Fil-Am for Seniors

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 Toby Miclat 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: (2) living rooms, dining room, kitchen with refrigerator, oven, stove, dishwasher, sink/faucet, (5) resident rooms, (1) staff room , (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-#5 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 Six (6) resident files, Six (6) residents medications, and three (3) staff files. Inspection tool completed. Per Title 22 regulations, deficiency is being cited in 809-D page. Exit interview conducted and a copy of this report and appeal rights were discussed and provided.the state’s words, verbatim · CDSS document, Jun 20, 2023

Allegation investigated: Resident had access to medications resulting in overdose Resident did not receive timely medical attention Resident's medications were mismanaged Resident's care needs were not being met

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced complaint investigation visit on 06/19/23 to deliver findings regarding the above allegations. LPA Ramirez was met by Administrator Toby Miclat and explained the purpose of the visit. The investigation consisted of the following: LPA Truman conducted initial compliant visit on 01/19/21 and required a needs further investigation. On 03/21/23, LPA Ramirez conducted an unannounced subsequent complaint visit and required a needs further investigation. Staff (S1-S4), Resident (R2) and Witness #1 (W1) were interviewed. LPA requested and obtained the following documents: LIC 500 Personnel Report, Resident roster, Resident#1 (R1) Emergency ID Page, Physician's Report, Medical records for R1, Admissions Agreement and any other pertinent documentation that may assist with this investigation. SEE LIC 9099-C for continuation... Unsubstantiated The investigation revealed the following: Regarding the above allegations- Resident had access to medications resulting in overdose: It is alleged that R1 had access to medications which resulted in R1 overdosing and being administered Narcan in the ER. R1 was admitted into the facility on 03/20/2020. Physician’s Report dated 2/25/2020 revealed R1 required medication management. Four (4) out of the four (4) staff interviewed deny the above allegation. During physical plant tour of facility on 03/21/23, LPA Ramirez observed centrally stored medications cabinet to contain a padlock and was inaccessible to residents in care. LPA reviewed R1’s Centrally Stored Medication List (LIC 622). Per facility staff, R1 was administered medications as directed by physician and according to label on all prescriptions. LPA Ramirez could not locate any other pertinent documents that suggest facility staff did not adhere to directions on medications list. On 04/05/23, LPA Ramirez sent R1’s LAB results and discharge documents dated 01/07/21 to this departments Program Clinical Consultant. Due to limited information provided at that time, consultants were not able to provide complete interpretation and conclusion of results. Resident did not receive timely medical attention: It is alleged that R1 did not receive medical attention in a timely manner. Four (4) out of four (4) staff deny this allegation. LPA Ramirez reviewed facility staffing notes dated 01/07/21, 01/25/21 and 01/27/21, which documented R1 requiring medical treatment and intervention/solution. LPA Ramirez reviewed medical treatment and discharge documents dated 01/07/21 for R1. One (1) resident interviewed denied this allegation. Resident's medications were mismanaged: It is alleged that R1’s medications were mismanaged. LPA Ramirez reviewed R1’s Centrally Stored Medications list. LPA could not locate any discrepancies upon review of medication list. Four (4) out of four (4) staff deny this allegation. One (1) resident interviewed denied this allegation. LPA Ramirez could not locate any other pertinent documents that suggest facility staff were mismanaging R1’s medications. Resident's care needs were not being met: It is alleged that R1’s care needs were not being met. Four (4) out of four (4) staff deny this allegation. One (1) resident interviewed denied this allegation. LPA Ramirez reviewed staff progress notes that revealed staff administered care to R1 on daily basis. Although the above allegations 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 allegation is UNSUBSTANTIATED. Exit interview was conducted with Toby Miclat and a copy of this report was provided via email due to printer problems.the state’s words, verbatim · CDSS document, Jun 19, 2023 · control 28-AS-20210111094558

Allegation investigated: Resident had access to medications resulting in overdose Resident did not receive timely medical attention Resident's medications were mismanaged Resident's care needs were not being met

