Senior Manor Care II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced Annual required and infection control visit to the above facility. LPA was met by Norma Apesto, House Manager and the purpose of today’s visit was explained. There are currently (5) residents in the facility. (1) residents are ambulatory, (3) are non-ambulatory, (1) bedridden. The facility is a single-story structure located in a residential neighborhood. It consists (5) bedrooms, (2 -1/2) full bathrooms, shaded back yard, front yard, laundry room in the attached garage. LPA and Norma toured the entire inside of facility. Documents are posted as mandated. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. Bedroom 5 is a staff bedroom. The (2) bathrooms have grab bars and non-skid mats and are clean and operational included 1/2 bathroom. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry & visitors and temperatures are logged and checked, sanitizer/soap and (No-paper towels)are in all the bathrooms and additional sanitation supplies are stored in the garage. LPA observed staff wearing masks, resident private rooms will be converted to isolation rooms (if needed) (No- trash cans with lids in all bathrooms,) (No-cart for PPE’s), (No - mitigation plan posted and/or in folder,) (No - Fit testing completed for staff,) and required postings throughout the facility. Visitor designated area, facility has internet & IPHONE for residents to use, resident’s temperatures are checked and logged (once a day). (No- Emergency plan updated and/or posted); PPE's are enough for 30 days. All residents and staff are vaccinated and boosted According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe any deficiencies, therefore no citations were issued at this time. Technical Advisory (TA) were issued. 1. No fit testing completed for staff 2. No paper towels in 1/2 bathroom. 3. No trash can with lid in 1/2 bathroom. 4. No cart for PPE's. 5. No mitigation plan posted and/or in binder. 6. No emergency Plan posted and/or in binder. An exit interview conducted with Norma Apresto, House Manager and a hard copy of report provided.the state’s words, verbatim · CDSS document, Feb 27, 2023

The state marks this report as 7 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 07/05/2022 around 12:00 PM Licensing Program Analyst (LPA) Jose Calderon conducted a Case Management -Other / Health and Safety Check visit to the facility listed above. Today’s visit was conducted face to face with Administrator Steven Gradney. LPA Calderon conducted a physical tour which consisted of a review of the facility's living room, kitchen, backyard and 4 bedrooms and 2 bathrooms. LPA Calderon observed supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days maintained on the premises. LPA also observed current supply of Medications kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Corrections were made for drawer for room 2 and boxes were cleared for room 3. No other violations were found or noted for the above facility. A exit interview was conducted with Administrator Steven Gradney and a hard copy was provided by hand for signature.the state’s words, verbatim · CDSS document, Jul 5, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ana Soto conducted an unannounced annual required visit to the above facility. LPA met with Charles Abad, House Manager and the purpose of today’s visit was explained. There are currently 6 residents in the facility. 1 ambulatory, 1 bedridden, and 2 non-ambulatory. The facility is a single story structure located in a residential neighborhood. It consists of the following: 5 bedrooms, 2 1/2 bathrooms, living room, kitchen, dining room/office area, shaded area, indoor and outdoor activity area, laundry room in the attached 2 car garage. LPA and Charles toured the entire facility inside and out. Documents are posted as mandated. Bedrooms 1-4 are occupied by residents and contain the mandated furniture. Bedroom 5 is a staff bedroom. The (2) bathrooms are clean and operational. 1/2 bathroom has a broken sink faucet, First aid kit complete with manual; smoke detectors and carbon monoxide detector were in compliance and operational. No firearms are stored at facility and no bodies of water present. Medications are stored, locked and inaccessible to residents. 1 staff file complete. 1 resident file was complete byt medication log was missing initial for 04/08/22-04/10/22. Medication for R1 had empty medication, facility requested refill and will have medication for R#1 today. Ample supply of perishable and nonperishable food, hot water temperature is 112 degrees Fahrenheit, linens and personal hygiene supplies are adequate, hazardous toxins and/or sharp items are inaccessible to residents, 1 fire extinguishers are fully charged. Exit, walkways and/or passageways, front and back yard are free of debris and/or hazards. The facility is in good repair. During the visit, LPA observed the facility infection control practices. LPA observed a sanitizing station at the facility entry, visitors are logged, and temperature checked, sanitizer/soap in the staff bathroom and additional sanitation supplies are locked in the garage. LPA observed staff was wearing masks, residents’ private rooms will be converted to isolation rooms (if needed) and required postings throughout the facility. The facility has an approved Mitigation plan. The resident’s temperatures are checked and logged once a day. PPE's are enough for 30 days. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiencies and issued a citation or citations. An exit interview was conducted with Charles Abad, House Manager and a copy of Report and Appeal Rights provided.the state’s words, verbatim · CDSS document, Apr 13, 2022

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff does not provide adequate food service for residents. Residents care needs are not being met. Residents are not being provided activities. Facility's ramp poses a hazard to residents. Staff not informing resident's authorized representatives of incidents involving resident. Staff unable to communicate with resident due to language barrier.

