Southland Living

Allegation investigated: Staff are permitting resident to smoke in their room.

Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation listed above. LPA met with Administrator Victoria Tran to discuss the purpose for todays visit. LPA toured the physical plant, interviewed the administrator, staff #1-#2, resident #1-#5, and requested a copy of staff roster, and resident roster. Regarding allegation: Staff are permitting resident to smoke in their room. LPA Wesley interviewed Administrator Victoria Tran who stated that resident #1 doesn't smoke in their room, LPA interviewed the Wellness directors who said that resident #1 doesn't smoke in their room because her staff would tell her when they do their rounds. Wellness director also indicated that resident #2 brags and tells staff that she calls licensing all the time. LPA interviewed resident #1 and they said they do not smoke in their room. (Continued on LIC 9099C) continued on LIC 9099C. Unsubstantiated Resident #1 also denied drinking in their room getting drunk, and said their neck is not broken but it is fractured and they have hardware in place. If an individual were to look at the resident they couldn't tell their neck was broken and they are in an electric wheelchair. LPA Wesley went to resident #1's room and did not observe an odor or didn't see any indication that there was liquor(bottles in trash, cigarette buds trash, ash tray, ashes, cigarette holes in the bedding). Resident #2 said they have a fear of fires and purchased a fire extinguisher in case a fire breaks out in the facility. Staff confirmed that resident #2 had a fear of fires from childhood and may be paranoid that a fire will break out. Residents #3-#5 were interviewed and said they do not smell any smoke or didn't see, or hear of any residents getting drunk in the facility. LPA Wesley interviewed staff #2 who is a caregiver. They have indicated the resident smells like cigarettes because it lingers in their clothing, when they are out of their room it doesn't smell like cigarettes and they have never seen or heard of the resident drinking or getting drunk in the facility. Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegation is found to be Unsubstantiated. A copy of this report was given to the Administrator Victoria Tran.the state’s words, verbatim · CDSS document, Nov 3, 2023 · control 28-AS-20231027123826

Allegation investigated: Staff are making inapprorpiate comments towards resident. Staff yelled at resident. Staff are not providing resident with comfortable accomodations. Staff are not applying resident's medication. Staff are not meeting resident's walking needs. Staff are not providing adequate food service to resident.

Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation(s) listed above. LPA met with Administrator Victoria Tran to discuss the purpose for todays visit. LPA toured the physical plant, interviewed the administrator, staff #1-#2, interview Administrator, and requested a copy of staff roster, resident roster. Regarding allegation:Staff are making inapprorpiate comments towards resident, Staff yelled at resident, Staff are not providing resident with comfortable accomodations, Staff are not applying resident's medication, Staff are not meeting resident's walking needs, Staff are not providing adequate food service to resident. During the interview with Administrator she advised that none of her staff are required to walk the residents. LPA then looked at the resident roster and staff roster and did not see any of the names on the list that was continued on LIC 9099C. Unfounded spoken about on the back on the LIC 802(Complaint Report). The complaint is for the SNF(Skilled Nursing Facility) that is located next door. Based on the information gathered during this visit, the allegation(s): Staff are making inappropriate comments towards resident, Staff yelled at resident, Staff are not providing resident with comfortable accommodations, Staff are not applying resident's medication, Staff are not meeting resident's walking needs, Staff are not providing adequate food service to resident are deemed UNFOUNDED. A finding of UNFOUNDED means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Therefore, we have dismissed the complaint. Exit interview conducted with Administrator Victoria Tran and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 20, 2023 · control 28-AS-20231013090742

Allegation investigated: Staff made resident feel uncomfortable. Staff is stealing resident personal belongings.

Licensing Program Analyst(LPA) Nicol Wesley conducted an unannounced 10 day complaint investigation visit for the allegation(s) listed above. LPA met with Administrator Victoria Tran to discuss the purpose for todays visit. LPA toured the physical plant, interviewed residents #2-#6 and staff #1-#2, interview Administrator, and requested a copy of staff roster, resident roster, and copy of the check form for body check conducted on 08/14/23. LPA attempted to interview resident #1 via phone and in person but was not successfull. Regarding allegation: Staff made resident feel uncomfortable. LPA Wesley interview #2 out of #6 residents who stated they wasn't uncomfortable with the body checks that were conducted, Interviewed staff #1 who stated resident #1 approached her and staff #2 in their office and told them I heard you were looking for me to do a body check, and the resident took all of her clothes off and bent over. She said I dont want to catch (Continued on LIC 9099C) Unsubstantiated any of that. The interview with staff #2 was consistent with staff #1 and she also said, just go ahead a check me. The body checks that were conducted were voluntary and the resident can deny if they wanted. Regarding allegation: Staff is stealing resident personal belongings. LPA interviewed staff #2-staff #6 and they all stated that the staff has not stolen any of their personal belongings, haven't heard of the staff stealing anyone's personal belongings. LPA Interviewed the administrator, staff #1, and staff #2 and they indicated that they have never stolen any resident personal belongings, never heard of any residents stealing anyone's personal belongings, and would notify and report it to someone if they did hear of them stealing. Based on LPAs observation and interviews, the preponderance of evidence standard has not been met, therefore the above allegations are found to be Unsubstantiated. A copy of this report was given to the Administrator Victoria Tran.the state’s words, verbatim · CDSS document, Sep 28, 2023 · control 28-AS-20230920143231

