Wonder's Years

Type of visit: POC

Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 06/02/2023. LPA De Perio explained reason for visit, was greeted and granted entry by facility staff (S1) Mariadelos Trujillo Cruz, who notified facility administrator (AD) Juan Garcia Trujillo. On 06/02/22 facility failed to issue a resident a refund. Deficiency cited under Title 22 Regulation 87507(5)(c) pertaining to Admission Agreements has been CLEARED. On 07/01/23, AD Trujillo issued resident a refunded check with the agreed upon amount. Licensee has complied with the terms of the POC. An exit interview was conducted with S1. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Jul 11, 2023

Type of visit: POC

Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 06/02/2023. LPA De Perio explained reason for visit, was greeted and granted entry by staff on duty (S1) Mariadelos Trujillo Cruz. On 06/02/22 facility failed to complete an individual written admission agreement. Deficiency cited under Title 22 Regulation 87507(a) pertaining to Admission Agreements has been CLEARED. LPA De Perio reviewed proof of understanding regarding the regulation cited and reviewed resident charts, of which it was observed that the current residents have signed admission agreements. Licensee has complied with the terms of the POC. An exit interview was conducted with S1 Cruz and facility administrator Juan Garcia Trujillo via telephone call. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Jun 20, 2023

Allegation investigated: Facility did not issue a refund to resident. Facility did not provide an admission agreement to resident.

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to the facility to deliver the findings for the complaint received on 5/3/23. LPA arrived to the facility, explained reason for visit, was greeted and granted entry by staff on duty (S1), Mariadelos Trujillo Cruz. It was alleged that the facility did not issue a refund to resident. LPA conducted a total of 6 interviews which consisted of staff, residents, and external parties. 3 out of the 6 interviews conducted corroborated with the allegation, of which 1 provided a direct admission admitting to not issuing a refund. LPA reviewed documents such as the facility admission agreement, financial documents and bank statements. It was observed that the resident provided the facility with a "months worth" check, however, resident only resided at the facility from 4/22/23 to 4/30/23. Substantiated It was alleged that the facility did not provide an admission agreement to resident. LPA conducted a total of 6 interviews which consisted of staff, residents, and external parties. 3 out of the 6 interviews corroborated with the allegation by stating that an admission agreement was never provided. 1 of the interviews stated “there were no talks of anything to do with an admission agreement…I think that's the issue right now with the refund" (regarding to the previous allegation). 1 of the interviews also provided a direct admission of not providing the resident (R1) with an admission agreement. LPA reviewed documents such as the facility admission agreement and R1’s file, of which it was observed that the facility did not have a copy of the signed admission agreement from R1 because it was not provided. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, the preponderance of evidence standard has been met, therefore the allegations are SUBSTANTIATED. An exit interview was conducted with S1 and facility administrator (AD) Juan Garcia Trujillo via phone call. A copy of this report was provided and explained. It was alleged that facility staff not following physical therapists instructions. LPA conducted a total of 6 interviews which consisted of staff, residents and external parties. 4 out of the 6 interviews conducted stated that the resident in the allegation (R1) had a physician therapy assessment conducted, however, no official instructions were provided. It was also stated that that the physical therapist had scheduled a second session with R1, however, by the time the session came, R1 had already moved out of the facility. LPA reviewed pertinent documents, however 1 interview specified that everything regarding physical therapy was “verbal and nothing was written”. It was alleged that the facility not allowing resident to drink coffee. LPA conducted a total of 6 interviews which consisted of staff, residents, and external parties. 4 out of the 6 interviews conducted did not corroborate with the allegation by stating that the facility does offer and serve coffee to residents. LPA reviewed pertinent documents such as the facility menu, the physician report of the resident, and photos. It was observed that the pictures of the meals the facility served (regarding to previous allegation), also included pictures of the resident drinking coffee. LPA conducted a tour of the facility and also observed that the facility is supplied with coffee. Based on LPA’s interviews which were conducted, review of documents obtained, and observations, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with S1 and facility administrator (AD) Juan Garcia Trujillo via phone call. A copy of this report was provided and explained.the state’s words, verbatim · CDSS document, Jun 2, 2023 · control 22-AS-20230503123146

