House of Grace

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Jose Villalobos conducted an unannounced Annual inspection focused on domains within the Compliance and Regulatory Enforcement (Care) Tools. LPA met with Administrator Rebecca Sinclair and the purpose of the visit was discussed. Structure/Physical Plant: The facility is part of a single story home located in a residential area and contains the following: living room, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, (3) resident rooms, (2) bathrooms for residents; bathrooms with shower, toilet and washbasin. A back yard with shaded area and seating for resident use. A connected garage inaccessible to residents for storage, Laundry, office/resting space for staff. The residence is equipped with central air and heating. Adequate accommodations observed throughout facility. Facility observed to be clean of obstruction and debris. Bedrooms #1-#3 for resident use are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, beds for each resident, and closet space. Bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats. Medications are stored, locked and inaccessible to residents in care. Required linen/supplies observed. Facility has a working phone landline. Fire Extinguisher observed fully charged and up to date. The hot water temperature was measured within title 22 regulations. The food supply in the kitchen and pantry has at least two days perishable and seven days non perishable food. Smoke detectors and also carbon monoxide detectors observed, all detectors tested and operational. All appliances observed operational. Toxins and sharps observed to be Locked/stored for staff use only. POSTINGS: All necessary postings were observed to be posted in appropriate places. A current Plan of Operations and Disaster plan is maintained at the facility. RECORD REVIEW: LPA reviewed five (5) resident files, five (5) residents medications, and three (3) staff files. Inspection tool completed and no deficiencies cited on todays visit. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 20, 2023

Allegation investigated: Staff not allowing Long Term Care Ombudsman entry into the facility.

