Happy Home Care for Elderly

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cynthia Chan conducted a case management visit regarding the death of two Residents. LPA met with Licensee/Administrator, Jung “Eunice” Kim and explained the purpose of the visit. On 6/24/23, The News reported a double homicide that occurred at the facility. A facility staff arrived in the morning and found 2 residents inside the restroom floor and were unresponsive. The staff immediately called 911 to report the incident. This prompted the department to conduct a visit to the facility. On 6/25/23, Regional Manager Araceli Ramirez and LPA Kimberly Ramirez conducted a health and safety check at the facility and gathered documents pertaining to Resident #1 (R1), Resident #2 (R2), Staff #1 (S1), and Staff #2 (S2). During the visit on 06/25/23, it was discovered that S1 was arrested for the murder of two residents of the facility. Due to the nature of the deaths, the Department of Social Services Community Care Licensing Division Investigation Branch (IB) Investigator, Ryan Miles conducted a further investigation. Investigator Miles interviewed the licensee/administrator, Jung Kim, S1 and S2. Investigator also obtained the L.A. County Sherriff’s report and 911 calls made to the Walnut Sheriff’s Station. On 8/24/23, Investigator Miles interviewed the suspect while in custody and admitted to the murder of both residents but did not want to go into further details of how the incident occurred. The investigation revealed that S1 started working and residing at the facility on 06/01/23. However, S1’s background clearance did not clear until 06/16/23. Therefore, the licensee allowed S1 to begin working and residing at the facility prior to completing a criminal record clearance. On 06/30/23, the licensee was issued an immediate civil penalty of $500 for allowing S1 to work in the facility prior to obtaining a background clearance. Based on the interviews conducted and supporting documents provided, there is sufficient evidence to support the allegation of Conduct Inimical, therefore, the finding is substantiated. An Immediate Civil Penalty of $500 is being issued today. Refer to LIC421IM. The issuance of an additional Civil Penalty is being assessed based on health and safety code 1569.49(e) if the department determines the death of the client is due to neglect. An exit interview was held. A copy of this report, LIC421IM, and appeal rights were given to the licensee.the state’s words, verbatim · CDSS document, Oct 10, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Oct 11, 2023

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) (4) To care, supervision, and services that meet their individual needs...delivered by staff... This requirement is not met as evidenced by: Based on interviews, the licensee did not ensure that the residents are provided with care, supervision, and services that meet their needs which poses an immediate health, safety, and personal rights to residents in care.the state’s words, verbatim · CDSS document, Oct 10, 2023

Plan of correction: The licensee shall ensure each staff member is qualified to provide care and supervision to all residents. The licensee shall provide in-service training to all staff regarding the care plan for each resident and ensuring there is sufficient staffing to meet their needs. This POC is due by 10/11/23.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cynthia Chan conducted a case management visit to interview staff. LPA met with administrator, Eunice Kim, to explain the reason for the visit. LPA obtained a copy of the personnel report and interviewed Staff #1 who was on duty. No deficiencies issued. A copy of this report was given to the staff.the state’s words, verbatim · CDSS document, Oct 10, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management Visit on 6/30/23 at 8:35 am to issue a $500 civil penalty. LPA Ramirez was greeted by Licensee/Administrator Jung Kim and LPA explained the purpose of the visit. Case Management Findings: On 6/25/23 RM Ramirez and LPA Ramirez conducted a Case Management visit to perform a health and wellness check on residents in care and to gather information regarding the two (2) recent deaths of Resident #1 (R1) and Resident #2 (R2) on 06/24/23. Copies of pertinent documents for Staff #1 (S1) and interview of staff on 6/25/23, revealed Licensee Jung Kim failed to obtain required criminal record clearance or a criminal record exemption from the State Department of Social Services before S1’s gainful employment at the facility, direct contact with residents in the facility and residing in the facility. Medication Administration Record (MAR) for the month of June 2023 for R1 and R2 appear to record S1’s signature/or initials starting 6/1/23 and on various other days till 6/23/23. LPA Ramirez compared MAR to “Staff Annual Education, Staff Continuing Education, Staff Initial Training, and On-Site Orientation sheets S1 signed/or initialed by S1 and recorded in S1’s facility personnel file. Interview with Licensee Jung Kim on 6/25/23 revealed S1 began employment at the facility on 6/1/23 however, the State of California Department of Justice did not formally issue a DOJ APPLICANT FINGERPRINT RESPONSE letter clearing S1 till 6/16/23. It was revealed S1 worked at the facility without criminal background clearance for a total of fifteen (15) days. A $500 civil penalty is being issued. Exit interview is being conducted with Licensee Jung Kim and a copy of this report, 809-D, LIC 421BG, and appeals rights was provided.the state’s words, verbatim · CDSS document, Jun 30, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jul 1, 2023