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(a) · Plan of correction due date: Jun 16, 2023

87507 Admission Agreements (a) The licensee shall complete an individual written admission agreement...with each resident or the resident's representative, if any. This requirement is not met as evidence by: Based on LPA's observations, interviews and record reviews, facility failed to complete an indiviudal written admission agreement.... This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 2, 2023

Plan of correction: As plan of correction (POC), facility will review the regulation cited, and will provide proof of understanding to the assigned LPA on or by 6/16/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(5)(c) · Plan of correction due date: Jun 16, 2023

87507 Admission Agreements (5) Refund conditions (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... This requirement is not met as evidence by: Based on LPA's observations, interviews and record reveiws, facility failed to issue a refund of any fees paid in advance covering the time after the resident's personal properly has been removed... This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 2, 2023

Plan of correction: As plan of correction, (POC) facility will issue the resident a refund for the amount reflected of when resident was no longer residing at the facility. Facility will provide proof of refund and the regulation cited to the assigned LPA on or by 6/16/23.

Allegation investigated: Facility does not provide a comfortable environment for residents in care. Adult in the home yells at residents. Facility does not provide activities for the residents.

Licensing Program Analyst (LPA) Celine De Perio made an unannounced 10-day visit to this facility to conduct an investigation for the complaint received on 4/26/23 and to deliver the findings. LPA De Perio explained reason for visit and was greeted and granted entry by facility administrator (AD) Juan Garcia Trujillo. For today's visit, there are a total of 2 residents in care of which 2 are on hospice and 2 staff on duty. LPA De Perio conducted a tour of the facility and conducted interviews which consisted of staff and residents, and reviewed and requested copies of the pertinent records. This department has investigated the complaint alleging that facility does not provide a comfortable environment for residents in care. (SEE LIC9099-C) Unfounded LPA De Perio conducted a total of 4 interviews which consisted of staff and residents, of which 4 out of the 4 interviews conducted did not corroborate with the allegation. 2 out of the 4 interviews conducted stated that the facility is "good" and that "staff are nice". During the tour of the facility, LPA also observed that all residents rooms were provided with furniture in good repair. LPA reviewed the following documents such as but not limited to: resident 1 and resident 2 physician reports, and functioning assessments, and facility admission agreement. Based on observations and review of documents obtained, we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This department has investigated the complaint alleging that adult in the home yells at residents. LPA De Perio conducted a total of 4 interviews which consisted of staff and residents, of which 4 out of the 4 interviews conducted did not corroborate with the allegation. 2 out of the 4 interviews denied of ever witnessing or hearing a staff yell at a resident, and denied of ever being yelled at. LPA reviewed the following documents such as but not limited to: resident 1 and resident 2 physician reports, and functioning assessments, and house rules. Based on observations and review of documents obtained, we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This department has investigated the complaint alleging that facility does not provide activities for the residents. LPA De Perio conducted a total of 4 interviews which consisted of staff and residents, of which 4 out of the 4 interviews conducted did not corroborate with the allegation, by stating that the facility has an activity schedule. 3 out of the 4 interviews conducted stated that the facility has activity supplies to use, however, the preferred activity for the current residents is to watch television. During the tour of the facility, LPA De Perio observed that the facility had activity supplies such as: Bingo, card games, board games, coloring and arts and crafts. LPA reviewed the following documents such as but not limited to: resident 1 and resident 2 physician reports, and functioning assessments, and the facility activity schedule. Based on observations and review of documents obtained, we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. For today's visit, no citation was issued. An exit interview was conducted and a copy of this report was provided and explained to AD Trujillo.the state’s words, verbatim · CDSS document, May 2, 2023 · control 22-AS-20230426143812

Allegation investigated: Staff yelled at resident in care.

Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to this facility. LPA De Perio was greeted and granted entry by staff on duty (S1) who contacted facility administrator (AD) Juan Garcia Trujillo about visit. AD Trujillo was unable to be present during time of visit, however, provided consent for S1 to receive and sign report. LPA De Perio stated the purpose of this visit which was to deliver the final findings for the complaint received on 11/7/22 against this facility. For today’s visit, there are a total of 2 residents in care and 1 staff on duty. This agency has investigated the complaint alleging that staff yelled at resident in care. Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. See LIC9099-C. Substantiated For today's visit, a citation was issued per Title 22 Division 6 of the California Code of Regulations. See LIC9099-D. LPA De Perio conducted an exit interview with S1 and copy of this report, LIC9099-D and Appeal Rights were left in this facility.the state’s words, verbatim · CDSS document, Dec 5, 2022 · control 22-AS-20221107095603

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Dec 5, 2022

87468.1 Personal Rights of Residents in All Facilities (a) Residents... shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff... This requirement is not met as evidence by: Based on observation, and interviews, facility did not ensure that resident was accorded dignity in their personal relationships with staff. This poses an immediate threat on safety of clients in care.the state’s words, verbatim · CDSS document, Dec 5, 2022

Plan of correction: As plan of correction, facility will provide training to staff regarding regulation cited and will provide proof to Community Care Licensing and assigned LPA on or by 12/19/22.

Allegation investigated: ) Staff were not adequately assisting the resident with the administration of medications. 2) Staff is using restraints on a resident. 3) Staff offered medication to authorized representative for resident that was not ordered by the doctor. 4) The owner did not terminate the contract upon death of the resident.

Licensing Program Analyst (LPA), Kathrina Chin conducted an unannounced visit for the purpose of delivering the findings on a complaint investigation. LPA Chin met with Administrator, Juan Trujillo. During the investigation of the above allegations, LPA Chin interviewed staff, witnesses as well as reviewed and obtained pertinent records. It was alleged that facility staff was not dispensing Morphine per doctor's orders to R1 who was on hospice care. LPA Chin interviewed S1 and S2 who stated that Morphine was given at approximately 9:30 AM on January 5, 2022. The family members of R1 arrived at approximately 10 AM. R1's family requested for additional Morphine to be given to R1. However, S1 explained to R1's family members that he has just administered Morphine to R1. R1's family members did confirm that S1 showed them the bottle of Morphine and that S2 told them that he needs to follow the instructions from the doctor and nurses of the hospice agency. (Continued on LIC 9099C) Unsubstantiated The hospice nurse arrived soon after and administered the Morphine medication. LPA Chin reviewed the hospice medication list which indicates that Morphine is to be given every two hours as needed. It was alleged that R2 was restrained with a belt on her wheelchair. LPA Chin has visited the facility on two occasions. On both visits, R2 was not restrained and was observed sitting in the dining table without a wheelchair. LPA Celine De Perio has visited the facility and stated that she has not observed R2 to be restrained on her wheelchair. LPA attempted to interview R2 but was unable due to cognitive impairment. S1 and S2 stated that R2 has never been restrained. R2 is on hospice care since July 27, 2021. It was alleged that S1 offered the responsible party of R1 medication for R1 that was not ordered by the doctor in order to help R1 sleep better. LPA interviewed S1 and he denied that he ever offered any medication to help the resident sleep better. S1 said that he only gives his residents medications that their doctors have ordered. LPA interviewed S2 and she said she passes out medications only ordered by the resident's doctors and nothing more. R1 moved into the facility on December 30, 2021 and moved out on January 5, 2022. R1's responsible party did not provide a thirty day notice. S1 stated that the hospice agency nurse informed him of R1's moving out of the facility the same day that R1 moved out. S1 had no prior knowledge. R1's responsible party signed a document that they were moving R1 out of the facility on January 5, 2022 and there would be no refund. Based on the information gathered during the investigation and review of all documents obtained, the following allegations: Staff were not adequately assisting the resident with the administration of medications, Staff is using restraints on a resident, Staff offered medication to authorized representative for resident that was not ordered by the doctor, The owner did not terminate the contract upon death of the resident are deemed Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted, appeal rights explained and provided. A copy of this report was provided during the visit to Juan Trujillo, Administrator.the state’s words, verbatim · CDSS document, Dec 2, 2022 · control 22-AS-20220118151938

Allegation investigated: Staff administers sedatives to resident to make her sleep for longer hours.

Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to this facility. LPA met with Administrator (AD) Juan Garcia Trujillo. and stated the purpose of this visit which was to deliver the final findings for the complaint received on 7/28/22 against this facility. For today’s visit, there are a total of 3 residents in care. This agency has investigated the complaint alleging that staff administers sedatives to resident to make resident sleep for longer hours. On the visit conducted on 8/3/22, LPA De Perio interviewed staff and inquired about when evening and bedtime medications were given and was informed that per prescription, evening medications are supposed to be given between 7:00 PM – 7:30 PM, and bedtime medications between 7:30 PM – 8:00 PM. On 8/5/22, LPA De Perio conducted an unannounced continuation visit at facility. . Substantiated At 5:52 PM, LPA De Perio observed three residents in bed. One of the three residents was able to verbalize to LPA De Perio "They gave my pills too early again. I'm sleepy". LPA De Perio reviewed the bubble packs of medications for all the residents and inquired to AD Trujillo what time “sleeping medications” were given. AD Trujillo stated, "We give it to them between 6 to 6:30. But we just happen to give it early today" When asked what time evening and bedtime medications were given to residents on 8/5/22, AD Trujillo stated, "around 5”. Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED For today's visit citations were issued per Title 22 Division 6 of the California Code of Regulations. See LIC9099-D. LPA De Perio conducted an exit interview with AD Trujillo and a copy of this report, regulation discussed and specified on LIC9099-D and Appeal Rights were provided to the facility.the state’s words, verbatim · CDSS document, Oct 11, 2022 · control 22-AS-20220728091448

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Oct 25, 2022

87468.1 Personal Rights of Residents in All Facilities (3) To be free from...interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidence by: Based on interviews conducted, file reviews and observations, facility did not adhere to the regulation specified due to interfering with residents living functions such as sleeping. This poses an immediate threat on the safety of residents in care.the state’s words, verbatim · CDSS document, Oct 11, 2022

Plan of correction: As a plan of correction (POC), administrator will provide training to staff with the regulation specified, and will submit proof of training to CCL and assigned LPA on or by 10/25/2022.

Allegation investigated: Due to staff neglect, resident sustained multiple falls, resulting in injuries while in care. Due to staff neglect, resident's health is deteriorating causing her to lose 25 lbs. while in care.

Licensing Program Analyst (LPA) Celine De Perio made an unannounced visit to this facility. LPA met with Administrator (AD) Juan Garcia Trujillo. and stated the purpose of this visit which was to deliver the final findings for the complaint received on 7/28/22 against this facility. For today’s visit, there are a total of 3 residents in care. This agency has investigated the complaint alleging that due to staff neglect, resident sustained multiple falls, resulting in injuries while in care. LPA De Perio conducted file reviews, staff and resident interviews, and based on the information gathered during the investigation and review of documents obtained, LPA is 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. Unsubstantiated This agency has investigated the complaint alleging that due to staff neglect, resident's health is deteriorating causing her to lose 25 lbs. while in care. LPA De Perio conducted file reviews, staff and resident interviews, and based on the information gathered during the investigation and review of documents obtained, LPA is 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. LPA De Perio conducted an exit interview with AD Trujillo and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Oct 11, 2022 · control 22-AS-20220728091448

