A1 Elder Care

Allegation investigated: -Resident was forced to leave the facility

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz made an unannounced visit for the purpose to deliver findings for complaint allegation listed above. LPA Quiroz was greeted and met with Administrator (AD) Bindi Shah and discussed purpose of today's visit. On 10/19/2020, LPA Quiroz conducted 10 day visit virtually due to COVID-19 precautionary measures. Regarding the allegation "Resident was forced to leave the facility," the investigation revealed Resident 1 (R1) was admitted to the facility on 9/26/2020 and voluntarily moved out of the facility on 10/18/2020 to be closer to their family and in an envioronment to better meet his cooking preference needs. Interviews conducted with six of seven interviewees concluded (R1) refused to eat food provided by the facility and that (R1) preferred to cook his own meals consisting of Indian food with strong spices in his bedrom area. Five of seven interviewees indicated (R1) requested to have an instapot and cooking devices in their bedroom area to cook at their own leisure. CONTINUED... Unfounded CONTINUED....Five of seven interviewees indicated "The smell was very strong and (R1) would cook late at night in facility kitchen and we started getting complaints from other residents residing in the facility." Therefore based on the preponderance of evidence through interviews and observations conducted by LPA Quiroz, the allegation that the "Resident was forced to leave the facility" is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint. An exit interview was conducted with Administrator Bindi Shah via telephone and Caregiver Gloria Sandoval in person, and a copy of this report and LIC 811- Confidential Names were provided at exit.the state’s words, verbatim · CDSS document, Aug 1, 2023 · control 22-AS-20201016145443

Type of visit: POC

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 12/08/2022. LPAs were greeted and granted entry into the facility by Caregiver Leticia Solis and explained the reason for the visit. Administrator Bindi Shah arrived during the visit. Deficiency cited under Title 22 Regulation 87202(a) pertaining to Fire Clearance has been cleared. There are no residents residing in the un-permitted room. Resident 1 has been relocated to a shared room and Resident 2 has moved out of the facility. Licensee has complied with the POC. LPA Lyman consulted with Administrator Shah regarding all required components for the resident room. Administrator Shah added required elements during the visit. Licensee has been advised to remain in compliance with all regulations. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 19, 2022

Type of visit: Case Management - Health Checks

Licensing Program Analysts (LPAs) Andrea Mendivil and Kimberly Lyman made an unannounced visit to conduct a case management health check in conjunction with a Plan of Corrections visit. LPAs were greeted and granted entry into the facility by Leticia Solis. Administrator Bindi Shah arrived at 8:48 AM, Licensee J Shah arrived at 9:10 AM. During the inspection, LPAs and Leticia toured the facility. Residents in care appeared to be safe, no imminent health and safety hazards were observed. LPAs observed residents relaxing in their respective rooms. LPAs observed residents to be well groomed and no visible injuries noted. No deficiencies were cited during this visit. An exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 19, 2022

Type of visit: Office

An informal virtual meeting was held on Microsoft teams at Orange County Adult and Senior Care Regional Office in Orange. The informal meeting process was explained to Licensee. At this informal conference, present were: Regional Manager Marina Stanic, Licensing Program Manager Luz Adams, Licensing Program Analyst (LPA) Kimberly Lyman, Licensee J Shah and Administrator Bindi Shah. The purpose of the meeting was to discuss actions moving forward regarding the altered room in the facility. The following was discussed during the meeting: LPA Lyman to contact Code Enforcement to obtain in writing clear instructions on the steps to obtain city approval and fire clearance for room #5 on the facility floor plan. Due to the compromised room #5, Licensee agrees to relocate residents residing in room #5. Facility to rearrange facility rooms to accommodate shared rooms for residents currently residing in room #5. Facility to notify resident's responsible parties in writing of relocation of residents to either a shared room or hotel. Facility to provide pictures or a tour via FaceTime to LPA for approval of re-arranged rooms. License agrees to consult with the department regarding the ongoing process to obtain city approval and fire clearance for room #5. Exit interview conducted and a copy of this report will be emailed to Licensee.the state’s words, verbatim · CDSS document, Dec 15, 2022

Type of visit: POC

Licensing Program Analysts (LPAs) Kimberly Lyman and Andrea Mendivil conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 12/08/2022. LPAs were greeted and granted entry into the facility by Caregiver Arlene Molina and explained the reason for the visit. Caregiver Leticia Solis arrived during the visit. Deficiency cited under Title 22 Regulation 87202(a) pertaining to Fire Clearance has NOT been cleared. Two residents are residing in the un-permitted room. Facility removed center wall but residents are still in room and room alteration has not been approved by the city. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 12, 2022