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidence by: Licensee Jung Kim failed to obtain required criminal record clearance or a criminal record exemption from the State Department of Social Services before S1’s gainful employment at the facility, direct contact with residents in the facility and residing in the facility.the state’s words, verbatim · CDSS document, Jun 30, 2023

Plan of correction: Licensee shall certify in writing to this licensing agency, all future staff will be subject to a criminal clearance and obtain clearance before staff begins employment, resides at facility or has direct contact with residents in care. LIC 421BG-Civil Penalty of $500 was assessed on 6/30/23.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced case management visit to the facility. The purpose of today’s visit was to serve the Order to Licensee of Immediate Exclusion from Facility for Staff #1 (S1). An investigation by the California Department of Social Services was conducted and it was determined that S1 violated California Code of Regulations Title 22 for personal rights. On today's visit LPA met with Licensee Jung Kim and explained the reason for the visit. Licensee was provided with copies of the Order to Licensee of Immediate Exclusion and Order to Individual for Immediate Exclusion letters and Government Code 11522. Exit interview held. A copy of the report was provided to Licensee Jung Kim.the state’s words, verbatim · CDSS document, Jun 27, 2023

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 06/27/2023 at 8:34am. LPA was met by Licensee Jung Kim and explained the purpose of the visit. Facility is licensed to serve residents over 60 years old. The facility cares for elderly residents with dementia and is allowed to care for two (2) hospice residents. LPA OBSERVATIONS: Tour began at 9:15am and was led by licensee. The facility is a single-story building located in a residential area with four (4) client bedrooms, two (2) bathrooms, kitchen, dining room, living room, front yard, backyard, and attached garage. Staff living corridors is currently not occupied. · Front Yard: Was clean and well maintained. No hazards were observed. · Kitchen: LPA Ramirez observed kitchen cabinets near stove to contain caked-yellowish and brown splatter stain. LPA Ramirez observed the ceiling above the stove area to contain red and yellow splatter. LPA Ramirez did not observe sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in bottom kitchen cabinet, to be inaccessible to four (4) out of four (4) residents in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to four (4) out of four (4) residents in care. Kitchen sink water temperature was measured at 113.8 degrees F. · Dining Room/Living room: Dining room was observed to be clean and contained one table with plenty of seating. Living room was observed plenty of seating and lighting. LPA Ramirez observed fully charged fire extinguisher in this area. SEE 809-C for continuation. · Linen Closet: Contained plenty linens, towels, and hygiene products. · Resident Rooms 1 - 4: Bedroom 1 is currently shared and has a private bathroom. LPA Ramirez observed bedroom #1 to contain the required furnishings, linen and lighting. Resident bedroom #2 and #3 are private rooms. LPA Ramirez observed bedroom #2 and #3 to contain the required furnishings, linen, and lighting. Bedroom #4 is shared and LPA Ramirez observed the required furnishings, linen and lighting. LPA Ramirez observed a 3-inch crack inside bedroom #4 wall, near door entry. · Bathrooms: Private bathroom# 1 was observed to be clean and contained soap and paper towels. Signs promoting hand washing were observed. Water temperature in this bathroom was measured at 107.4 degrees F which is in the required 105 – 120 degrees F. Shared bathroom #2 was observed to be clean and water temperature was measured at 113.1 degrees F which is in the required 105 – 120 degrees F. LPA Ramirez observed a 3x3 inch circular hole located in shared bathroom #2, behind bathroom door and was exposing drywall. · Centrally Stored Medications: LPA observed cabinet located in dining room area to be locked and inaccessible to residents. LPA reviewed six (6) out of six (6) resident medications and Medication Administration Record (MAR). LPA Ramirez observed some irregularities on MAR for Resident #1 (R1) and Resident #2 (R2). · Backyard: LPA Ramirez observed overgrowth of weeds and grass. LPA Ramirez observed multiple beds of plants and vegetables growing throughout backyard. LPA observed plenty of seating and shade. No large bodies of water were observed. LPA observed carbon monoxide in hallways. Smoke detector was tested during visit. Administrator certificate 6029285740 was observed for Jung Kim with an expiration date of 05/15/22. Proof of fire and earthquake drill could not be provided. Staff files are maintained at facility. Thirteen (13) staff files (S1 – S13) were reviewed. Verification of staff training and orientation is missing complete date(s) of attendance. Staff have current First Aid/CPR certification. Staff have their Health Screening and Tuberculosis Screening on file. Staff are also trained on Abuse Reporting and Resident Rights. Staff have on-going training. LPA Ramirez reviewed and obtained a copy Infection Control Plan. Licensee provided LPA Ramirez is a copy of liability insurance, however, it does not meet the liability limits. LPA Ramirez observed posted Emergency Disaster Plan. Deficiencies are being cited during visit. Exit interview was conducted with Licensee Kim and a copy of this report, 809-D and appeals rights were provided.the state’s words, verbatim · CDSS document, Jun 27, 2023

