Cascades of Grass Valley

Allegation investigated: Residents are not being showered timely Residents are left in soiled diapers/clothing Resident hygiene needs are not being met Resident rooms are not cleaned timely Staff do not re-order diapers and wipes timely for residents

LPA Parks arrived on Tuesday September 26, 2023, to conclude a complaint investigation regarding the above allegations. LPA met with Administrator Haley and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator, Wellness Director, Med techs, and caregivers. LPA reviewed staffing schedules for memory care and assisted living. Additionally, LPA reviewed LIC602s and care plans for R1, R2, and R3. The result of the investigation is as follows: Upon the initial complaint visit, LPA and Administrator toured the facility and visited all apartments which have residents who are provided incontinence care. This included 10 apartments on the assisted living side and 13 apartments in memory care. LPA noted that all apartments and bathrooms were clean and organized. Additionally, LPA observed residents to be clean, groomed, odor free. Unfounded LPA noted a slight odor in apartment which housed R1 and R2. While discussing this with the Administrator, LPA learned that a care conference was already scheduled to discuss increasing the care for R2. Staff interviews noted that R2 was resistant at times to care. LPA interviewed staff regarding the allegations of rooms not being cleaned timely. All interviews indicated that rooms were cleaned timely. All rooms were deep cleaned weekly and cleaned as needed by care staff. Interviews revealed that residents are showered according to their care plan. Staff stated that if residents refuse showers, they are asked again, or ask the following shift to attempt. Interviews stated that residents are toileted according to their care plan. Additionally, staff stated that resident are routinely toileted when incontinence care is provided. No staff interviews acknowledged that residents’ incontinence needs are not being met. Additionally, staff stated that resident’s hygiene needs are being met. LPA observed the facility’s supply closet which contains additional incontinence supplies should residents need any. Interviews acknowledged that staff could use the supply closet if the resident’s personal supply is out. Additionally, all interviews stated that at no time has the facility been without gloves for the staff. Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 26, 2023 · control 59-AS-20230908081246

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melissa Parks and Associate Governmental Program Analyst (AGPA) Katie Keith arrived on Tuesday August 22, 2023 to conduct the unannounced annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA and AGPA reviewed resident (8) and staff (8) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training. Facility is complaint with fire drills. Additionally, LPA reviewed elopement drills. LPA, AGPA, and Executive Director toured the facility together to ensure the health and safety of residents in care. The areas toured included memory care apartments, memory care common areas, memory care courtyard, assisted living apartments, assisted living courtyard, lobby, kitchen, and laundry rooms. LPA and AGPA observed the facility's emergency food, water storage and PPE. All water temperatures were within the required range. LPA and AGPA observed unlocked over the counter medication in a cabinet in the first floor hallway (pictures taken). See 809-D for citation. LPA requested an updated copy of LIC610E, LIC500, and current liability insurance by 8/31/2023. Exit interview conducted. Appeal rights were given. A copy of this report was emailed to the Administrator.the state’s words, verbatim · CDSS document, Aug 22, 2023

Type of visit: Case Management - Incident

LPA Parks arrived on Wednesday May 17, 2023 to conduct a case management visit. LPA met with Administrator Haley and explained the purpose of the visit. This is a follow up visit for an incident that occurred on 5/13/2023. On Saturday May 13, 2023, front desk employee heard R1 yelling for help from outside the facility. Facility nurse and staff quickly went outside and observed R1 outside the front doors, to the left of the front pillar. R1 was observed to be on the ground, with their electric wheelchair on top of them. R1 was yelling 'get this chair off of me'. R1 refused to go to the hospital, denied hitting their head, and denied being in pain. Facility staff assisted the resident and wheelchair to an upright position. Facility nurse noted no visible wounds and R1 was speaking clearly. Facility nurse notified resident's DPOA of the incident and their refusal to go to the hospital. Approximately 10 minutes later, Facility nurse then observed blood in R1's catheter bag and R1 was complaining of bilateral ankle pain. R1 agreed to go to the hospital for evaluation. Administrator was notified later in the day, while at the hospital, R1 became short of breath and was subsequently put on a ventilator. Due to R1's advanced directives, resident was taken off life support at the hospital and passed shortly after. During today's visit, LPA reviewed the LIC624 and death report regarding this incident. LPA reviewed R1's physicians report, care plan, motorized chair assessment, and mini mental exam. LPA interviewed the Administrator, Wellness Director, and facility staff regarding the incident. LPA needs to interview three additional staff who observed the incident, but were not scheduled to work today. LPA obtained employee and DPOA contact information for interviews. Additionally, LPA obtained a copy of R1's advanced directive paperwork. No deficiencies cited. Exit interview conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 17, 2023

Allegation investigated: Residents are not propperly supervised while in care

LPA Parks arrived on February 21, 2023 to conclude the investigation regarding the above allegation. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Throughout the course of the investigation, LPA interviewed staff including Administrator, Wellness Director, Assistant Wellness Director, med techs, caregivers, and agency staff. LPA reviewed Physicians’ Reports, care plans and progress notes for R1 and R2. Additionally, LPA reviewed staffing schedules for the months of October, November, and December. Based on interviews and review of documentation, there is sufficient staffing for the memory care unit. Those interviewed acknowledged that there is sufficient staff in order to meet the resident’s needs and provide observation. During the day shift there are two caregivers, one nurse, and activities assistant providing activities throughout the day. On the PM,there are two caregivers, Unsubstantiated and nurse until 8pm. On the overnight (NOC) shift, there is one caregiver and one med tech who floats between the memory care unit and the assisted living portion of the facility. At the time of the initial complaint, the census for the memory care unit was 15 residents. Based on information obtained during the investigation, LPA finds the allegation to be UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, Exit interview. Appeal rights were printed and given along with a copy of this report.the state’s words, verbatim · CDSS document, Feb 21, 2023 · control 25-AS-20221230145725

