Miracle Mile Manor RCFE

Allegation investigated: Staff did not refund resident

On 5/10/2023 Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced subsequent complaint investigation at the facility listed above. LPA arrived at facility and was greeted by Edith Nagel Administrator (S1) LPA explained the purposed of the visit is to deliver findings on the allegation listed above. The investigation consisted of the following: LPA Randle toured facility, LPA requested pertinent documents pertaining to the investigation. The following documents were gathered: Staff and Client Rosters, file for resident (R1) including admission agreement and any other pertinent documentation regarding R1. LPA reviewed facility files and interviewed staff (S1), Resident (R1) was not interviewed R1 was not at the facility R1 returned home, further R1’s agreement was entered into by R1’s daughter (CW1). LPA did interview (CW1). LPA requested, received, and reviewed the following information: file of R1, Staff roster, Resident roster, and other documents relevant to the investigation. Unsubstantiated Investigation Revealed the following. Allegation: Staff did not refund resident LPA conducted an interview with S1, S1 denies the allegation. S1 informed LPA that all prorated rent monies are refunded to residents in a timely manner if due. S1 stated there are no residents, that S1 is aware of, that have not received a refund that is due. S1 also stated to LPA that R1 or (CW1) is not entitled to receive a refund for the days residing at the facility. S1 stated that R1 was receiving basic service for three months as requested by CW1. S1 stated that (CW1) signed the agreement within the scope of the agreement there contains a 30-day notice clause when leaving the facility. LPA interviewed CW1, CW1 provided a signed copy of the agreement signed by CW1 containing the 30-day notice clause. CW1 did not provide a power of attorney to LPA, however CW1 was acting as R1’s representative. CW1 stated that she was under the impression that there was a three-month minimum charge for residing at the facility. CW1 stated R1 left the facility after receiving a bill for the beginning of the fourth month of residency which was not paid by CW1 per S1, thus leaving a balance due to the facility per S1. LPA reviewed the records. Based on information gathered, the department did not find sufficient evidence to support the allegation. Although the allegation 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 allegation is Unsubstantiated. An exit interview was conducted and a copy of the LIC 9099 was provided to Edith Nagel Administrator.the state’s words, verbatim · CDSS document, May 10, 2023 · control 11-AS-20230210141143

Type of visit: Annual/Random

On 4/11/2023, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced One-Year Required Visit at the facility. LPA met with the Licensee Edith Nagel and conducted a risk assessment. Facility is approved to serve 5 non-ambulatory residents and 1 bedridden resident over the age of 60. LPA reviewed client records, staff records, medications, and inspected the entire facility. LPA and Edith inspected the entire facility inside and out. The facility has 5 resident bedrooms, 3 bathroom and 1 staff bathroom, a living room, a fireplace in the living which is cover by a metal fireplace screen. a dining room, and a kitchen. The outdoor facility has a backyard with a pool inaccessible with a 5-foot fence around it. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, adequate lighting, and sufficient toiletries accessible to clients. Water temperature measured 112.7 degrees. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector was operational. Smoke detectors were working properly, fire extinguishers were fully charged and operational, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and in order. Exits/Walkways around the home were free of debris and hazards. Continued on LIC 809C During today’s visit LPA observed that the facility has a half bed rail for R1 and R3 with no prescriptions in the file. LPA Shirley noticed during record review that Staff Iann Barrantes, Anita Lebon and Guadalupe Castillo were listed on the LIC500 Staff Roster but have no background clearance. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. During today’s visit there were deficiencies observed, Title 22 Chapter 6 Regulations are being cited. Please see LIC809- D. Exit interview held. A copy of the report and appeals rights was provided.the state’s words, verbatim · CDSS document, Apr 10, 2023

Type of visit: Required - 1 Year

On 3/27/23, Licensing Program Analyst (LPA) Felisa Shirley arrived at facility to conduct an unannounced One-Year Required Visit at the facility. LPA met with the Licensee Edith Nagel to conduct risk assessment. Facility is approved to serve 5 non-ambulatory residents and 1 bedridden resident over the age of 60. Due to unforeseen circumstances the visit could not be completed at this time. LPA Felisa will return a a later date to complete the visit. There were no deficiencies cited and exit interview conducted with Edith Nagel.the state’s words, verbatim · CDSS document, Mar 27, 2023

Allegation investigated: Resident has loss an excessive amount of weight. Resident is not awarded privacy. Staff are not meeting resident's hygiene needs. Resident's admissions agreement doesn't have a list of fees.

Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Today’s complaint investigation was conducted with Edith Nagel, the facility administrator. The investigation consisted of following: Interviews and Record reviews. On 02/04/22, LPA Soto interviewed Administrator, S#2, R#1, and R#2. LPA received the following documents on 02/04/22: Resident Roster, Staff Schedule, Face sheet/assessment, Facility notes dated from 08/06/21 – 01/25/22, Shower/sponge bath schedule, Emails dated 01/14/22 & 01/18/22, 01/28/22 – 01/31/22 (copy of text thread), Admission agreement, Physician’s report, Rent invoice, Covid test results, Weight chart, and SIR dated 01/16/22. Unsubstantiated Based on the LPA's investigation, the investigation revealed the following for Allegation #1 – Resident has loss an excessive amount of weight. Interviews with Administrator and S#2, the reason R1 has lost weight because R1 was started on a soft diet and R1 refuses to eat. Sometimes R1 not hungry and they cannot force feed R1. Some days R1 eats all the food they provided R1 and the next day, R1 might not want anything to eat. Interviews with R1, said, “If she hungry she eats, but she not hungry all the time, don’t feel like eating, not that much.” Interviews with R2, said, “I get well balanced meals, 3 times a day. Vegetables are a little over cooked, but I eat them.” LPA reviewed R1 physician's R1 is losing weight, but not because of malnutrition, R1's appetite has just diminished. Facility feeding R1 a well-balanced meal with fresh vegetables, protein, fresh fruits, and ensure drinks. The interviews and records reviewed did not concur with above allegation. Allegation #3 - Resident is not awarded privacy. Interviews with Administrator and S#2, R1 cannot hold telephone when she gets calls. The staff needs to assist her with the phone and R1 can’t hardly hear, so R1 has trouble hearing the person that calls R1. They leave the room when they hand her the phone, but again R1 is hard at hearing. R1 is awarded privacy. Interview with R2, R2 does have privacy, R2 shares a room with R1, R2 does see Administrator leave the room when R1 is on the phone, R1 cannot really hear. R2 always get privacy when R2 is on the phone. The interviews conducted do not concur with the above allegation. Allegation #4 - Staff are not meeting resident's hygiene needs. Interviews with Administrator and S#2, R1 get a sponge bath 3x times a week and a shower once a week, in R1 beds. They wrap the bed in plastic and give R1 a shower in the bed. It’s hard for R1 to get up and take shower R1 cannot sit or stand. Interview with R2, R2 takes care of own hygiene needs. R2 shares a room with R1. Interview with R1, said, “don’t get sponge bath or showers.” R2, interrupted, and said, “Yes, you do, they give sponge baths and showers.” LPA reviewed shower/ sponge schedule, sponge bath is given 3x times a week and shower once a week. LPA observed r1 nails, they were clean. The interviews, records reviewed, and observations conducted do not concur with the above allegation. Based on the LPA's investigation, the investigation revealed the following for Allegation #2 - Nurse denied entry into facility to assess resident. Interviews with Administrator on 02/04/22, on 01/20/22, R1’s family member sent a nurse from another facility to evaluate R1, Administrator denied the nurse entry because R1 family member did not give her prior notice and family member had not paid rent for the month. Administrator admitted that she denied entry to the nurse and LPA reviewed a text tread between administrator and R1 family member, where it showed that Administrator is telling family member did deny entry to the nurse. Administrator did not have to deny entry to nurse for assessment. The interviews and records reviewed did concur with the above allegation. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation. An exit interview was conducted with Edith Nagel, Administrator and a copy of Report and Appeal Rights provided. Allegation #5 - Resident's admissions agreement doesn't have a list of fees. Interview with administrator. The admissions agreement shows that $250 is owed for optional services. LPA reviewed admissions agreement and it does show the additional charge for $250 is for optional services. The administrator gave R1 family member the correct payment owed for monthly rent. 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 with Edith Nagel, Administrator, and a copy of report was provided.the state’s words, verbatim · CDSS document, May 6, 2022 · control 11-AS-20220128122541

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: May 16, 2022

87468.1 (a)(11) to have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This was not met as evidence by: Based on observations and interviews administrator denied entry to nurse, which potentially poses a health and safety risk for persons in care.the state’s words, verbatim · CDSS document, May 6, 2022

Plan of correction: Administrator to create a plan where she explains how will she avoid this in the future. To provided to LPA on or before POC due date.

Type of visit: Required - 1 Year

On 4/19/2022, Licensing Program Analyst (LPA) Ngozi Nwaokoro conducted an unannounced One-Year Required Visit at the facility. LPA met with the Licensee Edith Nagel and conducted a risk assessment. Facility is approved to serve 5 non-ambulatory residents and 1 bedridden resident over the age of 60. LPA reviewed client records, staff records, medications, and inspected the entire facility. LPA and Edith tour the entire facility inside and out. The facility has 5 resident bedrooms, 3bathroom and 1 staff bathroom, a living room, a fireplace in the living which is cover by a metal fireplace screen. a dining room, and a kitchen. The outdoor facility has a backyard with a pool inaccessible with a 5-foot fence around it. All client rooms were checked. Mattresses and box springs were in good condition, adequate lighting, plenty of dresser and closet space was observed. Walls and floors were clean and in good repair. Bed linens, comforters and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulation. Toilets and water faucets worked properly. Shower was free of mold/mildew, adequate lighting, and sufficient toiletries accessible to clients. Water temperature measured 111.4 degrees. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Carbon monoxide detector was operational. Smoke detectors were working properly, fire extinguishers were fully charged and operational, toxins and knifes were locked and inaccessible to clients. Medications were centrally stored and properly locked, first aid kit was checked and in order. Outside grounds were toured and no bodies of water were observed. Exits/ Walkways around the home were free of debris and hazards. Continue on LIC 809C During today’s visit LPA observed that the facility was has full bed rails for all residents. LPA also observed that one resident’s medication was given without been charted in the MAR. During today’s visit there were deficiencies observed, Title 22 Chapter 6 Regulations are being cited please see LIC809- D. Exit interview held. A copy of the report and appeals rights was provide.the state’s words, verbatim · CDSS document, Apr 19, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Apr 19, 2022

(h) All medication side effects observed by the facility personnel or reported to the personnel by residents, their authorized representative, significant other, relative, or friend shall be reported to the physician immediately. (1) There shall be documentation of the date and time the report is made to the physician.the state’s words, verbatim · CDSS document, Apr 19, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Apr 19, 2022

(a) Based the the individuals preadmission appraisal, and subsequent changes to that appraisal, the facility shal provide assistance and care for the resident in those activities of the daily living which the resident is unable to do for him/herself. Postural support may be used under the following condition. (B) Bed rails that extend the ential lenght of the bed are prohibited except for residents who are currently recieving hospic care and have a hospic care plan that specifies the need for full bed rails.the state’s words, verbatim · CDSS document, Apr 19, 2022