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection focusing primarily on the Infection Control. LPA De Perio explained reason for visit and was greeted and granted entry by staff on duty who checked temperature prior to entering facility. During the visit, 1 staff was on duty, who contacted facility administrator (AD) Juan Trujillo about visit. AD Trujillo was unable to be present at the time of visit, but provided consent for caregiver (CG) Mariadelos Trujillo Cruz to give tour, receive and sign report. As of 9/8/22, there are 0 active COVID-19 cases in the facility as verified. LPA De Perio observed the COVID-19 precautionary signs posted in the hallway of the facility. The PUB475 "See Something, Say Something" poster was also observed at the entrance of the facility. LPA observed the Administrator's Certificate for Juan Trujillo, which expires on 2/7/23. LPA De Perio toured the interior and exterior portions of the facility with CG Cruz. The facility is a 2 level structure and is licensed for 6 non-ambulatory, 0 bedridden and 5 hospice (of which increase was approved on 5/20/21). LPA De Perio observed no residents residing on the second floor and verified that second level is not for resident use. For this visit, there are a total of 4 residents in care, 3 on hospice, 0 bedridden. All bedrooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. The restroom was observed to be in good repair, toilet was operational, and grab bars and non-skid floor mat was provided. Water temperature in restroom was measured to be at 106.8 degrees Fahrenheit and hand washing signs were also posted, Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguisher was charged, mounted and located in the kitchen. Facility had back-up emergency food and water supply, located in the garage. LPA De Perio observed that First Aid Kit had all the required components. The facility had an adequate supply of PPE that was located in the garage. Medications were locked in the living room closet. Toxins were also observed to be locked and inaccessible to residents and located in the garage. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. There are two gates in the backyard, which was self-closing and self-latching. Facility has a pool in the backyard of which is closed off by a gate. LPA De Perio verified the Coronavirus 2019 (COVID 19) mitigation plan of the facility with CG Cruz. LPA De Perio discussed Assembly Bill 665 requires that a licensee of any adult or senior care residential facility that has internet service provide at least one internet access device, such as a computer, smart phone, tablet or other device, that: can support real-time interactive applications; is equipped with video conferencing technology, including microphone and camera functions; and is dedicated for client or resident use. LPA De Perio discussed with CG Cruz to review, and subscribe for emails regarding the Provider Information Notices (PINs) as well as to attend the CCLD Informational Calls to ensure that facility and staff are up to date. The PINs can be accessed at: www.ccld.ca.gov. For today's visit no deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. No citations were issued. LPA De Perio advised CG Cruz to use the general email address: CCLASCPOrangeCountyRO@dss.ca.gov for any inquiries and to specify attention to the assigned LPA. LPA De Perio conducted an exit interview with AD Trujillo via phone and CG Cruz and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Sep 8, 2022

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Albert Marin and Celine De Perio made an unannounced case management visit to this facility. LPAs met with AD Juan Trujillo and stated the purpose of the visit. LPAs Marin and De Perio conducted a tour in the interior and exterior portions of the facility, LPAs observed that smoke alarm in each shared resident's room was low on battery; and AD replaced the batteries and were tested to be operational. LPAs also observed video surveillance unit installed in each resident's room. LPA conducted interviews and review of capability of the camera. Per AD and verified by LPA Marin, cameras located in resident's room was off and did not have recording or playback capability at this time. Cameras were used only at night as an alert system in event there are movements inside the resident's rooms. Per advice, AD Trujillo removed the cameras located in the resident's rooms. LPA provided AD with guidance on the requirements of maintaining video surveillance system in the common areas of the facility. LPA Marin also discussed California Code of Regulations Section (CCR) 87355 Criminal Record Clearance, CCR Section 7303 Maintenance and Operation; and CCR 87570 Infection Control Requirements. For this visit, no citation was issued at this time. LPAs Marin and De Perio conducted an exit interview with AD Trujillo; and copies of this report, Guidelines on Video Surveillance, CCR 87355 and CCR 87303 were left in the facility.the state’s words, verbatim · CDSS document, Aug 3, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Albert Marin made an unannounced required annual inspection in this facility. LPA met with Administrator (AD) Juan Garcia Trujillo and stated the purpose of this visit. The facility is a two - level structure and licensed for 6 non-ambulatory and with hospice waiver for five. For this visit there were three residents under hospice care. About 3:07 PM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. For this visit, there were four residents in care and two staff members on the floor. LPA toured the interior and exterior portions of the facility. There were three shared resident’s rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke, carbon monoxide and auditory exit alarms and signal system were tested to be operational. Bathrooms were observed to be in good repair; and provided with handrails and nonskid - floor mats. Hot water was measured at 110 degrees Fahrenheit. Facility met the minimum two-day perishable and seven-day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. For the exterior portion, facility had outside furniture in good repair; grounds were free of tripping hazards; and pool feature enclosed by steel gates and rendered inaccessible to residents in care. Side exit door was elf-closing and self latching. LPA Marin reviewed the COVID 19 mitigation plan of the facility. For this visit, the facility was observed to be in substantial compliance with Title 22 Division 6 of the California Code of Regulations. LPA Marin conducted an exit interview with AD Juan Garcia Trujillo; and copy of this report was left in the facility.the state’s words, verbatim · CDSS document, Sep 29, 2021