Allegation investigated: Staff do not administer resident's medication as prescribed Staff do not ensure a comfortable living environment for resident Staff violated residents personal rights

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint investigation visit for the allegation(s) listed above. LPA met with assistant administrator Zachary Miller and the purpose of the visit was discussed. Administrator Victoria Tran arrived shortly after. On todays visit, LPA toured the physical plant, interviewed staff #1-#5 (S1-S5) and Residents #1-6 (R1-R6). LPA collected documents from R1's file such as: Facesheet, physicians report, needs and services plan, medication list and medication log for the month of august. LPA collected a copy of the staff and residents roster as well as a copy of the list of body checks conducted on 8/14/23 for the residents of the facility. The investigation revealed the following: In regards to the allegation "Staff do not administer resident's medication as prescribed" it was alleged that staff provided R1 an extra dosage of apriprazole (Abilify) causing R1 to be overmedicated this month. (5) of (5) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation... Continued on LIC 9099-C Unsubstantiated Interviews show that R1 is only provided what is prescribed and nothing more or nothing less unless they refuse medications. There was no documentation of medication errors for R1 or of staff noting issues with R1 due to medication for the month of August. LPA reviewed notes from staff stating that R1 requested an extra dosage of abilify on 5/26/23 but was refused due to them already receiving the required amount by physicians orders. Interviews do not show that R1 was overmedicated. Based on interviews, files reviewed and observations, there was not enough supportive evidence to corroborate the 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. In regards to the allegation "Staff do not ensure a comfortable living environment for resident" it was alleged that S1 and S2 raise the volume of the music in the dining room to make R1 uncomfortable and have auditory hallucinations. (5) of (5) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interviews with residents and staff does not show that staff are purposely making residents uncomfortable in the facility. Staff interviewed denied turning up the volume in the dining room to make R1 uncomfortable. (5) of (6) residents stated they have never seen staff attempt to make R1 uncomfortable to they may leave and go to their room. Based on interviews, files reviewed and observations, there was not enough supportive evidence to corroborate the 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. In regards to the allegation "Staff violated residents personal rights" it was alleged that staff of the facility conducted body checks on residents on 8/14/23 and inappropriately touched R1. (5) of (5) Staff interviewed denied the allegation. (5) of (6) Residents interviewed could not corroborate the allegation. Interviews state that the staff the facility attempted to conduct skin checks on all residents of the facility on 8/14/23 for rashes due to possible exposure to scabies. Interviews with staff and residents state that it was not forced and it was voluntary. Interviews do not show that staff inappropriately touched residents who participated and no one had an issue with being asked as they understood the reason for the check. Interviews also show that R1 agreed to the body check but after the fact, got upset that the staff were doing that to residents. LPA reviewed documentation of roster from 8/14/23 listing residents who were checked and there were names of residents who refused. This shows residents were not forced to let staff conduct skin checks. Interviews with (5) of (6) residents stated that staff did not put hands on them or violated their personal rights. S1 and S3 were present during R1's skin check and they denied touching R1 inappropriately. Based on interviews, files reviewed and observations, there was not enough supportive evidence to corroborate the 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. Exit Interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2023 · control 28-AS-20230825095443

