Lois Guest Home II

Allegation investigated: Resident was inappropriately touched while in care

Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility to deliver findings for the complaint received on January 30, 2023. LPA arrived at the facility, explained the purpose of today’s visit and was granted entry by staff on duty who contacted facility administrator (AD) Louie Dormido. AD Dormido was unable to be present during the time of visit, but provided consent for staff on duty (S1) Esther Forsyth to receive and sign report. The complaint was investigated by the Department. Findings are based upon this investigation which included record reviews and interviews. It is alleged that a resident was inappropriately touched while in care. The investigation revealed that the resident reported being touched by a female caregiver around the private area during a shower, however, the caregiver denies the allegation, and stated that the resident can wash own body. Unsubstantiated The resident was then interviewed a second time, and reported that the caregiver was a male, and only the inner thigh was touched. Per resident’s physician reports dated September 18, 2022, revealed that the resident is not diagnosed for dementia but with behaviors of being confused and forgetful. Based on the information gathered during the investigation, review of documents obtained, and due to the conflicting information obtained, the Department unable to ascertain if the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED. No citation is issued. An exit interview was conducted with S1 and AD via phone call. A copy of this report was explained and provided during the visit.the state’s words, verbatim · CDSS document, Jun 14, 2023 · control 22-AS-20230130101538

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to conduct a case management: health and safety check in this facility. LPA De Perio met with licensee (LE) Louie Dormido stated the purpose of this visit. LPA De Perio conducted a tour of the interior and exterior portions of the facility with LE Dormido and staff on duty. The facility is a single level structure and is licensed for 6 non-ambulatory residents, 60 years and older of which 2 may be on hospice and 0 may be bedridden. Currently, there are a total census of 5 residents in care of which 2 are on hospice. LPA De Perio observed resident bedrooms to be in good repair, and is equipped with clean linens, adequate storage space, and kept free of tripping hazards. Water temperature in restrooms were measured to be at 108.6 degrees Fahrenheit. Smoke and carbon monoxide detectors were tested and observed to be operational. Auditory alarms were also tested and observed to be operational. The restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Facility had back-up emergency food and water supply. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers were charged, mounted and located on the hallway wall next to the dining area. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. LPA De Perio observed the emergency disaster and evacuation plan, which is posted in the kitchen. For this visit, LPA De Perio did not observe immediate threats on the health and safety of residents in care. No citation has been issued at this time. An exit interview was conducted and a copy of this report was provided to LE Dormido.the state’s words, verbatim · CDSS document, Jan 31, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA)Andrea Mendivil conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted and granted entry into the facility by Caregivers Ester Forsyth and explained the reason for the visit. During visit Licensee Louie Dormido arrived at 2:00 PM. At 1:20 PM, LPA toured the facility with Caregiver Ester Forsyth. Facility is 6 bedroom, 3 bathroom single story home with a detached garage. Facility has 5 residents present during today's visit. LPA observed residents relaxing in the facility and in their respective rooms. Facility appears clean and sanitary. All residents rooms had the required elements as well as restrooms stocked with soap. LPA observed emergency food and water. LPA toured the outside grounds and observed outside shaded visitation area. Exit gate is unlocked and self latching. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation. LPA reviewed all residents files and all contained required documentation including updated emergency information. All staff and residents are vaccinated for Covid 19. No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 26, 2022

Type of visit: Required - 1 Year

On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted and granted entry into the facility by Caregiver Esther Forsyth and explained the nature of the visit. Upon arrival to the facility, LPA Called and spoke to Licensee/Administrator Louie Dormido via telephone and explained nature of the visit. Administrator (AD) Kenneth Forsyth arrived to facility shortly after and met with LPA Quiroz. This facility is licensed to provide services to residents age range 60 years and over, 6 Non-Ambulatory Residents and has a hospice waiver for two (2) residents. AD Kenneth Forsyth has an Administrator Certificate with expiration date of 02/15/2023. On or about 1:22pm LPA Quiroz along with AD Kenneth Forsyth toured the inside and outside of facility. There are five residents in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz observed one (1) resident in living-room area resting watching television. Three residents were observed in their bedrooms resting. AD Forsyth indicated R1 is currently not at the facility and is at a Skilled Nursing Facility. Four of five residents appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected residents’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. AD Forsyth indicated facility is taking temperatures daily; however not documenting results. LPA Quiroz observed the emergency disaster and evacuation plan. Facility has back-up emergency food and water supply as well as PPE supplies. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs for resident’s enjoyment. CONTINUED ON NEXT PAGE... Facility has completed the LIC 808 Mitigation Plan. During today's visit, LPA Quiroz reviewed LIC 808 Mitigation Plan . LIC 808 requiring changes/updates. AD Forsyth agreed to discuss LIC 808 with L/AD Louie Dormido, update and resubmit LIC 808 Mitigation plan to CCL by 10/30/2021. During today's inspection visit, LPA Quiroz reviewed five of five resident records. AD Forsyth indicated "all residents and staff at facility are fully vaccinated for COVID-19." Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations. LIC 9102 Technical Violation was provided during today's visit for COVID-19 guidance. (SEE LIC809-D) This report was reviewed with Administrator kenneth Forsyth, and a copy of this report, LIC 811, LIC 9102, LIC 809-D and Appeal Rights were provided at exit.the state’s words, verbatim · CDSS document, Oct 26, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(1)(2) · Plan of correction due date: Oct 26, 2021

Care of persons with Dementia 87705(f)(1)(2)(f)The following shall be stored inaccessible to residents with dementia: (1) Knives...other items that could constitute a danger to the resident(s). (2) Over-the-counter medication, nutritional supplements or vitamins...Based on This requirement was not met as evidenced by:At 1:29pm, LPA Quiroz observed knives drawer next to stove and medication cabinet in kitchen area unlocked. This poses a potential health & safety for residents in care.House Manager and AD Forsyth stated "We forgot to lock it before leaving to lunch."the state’s words, verbatim · CDSS document, Oct 26, 2021

Plan of correction: House Manager Liliosa Manalili locked medication cabinet and knives drawer during today's inspection visit. AD Forsyth agreed to train all staff working in the facility on Care of persons with Dementia (87705) and submit proof of training by POC due date of 11/5/2021.