Bella Manor II

Type of visit: Required - 1 Year

On 06/03/2023 at 08:40 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at the Bella Manor II Facility. LPA Calderon was allowed entry into the facility by Administrator Christina Atencio. Administrator Atencio was asked questions regarding the full care tools control package (13) sections. Staff took LPA Calderon temperature prior to entrance into the facility. The facility is licensed for six (6) adult clients with developmental disabilities. Currently, there are five (5) residents residing in the facility with developmental disabilities. LPA Calderon explained to Administrator Christina Atencio, the purpose of the one-year (1) Annual Inspection visit, and escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: five (5) resident service records, five (5) resident medication records, three (3) staff records. LPA Calderon interviewed five (5) residents and three (3) staff members for visit. LPA Calderon inspected the inside facility and outside grounds to include all common areas. The facilities’ last fire drill was conducted on 04/30/2023. The one-story residential home consists of six (6) resident bedrooms, two (2) resident bathrooms, living room, dining room, family room, kitchen, office area, attached garage with washer and dryer/ storage area, backyard with table and chairs. No weapons are stored in the premises. Kitchen was inspected and observed to be clean and operational. A two-day (2) supply perishable and seven-day (7) supply of non-perishable foods are present in the facility. Emergency Water seven-day (7) supply is found in the garage. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Calderon observed the following during inspection of resident’s rooms: mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 108 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 109 degrees Fahrenheit. Kitchen hot water temperature properly measured at 111 degrees Fahrenheit. Facility (2) carbon Monoxide and (10 Smoke Detectors hard wired and were tested and are working properly. The facility two (1) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. Medications are centrally stored and in a locked storage cabinet in the kitchen. Facility first aid kit (3) is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio accessible to residents. LPA Calderon reviewed five (5) resident files and found to be complete. LPA Calderon reviewed five (5) resident medications and they were all found to be administered according to doctor's orders. three (3) staff files were checked and have the required documents. LPA Calderon noted the Administrator Christina M Atencio Certification # 6033226740 expiration date of 11/13/2024 was valid at time of visit. The facility does NOT handle resident's money/cash resources and NO Surety bond is needed. Commercial General Liability Policy #HFS0007071 policy period from 07/17/2022 to 07/17/2023 and a Commercial Professional Liability Insurance Policy #HFS0007071 policy period from 07/17/2022 to 07/17/2023 underwritten by Scottsdale Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. LPA Calderon spoke to Administrator Christina Atencio who will email full copy of insurance contact which shows all coverages to LPA Calderon by 06/09/2023. All the required documents are posted in the facility in a clearly visible area to all staff, clients, and guests. LPA Calderon reviewed LIC500 and noted all staff associated to facility per LIS. LPA Calderon reviewed the resident roster, LPA Calderon confirmed residents’ interview are on resident roster. During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff and residents were wearing face coverings, an isolation room and required postings throughout the facility. LPA Calderon observed the facility has a thirty-day (30) supply of Personal Protective Equipment (PPE). LPA Calderon advised the Administrator Christina Atencio to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe any deficiencies therefore NO citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Christina Atencio.the state’s words, verbatim · CDSS document, Jun 3, 2023

Allegation investigated: Resident received injuries while in care. Staff are not changing residents socks. Staff are not ensuring resident drinks enough water. Resident devloped a pressure injury while in care.

