Huntington Elder-Care I

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by care staff after explaining the purpose of the visit. LPA observed Administrator (AD) Carmen Achim’s certificate was current with an expiration date of December 01, 2027. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents and an approved hospice waiver for three. The facility is a one-story home with six resident bedrooms, one staff bedroom, seven restrooms, a living room, family room, dining room, kitchen and two car garage. During the inspection, LPA and staff conducted a tour of the inside and outside of the facility, common areas, resident rooms, garage and observed the following: LPA observed five residents in care and two staff present. LPA observed the See Something Say Something Poster (PUB 475) mounted on the wall in the living room. LPA observed that all resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored a hallway closet. LPA observed bathrooms were clean and equipped with grab bars and non-skid floor mats. Bathrooms were observed to be free of debris and mildew. Faucets and toilets were operational. Water temperature tested between 105.8 and 113.3 degrees Fahrenheit. LPA observed all windows were appropriately screened. LPA toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use. Continued on LIC 809C LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Gas stove, dish washer, microwave, washer and dryer were inspected and observed to be operable. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service date of March 27, 2026 and located by the exit to the back patio. Toxic chemicals, cleaning solutions, and disinfectants were observed to be locked and inaccessible to residents under the kitchen sink. Medication cabinet was observed to be locked and centrally stored in a hallway cabinet. LPA observed the First Aid Kit had all the required components. Per interview, disaster drills have not been conducted for the last quarter. Disaster drills were not present at the facility to be reviewed. LPA began review of the records. LPA reviewed five resident records. All the required documentation was present and current in the residents files reviewed. LPA reviewed two employee records. LPA observed Staff 1 (S1) did not have a health screening on file. LPA observed records reviewed have a current First Aid certificate. Based on the observations made during today’s inspection, 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, LIC 809C, LIC 809D, LIC 858, LIC 859, LIC 9102, Appeal Rights and the Legionnaire’s Disease fact sheet was left at the facility.the state’s words, verbatim · CDSS document, Apr 16, 2026

Type of visit: POC

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 03/06/2025. LPA was greeted and granted entry into the facility and explained the reason for the visit. Administrator Carmen Achim arrived during the visit. Deficiency cited under Title 22 Regulation 87309(a) pertaining to Storage Space has been cleared. During the visit, LPA observed sharps are secured. Licensee has complied with the POC. Deficiency cited under Title 22 Regulation 87411(f) pertaining to Personnel Requirements has been cleared. Licensee provided proof of TB test. Licensee has complied with the POC. Deficiency cited under Title 22 Regulation 87412(c) pertaining to Personnel Records has been cleared. Licensee provided proof of training in the staff file. Licensee has complied with the POC. LPA observed items on the advisory note given 03/06/2025 have been addressed. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 2, 2025

Allegation investigated: Facility lacked care and supervision resulting in resident sustaining a fracture Staff failed to provide residents medical information to paramedics Staff did not inform authorized representative of incident in a timely manner.

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced visit on this day for the purpose of delivering findings into the above allegations. On this day LPA was greeted and met with Administrator Carmen Achim and explained the reason for the visit. On August 24, 2022, the Department received a complaint alleging facility lacked care and supervision resulting in resident sustaining a fracture; staff failed to provide residents medical information to paramedics; and staff did not inform authorized representative of incident in a timely manner. A health and safety visit was conducted by the Department on August 25, 2022, and an investigation initiated. The investigation determined as follows: Per Physician Report dated December 01, 2020, Resident 1 (R1) is non-ambulatory and unable to transfer themselves in and out of bed. R1’s Preplacement Appraisal dated November 06, 2020, notes R1 as having an acute and chronic respiratory failure with hypoxia, has difficulty walking, osteoarthritis, low back pain, and obesity. R1 is also noted as having dementia. CONT ON LIC 9099C DATED 03/06/2025 Unsubstantiated Identification and Emergency Information Form dated December 03, 2020 documents R1 as requiring the use of a walker or wheelchair to ambulate. It also documents R1’s daughter-in-law. On December 17, 2022, R1 was found laying on their bedroom floor by Caregiver 1 (C1) after responding to a noise coming from R1’s bedroom. R1 reported they were trying to reach for a mirror in the night stand when their knee gave out, causing them to fall. C1 called Administrator Carmen Achim who is reported to live five minutes away. Upon arrival and finding R1 in pain, 9-1-1 was contacted. R1 was admitted to Hoag Hospital Newport Beach where they were admitted with a diagnosed fracture of right pubis and displaced fracture of anterior column (iliopubic) of right acetabulum. R1 was assessed by hospital staff to require a skilled nursing facility. Per Huntington Beach Fire Department 911 response records and documentation, response to R1’s fall occurred on December 17, 2022 at 6:42 PM at Huntington Elder Care home facility. Huntington Beach Fire Department scanned into records the documentation provided to them by Huntington Elder Care home which included R1’s insurance cards, medication lists and dosages, and R1’s identification and emergency information form. Per interview with facility staff, three of five staff interviewed denied any neglect occurred. The two remaining staff reported they were not present when the fall occurred. Interviews with three of three staff present during the time of the incident reported there was confusion over who was going to notify R1’s responsible party of the fall, which caused a delay in notification; However, once realized, R1’s responsible party was informed of R1’s hospitalization within 24 hours of fall occurring. Medical records obtained from hospital notate that R1’s family was contacted by the hospital social worker and no concerns of neglect were expressed. Documentation obtained from Administrator Achim included emails and text messages from R1’s responsible party in which they acknowledge an understanding that R1 is a fall risk and know they will have falls. It was further expressed that they felt “Your caregivers have been great…” Based on interviews conducted and records reviewed, the allegations that facility lacked care and supervision resulting in resident sustaining a fracture; staff failed to provide residents medical information to paramedics; and staff did not inform authorized representative of incident in a timely manner are deemed to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report and confidential names list was provided to Administrator.the state’s words, verbatim · CDSS document, Mar 6, 2025 · control 22-AS-20220824143608