Type of visit: POC

Licensing Program Analyst (LPA) Ashley Calderon, conducted an unannounced POC visit and upon arrival LPA met with Wellness Director Michelle Adams. Later met with Administrator Victoria Tran regarding citations issued on 05/23/22. The purpose of the visit was to inspect the facility to ensure the deficiencies cited were corrected and was discussed. On today’s visit, LPA observed the following deficiencies have been corrected: Section:87303 Maintenance and Operations, Due Date: 6/22/22.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. During today's visit LPA Calderon collected staff and residents roster, Maintenance Request Log from April 28, 2022 - July 1, 2022. LPA along side with Victoria toured all three laundry rooms (Laundry room #1, #2 and #3) in the one single story building, outside perimeters and resident's rooms. LPA interviewed Administrator, Staff #1-#4 (S1-S4) and Residents #1-#5 (R1-R5). LPA observed clean laundry room and facility, operable laundry machines: washer and dryer, all knobs on laundry machines intact, flooring in laundry rooms in good repair, panels on laundry machines secured, and observed inoperable/ large trash items/ furniture and materials equipment on the side of the facility near staff parking/ next to trash bins ready for pick up from waste company. This area is inaccessible to residents in care and does not pose as a health and safety hazard. LPAs interviews with residents stated laundry room is in good repair, clean and all pathways are cleared. LPA's interviews with staff stated laundry machines or any facility repairs gets fixed, repaired or replaced in a timely matter. LPA reviewed Maintenance Log and laundry repair status were completed. LPA Calderon cleared POC from deficiencies cited on 5/23/22 by LPA Nicol Wesley. LPA Calderon observed facility to be in good repair. No deficiencies were cited. LPA Calderon conducted the exit interview with Victoria Tran, a copy of this report LIC 809 and POC letter was provided.the state’s words, verbatim · CDSS document, Jan 27, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the unannounced annual inspection with the focus of the infection control domain. LPA met with Administrator, Victoria Tran, who assisted with the visit. The facility is licensed to serve 75 non-ambulatory residents, of which 10 may be bedridden. The approved bedridden rooms are #2,#4 through #12. The hospice waiver is approved for 10 residents. LPA toured the facility and observed the following: * Visitors and Staff sign-ins are in the main building which is connected to the skilled nursing building. The assisted living side is located to the left of the building. Temperature and symptom checks are done at the main entry. * Covid-19 signage are posted throughout the facility. Hand washing signs are posted in the bathrooms. Seats are blocked off to promote social distancing in common areas. * The facility maintains at least 30 days of PPE supplies. * Food supplies of 2 day perishable and a week of non-perishable are observed. The meals are cooked in the skilled nursing building and are brought over in covered carts to serve residents. * Medications are centrally stored in the Medication Room. LPA reviewed 5 residents' medications and medications are being administered as prescribed. * The fire extinguishers were last inspected on 2/10/22. * Staff were observed wearing a face mask. * Staff are cleaning/disinfectant at least once every shift. There are no deficiencies issued today. The exit interview was held. A copy of this report was given to the Administrator.the state’s words, verbatim · CDSS document, Jan 26, 2023

Allegation investigated: Staff member pushed resident while in care.

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint visit to the facility. Upon arrival, LPA met with Victoria Tran (Administrator) and explained the purpose of the visit. During today's visit, LPA obtained/reviewed a copy of the Staff/Resident rosters and interviewed Staff #1 in the office. In regards to the allegation: Staff member pushed resident while in care. LPA interviewed Staff #1 who stated that Resident/Alleged Victim is not a resident of the facility and have never been a resident of the facility. Resident/Alleged Victim reside in the Skilled Nursing facility adjacent to this licensed facility. LPA reviewed the Resident roster and resident is not on the roster. This agency has investigated the complaint alleging Staff member pushed resident while in care. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint. Exit interview conducted with Victoria Tran and a copy of this report provided. Unfoundedthe state’s words, verbatim · CDSS document, Sep 26, 2022 · control 28-AS-20220920124636

