Lakeview Homes Mission Viejo

Type of visit: Case Management - Incident

On today’s date, Licensing Program Analyst (LPA) Sean Haddad conducted an unannounced visit for the purpose of delivering findings on the investigation of a self-reported incident report received in the Orange County Regional Office (OCRO) on 04/24/23. LPA was greeted and granted entry into the facility and met with Staff #1 (S1) Karen Zambrano and House Manager Sarah Levante. During course of the investigation, the Department interviewed staff and residents as well as reviewed and obtained pertinent documentation. Regarding the allegations of physical abuse and failure to seek timely medication / lack of care, the following was concluded: Resident #1 (R1) was admitted to the facility on 12/14/17. Per facility face sheet dated 07/18/22, R1 has diagnoses of Bipolar I Disorder with Psychotic Features and Mild Intellectual Disability. On 04/24/23, the OCRO received a self-reported incident report stating that on 04/18/23, at approximately 1300 hours, R1 called out from their room. Staff #1 (S1) and Staff #2 (S2) found R1 on the floor and assisted R1 from the floor. Staff assessment did not reveal any "apparent injury." R1 advised S1 they fell on the floor and complained about pain and was given Tylenol. The fall was not witnessed. House Manager (HM) Sarah Levante instructed S1 and S2 to observe R1 throughout the day. On the evening of 04/18/23, Staff #3 (S3) observed a bruise on R1’s right top shoulder but reported that R1 was not in any pain. R1 also reported to S3 and Staff #4 (S4), "I fell on the floor ... I don't want to get up ... I don't want to go to day program” and that S1 dragged and pulled them. This was reported to Administrator Peter Ventura who instructed S3 and S4 to observe R1 through the night and that he would assess R1 in the morning. The following afternoon, 04/19/23 at 1630 hours, Administrator Peter Ventura arrived at the facility, assessed R1, was told by R1 that they fell on the floor and rolled “on” the bed, but reported R1 was not aware of when the fall occurred or what they were doing prior to the fall. R1 was transported to Saddleback Family Urgent Care on 04/19/23, was seen at 1758 hours, and x-rays diagnosed R1 with a closed fracture of the right clavicle. The incident was self-reported within the 48-hour requirement. The interviews conducted consistently show that S1 has not used physical force with the resident even though the resident reported being pulled by staff. The facility staff that was present refute this information and stated that R1 was in another room alone when the incident occurred. Moreover, the resident has a history of lying and in subsequent interviews denied being assaulted by S1. There is not enough information to support the allegation of physical abuse. Based on the preponderance of evidence gathered through multiple interviews and documents obtained; the allegation “physical abuse” has not been met; Therefore, this allegation is deemed to be UNSUBSTANTIATED. However, it was determined that S1 uses their voice to redirect the residents. It was corroborated that S1 shouts at residents. When interviewed, S1 admitted to not calling 9-1-1 when they discovered that the resident had an unwitnessed unforeseen fall. S2 wanted to call 9-1-1 but, was prevented from doing so because S1 took the phone from them while speaking with their supervisor, HM. HM then instructed S2 to only observe the resident until the following day. HM admitted staff should have contacted emergency services. There is sufficient information to support the allegation of failing to seek timely medical attention. Based on the preponderance of evidence gathered through multiple interviews and documents obtained; the allegation “failure to seek timely medication / lack of care” has been met; Therefore, this allegation is deemed to be SUBSTANTIATED. The facility is being cited per Title 22, Division 6 of the California Code of Regulations. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted with House Manager Sarah Levante and a copy of this report, along with LIC809-D, Appeal Rights, LIC421IM, and the LIC 811, identifying confidential names were provided at exit.the state’s words, verbatim · CDSS document, Oct 30, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Oct 31, 2023

87465 Incidental Medical and Dental Care … (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health… This requirement was not met as evidenced by: Based on interviews and documents, on 4/18/2023 the facility did not call 9-1-1 immediately after R1’s fall and injury and only took R1 to urgent care the next day, which posed an immediate health risk to persons in care. CIVIL PENALITY ASSESSED.the state’s words, verbatim · CDSS document, Oct 30, 2023

Plan of correction: Licensee stated they will conduct training for staff on responding to resident injuries and calling 9-1-1 and will submit proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.2(a)(8) · Plan of correction due date: Oct 31, 2023

87468.2 … Personal Rights … (a) … (8) To be free from … intimidation, and verbal, mental … abuse. This requirement was not met as evidenced by: Based on interviews, the licensee did not ensure residents are not shouted at by staff, which poses an immediate personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 30, 2023

Plan of correction: Licensee stated they will conduct training for staff on proper interactions with residents and submit proof to LPA by POC due date.