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced visit to Huntington Beach Elder-1. The purpose of today’s visit was to conduct the Annual Required inspection. LPA was allowed entry into the facility and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 3 residents and the home currently has 6 residents with 2 on hospice. Administrator Carmen Achim arrived during the visit. LPA Lyman along with Caregiver San Juan toured the facility at 12:22 PM. LPA toured the physical plant, checked food service, first aid kit and reviewed records. The home consists of six resident bedrooms, one common restroom, six resident restrooms, living room, dining room, staff room and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. LPA observed one resident with half rails and one resident with full rails. Resident rooms are single occupancy. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and shower was free of mold/mildew. At 12:30 PM, LPA observed unsecured scissors in the medication area. Water temperature measured between 112.6 and 113.3 degrees F in all facility restrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the elements including thermometer, tweezers and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. At 12:40 PM, LPA observed unsecured knives and scissors in an unlocked cabinet. Kitchen appliances are operational during today's visit. Carbon monoxide detector tested operational during today's visit. Fire extinguisher is fully charged. LPA toured the outside grounds and there is ample shaded seating for residents. Exit gate is unlocked and operational. LPA observed ample emergency food. LPA reviewed the emergency disaster plan and plan is thorough and complete. Facility provides activities in the form of exercise, and games. CONTINUED ON LIC 809C DATED 03/06/2025. LPA reviewed five resident files and two staff files. Resident files contained required documents including admission agreements, physician reports and resident appraisals. Staff files reviewed contained criminal record clearance and first aid/ TB. Staff files did not contain proof of required training. LPA reviewed medication storage and administration. Medications are stored in a locked cabinet. Medications are being administered per physician order. Licensee to forward an updated LIC 500 to LPA by 03/20/2025. Based on the observations made during today’s visit,deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Mar 6, 2025

Type of visit: Required - 1 Year

On 8/14/2024, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility for a required annual inspection. LPA met with Administrator, Carmen Achim who was informed of the purpose of LPA's visit. The facility has a fire clearance for six (6) non-ambulatory elderly residents. The facility also has an approved hospice waiver for three (3) and LPA was informed three (3) residents are currently receiving hospice services at the facility. During today's visit, LPA observed Staff 1 (S1), Staff 2 (S2), and five (5) residents present. LPA toured the facility with Administrator Achim and observed the facility is made up of a one-story home with six (6) resident bedrooms, six (6) resident bathrooms, a staff room, kitchen, dining room, living room and attached garage. During the tour, Administrator Achim tested one (1) of the smoke alarms/carbon monoxide detectors and LPA observed it to be operational. LPA also observed a charged fire extinguisher mounted in the hallway leading to the facility's backyard. Indoor and outdoor passageways were free of obstruction. The facility has outdoor shaded seating for the residents in care. There were no bodies of water observed on the premises. Medications are secured in a locked cabinet near the visitor's restroom. Resident bedrooms had the required furniture and lighting. Bathrooms had grab bars near the toilet and in the showers. LPA observed a hallway closet filled with clean linens and towels. The facility had a 2-day supply of perishable foods and 7-day supply of non-perishable food items. Resident files reviewed had signed admission agreements and physician reports. Long Term Care Ombudsman and complaint information are posted near the front entrance. LPA attempted to review the personnel records for the S1 and S2 present. Administrator Achim reported the facility does not have personnel records for S1 and S2. Administrator Achim added S1 and S2 had their personnel records in their car and recently had a car accident and no longer have their records. Additionally, interviews and a record review, revealed S1 present has not submitted to a criminal record clearance or obtained an exemption to work in the facility. Administrator Achim added they did not double check to verify S1 possessed a criminal record clearance or exemption prior to working in the facility. S1 was interviewed and reported they have been working in the facility for one (1) week. During today's visit, LPA issued a deficiency for the lack of personnel records and assessed a civil penalty for S1's lack of criminal record clearance or exemption. An exit interview was conducted where this report was reviewed and provided to Administrator Achim along with a LIC 809-D, LIC421BG, Confidential Names List (LIC 811), and Appeal Rights.the state’s words, verbatim · CDSS document, Aug 14, 2024