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Kimberly Ramirez and Regional Manager (RM) Araceli Ramirez conducted an unannounced Case Management visit to the facility on 06/25/23 and gained entry into the facility at 12:59 pm, to perform health and wellness check and gather information regarding two recent (2) resident deaths at the facility. LPA Ramirez and RM Ramirez were greeted by Administrator Jung H. Kim and explained the purpose of the visit. The facility is located on a residential street and is a single-story home. LPA Ramirez and RM Ramirez conducted physical plant tour, interviews of Staff #1- 2 (S1- S2), attempted resident interviews #1 -4 (R1 -R4), copies of staff files (S2,S3), copies of resident files (R1-R6), staff roster, resident roster and any other pertinent documents related into this investigation. No immediate hazards were observed during visit. Additional information is required, and this licensing agency may return to gather additional documentation and interviews. A copy of this report is being provided to Administrator Kim.the state’s words, verbatim · CDSS document, Jun 25, 2023

Allegation investigated: Facility staff did not allow resident to have visitors. Facility staff did not safeguard resident's belongings.

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced and met with Administrator, Eunice Kim. The purpose of the visit was explained. LPA toured the facility and obtained a list of residents and staff. LPA also reviewed residents files and obtained copies of Resident #1 (R-1) documents. Interviews were held with the Administrator, 1 Staff, 2 Residents, and family member. R-1 is not longer residing at the facility. In regards to allegation - Facility staff did not allow resident to have visitors. It is alleged that a family member was denied visitation inside the facility. LPA interviewed the Administrator and another staff during the visit today. The Administrator and staff both denied not allowing any visitations to the facility. Administrator Ms. Kim stated that R-1's family members had visited the facility on different days while R-1 was residing at the facility. Unsubstantiated R-1 only resided at the facility for a few days and allowed them entry inside the home. Although the facility did not document the dates and times in which R-1's family visited, the administrator showed text messages with the family members allowing them to come to the facility. LPA interviewed R-1's family member who indicated that the staff denied entry to the home on one of the visits and took R-1 out instead. R-1's family member also stated that due to an appointment, it was decided to take R-1 with them rather than to stay there. Administrator and staff deny turning away any visitation of family members when they are present at the front door. LPA interviewed 2 Residents and both stated they get visitors at the home. In regards to allegation - Facility staff did not safeguard resident's belongings. LPA interviewed the administrator who stated they provide most of the items to the residents, such as a bed, bedding sheets, and personal hygiene products. Administrator stated that the inventory sheet is filled out upon admission and if there are valuables brought in, they are indicated on the Resident Personal Property and Valuables form. Ms. Kim recalled R-1 only bringing in a slipper and clothing but not bedding. LPA interviewed R-1's family member who stated that after discharge, R-1's belongings were returned in addition to the bedding that was requested to be used. Based on information gathered, there is insufficient evidence to support this 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. An exit interview was conducted. A copy of this report along with the appeal rights were provided to Administrator Kim.the state’s words, verbatim · CDSS document, Mar 9, 2023 · control 28-AS-20230303152941

