Circle of Grace

Allegation investigated: Staff does not ensure residents have access to receive telephone calls.

Licensing Program Analyst (LPA) Galarza conducted an initial 10-day complaint investigation visit in regards to the allegation listed above. LPA discussed the purpose of the visit with staff Diana Castellanos. Licensee Nvard Gevorkian arrived later and Administrator Anna Khachatryan was contacted telephonically. The investigation consisted of: A tour of the interior and exterior physical plant was conducted, with focus on landline telephone access/communication. Staff (S1- S4) and family members (F1- F5). Interviews with residents were attempted, but due to cognitive impairment due to Dementia no residents were interviewed. Resident (R1-R6's) Identification and Emergency Information face sheets were obtained, as well as R1's Conservatorship and Durable Power of Attorney documents, Physician's Report, LIC 500 Personnel Report, and Register of Facility Residents. ***See narrative summary on next page.*** Unsubstantiated Allegation: Staff does not ensure residents have access to receive telephone calls. It is alleged that resident's relatives attempt to call the facility multiple times (up to 15) phone calls in order for staff to answer the phone and/or they do not answer at all. According to staff interviews, residents are always given the phone when family call, unless the residents are sound asleep. Which in that case, the callers are asked to call back later. A total of four (4) staff were interviewed, all denied the allegation and stated that staff always answer the land line phone. Per staff, resident (R1) receives frequent phone calls from one of their adult children, and are always passed to R1. LPA called resident's responsible parties, of which the majority stated they do not have issues with accessing their loved one via telephone calls when desired and receive immediate communication and/or call backs from staff. However, four (4) out of the five (5) family members interviewed stated they never call the land line telephone because their loved ones have Dementia and are unable to communicate. The primary mode of communication is through the Administrator's cell phone, facility staff, or in person visits. During the course of the investigation, LPA learned that resident (R1) has a conservator that asked Administration staff not to pass phone calls to resident (R1) if one of their adult children calls, but it is not specified by the court order. This issue is being addressed in a separate case management report. Due to cognitive impairment no resident interviews were conducted. There are two land line telephones in the facility, one in the kitchen and one in the living room. The land line telephone line was tested and is found to be operational. There is insufficient evidence to proved the allegation. 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. Exit interview conducted with staff Diana Castellanos. A copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 17, 2023 · control 28-AS-20230814181129

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Galarza generated this Case Management - Deficiencies report in conjunction with complaint control # 28-AS-20230814181129 pertaining to observations made during file review. The purpose of the report was explained telephonically to Administrator Anna Khachatryan. Administration staff received an email directive from resident (R1's) conservator asking staff to ban phone calls from one of R1's adult children. However, per file review Conservatorship court documents specify the conservatee's /(R1's) keeps the right to receive visits from family and friends, and does not specify that phone calls from family and friends shall be banned. Per ASSEMBLY BILL 937 (Wieckowski), Chapter 127, Statutes of 2013,....a licensee may not violate a conservatee resident’s personal rights, including, but not limited to, the right to receive visitors, telephone calls, and personal mail at the request of a conservator, unless specifically limited by a court order. Deficiency is cited. An exit interview was conducted and a copy of the report and appeal rights were issued to staff Diana Castellanos.the state’s words, verbatim · CDSS document, Aug 17, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(14) · Plan of correction due date: Aug 31, 2023

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To have reasonable access to telephones, to both make and receive confidential calls. The licensee may require reimbursement for long distance calls. This requirement was not met evidence by: Based on record review and interviews conducted, R1's conservator instructed staff to ban incoming phone calls from one of R1's adult children. However, conservatorship has not expressly taken the right away from R1; which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 17, 2023

Plan of correction: Adminsitrator agreed to submit a plan of correction that includes: 1. Proof of meeting with R1's conservator 2. Staff training/log in regulation 87468.1