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting a Required – 1 Year Inspection. LPA met with Staff #1 (S1) Karen Zambrano and discussed the purpose of the inspection. House Manager (HM) Sarah Levante arrived during the inspection. Administrator (AD) Peter Ventura appeared via telephone. LPA reviewed Infection Control requirements. At about 2:00PM, LPA and HM conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: Structure: this is a one-story home. Facility is a 4-bedroom, 3-bathroom, one-story house with an attached garage that is being used for storage. LPA observed 2 staff and 3 residents present at the facility. Resident Bedrooms: the 4 resident bedrooms are spacious and will easily accommodate the residents’ furnishings. Furniture for each resident bedroom inspected. Staff Bedrooms: there are no staff bedrooms. Bathrooms: the bathrooms were clean, faucets and toilets were operational. Water temperature: tested at 119.3 degrees F in the common client bathroom and 119.6 in the private client bathroom. LPA inspected all rooms in the facility. Linens & Hygiene Supplies: new linens and fully stocked linen closets were observed. Emergency Phone Numbers, Exit Plan & Menu: reviewed. Food Service: LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. Carbon Monoxide, Smoke Detectors, Fire Extinguisher: observed and tested, including the wired smoke detectors/carbon monoxide detectors. Appliances: stove burners, microwave, washer, and dryer inspected. Knives: observed locked in the kitchen. Toxins: observed locked in the kitchen and in the garage. Medication cabinet: observed to be locked. First-Aid Kit and Activity Supplies: observed and available. LPA discussed licensing fees with AD. At about 3:00PM, LPA reviewed 3 resident files and 2 staff files, interviewed 3 residents and 2 staff, and inspected medications for 3 residents. CONTINUED. During the inspection, LPA and HM observed the following: Per staff files, S1 and S2 did not complete the 40-hour initial or 20-hour annual training. The facility has 2 fire extinguishers, but neither was inspected in the last year. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Oct 30, 2023

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Health Checks

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of a health and safety check and to follow up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 04/24/23. LPA met with Staff #1 (S1) Beverlie Moya and Staff #2 (S2) Albert Yusikee and explained the purpose of the inspection. Administrator (AD) Peter Ventura appeared via telephone. During the inspection, LPA and S2 toured the facility. LPA observed there were 2 staff present. LPA observed 3 residents present. LPA conducted health and safety checks on the 3 residents present and confirmed they were doing well and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed the electricity and water were running, the medications were properly stored, and the facility had soap and paper towels. LPA requested and reviewed copies of the resident roster, staff roster, resident files, and staff files. Facility representative was advised that at this time further investigation is required. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Apr 27, 2023

Type of visit: Case Management - Incident

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on two incident reports received on 11/29/2022 regarding the presence of bruising on the arm and face of client C1, reported by both the facility and the client's day program Vocational Innovation. LPA was greeted and granted entry by caregiving staff after stating the purpose of the visit. The report transmitted on 11/29/2022 references a previous unreported fall incident that occurred on 11/24/2022. LPA reviewed client records for C1 at the facility, found and made copies of an incident report transmitted to the Regional Center of Orange County on 12/06/2022 indicating "On 11/24/2022 Per Staff Anne Plander Diane accidentally fell down in the backyard when she was trying to use the wheelchair. She was on a kneeling position when they saw her. Staff immediately assisted her to get up and ask her if she's okay and Diane asnwered 'I'm OK'. Body check was done no bruises was noted at that time. On 11/25/2022 at 6:45 am DSP Beverlie noted bruise on Diane's arm when body check was being done". No evidence of a submitted Special Incident Report (SIR) is found in the Regional Office SIR log. When asked about the bruise, caregiver Beverlie Moya describes it as about an inch wide on client's C1 left forearm. Client C1's Individual Program Plan dated 05/05/2022 makes a reference to yet another incident on 04/01/2022 stating: "On 4/1/22 at 10:00am Diane had an SIR. She was taken to UCI Emergency through 911 with the consent/request of sister/conservator Crista Smith. Diane has been restless/agitated/confused the past few days. According to sister, this can be historically indication of mania and Diane would need acute psychiatric support at at hospital. Diane was taken to UCI accompanied by her sister." No evidence of a submitted Special Incident Report (SIR) is found in the Regional Office SIR log. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA also reviewed resident's daily progress notes from 11/24/22 until 11/29/22. Bruising is noted but no clear explanation of how client received the bruise are present. LPA was able to observe client C1 relaxing in the facility's living room. Client appeared relaxed, clean and well taken care of. Client also observed smiling and discussing with caregiving staff. Caregiving staff present is adequately cleared and associated in Guardian. House manager Sarah Levante is currently stated to be away in the Philippines since approximately 12/08/2022. Administrator Peter Ventura is also unavailable and stated by caregiving staff to be returning on 12/14/2022. In the meantime, administrator duties are covered by Walter Abila. No documentation of the arrangement has been submitted to the Department at this time. Based on the documents reviewed and observations made during today's visit, one citation is being issued per Title 22 of the California Code of Regulations. A Technical Advisory note is also issued in regards to the provision made in the absence of the facility's designated administrator. An exit interview was conducted and a copy of this report along with appeal rights was provided to facility representative.the state’s words, verbatim · CDSS document, Dec 14, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80061(b) · Plan of correction due date: Jan 14, 2023

