Family First Board & Care

Allegation investigated: Staff did not maintain complete file of resident's records Staff were not trained to care for hospice resident

On 8/30/23 Licensing Program Analyst (LPA) Felisa Shirley, conducted an unannounced complaint visit to the address listed above. LPA arrived at 8:54am and spoke to Administrator Rosemarie Famison and the purpose of the visit was discussed. LPA was granted access to the facility. The investigation consisted of the following: On 8/30/23 LPA reviewed and requested copies of the following records: Staff files, Resident files, Staff and Resident rosters, Training documents. LPA also requested and received the following for resident 1 (R1): Admission Agreement, ID and Emergency information, Physician’s Report, Preplacement Appraisal Information, Appraisal/Needs and Services Plan, Medication Administration Records, Hospice Notification, Incident Reports and Death Report. The investigation revealed the following: Con'd on 9099-C Unsubstantiated Allegation : Staff did not maintain complete file of resident’s records On 8/30/23 from 9:15am to 10am LPA Shirley reviewed facility files. During file review, LPA reviewed Facility files for Residents 1 – Resident 6 (R1-R6) and observed: Admission Agreements, Identification and Emergency Info, Physician’s Report/TB Test/Ambulatory Status, Medical consents, Preplacement/Resident Appraisals, Cash Resources, Personal Rights, and Medication Records. All required documentation was present in file. Based on information gathered, the department did not find sufficient evidence to support allegations “Staff did not maintain complete file of resident’s records. Allegation : staff were not trained to care for hospice residents On 8/30/23 at 9:15am LPA reviewed all training records of staff. During file review, LPA found that all Staff completed the following trainings: What to do in Case of an Emergency/911, Bed Positioning for Stroke, and the following Hospice Trainings: What is Hospice/Responsibilities of Hospice versus Facility Staff,(60 mins), How to Preserve skin Integrity, (30 mins), Incontinence care, Repositioning and transferring techniques, (30 mins), Choking, (30 mins), Fortitude Hospice, (30 mins), Oxygen Education, Foley Catheter Education, (60 mins). Base on information gathered, the department did not find sufficient evidence to support allegations, “Staff were not trained to care for hospice residents. An exit interview was conducted and a copy of the LIC 9099 was provided to Administrator Rosemarie Famison.the state’s words, verbatim · CDSS document, Aug 30, 2023 · control 11-AS-20230823115449

Allegation investigated: Staff did not address resident’s change in condition

On 7/28/23 Licensing Program Analyst (LPA) Felisa Shirley and Licensing Program Manager (LPM) Stephanie Cifuentes, conducted an unannounced complaint visit to the address listed above. LPA and LPM arrived at 8:20 and spoke to Administrator Rosemarie Famison and the purpose of the visit was discussed. LPA and LPM were granted access to the facility. The investigation consisted of the following: On 7/28/23 LPA and LPM reviewed and requested copies of the following records: Staff files, Staff and Resident rosters, Case Management Progress Notes, Family First Sign in Sheet. LPA also requested and received the following for resident 1 (R1): Admission Agreement, ID and Emergency information, Physician’s Report, Preplacement Appraisal Information, Appraisal/Needs and Services Plan, Medication Administration Records, Hospice Notification, Incident Reports and Death Report. con'd on 9099-C Unsubstantiated The investigation revealed the following: Allegation: Staff did not address resident’s change in condition On 7/28/2023 at 9am LPA Shirley reviewed facility files. During file review, LPA found that Resident 1 (R1) was admitted to Fortitude Hospice Inc. on 5/16/2023. LPA S Per R1’s hospice folder, facility can send resident to the hospital if needed. LPA Shirley reviewed facility sign in sheet and noted that on 6/4/23 at 2:28pm and 8:30pm there are sign ins from Fortitude Hospice Inc to visit R1. It is alleged that R1’s condition changed, and facility staff did not appropriately address the change. On 7/28/2023 From 9am to 1pm LPA Shirley interviewed Staff 1-Staff 2 (S1 - S2), Resident 1-Resident 3(R1-R3) and Witness 1-Witness 3 (W1-W3) and learned the following. On June 4, 2023, S1 noted that R1 was having difficulties breathing and her oxygen levels were low, so the facility contacted hospice around 12:30pm. Fortitude Hospice recommended a treatment and stated they would send one of their staff to assess R1. Facility staff completed treatment given to them by hospice and at 2:20pm hospice staff arrived and R1 was stabilized. Early evening, R1’s condition changed again and S1 called hospice agency at 7:19pm, where she and the hospice staff conducted a facetime call regarding residents’ condition. Per W2, R1’s family contacted at this time and Fortitude Hospice recommended continuing care treatment for R1 instead of hospitalization. Family agreed and W3 arrived at facility at 8:30pm for continuing care treatment. R1 passed at 10:43pm. Based on information gathered, the department did not find sufficient evidence to support allegations " Staff did not address resident’s change in condition.” An exit interview was conducted and a copy of the LIC 9099 was provided to Administrator Rosemarie Famison.the state’s words, verbatim · CDSS document, Jul 28, 2023 · control 11-AS-20230721151022