On 03/10/2022 Licensing Program Analyst (LPA) Ulysses Coronel initiated a complaint investigation for the allegations listed above. LPA met with Christina Atencio the facility administrator and the purpose of the visit was explained. The investigation consisted of the following: On 01/18/2022 LPA Coronel interviewed the administrator ,2 staff, 2 residents and requested and reviewed facility and resident records. On 03/07/2022 LPA conducted record reviews. On 03/10/2022 LPA conducted a tour of the facility, record reviews of resident’s records and interviewed the administrator ,2 staff, 4 residents and 2 witnesses. 1 out of 5 residents R5 is not at the facility. The investigation revealed the following: Regarding the allegation, “Resident received injuries while in care.” On 03/07/2022 R1’s Home Health Record reviews indicate that R1 slid down wheelchair, with worsening of skin tear. Patient unknowingly scratches wound. On 03/10/2022 record reviews indicate that R1 takes a blood thinner Eliquis. Unsubstantiated On 03/10/2022 the administrator and 2 staff denied the allegation, caregiver S1 stated. “Most of R1’s wound are from scratching Themselves. 3 out of 4 residents denied the complaint, R2 stated “I have not heard of anyone getting injured here.” R1 was not available for interview. Witness W1 stated. “R1 is very fragile, their skin breaks down easily due to taking Eliquis. Regarding the allegation, “Resident received injuries while in care.” 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. Regarding the allegation, “Staff are not changing residents’ socks.” On 03/10/2022 LPA observed that R1 was wearing a clean pair of socks and had at least 6 pairs of socks in their drawer. On 03/10/2022 the administrator and 2 staff denied the allegation, staff S2 stated “We change residents including R1’s socks daily, R1 has mostly dark colored socks. 3 out of 4 residents denied the allegation, R4 stated “Someone is always here, they always change our clothes .” R1 was not available for interview. Witness W1 stated,” R1 always looked good, I visit always every day. I would know if there were any problem.” Regarding the allegation, “Staff are not changing residents’ socks.” 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. Regarding the allegation, “Staff are not ensuring resident drinks enough water.” On 03/10/2022 LPA observed that residents R2 and R4 had glasses of water by their bedside. During record reviews LPA observed that per doctors order R2 is on a Restricted Fluid intake of 1000 ml per day. On 03/10/2022 the administrator and staff denied the allegation, staff S1 stated that “I make sure that each resident has a water bottle by their side.” 3 out 4 residents denied the allegation, R2 stated “I don’t have any complaints about water, they fill up my cup when it gets empty.” R1 was not available for interview. Witness W2 stated, “That is not a problem, R2 cannot drink too much water and is only allowed to take 1000 ml of fluids daily, R2 has had this condition since 2018.” Regarding the allegation, “Staff are not ensuring resident drinks enough water.” 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. Regarding the allegation, “Resident developed a pressure injury while in care.” On 03/07/2022 R2’s Home Health records indicate that on 01/17/2022 – “Skilled Nurse assessed patient (R2) with new right buttocks boil that is firm and red.” On 03/10/2022 the administrator and 2 staff denied the allegation, the administrator stated, “R2 never had a pressure injury, R2 had a boil and it’s now healed. On 03/10/2022 3 out of 4 residents denied the allegation, R2 stated “No I do not have any, a nurse comes here and looks after me, his name is Steven.” Witness W2 stated, “I visit often R2 never had pressure injuries, there may be redness here and there but they would tell me about them and they get better eventually.” Regarding the allegation, “Resident developed a pressure injury while in care.” 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. An exit interview was conducted. A copy of this report was provided to Christina Atencio the facility administrator.the state’s words, verbatim · CDSS document, Mar 10, 2022 · control 11-AS-20220114144027