The California Code of Regulations Section 80061 on Reporting Requirements states that "Upon the occurrence (...) of any of the events specified (....) below, a report shall be made to the licensing agency. Events reported shall include the following: Any injury to any client which requires medical treatment. Any unusual incident or client absence which threatens the physical or emotional health or safety of any client." This requirement is not met as evidenced by unreported incidents on 04/01/22 and 11/24/22. This failure to report poses a potential risk to the health and safety of the persons in charge.the state’s words, verbatim · CDSS document, Dec 14, 2022

Plan of correction: Licensee and administrator will review the cited regulations and ensure that an adequate reporting process is in place for any future incidents.

Type of visit: Required - 1 Year

On 09/06/2022 at 11:15am, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection focusing on Infection Control procedures. LPA was greeted and granted entry by caregiving staff and explained the purpose of the visit. House Manager Sarah Fresco was notified by telephone and arrived later to assist with the visit. Administrator Peter Ventura was also notified of the ongoing visit. At approximately 11:35am, LPA accompanied by caregiver toured the physical plant of the facility. There are currently four (4) residents in care, none of which are receiving hospice care. One resident's bed is observed to be equipped with half rails. LPA requested the required physician order for postural supports which was provided by the facility during the visit. Residents are observed relaxing in the common areas or in their respective bedrooms and appear clean and well taken care of. The bedrooms include all necessary components. Bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. Sharp instruments and cleaning supplies are stored under the sink in a cabinet secured by a magnetic lock. The centrally stored medication is located in the kitchen in a magnetically locked cabinet. A laundry area along with detergent are observed in the locked attached garage. LPA observed a sufficient supply of food and water present. LPA observed the facility has COVID-19 Precautions posters and all required department postings. Staff present is adequately cleared and associated in Guardian. The fire extinguisher present is mounted and charged. Service dates are up-to-date. The posted administrator certificate is shown to be out-of-date, however facility manager was able to provide documentation of the required coursework and valid certification during the visit. LPA provides consultation on the necessity to replace the posted document with a valid copy. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 LPA and caregivertoured the outside of the facility and observed it to be free of obstructions. Outdoor furniture and a shaded area are present for the enjoyment of residents and visitors. The perimeter gates on both sides of the facility are self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report was provided and left at facility.the state’s words, verbatim · CDSS document, Sep 6, 2022

Type of visit: Case Management - COVID-19

Licensing Program Analysts (LPA) Norman Woodridge conducted an unannounced visit to the facility to conduct a case management visit and to review Coronavirus 2019 (COVID-19) mitigation plan. LPA stated the purpose of the visit, was granted entry by staff 1 (S1), and went through screening procedure upon entering the building. LPA conducted a tour of the inside and outside of the facility. No deficiencies were noted. LPA spoke to Staff 2 (S2). LPA discussed Provider Information Notice 21-38-ASC: Update Guidance for the Use of Masks, Surgical Masks, Respirators Related to Coronavirus Disease 2019 (COVID-19). LPA discussed Covid-19 Mitigation Plan with S2 and requested a copy of the completed LIC 808 form. A copy of PIN 21-38-ASC was given to S2. No deficiencies were noted and citations were not issued. LPA Norman Woodridge conducted an exit interview with S2 and provided her with a copy of this report.the state’s words, verbatim · CDSS document, Sep 23, 2021