This is a corrected version of previous complaint dated 06/19/23. Report was corrected to indicate "Public" viewing. Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced complaint investigation visit on 06/19/23 to deliver findings regarding the above allegations. LPA Ramirez was met by Administrator Toby Miclat and explained the purpose of the visit. The investigation consisted of the following: LPA Truman conducted initial compliant visit on 01/19/21 and required a needs further investigation. On 03/21/23, LPA Ramirez conducted an unannounced subsequent complaint visit and required a needs further investigation. Staff (S1-S4), Resident (R2) and Witness #1 (W1) were interviewed. LPA requested and obtained the following documents: LIC 500 Personnel Report, Resident roster, Resident#1 (R1) Emergency ID Page, Physician's Report, Medical records for R1, Admissions Agreement and any other pertinent documentation that may assist with this investigation. SEE LIC 9099-C for continuation... Unsubstantiated The investigation revealed the following: Regarding the above allegations- Resident had access to medications resulting in overdose: It is alleged that R1 had access to medications which resulted in R1 overdosing and being administered Narcan in the ER. R1 was admitted into the facility on 03/20/2020. Physician’s Report dated 2/25/2020 revealed R1 required medication management. Four (4) out of the four (4) staff interviewed deny the above allegation. During physical plant tour of facility on 03/21/23, LPA Ramirez observed centrally stored medications cabinet to contain a padlock and was inaccessible to residents in care. LPA reviewed R1’s Centrally Stored Medication List (LIC 622). Per facility staff, R1 was administered medications as directed by physician and according to label on all prescriptions. LPA Ramirez could not locate any other pertinent documents that suggest facility staff did not adhere to directions on medications list. On 04/05/23, LPA Ramirez sent R1’s LAB results and discharge documents dated 01/07/21 to this departments Program Clinical Consultant. Due to limited information provided at that time, consultants were not able to provide complete interpretation and conclusion of results. Resident did not receive timely medical attention: It is alleged that R1 did not receive medical attention in a timely manner. Four (4) out of four (4) staff deny this allegation. LPA Ramirez reviewed facility staffing notes dated 01/07/21, 01/25/21 and 01/27/21, which documented R1 requiring medical treatment and intervention/solution. LPA Ramirez reviewed medical treatment and discharge documents dated 01/07/21 for R1. One (1) resident interviewed denied this allegation. Resident's medications were mismanaged: It is alleged that R1’s medications were mismanaged. LPA Ramirez reviewed R1’s Centrally Stored Medications list. LPA could not locate any discrepancies upon review of medication list. Four (4) out of four (4) staff deny this allegation. One (1) resident interviewed denied this allegation. LPA Ramirez could not locate any other pertinent documents that suggest facility staff were mismanaging R1’s medications. Resident's care needs were not being met: It is alleged that R1’s care needs were not being met. Four (4) out of four (4) staff deny this allegation. One (1) resident interviewed denied this allegation. LPA Ramirez reviewed staff progress notes that revealed staff administered care to R1 on daily basis. Although the above allegations 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 allegation is UNSUBSTANTIATED. Exit interview was conducted with Toby Miclat and a copy of this report was provided via email due to printer problems.the state’s words, verbatim · CDSS document, Jun 19, 2023 · control 28-AS-20210111094558

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tao conducted an unannounced annual required visit at the facility. LPA met with Administrator, Toby Miclat, who assisted with the visit. The purpose of the visit was discussed. Facility is licensed to serve four (4) non-ambulatory and two (2) ambulatory residents, age 60 and above, of which one (1) maybe bedridden. Annual licensing fees are current. Administrator certificate is current and the expiration date is 10/12/23. Currently, one (1) hospice resident residing at the facility. 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 facilities physical plant, indoor and outdoor. The facility has a living room, dining room, kitchen, five (5) resident rooms, two (2) bathrooms, and locked storage 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’s last service was on 11/10/21 and gauzes showed “1” fully charged. Facility maintains a comfortable temperature for residents. Auditory alarm devices to monitor exits are operable. 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 112.5 degrees Fahrenheit which is within Title 22 Regulation guidelines. Adequate linen and personal hygiene supplies are observed. Administrator stated there were no weapons or ammunition on premises. The first aid kit is fully stocked. Mandated documents and signages are posted in common areas. Medication are centrally stored in a locked cabinet in the storage room 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, Toby, who’s signature on this form confirming receipt of these documents. A copy of LIC 809s report was provided.the state’s words, verbatim · CDSS document, Jun 17, 2022