Visionary Carmel-By-The-Sea Assisted Living

Type of visit: Required - 1 Year

On 7/6/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced at the facility to conduct a Required Annual Inspection. LPA met with Administrator Angelique Robinson. Administrator certificate was current. There were 2 residents on hospice at the time of the inspection. LPA toured the facility inside and outside. Pathways and doors were clear and free from obstruction. Smoke-detectors and carbon-monoxide detectors were present and operational. Facility was clean and odor free. LPA observed sufficient amount of perishable and non-perishable foodstuffs. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, odor free, and water temperature was within required temperature range. Sharp items were secured in a locked drawer in the garage. A locked cabinet was observed to store resident medications, and medications appeared to be administered properly. Outdoor areas were free from hazards and there was adequate seating for residents. LPA reviewed facility plan of operations and emergency disaster plan. LPA reviewed a sample of resident files. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan, and a copy of current Administrator’s Certificate to update the facility file. No deficiencies were cited during the inspection, exit interview conducted with Licensee, a copy of the report was provided.the state’s words, verbatim · CDSS document, Jul 6, 2023

Allegation investigated: Resident sustained multiple bruising while in care Facility staff did not seek medical treatment for resident in care Staff are not ensuring residents getting their daily nutrition Unusual Incident reports are not documented Staff not helping residents with incontinence needs Staff made inappropriate comments to residents

Licensing Program Analyst (LPA) Marybeth Donovan arrived unannounced to deliver the complaint investigation findings related to the above allegations. LPA met with Angelique Robinson Administrator and explained the purpose of the visit. Resident sustained multiple bruising while in care: Family member noticed resident R1 had bruises on R1’s legs that R1 may have got from accidentally hitting something. Family member said R1 did not have any concerning marks on R1 when R1 lived at the facility. On 10/27/2020 staff member told family member that R1 had an open sore on R1’s buttocks area. Family member had not been previously notified by staff about the sore. Administrator was not aware of R1 having bruise on R1’s left hip or fingerprint marks on R1’s right and left knee and four red bruises on R1’s upper mid thighs as stated in the complaint. Page 1 of 4 Unsubstantiated 6 of 7 staff never observed any bruises on R1. 1 Staff (S1) noted in an incident report dated 10/12/2020 that R1 had a bruise on R1’s upper left thigh, and R1 was complaining that it hurt. The report stated that S1 worked the previous night and S1 did not notice the bruise and R1 was not hurting. On 10/29/2020 R1 met with medical doctor and had an x-ray of R1’s pelvis. The findings indicated no fractures. Facility staff did not seek medical treatment for resident in care: Administrator said resident R2 has had a sore near R2's left ear prior to being placed at the facility. Sometime in mid to late September, caregiver notified Administrator that the sore near R2’s left ear was slightly bigger and red. Administrator scheduled an appointment with medical doctor on 9/15/2020 to have R2’s ear checked. Administrator said the sore on R2’s ear was due to skin cancer. Primary care physician was first notified by facility staff member about R2’s ear wound during visit on 9/15/2020. Primary care physician had prior visits with R2 in August and September and did not previously notice the wound. R2’s family member (F2) first noticed the wound 2-3 weeks prior to 12/8/2020. F2 believed, R2 got the wound from picking at R2’s face. Staff are not ensuring residents getting their daily nutrition: Administrator and 7 staff were interviewed and stated that staff always provide meals, fluids and encourage residents to eat and drink fluids. Care Logs reviewed for August -October 2020 note staff monitoring residents’ food and water intake. S1 stated that meals are prepared fresh. Meals include fresh fruit, proteins, and vegetables. Groceries are purchased monthly and fresh produce weekly or as needed. S5 stated that R1 sometimes did not want to eat. At times staff would assist R1 but R1 could eat on their own if they chose to. 3 of 6 residents stated that there are getting enough food and liquids. 3 of 6 resident were not able to respond to interview questions. Menus reviewed for 10/2020 and noted a selection of fruits, proteins and vegetables were included. Other menu options are provided. Staff try to prepare food items preferred by each resident. On 10/27/2020 LPA observed 6 Residents were having lunch in the dining room. A variety of foods to include hot dogs wrapped in a crescent roll (Pigs in the Blanket), fries, watermelon and peanut butter brownie with whipped cream. Page 2 of 4 Unusual Incident reports are not documented Administrator denies not reporting incidents. Administrator stated that each incident is reviewed to determine if an incident report needs to be completed. A resident will be checked for signs of injury and pain. An incident that occurred in mid-September involving R1 was not written as R1 was not observed by staff to have any skin tears or bruising. S1 stated that staff note incidents, complete reports and forward to the Administrator for review. S2 notes incidents in the care logs and reports those to the Administrator but does not generate formal reports. S3 stated the administrator is responsible for all reporting. Records review of Care Logs and Incident Reports were reviewed for the period of 8/1/2020 through 10/31/2020. Resident monitoring for change in condition and incidents were recorded in the care logs. Incident Reports involving injury or complaint of pain were generated and submitted to the Department. Staff not helping residents with incontinence needs Administrator denies residents incontinent needs are not being met. Administrator stated that staff are continually checking on residents to see if they need assistance with toileting or incontinence needs. The overnight staff do rooms checks every two hours. The room checks are not logged. 4 of 4 staff deny residents toileting or incontinent needs are not met. S1 stated that staff check on the residents frequently during the am, before and after meals. S3 stated that staff are aware of those residents that need additional monitoring and more frequent checks. 3 of 6 residents do not have issues with care provided. Records review of Care Log for the period of 8/1/2020 through 10/31/2020 notes instances were room checks were completed to document additional monitoring of residents. Staff made inappropriate comments to residents Administrator and 4 staff were not aware or did not have direct knowledge of staff making inappropriate comments were made to residents. 3 of 3 residents did not have any concerns regarding care or staff. Review of facility records, Incident reports and Care Logs, resident files did not note any incidents of inappropriate comments by staff to residents. Page 3 of 4 The Department has investigation the above complaint allegations. Based on information from interviews conducted and records reviewed, although the allegations listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No Deficiencies cited under California Code of Regulations Title 22 Report reviewed with Angelique Robinson Administrator and a copy of this report provided. Page 4 of 4 The Department investigation the above complain allegation. Based on interviews and records review, there is preponderance of evidence to prove the alleged violations did occur, therefore the allegation is SUBSTANTIATED. See 9099-D for deficiencies cited per the California Code of Regulations, Title 22. Immediate Civil Penalty being assessed in the amount of $500.00. Report reviewed with Angelique Robinson Administrator and a copy of this report and appeal rights provided. Page 2 of 2the state’s words, verbatim · CDSS document, May 27, 2022 · control 26-AS-20201022154232