Allegation investigated: Staff did not address cockroaches in the facility

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Assistant Administrator / Janice Solis and was later joined by the Administrator / Victoria Tran who assisted with the visit. LPA Katrdzhyan explained the purpose of today’s visit is to discuss the above mentioned allegation of Staff did not address cockroaches in the facility . During today's visit, LPA interviewed the Administrator, Staff members 1 through 4 (S1 - S4) and Residents 1 through 4 (R1 - R4). LPA toured the dining room (which is currently being used as the activities room) and random selection of resident rooms. LPA also toured room 69-A, which is being used a storage room. Copies of invoices from Orkin Pest Control were obtained and reviewed. The investigation revealed the following; Allegations: Staff did not address cockroaches in the facility. The details of this allegation states that the facility is infested with cockroaches. Substantiated Based on interviews conducted, LPA obtained statements which were consistent and corroborated with the allegation. Statements obtained confirmed observing cockroaches in facility hallways and in resident rooms. At 11:55am, LPA toured the dining room and observed dead cockroaches throughout the dining room area. At 12:02pm, LPA toured room 69-A and observed dead cockroaches in the living room area, bathroom floor, bathroom cabinet, and inside the bathtub. According to the Administrator, the facility has a contract through Orkin Pest Control which regularly services the facility (once a month) and sprays certain areas of the facility. The Administrator was unsure why there were dead cockroaches found in the dining room and in room 69-A. Based on interviews conducted and LPA's observation, there is sufficient evidence to support this allegation to be true. Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided along with the Appeals Rights. is infested with rodents. Based on interviews conducted, the majority of the statements obtained were inconsistent and did not corroborated with the allegation. Staff and residents interviewed denied the facility having an infestation of rodents. Staff and residents denied observing rodents (rats) inside the facility. LPA reviewed the monthly invoice records from Orkin for period April 2022 - June 2022 and discovered that servicing is done for preventative measures at the facility by inspecting all areas, servicing all interior tin cats (kitchen, laundry and storage) and servicing all exterior bait stations. No indication was made on the invoice records of rodents being present inside the facility. Based on interviews conducted, LPA's observation and record reviews, there is insufficient evidence to support this allegation to be true. Allegation: Staff did not address flies in the facility. Based on interviews conducted, the majority of the statements obtained were inconsistent and did not corroborated with the allegation. Staff and residents interviewed denied the facility having an infestation of flies. During a walk through of the facility, LPA did not observe an infestation of flies inside the facility. LPA learned that once in a while resident rooms may have fruit flies due to residents leaving foods/fruits inside their rooms and forgetting to dispose them. Based on interviews conducted and LPA's observation, there is insufficient evidence to support this allegation to be true. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jul 1, 2022 · control 28-AS-20220621140044

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 15, 2022

Maintenance and Operation. 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 is not being met as evidenced by: Statements obtained confirmed observing cockroaches in facility hallways and in resident rooms. At 11:55am, LPA toured the dining room and observed dead cockroaches throughout the dining room area. At 12:02am, LPA toured room 69-A and observed dead cockroaches in the living room area, bathroom floor, bathroom cabinet, and inside the bathtub.the state’s words, verbatim · CDSS document, Jul 1, 2022

Plan of correction: Administrator will develop a plan with a licensed pest control company and provide a copy of the contract to CCL outlining a revised approach to eradicate the ongoing issue of cockroaches inside the facility. POC must be submitted to CCL by the POC due date.

Allegation investigated: Facility is not being cleaned Residence bedding not changed timely

Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Victoria Tran who assisted with the visit. Regarding the allegation that facility is not being cleaned, the investigation consisted of tour of facility, including resident rooms, interview(s) with Administrator and Staff #1- Staff #4, and Resident #1 - Resident #5. Administrator and Staff interviewed denied the allegation. Staff stated that the facility is being cleaned daily, and resident rooms are cleaned once per week, and more often if needed. Residents interviewed were unable to corroborate the allegation. 4 out of 5 residents stated that the facility staff do clean the facility, and they stated that resident(s) rooms are cleaned weekly, and more often if needed. During the facility tour, LPA observed that the facility and resident rooms appeared to be clean. Regarding the allegation that residence bedding is not changed timely, the investigation consisted of tour of facility, including resident rooms, interview(s) with Administrator and Staff #1- Staff #3, and Resident #1 - Resident #5. Unsubstantiated Staff interviewed denied the allegation. Staff stated that resident(s) bedding is changed once per week, and more often if needed. Residents interviewed were unable to corroborate the allegation. 5 out of 5 residents stated that facility staff do change their bedding or residents change it themselves if they choose to. LPA observed that resident(s) bedding appeared to be clean during room tour(s). Based on LPA's observations and interviews, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Victoria Tran.the state’s words, verbatim · CDSS document, Jun 22, 2022 · control 28-AS-20220613152732