Licensing Program Analyst (LPA) Alma Gonzalez conducted a subsequent complaint visit to deliver investigation findings for the above stated allegation. LPA met with Administrator Michelle Aguirre and explained the reason for the visit. The investigation consisted of: During the initial visit conducted on 1/21/22, LPA conducted interviews with Administrator Michelle Aguirre and Rebecca Sinclair. LPA collected copies of Staff and Resident Rosters. LPA conducted a tour of facility kitchen and observed food supply which was adequate at the time of visit. LPA observed an ample supply of food in refrigerator and non perishable food in kitchen cabinets. There was also an ample amount of fruits and vegetables. LPA also collected copy of facility menu and visitation guidelines/ procedures. On 2/16/22, LPA conducted a telephone interview with Wise & Healthy Aging, Long Term Care (See LIC9099C for continuation) Substantiated Ombudsman (LTCO) Staff 1 and received a copy of a document mailed to facility administrator from LTCO dated 1/25/22. On 1/26/23, LPA conducted interviews with Staff 1-2 (S1-2), Residents 1-5 (R1-5) and conducted telephone interviews with R1 Family Member (R1 FM), R2 FM 1-2, R3 FM, and R5 FM. LPA attempted a phone call to R4 FM but did not receive a call back. LPA additionally collected copies of Staff Roster and visitation logs. LPA reviewed 5 Resident files. Investigation revealed the following: Regarding allegation, Staff not allowing Long Term Care Ombudsman entry into the facility, it is alleged that the facility administrator/ facility staff are not allowing LTCO staff to enter the facility. Administrator/ and or facility staff allegedly denied entry/ access into facility to LTCO staff on various dates: 2/26/21, 9/17/21, and 1/14/22. Interview with administrator revealed that she did not deny entry to LTCO staff and stated that LTCO staff were harassing her with the frequency of visits and stated that LTCO should only visit every three (3) months. Interview conducted with LTCO staff revealed that they were denied access into the facility on various dates (2/26/21, 9/17/21, and 1/14/22). LTCO staff stated that they were eventually allowed access into the facility on 2/26/21 only after being educated by LTCO Staff and Community Care Licensing (CCLD) staff about LTCO right of access to the facility. LTCO was also allowed access on 3/2/21 but on 9/17/21, LTCO staff again attempted to visit the facility, and the administrator again denied access. LTCO program had to call the administrator, and again educate administrator on LTCO right of access. Administrator stated to LTCO staff that she was not allowing entry due to the spike in COVID19 cases at the time. Administrator agreed to allow ombudsman entry. LTCO was allowed entry on 9/24/21 but again on 1/14/22, LTCO staff attempted to visit facility to conduct an investigation and was not allowed access into the facility by a facility caregiver who stated to LTCO staff that they could not allow ombudsman into the facility and they had call the administrator first. LTCO staff that they explained to the administrator that the LTCO is an essential visitor, and as such has the right to access the facility at any time. LTCO staff stated that Administrator did not give the caregiver permission to admit the LTCO staff into the facility and LTCO was not permitted access into the facility. LPA received a copy of a notice addressed to facility administrator from LTCO dated 1/25/22. The letter indicates the dates that LTCO staff was not allowed access into the facility and informs the administrator of their legal duties regarding allowing LTCO access and if the administrator continued to deny access they were in violation of federal and state law. The letter lists both federal and state laws regarding LTCO access to the facility. On 1/31/22, LPA received an email from administrator in which she states that she received the letter and also states that she spoke to CCLD staff Ombudsman (LTCO) Staff 1 and received a copy of a document mailed to facility administrator from LTCO dated 1/25/22. On 1/26/23, LPA conducted interviews with Staff 1-2 (S1-2), Residents 1-5 (R1-5) and conducted telephone interviews with R1 Family Member (R1 FM), R2 FM 1-2, R3 FM, and R5 FM. LPA attempted a phone call to R4 FM but did not receive a call back. LPA additionally collected copies of Staff Roster and visitation logs. LPA reviewed 5 Resident files. Investigation revealed the following: Regarding allegation, Residents are not allowed to have visitors, it is alleged that the facility residents are not allowed visits from family members. Interviews conducted with facility administrator and S1-2 revealed that residents are allowed to visit with family members and friends and whoever wishes to visit with residents. Staff stated that the visitors just have to go through the COVID19 screening. Interviews conducted with 1 out of 5 residents revealed that they do get visits and they do not have any concerns regarding visits. 3 residents were not able to interview as they were asleep during the visit and 1 resident did not properly answer LPA's questions regarding visits. LPA interviewed R1 FM, R2 FM 1-2, R3 FM, and R5 FM who all stated that they are able to visit with their family members and have never had any issues when they want to visit. They stated that they just have to ensure that their temperature is taken and are properly screened for COVID19. LPA reviewed visitation logs and observed that resident's visitors log in and are screened when visiting. Based on interviews conducted with facility staff, resident family members, 1 facility resident and LPA record review, there was not enough supportive evidence to concur with the reported allegation For allegation, Facility not serving an adequate amount of food to resident's, it is alleged that there is not an adequate amount of food in the facility to offer to the residents. Interviews conducted with facility administrator and S1-2 revealed that there is an adequate amount of food at all times in the facility to offer to the residents at all times. Interviews conducted with 1 out of 5 residents revealed that they do not have concerns about the food and stated that when they want additional servings the staff will provide it to them. 3 residents were not able to interview as they were asleep during the visit and 1 resident did not properly answer LPA's questions regarding amount of food. LPA interviewed R1 FM, R2 FM 1-2, R3 FM, and R5 FM who all stated that they are satisfied with the amount of food that they have observed when visiting the facility and stated that they have not noticed a low stock of food. On 1/21/22 and 1/26/23, LPA observed an ample supply of food in refrigerator and non perishable food in kitchen cabinets. There was also an ample amount of fruits and vegetables. Based on interviews conducted with facility staff, resident family members, 1 facility resident and LPA observations, there was not enough supportive evidence to concur with the reported allegation For allegation, Resident's are not offered a variety of meals it is alleged that the facility only serves ham sandwiches for dinner. Interviews conducted with facility administrator and S1-2 revealed that residents are served a variety of meals and are not just served ham sandwiches for dinner. Staff stated that residents are served a variety of foods and stated that they are served different meals daily and if they happen to not like something that is being served they can ask for something else. Interviews conducted with 1 out of 5 residents revealed that they do not have concerns about the food and stated that they are served a variety of foods, are given additional servings if they request and are also given an alternative meal if they do not like what is being served. 3 residents were not able to interview as they were asleep during the visit and 1 resident did not properly answer LPA's questions regarding variety of meals. LPA interviewed R1 FM, R2 FM 1-2, R3 FM, and R5 FM who all stated that they are satisfied with the food service and stated that they have observed that the residents are served a variety of meals. LPA reviewed the facility menu and observed that residents are served a variety of meals. LPA also observed an ample supply of food in refrigerator and non perishable food in kitchen cabinets. There was also an ample amount of fruits and vegetables. Based on interviews conducted with facility staff, resident family members, 1 facility resident, LPA observations and record review there was not enough supportive evidence to concur with the reported allegation. 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. Exit interview held. A copy of the report was provided to Facility Staff Venus Calzado. regarding LTCO right to access the facility and the email also states that she allowed LTCO staff come back and do their visit. The email does not state what date. Based on interviews conducted and LPA record review, the preponderance of evidence standard has been met; therefore, the above mentioned allegation is found to be SUBSTANTIATED. Deficiencies are being cited according to Title 22. Exit interview was conducted with Facility Staff Venus Calzado. A copy of the report and appeal rights were provided to Facility Staff.the state’s words, verbatim · CDSS document, Jan 26, 2023 · control 28-AS-20220120084056

