Whispering Oaks - Waverly

Allegation investigated: Facility staff are not meeting resident's needs Resident sustained an unstageable pressure injury due to negligence

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry by Administrator Imelda Caro and discussed the findings for the allegations listed above. The Department received a complaint on 07/28/2022 and LPA Mendivil conducted initial 10-day visit on 08/02/2022. During the course of the investigation LPA Mendivil interviewed staff and residents as well as obtained copies of pertinent documents such as physician’s reports, admission agreements and medication records. Regarding the allegation facility staff are not meeting resident's needs and resident sustained an unstageable pressure injury due to negligence, the investigation revealed the following: It was alleged that facility staff are not meeting resident’s needs. Based on interviews with 3 out of 6 residents indicated they believe that staff is taking good care of them and feels their needs are being met. Unsubstantiated The other 3 residents were not available to be interviewed as 2 were sleeping and 1 was with visiting family. Interviews with 3 out of 3 staff denied allegations that the staff is not meeting resident’s needs. Based on interviews with 3 out of 3 staff indicated they take care of the residents to the best of their ability. 3 out of 3 staff indicated they not yelled at a resident. 3 out of 3 staff reported that they have not been disrespectful to the residents. Per review of Resident 1 (R1) physician’s report dated 03/17/2022 R1 entered the facility with a Stage 1 wound, and it was noted on hospital discharge paperwork that R1 would be discharged with home health to assist with wound care. 3 out of 3 staff indicated they did not see the wound getting worse. Based on review of the physician report R1 has a history of skin breakdown. Therefore, based on the preponderance of evidence through record review and interviews the allegation Facility staff are not meeting resident's needs and resident sustained an unstageable pressure injury are determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint. No deficiencies cited. An exit interview was conducted and a copy of this report this report was provided to facility administrator.the state’s words, verbatim · CDSS document, Aug 22, 2023 · control 22-AS-20220728134559

Type of visit: POC

Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Whispering Oaks - Waverly. LPA Velazquez was allowed entry into the facility and met with Caregiver Gasparina Lofranco. The purpose of today's visit was to conduct a Plan of Correction visit for previously issued deficiencies that have not been corrected and a Repeat Violation had been issued. HSC 1569.652(c) Termination of Admission Agreement Upon Death of a Resident, removal of resident’s property; refund of fees paid; notice of contract termination and refunds. (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. During the Case Management visit dated March 1, 2023 the aforementioned was issued and the POC due date was March 2, 2023. On today's visit the citation has yet to be cleared. A civil penalty is being issued for a Repeat Violation in the amount of $250.00. An exit interview was conducted with Caregiver Gasparina Lofranco and a copy of this report along with the Civil Penalty and Appeal Rights were provided at the time of this visit.the state’s words, verbatim · CDSS document, Mar 9, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Whispering Oaks - Waverly. LPA Velazquez was allowed entry into the facility and met with Caregiver Gasparina Lofranco. While at the facility LPA Velazquez spoke with Administrator Imelda Caro and explained the purpose of today's visit. The purpose of today's visit was to conduct a Case Management - Deficiencies visit due the Licensee's failure to completely correct citations issued during the complaint investigation with Complaint Control Number: 22-AS-20201006154007. The original Plan of Correction (POC) due date was January 21, 2023. Deficiencies cited under California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted with Caregiver Gasparina Lofranco and a copy of this report along with the Appeal Rights and LIC 9098 were provided at the time of this visit. A POC correction letter was provided at the time of this visit for one citation that was cleared.the state’s words, verbatim · CDSS document, Mar 1, 2023

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Mar 2, 2023

Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds. (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement was not met as evidenced by: based on interview and record review the licensee failed to provide R1's family with a refund pursuant to statute and regulation. This poses a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Mar 1, 2023

Plan of correction: Licensee to refund R1's family the $600 that is still due via Cashier's check and mailed overnight to name and address provided. Licensee to provide written proof to LPA by POC due date.