Allegation investigated: Facility is in disrepair

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced initial complaint visit and met with Administrator Victoria Tran, Wellness Director Michelle Adams to discuss the purpose for todays visit. The investigation consisted of the following: LPA Wesley requested a copy of the resident roster, staff roster, facility sketch, interviewed Administrator Victoria Tran, other parties, and toured the facility physical plant. Regarding allegation: Facility is in disrepair. LPA Wesley and Administrator Tran toured the physical plant and observed 3 laundry rooms that contained washers and dryers for the staff and resident to use, the washer in laundry room #1 contains missing knobs and other knobs on the washer that are not operable, and flooring that needs to be repaired. Laundry room #2 contained a lint build up on the walls and cords, and the panel for the controls to be loose. Laundry room #3 contained 2 unoperable dryers. LPA Wesley observed the roof to have patches/repair work that was completed on 12/20/2021 from the previous rain storm that caused a leak during continued on LIC 9099C. Substantiated that time. The observation of the patches on a specific area on the roof(dining room area) does not indicate that the facility is in need of a new roof as the roof appears to be intact. During the interviews with residents and staff, it appears that there have not been any recent roof leaks. LPA Wesley and Administrator Tran toured the physical plant and did not observe there to be any mold on the interior and exterior areas of the facility that was toured during todays visit. LPA Wesley observed: wood pieces, toilets, iron gates, debris, old laundry equipment, inoperable work truck, wooden pallets on the side of the facility near the side parking adjacent from the school that was previously addressed during a case management inspection on 05/10/22. Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Appeal rights were given. Exit interview conducted.the state’s words, verbatim · CDSS document, May 23, 2022 · control 28-AS-20220513084603

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303 · Plan of correction due date: Jun 22, 2022

Maintenance and Operations 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 has not been met as evidence by: During todays visit, LPA oberved there to be washers and dryers in need of repairing/replacing and 2 in operable dryers in laundry room #3. Flooring in laundry room #1 in need of replacing, and laundry room #2 in need of a thorough cleaning/dust removal which can pose a health and safety risk for residents in care.the state’s words, verbatim · CDSS document, May 23, 2022

Plan of correction: The Licensee/Administrator shall have items cleaned/replaced/repaired and/or removed by POC date 06/22/22 and send proof of corrections to CCLD/Attn Nicol Wesley.

Allegation investigated: Facility had a fire. Facility telephones are not working. Facility lights are not operating properly.

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced subsequent visit and met with Administrator Victoria Tran, Wellness Director Michelle Adams to discuss the purpose for todays visit. The investigation consisted of the following: LPA Wesley requested a copy of the resident roster, staff roster, interviewed Southern California Edison (SCE) Foreman, other parties, Administrator Victoria Tran, residents, staff and collateral visits at nearby homes. Regarding allegations: Facility had a fire, Facility telephones are not working, Facility lights are not operating properly. LPA Wesley interviewed Administrator Victoria Tran who advised that on 05/05/22 around 3:35 pm there was an underground transformer that blew underground and also said that there was no fire inside of the facility electrical room. LPA Wesley interviewed Job Foreman Santiago from SCE who confirmed that there was an undergound circuit that caused and explosion due to a faulty transformer that had blown. SCE Foreman Unsubstantiated advised that the explosion(fire) caused a power outage and hundreds of neighbors and businesses were affected. Administrator Trans advised that the facility placed Back up lighting throughout the halls, and portable lights in residents rooms and also advised that there were no residents who required any insulin injections, or equipment. Administrator Tran also advised that the facility had emergency oxygen tanks delivered to the facility as a back up and that the underground electrical explosion that occurred outside of the facility premises did not affect the telephone lines. LPA Wesley interviewed staff and residents who confirmed that there was an electrical fire but it was not caused by a fire inside the facility electrical room, and the telephones were not affected. LPA Wesley and Administrator toured the facility and did not observed any indications that a fire occurred inside of the building. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations is unsubstantiated. No deficiencies were cited during todays visit. A copy of the licensing report was given during the exit Interview.the state’s words, verbatim · CDSS document, May 23, 2022 · control 28-AS-20220506112905

Type of visit: Case Management - Other

LPA Nicol Wesley conducted a case management inspection upon completing complaint visit #28-AS-20220506112905. LPA Wesley met with Administrator Victoria Tran and discussed the purpose for todays visit. During todays visit LPA toured the physical plant and observed the following deficiencies that are in need of correcting(See the attached LIC 809D) California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview conducted.the state’s words, verbatim · CDSS document, May 10, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jun 7, 2022

Maintenance and Operations 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 has not been met as evidence by: During todays visit, LPA Wesley observed several wooden pallets, older washers, bedframes, brown wrought iron gate, yellow iron fencing, old bedroom furniture, boxes, wood pieces, broken down work truck(tags expired 2020)....Which poses a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, May 10, 2022

Plan of correction: The Licensee/Administrator shall have items removed by POC date 06/07/22 and send proof of corrections to CCLD/Attn Nicol Wesley.

Allegation investigated: Facility did not safeguard resident's mail package.