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.35(C)(2) · Plan of correction due date: Jan 27, 2023

1569.35(C)(2) (2) If a local long-term care ombudsman or the State Long-Term Care Ombudsman files a complaint alleging denial of a statutory right of access to a residential care facility for the elderly under Section 9722 of the Welfare and Institutions Code, the department shall give priority to the complaint pursuant to Section 9721 of the Welfare and Institutions Code and notify the Office of the State Long-Term Care Ombudsman that an investigation has been initiated pursuant to this section. This requirement is not met as evidenced by: LTCO staff was not allowed entry into the facility on various dates:(2/26/21, 9/17/21, and 1/14/22). LPA conducted interviews with facility administrator and LTCO staff and reviewed a notice that was mailed from LTCO to facility administrator which stated that administrator denied LTCO access into the facility. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 26, 2023

Plan of correction: Administrator to review HSC 1569.35(c)(2) and submit written Plan of Correction which states that the facility administrator and staff will ensure the facility is meeting HSC Code and allows entry to LTCO staff into the facility. Administrator to submit a faxed or mailed copy of POC by due date.

The state marks this report as 8 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Allegation investigated: Facility does not properly store resident's medications.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with Staff #1. The Administrator, Michelle Aguirre, was not present at the time of visit, however, the purose of the visit was explained via phone. The investigation consisted of the following: LPA toured the facility, reviewed medication for all 6 residents, and conducted interviews with the Administrator and 2 Staff. The investigation revealed the following: Regarding allegation - Facility does not properly store resident's medications. The Administrator indicated staff had stored the resident's eye drop in the kitchen refrigerator which was unlocked. The concern has been addressed with the Staff and the medication is no longer stored at the kitchen refrigerator. Substantiated LPA interviewed Staff #1 who admitted to leaving the eye drop in the refrigerator because it was frequently given. Staff #1 stated the eye drop has been moved to the other refrigerator in the garage where residents do not have access. During the visit today, LPA reviewed the medications for all six residents. The only medication to be refrigerated is the eye drop of one of the residents. The rest of the medications are stored and locked in the cabinet located next to the garage door. LPA did not observe any medications stored in the kitchen refrigerator today. The resident's eye drop was stored in the garage area which residents do not access. Based on interviews conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted. A copy of this report, Plan of Correction, and appeal rights were provided to the staff.the state’s words, verbatim · CDSS document, Aug 25, 2022 · control 28-AS-20220817132746

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(2) · Plan of correction due date: Sep 1, 2022

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement is not met as evidenced by: Based on interviews, the licensee did not ensure that the eye drop medication was stored and locked in a place not accessible to residents which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 25, 2022

Plan of correction: The Administrator shall ensure that all medications are stored and locked making them inaccessible to residents. The plan of correction is due by 9/1/22. **This plan of correction has been cleared as of 8/25/22.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual required visit at the facility. LPA met with Administrator, Rebecca Sinclair, who assisted with the visit. The purpose of the visit was discussed. Facility is licensed to serve six (6) non-ambulatory, age 60 and above, approved for four (4) hospice waivers. Currently, three residents on hospice. Annual licensing fees are current. During the visit, the infection control domain tool was used, a tour of the facility was conducted, food supply was reviewed, and medications were reviewed. The facility is a single story house located in a residential neighborhood. LPA toured the facility- physical plant, indoor and outdoor. The facility consisted of three (3) bedrooms, two (2) bathrooms, family room, living room, garage with laundry area and office, kitchen, and dining room. All residents’ bedrooms are furnished with appropriate furniture for residents’ comfort. The bathrooms are furnished with grab bars and nonskid surfaces. Common areas are observed for the ability to safely serve the needs of the residents. Smoke detectors and carbon monoxide detector are tested and operable. Fire extinguisher was fully charged. Facility maintains a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable. Last disaster drill was conducted on 3/1/22. No swimming pool or bodily of water at the facility. Backyard has a shaded area for resident use. Interior and exterior space is available to permit residents to wander freely and safely. Sufficient supply of perishable and nonperishable foods is observed. Knives, tools, sharp items are inaccessible to residents. Hot water temperature is 118.5 degrees Fahrenheit which is within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies are observed. (-continued in LIC 809C-) Administrator stated there were no weapons or ammunition on premises. Mandated documents and signages are posted in common areas. Medication are centrally stored in a locked cabinet and inaccessible to residents. Resident records are stored in a locked cabinet and inaccessible to residents. Toxic substances are inaccessible to residents. No deficiencies were observed per California Code of Regulations, Title 22. An exit interview was conducted. This report was discussed with Administrator. A copy of LIC 809s report was provided.the state’s words, verbatim · CDSS document, Jun 17, 2022