Allegation investigated: Licensee failed to provide refund

Licensing Program Analysts (LPAs) Patricia Velazquez and Alvaro Ramirez conducted an unannounced subsequent complaint visit to deliver the findings of the investigation into the above allegation. LPAs Velazquez and Ramirez were allowed entry into the facility and met with Administrator (ADMIN) Imelda Caro and explained the purpose of the visit. On today's visit LPAs Velazquez and Ramirez conducted an interview with Administrator Imelda Caro. At 10:04 AM LPAs along with ADMIN toured the physical plant. LPAs along with ADMIN observed 5 residents in care and they all appeared well-cared for. Two were in the living room and 3 were in their rooms resting. During the course of the investigation, LPAs Criss Trinidad and Patricia Velazquez conducted interviews with the complainant, witnesses, and staff. LPA Velazquez also reviewed and obtained copies of facility and resident records. The records reviewed included the following for Resident (R) #1: South Coast Medical Center records, Resident Appraisal, Appraisal Needs and Services Plan, Resident's Information Record, Admission Substantiated Agreement executed on July 2, 2020 and signed by R1’s spouse and Administrator Imelda Caro, Care Partners Home Care Service Agreement executed on July 2, 2020, Physician's Report, Health Essentials itemized list of equipment provided, R1’s Trust bank statements documenting check number ending in 1561 in the amount of $6000 that posted on July 3, 2020 for payment to the facility as well as a debit card purchase in the amount of $468 payable to Care Partners, Legal documents naming one of R1’s children as the Trustee of R1’s Trust Account, email communication between R1’s family documenting return of the certified letters mailed to Administrator Imelda Caro, and R1’s Official Death Certificate documenting R1’s death on July 3, 2020 at 0613 hours with place of death at Whispering Oaks - Waverly. The investigation revealed the following: R1 was discharged from South Coast Global Medical Center on July 2, 2020 to Whispering Oaks – Waverly on hospice. Four of four individuals interviewed corroborated the allegation. ADMIN Caro could not corroborate the allegation. Per one of R1’s family members, Administrator Caro would not accept R1 into the facility until all documents were signed by R1’s POA and a check for $6000 was made payable to the facility. $1000 of that $6000 was for a preadmission fee. R1’s family stated Administrator Caro never provided them with a written statement describing all costs associated with the preadmission fee charges. The family was then asked to pay an additional $468 with a debit card for additional services to be provided by Care Partners. Furthermore when interviewed, Administrator Imelda Caro stated she had not refunded the family what was due to them following the death of R1 on July 3, 2020. R1 was only at the facility for 12 hours with the family paying $6468 up front. Administrator Imelda Caro could not provide LPA Velazquez with written proof of any refund that was made to the family of R1 nor a written statement describing all costs associated with the preadmission fee charges pursuant to statute and regulation. Based on LPA's observations, interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Licensee failed to provide refund is deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview was conducted with Administrator Imelda Caro and a copy of this report along with the appeal rights, LIC 811, LIC 9098 were provided at the time of this visit.the state’s words, verbatim · CDSS document, Jan 20, 2023 · control 22-AS-20201006154007

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.651(b) · Plan of correction due date: Jan 21, 2023

Preadmission fee or deposit for elderly at residential care facilities; written statement describing costs and stating whether fee is refundable; conditions for refund; refund rate schedules. This requirement was not met as evidenced by: based on interview and record review the licensee failed to provide R1's family with a written statement describing all the costs associated with the $1000 preadmission fee. This poses a potential risk to the health & safety of residents in care.the state’s words, verbatim · CDSS document, Jan 20, 2023

Plan of correction: Licensee to refund R1's family the $1000 preadmission fee via Cashier's check and mailed overnight to name and address provided. Licensee to provide written proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Jan 21, 2023

Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds. (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement was not met as evidenced by: based on interview and record review the licensee failed to provide R1's family with a refund pursuant to statute and regulation. This poses a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jan 20, 2023

Plan of correction: Licensee to refund R1's family the $5000 via Cashier's check and mailed overnight to name and address provided. Licensee to provide written proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Patricia Velazquez and Alvaro Ramirez conducted an unannounced Case Management visit to Whispering Oaks - Waverly. LPAs Velazquez and Ramirez met with Administrator Imelda Caro. During the complaint investigation visit with Complaint Number: 22-AS-20201006154007 LPAs Velazquez and Ramirez observed Staff (S) #1 did not appear on the Facility Personnel Report Summary dated January 15, 2023. At 10:37 AM LPA Ramirez called the Orange County Regional Office and spoke with staff who confirmed S1 was not associated to Whispering Oaks - Waverly. Deficiencies cited under California Code of Regulations Title 22 Division 6 Chapter 8. A civil penalty was also assessed. An exit interview was conducted with Administrator Imelda Caro and a copy of this report along with the appeal rights, LIC 811, LIC 9098 and LIC 421BG were provided at the time of this visit.the state’s words, verbatim · CDSS document, Jan 20, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jan 21, 2023

Criminal Record Clearance . 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: Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is not met as evidenced by: based on record review and interview the licensee did not transfer S1's criminal record clearance. This poses an immediate risk to the health and safety of residents in care. CIVIL PENALTY ASSESSEDthe state’s words, verbatim · CDSS document, Jan 20, 2023

Plan of correction: Licensee to ensure all staff have proper criminal record clearance transfer pursuant to regulation and submit written proof to LPA by POC due date.

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 Caregiver Marites Meres and explained the reason for the visit. Administrator Imelda Caro arrived at 12:45PM At 12:45 PM, LPA toured the facility with Administrator Imelda Caro. Facility is 6 bedrooms, 3 bathroom, one story home with an attached garage. Facility has 4 residents present during today's visit. LPA observed a screening and sanitizing station at entrance of the facility. LPA observed residents relaxing in their room and living room. Facility appears clean and sanitary. All resident rooms had required elements, including bed, chair, closet space and ample lighting. Restrooms are stocked with soap and paper towels and have hand washing postings. Facility has 2 refrigerators with 7 day non-perishables and 2 day perishables. LPA observed facility has 72-Hour emergency food and water supply. Facility has a secured location for resident medication and files. LPA toured the outside grounds and observed outside visitation area. Exit gates are 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 were noted during today's visit. This report was discussed with the facility representative and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 14, 2022