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced initial complaint visit and met with Administrator Victoria Tran, Wellness Director Michelle Adams to discuss the purpose for todays visit. The investigation consisted of the following: LPA interviewed Administrator Victoria Tran, Wellness Director Michelle Adams, and resident #1. LPA Wesley requested a copy of the resident roster, staff roster and requested copies of specific documents. Regarding allegation: Facility did not safeguard resident's mail package. During the interview with the Administrator she advised that she was not aware that resident #1 was expecting a package and they did not receive any packages addressed to resident #1 on 01/26/2022 or any other recent days. Wellness Direcor Michelle Adams also advised that the facility did not receive any packages delivered to the facility for resident #1. Resident #1 advised that did not receive the package that was ordered and contacted the mail carrier who Continued on LIC 9099C. Substantiated advised that the package was delivered to the facility. LPA Wesley was provided a copy of the invoice/receipt and delivery confirmation. LPA Wesley and Administrator Tran walked to the Skilled Nursing Facility(SNF) that also shares the same address as the Residential Care Facility for the Elderly(RCFE), on the same lot and the check in point for screening and delivery of packages. The investigation revealed that the SNF could not locate the delivery log, package and the previous receptionist no longer works in the facility. Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview conducted.the state’s words, verbatim · CDSS document, May 4, 2022 · control 28-AS-20220126164202

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87218(a)(2) · Plan of correction due date: May 17, 2022

Theft and Loss A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. This requirement has not been met as evidence by: On 01/26/22, Amazon delivered a package#112-03293623067463 to the facility that was received in the reception area for resident #1 in which they never received the package. This can pose a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, May 4, 2022

Plan of correction: The Licensee/Administrator shall provide a refund to resident #1 in the amount of $20.94 by POC date 05/17/22 and send proof of corrections to CCLD/Attn Nicol Wesley.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced visit for the purpose of conducting the required annual inspection. On today's visit LPA met with Administrator, Victoria Tran who assisted with the visit. LPAs discussed infection control practices with Ms. Tran, toured the facility inside and out, reviewed food supply, reviewed staff files, and reviewed resident medications. Bedrooms have the required furniture including bedframes, dressers, lamps and chairs. Beds have the required linen and the linen is in good condition. Passageways and exits are free of obstruction. The facility grounds are well maintained. The resident bathrooms are clean, and showers have non-skid materials. The hot water temperature measured at 107 degrees F. The facility temperature at the time the visit was comfortable. There is sufficient lighting throughout the facility. There are smoke detectors located throughout the facility, tested and operational. Carbon monoxide detector was also observed, tested and operational. LPA observed a sufficient supply of PPE in the storage room. Infection control signs were observed throughout the facility. Per California Code of Regulations, Title 22, and California Health and Safety Code, there were no deficiencies observed during the visit. Exit interview held and a copy of the report was provided to Ms. Tranthe state’s words, verbatim · CDSS document, Mar 10, 2022

Allegation investigated: Staff member handled resident in a rough manner.

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced initial complaint visit and met with Administrator Victoria Tran, and Wellness Director Michelle Adams to discuss the purpose for todays visit. The investigation consisted of the following: LPA Wesley requested a copy of the staff roster, resident roster and specific documents. LPA interviewed Administrator, staff and residents. LPA Wesley attempted to interview staff #1 and was not successful. Regarding allegation: Staff member handled resident in a rough manner. The investigation revealed that staff #1 appeared to handle the resident #1 and resident #2 a little rough while providing assistance with elements of daily living. Staff were interviewed and there was one staff who requested assistance with a resident transfer, and they advised that staff #1 handled a resident a little rough too quickly and the resident was not eased into their seat. During the interviews with staff, it was revealed that staff #1 was moving a little too fast when handling Continued on LIC 9099C. Substantiated providing care for residents. There was also another resident who complained when staff #1 entered into their room to provide assistance with incontinence care. During the interview with Administrator, they advised that they were not aware that staff #1 was handling residents in a rough manner until they received a complaint from resident #1 on 07/31/21, and at that time an internal investigation was conducted and staff #1 was suspended from work pending the outcome of the investigation. The Administrator did not observe there to be any physical injury or bruising. The Administrator crossed reported to Community Care Licensing Division(CCLD), Ombudsman(LTCO), and Adult Protective Services(APS). On 08/06/2021 staff #1 was reprimanded and placed on a performance plan and at that time staff #1 resigned. LPA attempted to interview staff #1 but was not successful as they no longer work at the facility. Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview conducted.the state’s words, verbatim · CDSS document, Aug 20, 2021 · control 28-AS-20210812140900

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Sep 3, 2021

Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by: On 07/31/21 staff #1 handled resident #1 in a rough manner, which can poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Aug 20, 2021

Plan of correction: Administrator will provide Personal rights training to all staff including but not limited to the handling and transfering of resdients who requires care and supervision. Provide the in service training log and sign in sheet to LPA Wesley by POC due date 09/03/2021.

