Harvard Hope House

Allegation investigated: Facility forced resident into choosing another agency.

On 10/01/2023, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit to deliver findings regarding the above allegation. LPA Richard met with Administrator Coxsom Amber and explained the reason for the visit. LPA and Licensee toured the facility. The investigation consisted of the following: On 09/21/2023, LPA Richard and Coxsom conducted a tour of facility grounds, and interviewed Administrator, Staff (S1) and Resident (R1) LPA Richard requested and obtained a Resident roster, staff roster, a Resident Notice of Proposed Transfer and Discharge, Admission Agreement, Patient Profile, Change Of Designated Hospice Provider, and Identification and Emergency Information. LPA Richard requested and reviewed R1 records, staff and client's records. Report Continues, See LIC9099C. Unsubstantiated Allegation: Facility forced resident into choosing another hospice agency. On 09/31/2023 at 3:26 PM, LPA Antonine Richard interviewed Brian Peters, ( W1) son of the alleged Victim/Resident: Regina Wright Peters DOB: 07/14/1944. Peters stated that on 09/09/23, he replaced All in one Hospice Care with Faith and Hope Hospice Care, because All in one Hospice Care didn't show up at Harvard Hope House on the day of admission. All in One Hospice didn't send a nurse to help his mother moving into the facility. On 10/02/2023, LPA interviewed the Licensee (S1), who said she called All in One Hospice Care on 09/05/2023, to let them know the resident was at the facility. They told her they would send a nurse tomorrow. Then on 09/09/2023, Peters decided to call Faith and Hope Hospice to come and help his mother move and sign the documents to Harvard Hope house. During file review, LPA found that Resident 1 (R1) was admitted to Harvard Hope House on 09/05/2023, waiting for All in One Hospice Care to come at the facility. During file review, LPA Richard found facility sign- in sheet and noted that on 09/6/2023 and 09/11/2023, All in one Hospice Care Nurse (LVN) sign in at Harvard Hope House to review medications only. The Licensee stated that All in One Hospice care didn't leave any binders with the plan of care or written orders for the patient. LVN stated the facility has to wait for the Registered Nurse (RN) to help with sign-in. Peters stated they were mad because we switched them to Faith and Hope Hospice Care, we were happy about doing it my mother needed help immediately. The Harvard Hope House was a great help to my mother. They didn't force my family to switch to another Hospice Care. Based on interviews with staff, witness, and records reviewed from investigation there is insufficient evidence to support the allegation: Facility force resident into choosing another hospice agency. 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. Based on the information gathered, records reviewed and interviews conducted, the Department found no evidence to support the allegation mentioned in the complaint. An exit interview was conducted with Licensee Coxsom Amber and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 2, 2023 · control 11-AS-20230915095946

Allegation investigated: Staff are not providing adequate supervision to residents in care. Staff are intoxicated while caring and supervising residents in care.

THIS REPORT SUPERSEDES THE REPORT DATED 08/09/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Harvard Hope House on 08/09/2023 and was greeted by Administrator Amber Coxsom (A1). LPA Calderon spoke to A1 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 allegations. During this investigation, LPA Calderon interviewed A1, S1, R1-R4, W1-W3. This interview was conducted on 08/09/2023. On 08/09/2023 LPA Calderon requested copies of the following: Video of facility home for 7/28, 7/29. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Staff are not providing adequate supervision to resident in care. This complaint alleged staff are not supervising residents in care. On 08/09/2023 LPA Calderon interviewed A1 for a complaint. A1 claimed that A1 was out of town on 07/28 and 7/29/2023. A1 admitted that vehicles do intersection takeovers and claimed by the complainant, but that no one associated with the facility had anything to do with the illegal actions. A1 lives in the back house and can supervise the licensed facility from close quarters. According to A1, S1 worked the night shift, and no one entered the facility after hours. On 08/09/2023 LPA Calderon interviewed S1 for this complaint and verified that S1 worked a double shift, no one entered the facility during or after hours and that the residents’ needs were met with S1's care and supervision. On 08/09/2023 LPA Calderon interviewed W1-W3 for complaint. W1-W2 reported they witnessed people coming from the back of the house and were drinking and doing drugs. W1-W2 claimed that unknown people were doing donuts in the middle of the intersection around 3 am on 07/29/2023 and they have video, of a female intoxicated and yelling in front of the facility. W3, a family member of A1, claimed that W3 did stay at A1's home and not at the licensed facility on 07/29/2023 and that W3's friend had taken W3’s car and made donuts in the middle of the intersection at 3 am. W3 recalled that no one had ever been into the facility but W3 did verify that W3 and a friend had been drinking. On 08/09/2023 LPA Calderon interviewed R1-R4 for this complaint. R2-R3 reported that they love living at the facility, had no immediate concerns about the care and supervision and that their needs are being met. enough staff to take care of their needs. R2-R3 stated that no strangers were observed inside the facility and had no knowledge of outside reckless activities. LPA Calderon was presented with surveillance video by the A1, the video revealed no one entered or exited the facility after hours on 07/29/23. Additionally, a white vehicle was seen driving in the middle of the intersection, but the driver's identity could not be determined. Regarding Allegation #2: Staff are intoxicated while caring and supervising residents in care. This complaint alleged staff intoxicated while taking care of residents in care. On 08/09/2023 LPA Calderon interviewed A1 for this complaint. A1 claimed to be out of town on 7/28 and 7/29/2023 when the incident happened. A1 declared that at no time had any staff members ever worked intoxicated while taking care of residents. A1 recalled that there was an intersection takeover, but this had nothing to do with A1 licensed staff, residents, or facility. On 08/09/2023 LPA Calderon interviewed S1 for this complaint and denied this accusation. S2-S3 reported that no staff member has ever worked intoxicated while caring for residents including S1. S2-S3 claimed that no staff has ever been drunk while taking care of their needs. R2-R3 stated that they love living at the facility. On 08/09/2023 LPA Calderon interviewed W1-W3 for complaint. W1-W2 stated that they observed people intoxicated coming from the back of the A1 home. W1-W2 stated that A1 family members were seen in front of the facility intoxicated. W3, a family member of A1, admitted that W3 and friends had some drinks at a local bar on 7/29 around 3:00 am. According to W3, W3 nor any friends ever entered the licensed facility and were not intoxicated. LPA Calderon reviewed the surveillance video, and it revealed unwarranted activity capture on footage. Therefore, evidence gathered from investigation there is insufficient evidence to prove that “staff are not providing adequate supervision to resident in care” “staff are intoxicated while caring and supervising residents in care”, therefore the allegation is unsubstantiated. An exit interview was conducted and copy of the Complaint Report was provided to the Administrator Amber Coxsom (A1).the state’s words, verbatim · CDSS document, Aug 9, 2023 · control 11-AS-20230731131913

