D'Best Care

Allegation investigated: Facility is clutter and unsanitary

Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced initial 10-Day complaint visit to initiate the investigation into the above allegation and to deliver the findings of the investigation. LPA was greeted and granted entry into the facility and initially met with Caregiver Lucille Nofies and LPA explained the reason for the visit. Administrator (AD) Ma Dinah Dela Cruz arrived shortly after. On today’s visit LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Two of six individuals interviewed corroborated the allegation.Two of six individuals interviewed denied the allegation and the remaining two individuals could not be qualified to answer questions. In the kitcken refrigerator LPA observed food particles and brown and red discoloration on the inside base of the container contaning produce. At 9:11 AM LPA observed brown and red discoloration on the interior base of the refrigerator and the floor right in front of the refrigerator. CONTINUED ON LIC9099-C... Substantiated During the investigation LPA reviewed documents including the Licensing Information System (LIS) Facility Personnel Report Summary dated 07/12/23. Per LIS Facility Personnel Report Summary S1 is not associated and/or cleared to work at the facility. Based on LPA observations and the interviews which were conducted, the preponderance of evidence standard has been met, therefore the following allegation: Female non-staff is sleeping in common area (living room couch) is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D A $500 Civil Penalty was issued. AD agreed to email the Physician Report (LIC602) and Admission Agreement for three residents in care by 07/17/23. An exit interview was conducted with AD Dela Cruz and a copy of this report along with the Appeal Rights were provided at the time of this visit. In the kitchen LPA observed that the countertop tile is missing grout and therefore is growing mold. At 9:18 AM LPA tour the back yard and observed a ladder, boxes full of clothes, a bicycle, a treadmill, and plastic bin containers stack on top of each other. On the side of the house leading to the exit gate LPA observed empty cardboard boxes stack on top of each other, a ladder, a rug, a portable propane tank, paint containers on top of each other and plastic bags fill with litter. Based on LPA observations and the interviews which were conducted, the preponderance of evidence standard has been met, therefore the following allegation: facility is clutter and unsanitary is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D An immediately $250 Civil Penalty was issued today for a repeat violation cited on 08/25/22. An exit interview was conducted with AD Dela Cruz and a copy of this report along with the Appeal Rights were provided at the time of this visit.the state’s words, verbatim · CDSS document, Jul 14, 2023 · control 22-AS-20230707101059

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jul 14, 2023

87355 Criminal Record Clearance (e) All individuals 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 is not met as evidence by: Based on interviews and AD admission S1 began working at the facility prior to being Associated/Eligible to work at the facility.the state’s words, verbatim · CDSS document, Jul 14, 2023

Plan of correction: Licensee to verify staff is associated and/or cleared on Guardian prior to their first day working at the facility. LPA observed that S1 is no longer working at the facility.

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

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: LPA observed food particles and brown and red discoloration on the inside base of the refrigerator container contaning produce. LPA also observed clutter on the back yard and on the side of the house leading to the exit gate. LPA observed that the kitchen countertop tile is growing mold.the state’s words, verbatim · CDSS document, Jul 14, 2023

Plan of correction: Licensee to sanitize and clean the kitchen refrigerator and countertop tile. Licensee to declutter the back yard and side leading to the exit gate. Licensee to email LPA proof by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Claudia Gutierrez made an unannounced visit for the purpose of conducting a Required/Annual Inspection. LPA was greeted by staff Lucille Nofies and granted entry into the facility. LPA Gutierrez discussed the purpose of the inspection. A single resident was eating at the dining table, LPA observed and took picture of medication on dining table that was left unattended. LPA asked the resident if the medication was theirs, resident stated “oh, no. I’ve already had mine”; a Deficiency was cited on today’s date. Administrator (AD) Maria Semcheshen arrived at 10:40 a.m. During the inspection LPA Gutierrez and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: This is a single-story house with five bedrooms, and two bathrooms, with two bedrooms being occupied by staff. During the inspection LPA observed one staff and four residents in care. Residents were observed resting in their respective rooms and in the common area. A 2-day supply of perishable and a 7-day supply of non-perishable food was observed during today’s visit. Upon record review LPA noted emergency care requirements were met. LPA observed the facility does not have a 30-day supply of PPE on hand; a Technical Advisory was given on this date. Under the patio in the back of the house LPA observed storage bins stacked to the ceiling, different bags and boxes also stacked on top of one another, and a washer with tape on the front of the door and a piece of tubing inside. On the side of the home an empty television box, a toilet, a table with dust laying on its side, empty water bottles, a 5-gallon industrial bucket, and different pieces of cardboard were all observed; a Deficiency was cited on today’s date. LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, infection control training, PPE, staffing and staffing shortages. Based on the observations made during today’s inspection, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 25, 2022

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: * Resident developed multiple stage 4 pressure injuries while in care

Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced complaint visit to deliver findings on the above allegation. LPA identified herself and discussed the purpose of the visit with Administrator Ma Dinah Dela Cruz. The complaint was investigated by Community Care Licensing Investigations Branch (IB). During the investigation, interviews were conducted with facility Administrator, staff and witnesses. Additionally, copies of Green Meadows Health Care medical records (certification period: 01/01/2021 – 03/01/2021) for Resident 1 (R1) and UCI Irvine Health medical records dated 02/06/2021, were obtained and reviewed. The investigation revealed the following: R1 is an 83-year-old diagnosed with Dementia, residing at the facility since 12/30/2020. R1 was receiving home care services from Green Meadows Home Health for physical therapy after having surgery on the right knee. Substantiated On or about 01/20/2021, R1 began to develop small ulcers on coccyx due to lack of mobility. A Home Health Licensed Vocational Nurse (LVN) was assigned to continue providing services and also began treating the pressure ulcers. Administrator stated that rotating R1 side to side, R1 began developing skin tears on both sides of the hips. On 01/19/2021, Administrator stated she requested from Home Health a wound specialist to see R1. On 01/26/2021 Home Health LVN told Administrator she believed R1’s wound was improving, and no wound specialist was recommended. Home Health LVN requested an air mattress for R1 and continued treating the ulcers and reporting to the physician. On or about 01/29/2021, R1 developed additional small ulcers across the lower extremities across left hip to right hip and the ulcer on coccyx had developed into a stage two. Home Health LVN along with facility caregivers attempted to treat the ulcers by continuing to rotate R1. On 02/04/2021, Home Health LVN requested that R1 be evaluated by Green Meadows Home Health Nurse Practitioner (NP) and another Home Health LVN. It was determined by the NP that R1’s pressure ulcer on coccyx had worsened but was going to wait for a wound specialist on 02/05/2021 to evaluate and treat the ulcers. On 02/06/2021, facility Administrator sent R1 to the hospital because no wound specialist had come out and Home Health LVN said R1’s ulcer developed to a stage four and had worsened. The facility requested numerous times to have R1 be seen by a wound specialist or a physician. They documented daily R1’s status and services they provided. The facility did not call 911 when staff observed R1’s change in condition and their inability to lift or move R1. In addition, Administrator stated facility was short staffed due to COVID-19 and aware R1 required two-person transfer. R1’s assessment was done via phone. Facility was aware of R1’s health condition (heart failure, hypertension, sensitive due to skin cancer, history of bed sores, no mobility due to knee surgery, cellulitis of right and left limbs, muscle weakness) per Appraisal/Needs and Services Plan dated 01/01/2021. Green Meadows Home Care prolonged the request of a wound specialist which never came and requested an air mattress which never came. The facility made the decision to send out R1 to UCI Health Care Hospital on 02/06/2021 because his ulcers worsened to a stage four rather than continue home care services. The facility is responsible overall for the condition and well being of the resident and should have provided timely medical attention sooner regardless of R1 receiving Home Care services. Both facility and Green Meadows Home Care failed to provide timely medical attention subjecting R1 to immediate decline in health and unnecessary pain and suffering. Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22, Division 6), is being cited on the attached LIC 9099-D. A Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49 An exit interview was conducted with Administrator and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) and LIC811.the state’s words, verbatim · CDSS document, Jul 27, 2021 · control 22-AS-20210212112450

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(6) · Plan of correction due date: Jul 29, 2021

Basic Services…(f) Basic services shall at a minimum include: (6) Arrangements to meet health needs, including arranging transportation, as specified in Section 87465, Incidental Medical and Dental Care Services. This requirement was not met as evidenced by: Based on interviews conducted and record reviews, R1 developed stage IV pressure injury under facility’s care. Facility did not provide timely medical attention to R1. This poses an immediate risk to the health & safety of the resident in care.the state’s words, verbatim · CDSS document, Jul 27, 2021

Plan of correction: Administrator states will conduct in-service training on section cited. Will provide proof of training to CCL by 08/06/2021.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced visit for the purpose of conducting a Required 1 Year inspection. LPA was greeted and granted entry by Administrator Mary Joyce Nora and reason for the visit was explained. Upon entry LPA was screen per COVID guidelines. LPA began the tour of the facility. The facility currently has 2 residents in care. LPA observed the residents relaxing. Residents appeared happy and well taken care of. Facility appears clean and sanitary. Staff screens all visitors to the facility and LPA observed the screening station in the entrance of the facility. Facility keeps documentation in regard to COVID for all the visitors, staff, and resident. LPA observed hand washing guidelines posted in all bathrooms of facility. LPA observed facility has COVID precautionary posting throughout the facility as well as all required Department postings. Facility has an active COVID-19 prevention plan in place for the safety of residents in care. LPA observed ample of emergency food and water as well as First Aid kit in the facility. Facility has an ample supply of PPE, incontinence, and cleaning supplies. Facility has sanitation precaution in place. LPA observed caregivers cleaning and sanitizing facility. LPA toured the outside and observed a shaded outside space for residents that can be used for outdoor visitation. Facility has a plan for COVID testing residents and staff as needed as well as a plan for isolation as needed. Facility has 6 bedrooms, 3 for residents and 2 staff bedroom. Mitigation Plan was submitted and has been approved. Based on the observations made during today’s visit, no deficiencies were noted per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator and a copy of this report was provided and left at facility.the state’s words, verbatim · CDSS document, Jul 27, 2021

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.