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Galarza conducted an unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Caregiver Diana Castellanos. Administrator Anna Khachatryan arrived shortly after. There are currently 5 elderly residents 60 years and older and 1 resident under age 59 residing in the facility. Four (4) residents are receiving hospice care, five (5) residents have Dementia, and one (1) resident is enrolled in home health. The following 12 (CARE) tool domains were utilized during the inspection: Infection Control, Operational Requirements, Physical Plant/Environment Safety, Staffing, Personnel Records/Staff Training, Resident Records/Incident Reports, Planned Activities, Food Service, Incident Medical and Dental, Disaster Preparedness, and Residents with Special Health Needs. Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were observed. There is a visitor sign-in station located in the main entrance. The Infection Control Plan and Covid-19 Mitigation Plan/MonkeyPox plans were reviewed. Operational Requirements: Facility has a current Plan of Operation at main headquarters. The facility has a Dementia Waiver in place. A Hospice Waiver for 2 is approved. A hospice waiver increase is pending approval. A fire clearance for 6 non-ambulatory adults 60 and over; of which one (1) may be bedridden in room #4. Liability Insurance in the amount of at least ($1,000,000) per occurrence and ($3,000,000) in total annual aggregate is in place and expires 5/30/2024. A surety bond is not applicable. Resident monies are not handled. Physical Plant/Environment Safety: The facility is a single-story home located in a residential area consisting of six (6) bedrooms, two (2) full bathrooms, kitchen, dining room, living room, laundry room, rear shaded patio area, and attached garage. Per Fire Marshall the facility was required to install fire doors. They were tested and observed operational. The interior and exterior physical plant was inspected. Exit doors are free of any obstruction and there are no pools or large bodies of water. Cleaning supplies and toxic substances are inaccessible to residents. Fire clearance was granted on 5/4/2022 for five (5) non-ambulatory residents and one (1) bedridden resident. The facility has two (2) fully charged fire extinguishers. Smoke and carbon monoxide detectors are operational. Water temperature readings measured within the required 105 - 120 degrees Fahrenheit. Water temperature ranged between 101.6 - 109.9 degrees Fahrenheit. The exterior north side gate door was locked from the interior facility grounds. There is no fire clearance approved for locked perimeter fence gate. Citation was issued. Staffing: A total of four (4) caregiver staff provide care and supervision to the clients. Personnel Records/Staff Training: Administrator certificates expired 3/8/2023. Administrator stated the renewal documents were submitted to the recertification unit but an Administrator Certificate has not been received yet. Proof of document submittal was provided. Four (4) personnel files/training were reviewed. Staff training, health clearance, criminal background clearance and 1st Aid/CPR training was verified. ***narrative continues next page*** Resident Records/Incident Reports: A total of four (4) resident files were reviewed. They included admission agreements, Physician's Reports, Appraisals, TB clearance, Functional Capability Assessment/Appraisals, hospice care plans, and emergency information. RCFE complaint poster and Personal rights were observed posted in the facility entrance area. Planned Activities: Sufficient space to accommodate both indoor and outdoor activities was observed. Indoor and outdoor activities are performed daily. The facility does not have a Resident Council. Food Service: Sufficient food supply is stored in the kitchen and pantry areas consisting of: 2-day perishables, 7-day non-perishables, and emergency food supplies. Physician order for modified diet is on file. Sanitation practices and kitchen cleanliness was observed. Incident Medical and Dental: Four (4) centrally stored 30-day supply of medications were reviewed. Medical and dental transportation is provided by family members. Disaster Preparedness: Emergency and Disaster Plan LIC 610E is in place. The last quarterly fire/emergency drill was completed on 2/15/2023. See next page Residents with Special Health Needs: One (1) resident receives home health services. Four (4) residents receive hospice care. Postural support physician orders are on file. Half and full bed rails for mobility assistance were observed in all resident beds. Residents (R1 & R2) have full bed rails but are not enrolled in hospice. *** Only hospice residents may have full bed rails. Citation was issued. Appraisals were observed in resident files. No residents have prohibited health conditions. Per California Code of Regulations, Title 22, deficiencies were cited. Exit interview was conducted with Administrator Anna Khachatryan. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, May 30, 2023

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Galarza and Valeria Maldonado made an Announced visit and met with Licensee Nvard Gevorkian and Administrator Anna Khachatryan to conduct a Pre-Licensing evaluation. An application was submitted to Community Care Licensing Department (CCLD) on for an initial application of a Residential Care Facilities for the Elderly (RCFE) to serve adults ages 60 and over. A hospice waiver for two (2) is in place. Dementia Plan is in place. The requested capacity is for six (6) [5 non-ambulatory & 1 bedridden in room #4]. Structure: Facility is a single-story home located in a residential area consisting of six (6) bedrooms, two (2) full bathrooms, kitchen, dining room, living room, laundry room, and attached garage.. Front yard is landscaped with grass. Bedroom Clients: Each bedroom is designated as a private bedroom. Bedrooms are equipped with one bed, night-stand, chair, lamp, and overhead lightning.Bathrooms: Have a working toilet, wash basin, and shower. One (1) bathroom has a walk-in shower. Linens & Hygiene Supplies: All beds had the required linen/supplies which include, pillowcase, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linens is stored in bedroom closets. Emergency Phone Numbers, Exit Plan: Emergency numbers are posted and readily available for review. Two (2) fully charged fire extinguishers were observed. Facility has a land line telephone. Food Service: Dishes, cups, and flatware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery, and other sharp kitchen utensils were observed locked and inaccessible. Adequate food supply is stored in the kitchen and consists of the following: 2-day perishables, and 7-day non-perishables. Smoke Detectors: There are electrical & inter-connected smoke detectors located in all bedrooms, common areas, and hallways. Appliances: Refrigerator, oven, microwave, dishwasher and washer/dryer are in working condition. The residence is equipped with central forced heating. Toxins: Cleaning supplies, and toxins are locked only accessible to staff. See LIC 809C for report continuation. Water Temperature: Hot water was tested in all bathrooms, and kitchen sink. Water temperature was not within normal limits 105 degrees Fahrenheit (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). Medication, First-Aid Kit & Book: Designated centrally stored medications cabinet, and the first-aid kit has been inspected which has at least the following: tweezers, scissors, antiseptic, bandages, gauze, thermometer; including a current First Aid manual. Clients & Staff Files: Designated area for files will be in the garage. Pools/Jacuzzi/Body of Water & Pets: The backyard has two (2) water fountains. Fire Clearance: Fire clearance is approved on 5/4/2022 for five (5) non-ambulatory residents and one (1) bedridden resident. Per Fire Marshall the facility was required to install fire doors; which were tested and observed operational. Component III: Component III was waived. No items of correction were identified. An exit interview was conducted, and a copy of this report has been furnished to Licensee. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.the state’s words, verbatim · CDSS document, May 19, 2022

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): 0 Method: Telephone call with CAB COMP II Participants: Anna Khachatryan, Administrator/Owner; Nvard Gevorkian CEO/owner; Shannon Betker, analyst. Applicant/administrator participated in COMP II at CAB via telephone call with analyst at CAB. Identification of the applicant and administrator was verified by confirming date of birth. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Staff training 4. Applicant and Administrator qualifications 5. Grievances, Complaints, Community resources 6. Food service 7. Medication management 8. Application document review and technical assistance: Pre-licensing inspectionthe state’s words, verbatim · CDSS document, May 11, 2022