Wild Flowers RCFE

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Helena Rummonds arrived unannounced to conduct an Annual Required inspection and was greeted by staff. LPA met with Caregiver, Gladys Flores. LPA initiated a tour of the facility around 9:20AM and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Staff bedroom was locked and inaccessible to clients. Six of six resident beds are equipped with half rails. Physicians reports reflected the need for half rails for mobility. LPA discussed with staff that physician is to fill out the report. Water temperature in bathrooms used by residents measured at 123 and 116 degrees F. Sink closest to water heater was not within the range of 105 to 120 degrees F allowed per regulation. LPA requested water heater be turned down slightly, and staff immediately turned down water heater. Extra hygiene products and linens were available. Cabinets containing cleaning supplies were located in garage and locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Facility has a pool in backyard that is fenced and locked. Emergency food and water supplies are stored in the garage. Facility has extra Personal Protective Equipment upon entry. Fire extinguishers were last serviced August 2023. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational during inspection. Fire/disaster drills are being conducted quarterly with the last one conducted July 2023. Continued on LIC 809-C Continued from LIC 809 Five staff files and five resident files were reviewed. Staff have required First Aid and CPR certificates. Training records were reviewed. Administrative Certificate for Administrator, Elizabeth Allen, 6000978740 expired 10/19/2023. Administrator has sent in all required recertification paperwork. Medications and medication records were reviewed. Administrator to submit updates of the following documents by 12/09/2023: Admission Agreement Personnel Report (LIC 500) Liability Insurance Infection Control Plan (If any changes) Emergency Disaster Plan (If any changes) No deficiencies cited during this inspection. Exit interview conducted. Copy of report discussed and provided to Administrator. Signature on form confirms receipt of documents.the state’s words, verbatim · CDSS document, Nov 9, 2023

Allegation investigated: Staff not following proper sanitizing practices.

LPA Bertozzi arrived unannounced to deliver findings regarding the above compaint allegation and met with Caregiver, Gladys Flores. Licensee Elizabeth Allen was available by phone. During investigation LPA conducted interviews, reviewed documents and made observations. Staff not following proper sanitizing practices – Complaint alleges that a facility staff answered the door with soiled gloves from providing wound care leaving blood on the door. Per interviews, facility staff do not provide wound care to residents in care. Staff denied answering the door in soiled gloves and providing wound care to a resident in care. LPA observed doors during inspection and did not see evidence of blood on or near handles. A finding that the complaint allegation that staff are not following proper sanitizing practices was unsubstantiated meaning that although the allegation may have happened there is not a preponderance of evidence to prove that the allegations occurred. Nothe state’s words, verbatim · CDSS document, Feb 3, 2023 · control 21-AS-20221214142506

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst Bertozzi arrived unannounced to conduct a Case Management inspection and met with Caregiver, Gladys Flores. During complaint investigation LPA discovered that facility has two hospice residents but only has a waiver for one. Recently facility had three hospice residents at one time. Additionally, the facility has a resident who is bedridden but facility does not have a bedridden fire clearance. In order to request a bedridden fire clearance, the following documents are to be sent to CCL no later than 12/17//2022: An LIC200 filled out entirely showing 1 bedridden in section 10B An updated facility sketch identifying bedridden room. In order to request an hospice increase, the following documents are to be sent to CCL no later than 12/17/2022: A written request for hospice increase to the Department that includes the specific maximum number of terminally ill residents which the facility wants to have at any one time, a statement by the licensee that they have read, Section 87633, Hospice Care for Terminally Ill Residents, this section and all other requirements within Chapter 8 of Title 22 of the California Code of Regulations governing Residential Care Facilities for the Elderly and that they will comply with these requirements, a statement by the licensee that the terms and conditions of all hospice care plans which are designated as the responsibility of the licensee, or under the control of the licensee, shall be adhered to by the licensee and a statement by the licensee that an agreement with the hospice agency will be entered into regarding the care plan for the terminally ill resident to be accepted and/or retained in the facility. The agreement with hospice shall design and provide for the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the licensee. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.the state’s words, verbatim · CDSS document, Dec 16, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87606(c) · Plan of correction due date: Dec 17, 2022

87606 Care of Bedridden Residents To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). Requirement has not been met as evidenced by: Based on document review, Licensee did not comply with the above regulation by retaining a bedridden resident without an approved bedridden fire clearance. This is an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Dec 16, 2022