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Staff Kui Yo and explained the reason for the visit. The purpose of the visit is to complete the required inspection.Shortly thereafter Administrator Jung Hyun Kim arrived. LPA Trueman toured the facility along with Jung Hyun Kim today 9/28/2022 at 2:15 PM and the following was observed: Facility contains 4 Client Bedrooms and 2 Client Bathrooms, dining room, living room, TV room, and backyard activity area. Required Annual inspection included Infection Control Domain and check of the food supply, medications and criminal clearance check. LPA observed sufficient supply of 2 day perishables and 7 day non perishables. Medication for clients were verified as being administered and a 30 day supply on hand. Visitation signage was posted along with signage for hand washing and proper sanitizing. Temperature checks are conducted 2x a day and logged. Staff have been trained in hand washing. All staff have criminal clearance. Staff are sufficient with no shortages and there is a plan to replace workers if ill. There are rooms available if isolation is needed. Staff wear masks. Bathrooms have proper signage for hand washing. There are multiple stations for hand sanitizing. Facility has sufficient supply of PPE. Facility has a specific plan to ensure proper cleaning and disinfection of environmental surfaces and laundry; commonly touched surfaces are cleaned and disinfected at least once every shift . Plan when to notify medical provider if symptoms develop or COVID-19 exposure or when to call 911 for severe respiratory distress. LPA observed outside gate with a lock that can only be unlocked with a numerical code. Deficiency cited on separate 809 and 809 D Case Management Report Advisory Notice issued during inspection. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 28, 2022

Type of visit: Case Management - Deficiencies

During the course of the 2022 Annual Inspection the following deficiency was observed: 87303(a ) 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. LPA observed outside gate locked with a locking mechanism that can only be opened with a numerical code Deficiency cited on 809 D. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 28, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 28, 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 met as evidenced by: LPA observed outside gate locked with a locking mechanism that can only be opened with a numerical code. Based on observation and interview, the licensee did not comply with the section cited, which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 28, 2022

Plan of correction: Administrator removed lock at time of visit, no further action needed Deficiency cleared..

Type of visit: Required - 1 Year

On 9/9/2021 Licensing Program Analysts (LPAs) Nina Galarza and Nune Margaryan conducted an unannounced site visit for the annual inspection. LPAs met with Jung Hyun Kim (Administrator) and explained the purpose of the visit. The facility is licensed to serve age range 60 and over. 6 ambulatory of which 3 may be non-ambulatory. Hospice waiver for 2. LPAs observed COVID19 informational and symptom posters by front door and throughout facility. There is hand sanitizer available throughout facility. The facility is located in a residential area. A tour of the single-story facility includes: Living room, den, garage/laundry/Storage, 4 bedrooms, 3 bathrooms, tv room, kitchen, dining area. The following was observed: Facility is operating within capacity and not beyond any conditions and limitation on the license. No pools and bodies of water, no firearms. Comfortable temperature for residents. All outdoor and indoor passageways are kept free of obstruction. Hot water temperature measures at 109.4 degrees F in bathroom #1. There are presence of grab bars for each toilet, bathtub and shower used by residents. Bathtub or shower have non-skid mats or strips. The total daily diet is of the quality and in the quantity necessary to meet the resident’s needs. Minimum of one week supply of nonperishable foods and 2 days of perishable foods observed. Perishable foods and beverages capable of growth of micro-organisms is stored in covered containers at appropriate temperature. The facility has sufficient staff to provide the services needed to meet resident needs. Staff in sufficient numbers to meet the needs of all dementia residents and to escort residents who leave the facility. Items that could constitute a danger is stored inaccessible to dementia residents. Staff assisting residents with ADLs has required training. Staff has Criminal Record Clearance. Resident have a medical assessment, signed by a physician within the last year. Facility has a disaster and mass casualty plan in writing and be readily available. No persons have a prohibited health conditions. Centrally stored medicines is kept in a safe and locked place. Carbon Monoxide detector and smoke alarm were observed to be functioning properly. LPAs observed fire extinguisher fully charged. CONTINUED 809-C The following deficiencies were observed at time of visit: LPAs observed both outside gates with a lock that can only be unlocked with a numerical code LPAs observed medication discrepancies for R1, R1 is being administered Vitamin D without a prescription, Vitamin C without a prescription label, and Probiotic without a prescription label. LPAs observed medication discrepancies for R2, R2 Nattokinase 2,000 FUS without a label and C-1000 Antioxidant without a label. Exit interview conducted, a copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 9, 2021