Type of visit: Prelicensing

On 1/30/23, at 9:00am, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a scheduled Pre-Licensing visit. LPA met with Administrator, Amber Coxsom, and explained the purpose of today's visit. The facility will be licensed at a Residential Care Facility for the Elderly and has been approved for the total capacity of six (6). Fire Safety Inspection approved four (4) nonambulatory residents and two (2) bedridden residents. Structure The facility is a single-story home in a residential neighborhood. The facility consists of four (4) resident bedrooms, two (2) bathrooms, kitchen, dining room living room, and office and check-in area. Physical Plant LPA and administrator toured the facility inside and out. The front door and client room four (4) have a ramp leading to the doors and all railing are secured. In the back yard there is a seating area with tables, chairs and an umbrella. On the property is an additional building that has its own address and is not part of the facility. LPA did not observe any bodies of water. LPA observed security cameras outside of the facility. All walkways are clean, clear, and free of obstructions, hazards and debris. Bedrooms LPA walked through and checked all bedroom. Bedrooms one (1) through three (3) have been approved for four (4) nonambulatory residents. Bedroom four (4) has been approved for two (2) bedridden residents. All bedrooms contain the required furniture including beds, nightstands with lamps, dressers, chairs and closet space for individual residents. All the beds have the required linens including a mattress cover, fitted sheet, blanket, comforter and pillow. Bathrooms Bathroom one (1) is a common bathroom and was checked by LPA. The faucets, toilet, bathtub and shower were in good repair and fully functioning. There is a cabinet in there that stores additional towels and hygiene products. The water temperature measured 114.6-degrees Fahrenheit. Bathroom two (2) is a private bathroom in bedroom four (4). The faucet, toilet, bathtub, and shower were in good repair and fully functioning. The water temperature measured 113.9- degrees Fahrenheit. There are built in cabinet where additional towels and hygiene products stored. LPA observed ample supply of hand soap, paper towels in both bathrooms. LPA observed nonskid mats in both showers and bathtubs. All safety handrails were securely fastened. Linens and Hygiene LPA observed additional linens in each resident room closets and in the closet in the hallway. Each resident is provided with a caddy that will contain any needed toiletries. In the hall closet there is an ample supply of adult briefs and chucks. In the cabinet in bathroom one (1) there are additional toiletries items. Kitchen LPA observed all appliances, including stove, oven, refrigerator, dishwasher, washer and dryer, to be in good working repair. LPA observed an ample supply of cutleries, pots, and pans that were in good repair. There is a locked cabinet that will contain knives and other sharps. LPA observed a 7- day supply of nonperishable foods. All cleaning products are locked in a closet in the kitchen and inaccessible to residents. LPA observed an ample supply of paper towels. The water temperature measured 116.3-degrees Fahrenheit. There is a monthly menus posted in the hallway. Common Areas The living room has ample seating for all residents. There are magazines available for residents. There is a fireplace that has a cover over the front and is inaccessible to residents. The dining room has ample seating for all residents. There are cabinets in the dining room that have games and activities available for residents. Posted in the hallway is the monthly activity calendar and daily schedule. All common areas have ample lighting and bright nightlights in the hallway. All walkways are clean and clear of obstructions and hazards. Safety LPA observed and tested five (5) smoke/carbon monoxide detectors in the facility. There are two (2) fully charged fire extinguisher, one mounted next to the kitchen and one in the dining room. The facility has working fire sprinklers throughout the facility that were installed 3 months ago. LPA observed a First Aid kit and manual in the office locked and inaccessible to residents. LPA tested the working landline. There is an ADT alarm system throughout the facility that informs then when a door and which door is opened in the facility. All exits are marked and have facility sketches posted next to them. LPA observed emergency plan, emergency numbers and all required documents posted in the facility. Infection Control There is a check- in station, at the office, when you enter the facility. There is a thermometer, hand sanitizer and logs for visitor, staff, and residents. LPA observed infection control signs posted throughout the facility. LPA observed sanitizing stations throughout the facility. LPA observed gloves mounted on the wall at the entrance of all bedrooms and bathrooms. Medications and Files Medications will be stored in the locked office in a locked cabinet, inaccessible to residents. Files for staff and residents will be locked in a filing cabinet in the locked office and inaccessible to residents. LPA reviewed the Liability Insurance, which is good till 1/20/24. There are no advisory notes. Componet III was reviewed and discussed. LPA conducted an exit interview with the Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 30, 2023

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 COMP II Participants: Amber Coxsom, Licensee/Administrator Interview Method: Telephone interview On December 23, 2022, 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, Dec 23, 2022