices are in place. Indoor and outdoor passageways, stairways, open porches, and other areas of potential hazard are free of obstructions. All window screens are clean and in good repair. Facility temperature is between 68°F. degrees and 73°F. degrees. Open porches, and areas of potential hazard are well-lit. Smoke alarms operate properly. Carbon monoxide detectors operate properly. BEDROOMS No client bedroom is a passageway to another room, bath or toilet. There is a bed for each client with a mattress, mattress pad, bedsprings, and pillow(s) which are clean and in good repair. Mattresses and pillows are flame-retardant. There is dresser and closet space for each client that includes at least two (2) drawers or eight (8) cubic feet of dresser space per client. There is a chair and lamp for each client and at least one (1) night stand per two (2) clients. BATHROOMS There is at least one (2) toilet and washbasin per six (6) clients, family, and personnel. There is at least one (2) shower or bathtub per ten (10) clients, family, and personnel. Hot water temperature is 113° Fahrenheit. Bathroom is located near client bedrooms. There are night-lights in the hallways outside non-private bathrooms. SUPPLIES There are client personal hygiene supplies to include soap, toothpaste, toilet paper, and comb. There is a sufficient supply of clean linens to permit weekly changing or more of client top sheets, bottom sheets, bedspreads, blankets, pillowcases, mattress covers, bath towels, hand towels, and washcloths. FOOD SERVICE Dining room is near kitchen. Refrigerator(s) and freezer(s) are clean and large enough for the storage of at least two (2) days of perishable foods. Freezer is 0° Fahrenheit. Refrigerator is a maximum of 45° Fahrenheit. A seven (7) day supply of non-perishable food is present. There are sufficient amounts of tableware, tables, dishes, and utensils. There are sufficient amounts of equipment for the storage, preparation, and service of food. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. RECORDS There is confidential storage of personnel records at the facility. There is confidential storage of client records at the facility. ADMINISTRATION The emergency exiting plan and emergency phone numbers are posted. Client Personal Rights are posted. Posting both sides of the Personal Rights form LIC 613 meets this requirement. Facility Visiting Policy is posted. Licensing Complaint Poster is posted. There is space available for resident council meetings and resident council postings. ACTIVITIES There are an outside and inside activity spaces with a shaded area and furnished for outdoor use. There is at least one common room available to clients for visitors. There are activity supplies to include board games and electronic gaming system. MISCELLANEOUS There are first-aid supplies to include sterile first-aid dressings, bandages, adhesive tapes, scissors, tweezers, thermometer, antiseptic solution, and a current first-aid manual. There is space and equipment for laundry. There is a space for clean linen storage and a separate space for soiled linen. There is an operating telephone available to clients. Emergency lighting and supplies to include flashlights with batteries. PRE-LICENSING CHECKLIST N/A COMPONENT III provided during visit Provided information about how to operate the facility within substantial compliance. During the pre-licensing inspection there were no deficiencies observed.the state’s words, verbatim · CDSS document, Mar 9, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care):0 COMP II Participants: Administrator/Licensee James Buckman Interview Method: Telephone interview On 1/30/2023, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Jan 30, 2023