Allegation investigated: Staff unlawfully evicted a resident Staff did not issue a refund

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. The investigation consisted of the following: On 12/31/20 LPA Flores conducted telephone interview with the administrator,and requested copies of Staff and Resident roster, Admissions Agreement, Face Sheet, Physician's Report, Needs and Care Assestment Plan, Financial and Admission Policies for 2 residents currently residing at facility and 1 resident who resided at facility until 2 weeks ago, and a Copy of Refund to be emailed to the LPA. On 7/12/21 LPA Flores reviewed resident #1's(R1) file, and requested copies of Admission agreement, resident record, resident property and values, eviction procedure, admission policy and procedure, resident appraisal, appraisal needs and services plan, centrally stored medication, medication administration record, physician's report, assisted living waiver information notice (ALW), admission record from Alcott Rehabilitation Hospital, ALW individual plan, text conversation between family and administrator. (CONTINUED ON LIC 9099C) Unsubstantiated The investigation revealed the following: Regarding allegation: Staff unlawfully evicted a resident. It is alleged resident #1(R1) was kicked out due to their inability to care for the elderly with dementia. On 7/12/21 LPA Flores reviewed R1's file and observed an admission agreement signed on 12/8/21. R1's physician report dated 12/11/20. R1's file contained a letter with effective date 12/22/21 and states "note: Federal regulations require that your transfer or discharge be made for one of the following reasons: the transfer to discharge is appropriate because she wants to move to another place." which does not state any of the elements of an eviction letter or state that facility is requesting resident to move out. R1 moved out on 12/22/20 according to the administrator by R1 family representative's choice. LPA reviewed text messages between R1's representative and administrator and found no evidence of facility requesting R1 to move out of the facility. Based on LPA's file review and interviews, conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED. Regarding allegation: Staff did not issue a refund . It is alleged facility is not willing to refund the 2 weeks of prepaid room & board fee. On 7/12/21 LPA Flores reviewed R1's file and observed an admission agreement signed on 12/8/21 and the agree monthly fee is $1069.72. R1 resided at the facility for 14 days, according to administrator the amount for the 14 days totaled and was charge $499.20 and additional charges for an amount of $35.05. Facility provided R1's responsible party a check for the amount of $499.64 dated 12/24/20. Admissions agreement signed and dated on 12/8/20 by responsible party states on section 8 Refund conditions states "other than this, regardless of the condition, the monthly fee paid in any given month will not be refunded." Based on LPA's file review and interviews, conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED Exit interview was conducted with Kim Jung administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 12, 2021 · control 28-AS-20201224141659

Allegation investigated: Facility staff did not seek medical attention in a timely manner. Facility staff did not distribute residents medication as prescribed. Facility staff did not follow physicians orders.