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: May 28, 2022

87468.1 Personal Rights of Residents in All Facilities a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interviews and records review R1 fell at the facility, no immediate medical treatment sought. R1 sustained a rib fracture confirmed by medical report dated 9/15/2022 which poses an immediate risk to Health and Safety of resident in care.the state’s words, verbatim · CDSS document, May 27, 2022

Plan of correction: Administrator to review the above Regulation regarding safe and healthful environment and submit a letter of understanding and conduct in-service training on 911 Protocols, When to Seek Medical Attention and Fall Prevention. Submit proof of completion to include date completed, participants and topic(s) discussed and submit plan to complete by POA date. I Immediate Civil Penalty being assessed in the amount of $500.00 for serious injury sustained by R1 resident in care.

The state marks this report as 9 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analyst arrived unannounced on another matter. LPA met with Angelique Robinson Administrator and explained the purpose of the visit. During the Department’s complaint investigation, it was determined staff member (S1) was not fingerprint cleared to work in the facility in September 2020. This was confirmed by interviews conducted and Licensing Information Systems records which noted S1 was not fingerprint cleared. Administrator stated that the facility and S1 tried to resolve fingerprint clearance issue but were unable to do so. S1 was removed from the facility staff schedule. Based on interviews and records review, there is preponderance of evidence to prove the alleged violations did occur, therefore the allegation is SUBSTANTIATED. See 9099-D for deficiency cited per the California Code of Regulations, Title 22. The Department is assessing an immediate CIVIL Penalty in the amount of $500.00.the state’s words, verbatim · CDSS document, May 27, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355 · Plan of correction due date: May 30, 2022

87355 Criminal Record Clearance dividuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department ... This requirement was not met as evidenced by: Based on interviews and records review S1 was not finger print cleared to working in the facilty which poses an immediate risk to Health and Safety of resident in care.the state’s words, verbatim · CDSS document, May 27, 2022

Plan of correction: Administrator removed S1 from the staff schedule and no longer works at the facility. Licensee with review the Regulation and on Criminal Record Clearance and submit a statement of understanding and review all current employees and new employee applicants are fingerprint cleared by the POC date. Immediate Civil Penantly being assessed in the amount of $500.00.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marybeth Donovan conducted an unannounced Required - 1 Year Annual Inspection to include Infection Control site visit and met with Alicia Salazar Administrator. LPA toured the facility inside and out to include the entry, bedrooms and bathrooms, kitchen, dining room, living room, laundry room and exterior. All fire exit routes were free and clear of obstructions. Medications are stored in a locked medication cabinet next to the kitchen. Toxins, cleaning supplies, knives and sharp objects are secured. Facility observed to have designated entry point for COVID 19 symptom screening with questionnaire. Bathrooms observed to be supplied with hygiene products. Hand washing signs were posted in bathrooms. Hand sanitizer available to residents and visitors. LPA observed to have adequate supply of Personal Protective Equipment (PPE). LPA reviewed the facility policies and procedures to include screening, isolation, disinfecting, staffing, training, supplies, PPE usage and social distancing. No citations were issued per the California Code of Regulations, Title 22. LPA reviewed report with Alicia Salazar Administrator and a copy provided.the state’s words, verbatim · CDSS document, Jul 12, 2021