Allegation investigated: Facility did not obtain resident's medication.

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced subsequent visit and met with Administrator Victoria Tran and Wellness Director Michelle Adams to discuss the purpose for todays visit. The investigation consisted of the following: On 02/18/21 LPA Wesley conducted a telphonic interview and requested copies of: staff roster, resident roster, medication/prescription list, current physicians report, and facility staff notes for resident #1 to be emailed/faxed by 02/19/21. LPA also interviewed the Wellness director Michelle Adams regarding the above mentioned allegation. Regarding allegation: Facility did not obtain resident's medication. During the investigation it was discovered that on 01/20/2021 resident #1 was re-admitted to the Southland Living upon receiving treatment from the Skilled Nursing Facility(SNF). Upon discharge from there was a list of medication for resident #1 that did not include any prescriptions for any type of relaxation medication. It has also been determined that resident #1 was Continued on LIC 9099C. Unsubstantiated receiving care from the SNF and Southland Living did not receive any additional orders from the doctor other than what was prescribed during resident #1's return to the facility per the doctors order on 01/20/21. During the interview with Wellness Director Michelle Adams, LPA was advised that resident #1's family member inquired about a medication for resident #1 and could not remember the name, and was informed by the Wellness Director that the currently Physician's orders did not include any medication prescription for relaxation. LPA Wesley reviewed resident #1's facility file which included but not limited to the observation of: Physician's reports, Medication profile(list of medication) dated 01/20/21 per the doctor's order, as well as the residents Medication Administrator Record(MAR) and there is not sufficient evidence to support the allegation facility did not obtain resident's medication. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations is unsubstantiated. No deficiencies were cited during todays visit. A copy of the licensing report was given during the exit Interview.the state’s words, verbatim · CDSS document, Aug 12, 2021 · control 28-AS-20210216105922

Allegation investigated: Facility is in disrepair.

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced initial complaint visit and met with Administrator Victoria Tran, Wellness Director Michelle Adams to discuss the purpose for todays visit. During the visit, Maintenance staff Ben Mota arrived and joined the visit. The investigation consisted of the following: LPA toured the facility including the dining area, and resident hallway, interviewed residents, interviewed staff and requested copies of specific documents. Regarding allegation: Facility is in disrepair. LPA toured the facility including the common areas/hallways, bathrooms, dining room, observed all pictures on the walls, ceilings, as well as the electrical outlets and did not observe/discover any items that were in disrepair. During the interview with Administrator Victoria Tran, she advised that on 08/03/2021 in the evening, staff reported that there was a water leak coming from the ceiling in one of the common hallways next to the conference. Administrator Tran said there was some water on the floor Continued on LIC 9099C. Unsubstantiated and staff blocked off both sides of the hallway so that no one would enter into the area. Administrator Tran advised that the Maintenance staff Ben Mota was called who had just exited the facility, came back and repaired the pipe. Administrator advised that the repair was completed within two hours and she completed a SIR(unusual incident report) to the department. LPA interviewed Maintenance staff Mota who informed the LPA that he shut the water down, fixed the pipe, cleaned the walls and floors. Staff Mota said the job took him less than 2 hours to complete and the leak was caused due to a heating coil(circulation stopped) that was between the pipes. Mota also advised that the facility is not in disrepair because as soon as something occurs, they repair it right away. Mota said he has been working in the facility for eighteen years. LPA interviewed a random selection of residents who said the facility is not in disrepair and did not know there was a leak in the hallway. Other residents were interviewed and said they were aware of the leak in the ceiling and it was repaired right away and also said the facility is not in disrepair. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations is unsubstantiated. No deficiencies were cited during todays visit. A copy of the licensing report was given during the exit Interview.the state’s words, verbatim · CDSS document, Aug 12, 2021 · control 28-AS-20210804160150

Allegation investigated: Staff did not seek medical attention for resident in a timely manner. Staff do not meet resident's grooming needs. Staff do not treat resident with dignity or respect.