Licensing Program Analyst (LPA) Elizabeth Irra conducted a subsequent visit to investigate the above allegations. LPA met with the Facility Administrator and discussed the pupose of today's visit. On 05/20/2020, LPA initiated this investigation. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, LPA conducted this investigation telephonically with the Facility Administrator. LPA obtained relevant documentation for this complaint investigation During this investigation, LPA interviewed the Facility Administrator and Staff #1 (S-1). LPA was unable to interview R-1 as R-1 is no longer residing at this facility (discharged on 05/01/2020 as R-1 required a higher level of care). LPA also obtained relevant documentation. ***Refer to LIC 9099C for the continuation of this report** Substantiated Allegation: Facility staff did not seek medical attention in a timely manner. During the course of this investigation, LPA interviewed Facility Administrator and Staff #1 (S-1). LPA was unable to interview R-1 as R-1 is no longer residing at this facility (discharged on 05/01/2020 as R-1 required a higher level of care). Interviewed Staff indicated R-1 received medical visits for wound care. Visits were conducted on 04/14/2020, 04/17/2020, 04/21/2020, 04/24/2020, 04/28/2020 and 05/01/2020. Per Facility Administrator, there is no visitor logs for R-1 other than the dates noted above. Per Facility Administrator, R-1 received televisit consultations prior to visits, however, Facility Administrator was only able to provide evidence of communication via text for 04/08/2020, 04/10/2020 and 04/11/2020. Facility Administrator was unable to provide evidence on any televisits nor visits prior to 04/08/2020. Per Facility Administrator, due to COVID-19, R-1 was only receiving tele-visits and visits to this home. Per Facility Administrator, S-1 was changing R-1's gauze and applying ointment since 03/29/2020 up until discharge. R-1 was admitted to this facility on 03/28/2020 from a Skilled Nursing Facility for wound care. Interviews and reviewed documentation corroborate this allegation. Allegation: Facility staff did not distribute residents medication as prescribed. During the course of this investigation, LPA interviewed Facility Administrator and Staff #1 (S-1). LPA was unable to interview R-1 as R-1 is no longer residing at this facility (discharged on 05/01/2020 as R-1 required a higher level of care). Facility Administrator indicated R-1 had ointment to be applied to the wound when R-1 was discharged from the Skilled Nursing Facility to this facility. Facility Administrator did not have any supporting evidence for this treatment/medication. Facility Administrator provided a prescription order for R-1 dated 04/21/2020 for ointment. There are no medication orders for wound treatment medication prior to 04/21/2020 on file. Interview and reviewed documentation corroborate this allegation. Allegation: Facility staff did not follow physicians orders. During the course of this investigation, LPA interviewed Facility Administrator and Staff #1 (S-1). LPA was unable to interview R-1 as R-1 is no longer residing at this facility (discharged on 05/01/2020 as R-1 required a higher level of care). Per Facility Administrator, S-1 was changing R-1's gauze and applying ointment since 03/29/2020 up until discharge. R-1 was discharged from this home on 05/01/2020. Per R-1's file review, there were no orders on performing routine wound care prior to 04/14/2020. Interviews and reviewed documentation corroborate this allegation. Refer to LIC 9099C for the continuation of this report. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. Deficiency as per California Code of Regulations, Title 22, Division 6 & Chapter 8, are being cited on the attached LIC 9099D. An exit Interview was conducted with the Administrator, a copy of this report and Appeal Rights were providedthe state’s words, verbatim · CDSS document, Jul 12, 2021 · control 28-AS-20200513100445

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(16) · Plan of correction due date: Jul 13, 2021

Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services. This standard is not met as evidence by: R-1 was admitted to this facility on 03/28/2020 for wound care. Visits were conducted on 04/14/2020, 04/17/2020, 04/21/2020, 04/24/2020, 04/28/2020 and 05/01/2020. Per Adm, R-1 received televisit consultations prior to visits. Adm was only able to provide evidence of communication via text for 04/08/2020, 04/10/2020 and 04/11/2020. Adm was unable to provide evidence on any televisits nor visits prior to 04/08/2020.the state’s words, verbatim · CDSS document, Jul 12, 2021

Plan of correction: Adm to provide training on Personal Rights of Residents to all staff and provide written statement as to how staff will adhere by these regulations. Adm to also submit proof of training in a form of a log which contains staff names, date of training, duration of training, presenter of training and curriculum used for this training to LPA Irra by POC due date of 07/13/2021.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(e) · Plan of correction due date: Jul 13, 2021

Incidental Medical and Dental Care:(e)For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. This standard is not met as evidence by: Adm indicated R-1 had ointment to be applied to the wound when R-1 was discharged from the Skilled Nursing Facility to this facility. Adm did not have any supporting evidence for this treatment/medication. Adm provided a prescription order for R-1 dated 04/21/2020 for ointment. There are no medication orders for wound treatment medication prior to 04/21/2020 on file.the state’s words, verbatim · CDSS document, Jul 12, 2021

Plan of correction: Continuation on next page. Continuation on next page.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e) · Plan of correction due date: Jul 13, 2021

This is a continuation of 87465(e). Per Adm, S-1 was changing R-1's gauze and applying ointment since 03/29/2020 up until discharge. R-1 was discharged from this home on 05/01/2020. Per R-1's file review, there were no orders on performing routine wound care prior to 04/14/2020.the state’s words, verbatim · CDSS document, Jul 12, 2021

Plan of correction: Adm to provide training on Incidental Medical and Dental Care to all staff and provide a written statement as to how staff will adhere by these regultations. Adm to also submit proof of training in a form of a log which contains staff names, date of training, duration of training, presenter of training and curriculum used for this training to LPA Irra by POC due date of 07/13/2021.