Plan of correction: Facility agrees to submit an updated LIC200 and Faciilty sketch as described in the LIC809 by POC due date, 12/17/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87632 · Plan of correction due date: Dec 17, 2022

87632 Hospice Care Waiver (a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. To obtain this waiver the licensee shall submit a written request for a waiver to the Department on behalf of any residents who may request retention, and any future residents who may request acceptance, along with the provision of hospice services in the facility. Requirement has not been met as evidenced by: Based on document review facility has 2 hospice residents but are only approved for one. This is an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Dec 16, 2022

Plan of correction: Facility agrees to submit a request for a hospice waiver increase to CCL by POC due date, 12/17/2022.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and met with caregiver, Gladys Flores. Licensee/Administrator, Elizabeth Allen was available by phone. The inspection is focused on the Infection Control procedures and practices of this facility Upon arrival, LPA was screened by staff for Covid-19 which included a temperature check and signing in. LPA confirmed that facility is no longer requiring vaccination verification per recent guidance. LPA initiated a walk-through of the facility around 9:45 am and observed the following: Facility has COVID-19 posters throughout that include hand washing signs in bathrooms. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Staff had masks on during this visit. Commonly touched surfaces are disinfected at least once per day. Facility continues to screen staff and residents and maintains documentation. Facility has a designated visitation area outside and is allowing for visitation in resident rooms per CCL guidance. Staff continue to receive training on infection control and donning and doffing of Personal Protective Equipment PPE but have not been N95 fit tested. LPA and caregiver discussed visitation and activities. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has more than a 30 day supply of PPE including but not limited to masks, gowns, and hand sanitizer. Facility maintains a 30 day supply of medication. Fire extinguishers were last serviced August 2022. Smoke Detectors and Carbon Monoxide detector were tested and operational. Continued on LIC809C Continued from LIC809C LPA observed multiple exterior ramps that have started to show wear and tear and requested that all ramps are assessed for security to ensure resident safety and are replaced when needed. Caregiver and LPA discussed their Emergency Disaster Plan and Infection Control Plan. Licensee/Administrator to submit updates of the following documents by 11/28/2022: LIC 308 Designated Administrator (if applicable) LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (review and update if changes) Liability Insurance No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Oct 28, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with staff Gladys Flores. Facility has 6 residents with 1 on hospice present. Facility offers activities of music, trivia, jeopardy, and other activities. During facility tour on 9/2/2021 with staff Gladys Flores facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was last charged on 8/2021. Smoke Detectors & Carbon monoxide detectors were found to be operational during the visit. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Dangerous items were stored inaccessible to clients in locked cabinet in the garage There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Hot water temperature measure 109.2 in residents’ bathroom faucet within Title 22 acceptable regulations of 105 to 120 degrees F. Infection Control: Facility has submitted a mitigation program plan that has been approved. Posters have been placed at facility and entrance has a table with hand sanitizer and other items designated for visitors and staff before coming into work. Facility has PPE supply stored in the garage and entrance. Facility has not hired new staff and has admitted new residents since COVID-19. Residents’ medications are stored locked in the kitchen and dining room cabinets. Facility has a 30-day supply of medication for residents. Residents are not wearing masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit. Continued LIC809-C In addition, facility has a designated area for visitors which are being allowed. As per facilities visitors are only allowed outside through the entrance gate. Residents also have available Zoom and telephone calls when contacting with family members and others. Staff had all PPE training required on file and have obtained N-95 fit testing. In addition, LPA advised facility to contact local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Disaster Drills had been conducted quarterly last being done 7/2/2021. Facility understands that unvaccinated staff must be tested once a week if PCR and vaccinated staff doesn’t need to be tested at this time if staff is able to show proof of vaccination which copy of vaccination card must be kept on facility file for staff at this time according with PIN 21-32 & PIN 21-32.1-ASC: UPDATED FACILITY STAFF TESTING AND MASKING GUIDANCE FOR CORONAVIRUS DISEASE 2019 (COVID-19). In addition, LPA had a discussion with administrator regarding visitation guidelines per PIN 21-40-ASC: UPDATED STATEWIDE VISITATION WAIVER, AND TESTING AND VACCINATION VERIFICATION GUIDANCE FOR VISITORS RELATED TO CORONAVIRUS DISEASE 2019 (COVID-19). LPAs reviewed Licensing Information System (LIS) with staff who stated that is correct and updated at this time. There were no deficiencies cited at this time.the state’s words, verbatim · CDSS document, Sep 2, 2021

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.