On 04/01/22 Licensing Program Analyst (LPA) Jade Jordan conducted a subsequent to conclude investigation complaint received on 07/03/20, which was previously initiated virtually. Lpa was met by House Manger Charles Abad, and the purpose of the visit was explained. Investigation Consisted of the following: Physical Plant Tour, Record Review of Admissions Agreements, Physician Report, Needs and Services, Resident Interviews, Staff Interview ****** Continued on 9099 C************************* Unsubstantiated Regarding Allegation: Staff does not provide adequate food service for residents. RP stated that R1 has a modified diet prescribed by the doctor due to high blood pressure, and diabetes. Rp states that the facility serves high salt food content such as soups, lots of Pork, and does not serve fresh fruits or vegetables. Record Review of R1 revealed that a modified diet was indicated of liquid, but did not indicate by a physicians prescription perimeters of food other than liquid. On 04/01/22 during physical tour LPA observed Fresh foods such as cabbage, lettuce, tomatoes, onion, bananas, orange, apples, celery, bell pepper, bread, snap peas, milk, apple sauce, oatmeal, cantaloupe, and some chicken, pork, frozen veggies, in the freezer. Record Review of other clients in care physician’s report revealed that no other residents have a modified diet. Therefore, Based on LPA’s Observation, Record Review, and Interviews the Department Finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Regarding the Allegation: Resident Care Needs are not being Met RP stated that the facility’s female staff did not want to help assist R1 with toileting and change of diaper, because staff felt it was inappropriate, in turn causing r1 to have to wait until a male staff was available. House Manager stated that they respect the privacy of residents, and that if resident feels comfortable either sex of a care giver they will move forward with assisting. LPA interview residents r2-r3. R2, and R3 stated that they don’t have any issue with staff assisting with their needs. R2, and R3 stated that they feel comfortable with male and female caregiver’s assistance and receive both. Based on LPA’s Observation, Record Review, and Interviews the Department Finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Regarding the allegation – Residents are not being provided activity’s Reporting Party stated that activities are not being provided, just TV’s. The compliant was made during Covid-19 Pandemic in which social distancing was recommended, and limited interaction with others due to the virus. Interviews with House Manger revealed that activities that are being offered at this time are walks outside, Gardening, and the facilities has board games. 3 of 4 residents are Non ambulatory, and choose not to participate. Interviews with Resident 2 (R2) revealed. That they Garden and go for walks. LPA observed a Bowling Game in the dining room, and outside garden area. Based on Interviews, and observation, Record Review the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Regarding Allegation: Facility's ramp poses a hazard to residents LPA observed virtually that the ramp was in good condition on 07/09/20 that the front ramp was in good condition and had been repaired prior to the complaint. LPA Observed on 04/01/22 during physical tour, that the Ramp in question was still in good condition. Therefore; the department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” ***** Continued on 9099 C**************** Regarding Allegation: Staff not informing resident's authorized representatives of incidents involving resident. Reporting Party stated that they were not notified of a fall, that did not result in hospitalization. Interviews with staff stated that in a life or death situation or hospitalization the proper authorities such as 911 is notified, Administrator, and responsible party. Responsible parties will be notified if the facility staff observes things on a resident that maybe detrimental to their health. Interviews with residents R2, And R3 care generally stated that they have no family or friends to be contacted in case of emergency. The witnessed fall from R1 did not result in injury or hospitalization. Therefore: Based on Record Review, observation, and Interviews the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Regarding Allegation: Staff unable to communicate with resident due to language barrier Interviews with House Manger stated that all Caregivers can speak English, as well as all residents in care who are verbal. Interviews with Resident 2, and 3 Generally stated that they are able to communicate with staff, and have their needs met. During the physical visit LPA observed Caregivers communicating effectively with residents in care. Therefore; Based on Record Review, observation, and Interviews the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An Exit Interview Conducted and copy of this report was providedthe state’s words, verbatim · CDSS document, Apr 1, 2022 · control 11-AS-20200703110054

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307A3 · Plan of correction due date: Apr 4, 2022

87307A(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of.. This standard was not met as evidenced by: Based on LPA interview Resident 3 stated that they did not have a toothbrush or toothpaste, and was not provided one by the facility. This poses a potential health, safety and personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Apr 1, 2022

Plan of correction: Facility will Provide proof of basic toothbrush and toothpaste for resident and will send an email photo to : Jade.Jordan@dss.ca.gov by POC due date of 04/04/22

Type of visit: Case Management - Other

On 04/01/22 Licensing Program Manager Conducted a case management in regards to Complaint Control # 11-AS-20200703110054. LPA Jordan observed the facility heating and air conditioning to be in working condition, and the temperature to be comfortable. Interviews with residents in care also indicated that they were comfortable. LPA Gave a technical advisory for no thermostat to ensure that temperature setting stays with the regulation within the home Per : 87303 Maintenance and Operation (b)A comfortable temperature for residents shall be maintained at all times. (1)The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). (2)The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. Technical Advisory was given regarding PIN 22-07-ASC, which requires that at all times the licensee provide assistance for arranging alternative communication for visitors such as video calls and online communications As of January 1st 2022 Licensee's must have internet access, and must provide at least one internet accessible device, such as a computer, smart phone, tablet that is equipped with video conferencing. The device must be available in a manor that allows client or resident to access it for personal personal or confidential manor, and be available for all residents/ clients in the facility within reasonable hours.the state’s words, verbatim · CDSS document, Apr 1, 2022