Licensing Program Analyst (LPA) Nicol Wesley initiated a complaint investigation for the allegation listed above. Due to the situation surrounding the Corona virus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Victoria Tran. The investigation consisted of the following: On 10/12/20, LPA Wesley conducted a telephonic interview and requested copy of: staff roster, resident roster, Activities calendar, and bathing/grooming schedule for the month of September 2020, and special incident reports. LPA also interviewed the Administrator, Staff(S1-S3), and Residents(R1-R5). The investigation revealed the following: regarding allegation: Staff did not seek medical attention for resident in a timely manner. During the interview with R1, LPA was informed that staff did not seek medical attention for them until 5 days later. R1 said they became ill with an infections but couldn't not confirm the date they became Continued on LIC 9099C. Unsubstantiated ill and do not recall which staff they asked to seek medical attention for them. During the interview with the Administrator Victoria Tran, she advised that on 09/27/20 she and some staff observed R1 to be delusional, screaming and yelling at staff and acting like they were confused. Administrator said when she noticed that R1 lit a cigarette inside the facility and asked them to put it out(she knew something was wrong because although R1 is non compliant they never lit a cigarette inside the facility). Administrator advised that R1 refused to put the cigarette out, began yelling and cussing and at that time staff also observed there to be an onset of slurred speech. Staff immediately called 911 and R1 was saying "I'm okay," when the paramedics and ambulance arrived R1 was transported to the Hospital Emergency Room, where they were admitted and treated for a medical condition. During the interviews with the Administrator, and staff( S1-S3), they indicated they always seek medical attention for all residents in a timely manner. During the interviews with Residents(R2-R5), they confirmed that they received medical attention in a timely manner if they were in need. LPA Wesley observed 2 Unusual Incident Reports(UIR/SIR) dated 09/28/2020 for R1. Regarding allegation: Staff do not meet resident's grooming needs and Staff do not treat resident with dignity or respect . R1 advised that they facility staff does not trim their hair or cut their nails and when they ask for staff to assist them, they are rude and does not assist them. R1 did not have any concerns regarding showering/hygiene. LPA Wesley observed the nail care log and care reference log for the month of September 2020. During the interview with Administrator Tran, she advised that during the pandemic, the facility has been following the stay at home order and department of public health guidelines and have provided nail care and hair grooming for the residents who may wish to participate by staff who are also nurses. The Administrator denied being rude to the residents including R1 or declining any services to them and have not observed any staff acting rude or declining services to any of the residents. Administrator also said that R1 receives services, but sometimes the resident refuses services so they can hurry and leave the facility to go into the community, disregarding the stay at home order and upon their return to the facility, R1 demands to receive the services at the times in which the staff is no longer available. During the interview with S1, they informed me that they schedule appointment times to provide nail care service for the residents and also make attempts to locate the residents so they wont missed their appointments. S1 advised that R1 returned to the facility and demands for staff to provide the services and begins yelling and cussing. S1 denied being rude to R1 and said they have never witnessed the Administrator or any other staff act rude to R1 or any residents in care. S1 said they never denied to provide service to R1 and said when its their turn for service, they are always out of the facility and sometimes they decline the services telling staff to "F" word out of my room!" Continued on LIC 9099(Page 3). cellphone with R1 belongs while they were being transported to the hospital. The Administrator was asked to replace R1 phone sever times as R1 has been without their phone for several months. In late January 2021 when the Administrator finally decided to replace R1's phone, it was communicated that R1 did not want to provide their personal information to the staff so they could replace the phone. LPA Wesley spoke to R1 and ask them to provide the information so they could receive another phone and R1 said they provided the box and charger to the receptionist months ago and believed they were playing games. The investigation revealed that there is sufficient evidence to support the allegation: staff did not safeguard resident's personal items. Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. A telephonic exit interview was conducted with Administrator Victoria Tran, and a hard copy was provided via email to obtain a signature. R1-R5 were interviewed and said their grooming and hygiene needs are being met and that staff has never been rude to them and they have not witnessed staff being rude to any residents. R2 informed the LPA that often times, they have witnessed R1 cuss out S1 when they would try to assist them with nail care and grooming services, and they feel bad that the staff has to receive such abuse. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. A telephonic exit interview was conducted with Administrator Victoria Tran, and a hard copy was provided via email to obtain signature. There are no citations issued, exit interview conducted.the state’s words, verbatim · CDSS document, Mar 9, 2021 · control 28-AS-20201005101805

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87218(a)(2) · Plan of correction due date: Mar 24, 2021

Theft and Loss. A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The licensee shall be presumed current value and shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to This evidence has not been met as required by: LPA Wesley requested the Administrator to replace R1s cellphone several times that was lost while under the facility care in 09/2020 as resident was being transported from the facility to the hospital. The phone was not replaced until 02/2021.the state’s words, verbatim · CDSS document, Mar 9, 2021

Plan of correction: The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. The licensee shall provide a written plan of action informing the Licensing agency the steps that facility will take to assure that the theft and lost policies are adhered to by POC date 03/24/21. **R1's cellphone and accessories were replaced in February 2021.***