Type of visit: POC

On 05/11/23, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an announced visit to the listed facility above. LPA met with Licensee, Rosemarie Famisan, and discussed the purpose of today's visit. During time of visit six (6) residents were present. During today's visit LPA Gibbs and Licensee Famisan walked the grounds. LPA inspected the garage, and observed that the garage is no longer being used as a living space. The space is being utilized according to facility sketch, LPA Gibbs observed a car and motorcycle parked in the garage, and a small area being used for storage. LPAGibbs provided Licensee Famisan with regulations 87611, 87612, 87617, and 87618 per LPM Alvarez's request. LPM Alvarez informed LPA Gibbs, they will contact CAB regarding today's visit An exit interview was conducted with Licensee/Administrator Rosemarie Famisan and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 11, 2023

Type of visit: Prelicensing

On 5/4/23 at 9:10 AM Licensing Program Manager (LPM)/ Eva Alvarez and Licensing Program Analysts (LPA)/Alfonso Iniguez conducted a pre-licensing evaluation Change of Ownership (CHOW) for an RCFE (Adult Residential Care Facility for the Elderly) facility type. Today’s pre-licensing evaluation was conducted with Rosemarie Famisan/Administrator/Licensee. The licensee has applied for a license to serve (6) 60 years and over. The fire clearance is approved for (3) non-ambulatory and (1) bedridden. Approved hospice waiver for (6) Hospice Residents. LPM and LPA toured facility Kitchen, Dining Room, Living Room, (4) Bedrooms, (2) Bathrooms, Garage, Back Yard, and Patio with shaded area. LPM and LPA observed sufficient storage areas for kitchen supplies, linens, medications (secured) and chemicals (secured). LPM and LPA observed the following during this visit: MEDICATIONS There is a locked centralized storage area for Resident medications. PHYSICAL PLANT LPM and LPA observed the 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 85°F. degrees. Open porch, and areas of potential hazard are well-lit and equipped with sturdy hand railings. Carbon monoxide/Smoke detectors operate properly. Evaluation Report continues LIC 809-C 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. There is dresser and closet space for each client that includes at least two (2) drawers 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 (2) toilets and washbasins per six (6) clients, family, and personnel. There is at least one (2) shower per ten (10) clients, family, and personnel. Hot water temperature is between 105°F.-120°F. degrees Fahrenheit. Bathrooms are located near client bedrooms. Facility has enough night-lights in all hallways. SUPPLIES There are client personal hygiene supplies to include soap, toothpaste, toilet paper. 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 and freezer are clean and have the capacity to store at least two (2) days of perishable foods. There is storage for seven (7) day supply of non-perishable food. There are enough tableware, tables, dishes, and utensils. All equipment, dishes, and utensils are clean and well maintained. All kitchen, food storage, and preparation areas are clean. RECORDS There is confidential storage for personnel records at the facility. There is storage for Resident confidential information and records at the facility. Evaluation Report continues LIC 809-C 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 is an indoor activity space. There is at least one common room available to clients for visitors. There are activity supplies to include board games located in the living room. 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. LPM and LPA observed a sign-in/sanitation station at the facility entry. There is hand sanitizer located at the entrance of the facility. Facility has screening process for all visitors, sanitizer/soap and paper towels. During today’s inspection LPA found the following correction is required: Currently Garage has been converted into living space and occupied by staff member. Correction needed: Licensee will ensure the garage is utilized according to facility sketch. LPA will inform CAB regarding today's visit Exit interview conducted with Rosemarie Famisan/Administrator-Licensee.the state’s words, verbatim · CDSS document, May 4, 2023

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Rosemarie Famisan, Licensee/Administrator Interview Method: Telephone Interview On April 24, 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, Apr 24, 2023