Type of visit: Case Management - Incident

LPA Parks arrived on Tuesday February 21, 2023 to conduct a case management visit. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. This is a follow up visit for an incident that occurred on 2/14/2023. As R1 was eating dinner, he began to choke. S1 performed the Heimlich maneuver. After the abdominal thrusts were unsuccessful, S2 began to perform CPR per the 911 operator's instructions. Approximately two minutes later, paramedics arrived and took over. R1 was transported to the hospital. R1 passed away on 2/15/2023. LPA interviewed S2 who was present during the incident. Additionally, R1’s spouse (R2) was interviewed. LPA obtained R1's physicians report, care plan, and copies of staff CPR/First aid certificates. LPA also obtained contact information for one staff and one visitor who assisted during the incident. No deficiencies were cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 21, 2023

Allegation investigated: Facility food storage is not properly sanitized.

LPA Parks arrived on Monday January 30, 2023 to conclude the investigation regarding the above allegation. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Throughout the course of the investigation, LPA interviewed staff including Administrator, Business Office Director, Food Service Director and kitchen staff. Additionally, LPA interviewed the Nevada County Evnironmental Health officer. LPA also toured the kitchen including walk-in refrigerator, walk-in freezer, and food storage room. LPA observed the following during the initail complaint visit: food and dirt under prep tables and stains on walls and ceilings in the kitchen (pictures taken). Kitchen staff interviewed could not provide LPA with a cleaning schedule. Additionally, the Administrator at the time of the complaint acknowledged that the kitchen's current state was unacceptable and that they would be hiring a company to deep clean. Substantiated Therefore, the allegation that facility food storage is not properly sanitized is SUBSTANTIATED. As a result of this investigation, LPA finds the allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited on 9099-D. Appeal rights were printed and given. Exit interview conducted. A copy of this report was left at the facility. Dietary Manager, she learned that this was the day the facility received their food order, and the boxes/food items are being put away. After the food is organized and stored in the appropriate area of the kitchen, no boxes are left on the floor. LPA interviewed dietary staff and care staff who all acknowledged that anyone serving food washes their hands prior to serving. Based on information obtained during the investigation, LPA finds the allegations to be UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 30, 2023 · control 25-AS-20221031095122

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 28, 2023

Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. . . this requirement was not met as evidenced by dirt, food, and stains on refrigerator, pantry, and kitchen floor. This poses an indirect threat to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jan 30, 2023

Plan of correction: Facility to provide LPA with a cleaning schedule by POC date 2/28/2023

Allegation investigated: Staff do not provide activities for residents in care

LPA Parks arrived on Tuesday November 29, 2022 to conduct a complaint investigation regarding the allegation that facility is not providing activies for residents. Prior to the visit, LPA completed the required COVID-19 testing protocols and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. LPA Parks learned that S1 voluntarily quit as Activity Director on October 28, 2022. The facility has a part time activities assistant who conducts activities on Sundays and Mondays. Additionally, care staff conducted activities for residents. On November 15, 2022, S2 (who previously worked on-call in the activities department) returned from travel and began fulfulling the Activities Director duties. Activities include: daily exercise, armchair travel, arts and crafts, bingo, tai chi, and wine and cheese. Staff interviewed stated that if an activities employee was not present, care staff or management would assist with activities. Additionally, S3 (who has been on leave) is returning as a full time activities assistant on December 5th. LPA obtained calendars which show daily activities and any holiday events. Unfounded While there was a gap in having a full time Activity Director, there was no evidence that activities were not being conducted. The facility immediately began to problem solve until a full time activities person was established (approximately two weeks). Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegation is found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. A copy of this report was left at the facilitythe state’s words, verbatim · CDSS document, Nov 29, 2022 · control 25-AS-20221031085945

Type of visit: Required - 1 Year

LPA Parks arrived on Monday August 8, 2022 to conduct the annual inspection. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. LPA was screened by LVN Haley Parker at the front desk of the facility. LPA and Administrator completed the infection control domain together and facility was found to be in substantial compliance at this time. LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to dining room, model apartments, cleaning closet(s), laundry room, PPE supply room, and the Lodge (memory care). In the areas toured, no immediate health, safety, or personal rights violations were observed. Facility has a supply of more than 30 days of full PPE. LPA requested updated copies of LIC500, LIC610 and current liability insurance. No deficiencies are being cited as a result of todays inspection. Exit interview conducted. LPA was unable to print a copy of this report at the facility. LPA will email copy of the report to the Administrator on 8/10/2022.the state’s words, verbatim · CDSS document, Aug 8, 2022

Type of visit: Required - 1 Year

LPA Lusby arrived on Monday August 30, 2021 to conduct the annual inspection. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. LPA was screened by staff at the front desk of the facility. LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, activity room, hallways, and the Lodge (memory care). In the areas toured, no immediate health, safety, or personal rights violations were observed. Facility has a supply of more than 30 days of full PPE. LPA and Administrator completed the infection control domain together and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of todays inspection. Exit interview conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 30, 2021