Type of visit: Required - 1 Year

On 03/09/22 Licensing Program Analyst (LPA) Jade Jordan Conducted an Unannounced Annual Inspection, with an emphasis on Infection Control. LPA was met by Facility Administrator Christina Atencio and the purpose of the visit was explained. Upon Entry LPA observed Covid-19 postings on the exterior of the facility, and was screened for Covid 19, including a Temperature check. The Facility is licensed for 6 non-ambulatory residents. The interior consists of 4 resident bedrooms of which 1 is shared, 1 Staff Bedroom, 1 Living room, 1 dinning room, 1 den, Laundry space, 2 bathrooms , and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature properly measured at 111.0. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards, doorways were free of obstructions. Administration certificate expires 11/13/2022. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. All cleaning solutions, hazardous items, and medications were securely locked. A fire extinguisher was available and fully charged. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. The facility is following their mitigation plan. LPA observed a minimum of 30 day supply of PPE, which included N95 masks, gowns, face shields, surgical masks, hand sanitizer, soap, disinfectant, paper towels trash can with lid. Fit testing was completed by staff on 04/02/21. All staff a fully vaccinated and have documentation in their staff files. A daily Covid log is taken for visitors ,staff , and residents. No deficiencies were noted during this visit. A copy of this report was provided, and an exit interview was conducted.the state’s words, verbatim · CDSS document, Mar 9, 2022

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff are not following proper protocol for COVID-19. Staff failed to provide resident with privacy. Staff failed to provide a safe and comfortable environment.

Licensing Program Analyst (LPA) Ulysses Coronel initiated a complaint investigation for the allegation listed above. LPA met with Christina Atencio the facility administrator and the purpose of the visit was explained. The investigation consisted of the following: On 01/18/2022 LPA Coronel LPA interviewed the administrator 2 staff and 6 residents. LPA requested copies of and reviewed facility records and resident R1 and R2’ resident records. The investigation revealed the following: Regarding the allegation “Staff are not following proper protocol for COVID-19.” During todays visit LPA observed that staff were conducting COVI-19 screenings at the entrance, which included symptom checks and verification of COVID-19 Vaccination. Staff S1 stated that if an essential visitor is not able to present proof of vaccination then I will call the administrator for further assistance. The administrator stated that “I will call that essential visitors office to get verification of their vaccination. We are following the most recent guidance provided by the state...” Unsubstantiated During todays visit LPA conducted a review of the California Department of Public Health’s Requirements for Visitors in Acute Health Care and Long-Term Care Settings dated 12/31/2021 which orders the following:” Effective 01/07/2021… Visitation shall be permitted only in accordance with this Order….B. …Adult and Senior Care Residential Facilities must either: (1) for indoor visitation, verify visitors are vaccinated, have had all recommended doses… and provide evidence of a negative SARS-CoV-2 test within one day of visitation for antigen tests, and within two days of visitation for PCR tests; OR (2) permit only outdoor visitation for those that do not meet all the requirements in Section B (1). LPA did not observe exemptions for home health nurses. Regarding the allegation " Staff are not following proper protocol for COVID-19" 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. Regarding the allegation: “Staff failed to provide resident with privacy.” During today’s visit LPA observed that resident R1 is staying in a private bedroom and R2 is staying in a shared bedroom, LPA observed a curtain placed which provides privacy between R2 and their roommate. During interviews staffs S1, S2 and S3 stated that they allow all visitors privacy during their visits with residents, S1 stated that “We only provide assistance when the nurses asks, we step out of the room and close the door.” When asked if they were being provided privacy during nurse visits, residents R1, R2, R5 and R6 were not available to provide answers, residents R3 and R4 said “Yes” R3 stated “I have no complaints, S2 takes good care of me.” Regarding the allegation: “Staff failed to provide resident with privacy.” 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. Regarding the allegation: “Staff failed to provide a safe and comfortable environment.” During todays visit LPA observed small sized trash cans with plastic bag liners located next to all residents’ bed. Staff S2 stated that “We always have trash cans available and we empty the trash cans after each use. Also essential visitors can always ask us for assistance and we will help them dispose of trash” During todays visit LPA did not observe any resident being visibly uncomfortable, R3 and R4 stated that they felt good about the way they were treated by staff residents R1, R2, R5 and R6 were not available to provide interviews. Regarding the allegation: “Staff failed to provide a safe and comfortable environment.” 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. An exit interview was conducted. A copy of this report was provided to with Christina Atencio the facility administrator.the state’s words, verbatim · CDSS document, Jan 18, 2022 · control 11-AS-20220113075855