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 11/21/2022. LPA was greeted and granted entry into the facility by Caregiver Gloria Sandoval and explained the reason for the visit. *Deficiency cited under Title 22 Regulation 87211(a)(1)(D) pertaining to Reporting Requirements has been cleared. Licensee has complied with the POC. Licensee has been advised to comply with all department regulations. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 8, 2022

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced health and safety visit in conjunction with a Plan of Correction visit. LPA was greeted and granted entry into the facility by Caregiver Gloria Sandoval and explained the reason for the visit. During the visit, LPA toured the facility and observed the split resident room referenced in complaint #22-AS-20221115083100 and observed two residents are residing in the split room. On 11/21/2022, Licensee was cited for altering the room without a permit and LPA conducted a visit with City of Orange Code Enforcement. Licensee and Administrator participated in a phone call, same day, with LPA Lyman and LPM Alisa Ortiz regarding the resident residing in the room during that visit. Per Code Enforcement, Licensee and Administrator were advised no residents were to be residing in the room until the room was permitted. During today's visit, LPA Lyman spoke with Licensee Shah who stated he had submitted the paperwork to the city and was waiting for response. Licensee stated intent to go down to Code Enforcement to get an update. LPA reiterated no residents were to be residing in the room until permitted. Licensee ended the call. LPA made multiple attempts to contact Administrator and received no response. Licensee to forward a copy of resident roster to LPA by close of business Friday, December 9, 2022. 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 Licensee and a copy will be provided as well as appeal rights.the state’s words, verbatim · CDSS document, Dec 8, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Dec 9, 2022

All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement is not being met as evidenced by: Based on observation, Licensee altered a resident room off the floor plan approved by fire authority. Fire clearance is granted according to floor plan at time of inspection. Licensee has two residents residing in the altered room. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED.the state’s words, verbatim · CDSS document, Dec 8, 2022

Plan of correction: Licensee to relocate residents out of the un-permitted room and forward proof to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Dec 22, 2022

All facilities shall have a qualified and currently certified administrator.. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible...This requirement is not being met as evidenced by: Based on observation, Licensee failed to ensure a back-up administrator is available at the facility. During the visit, Administrator is unavailable and did not return LPA's calls. However, Administrator communicated to caregiver via phone calls. This poses a potential health and safety risk to residents in care,the state’s words, verbatim · CDSS document, Dec 8, 2022

Plan of correction: Licensee to submit a plan for back-up administrator to LPA by POC due date.

Allegation investigated: -Staff did not provide resident with sufficient room to comfortably and safely accommodate resident. -Resident bedroom is being used as a passageway to another room, bath or toilet.

This unannounced visit conducted by Licensing Program Analyst (LPA) Ruth Martinez is being conducted to initiate the 10 day visit to investigate the above mentioned complaint allegation. LPA arrived at facility was greeted at the door by caregiver and granted entry. LPA met with caregiver and explained the nature of today’s visit. Bindi Shah, Administrator arrived shortly after and met with LPA and explained the nature of the visit and allegations were explained. Findings are based upon this investigation which included interview conducted and tour of the physical plant of the facility. It is alleged that staff did not provide resident with sufficient room to comfortably and safely accommodate resident and resident bedroom is being used as a passageway to another room, bath or toilet. LPA Lyman Continued on LIC9099-C Substantiated conducted a visit on 11/21/22 and revealed the following: Administrator and Licensee state a wall was put up to split a resident room into two private rooms and a permit was not pulled. LPA reviewed facility floor plan which shows the floor plan does not match the actual physical plant. On today’s visit upon observation LPA observed that there was a door in place in the installed bedroom, however that door has been removed since 11/21/22. LPA observed that the air vent was on left side of bedroom on the opposite side of the wall. Interview with resident indicated that since the vent was only on one side of the bedroom the air would not properly circulate due to the placement of the door. Resident indicated that bedroom bathroom would be used by occupants of the bedroom and caregivers. Prior to the wall being added the bedroom was private and R1 was the sole occupant of it. R1 indicated that wall was added around the week of 11/10/22. R1 indicated having an issue once the door and wall was placed because it now became a shared room rather than a private room because with the wall installation and door, it became a passageway to residents’ bathroom by other residents and caregivers and further more was used as a passageway to the other part of the bedroom. Interviews with staff revealed that the wall had been installed about two weeks ago and that the door in bedroom has now been removed permanently and will not be replaced to remain as an open entryway. Staff indicated that the flow of air is now access to all parts of the bedroom. It was indicated that bedroom was used as a passage way to the bathroom by caregivers and access to other parts of the bedroom. 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, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted, and a copy of this report was provided to facility administrator along with appeal rightsthe state’s words, verbatim · CDSS document, Nov 23, 2022 · control 22-AS-20221116173328

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87307(a)(C) · Plan of correction due date: Nov 24, 2022

Personal Accommodations and Services (a) The facility shall be large enough to provide comfortable living accommodations and privacy for the residents (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not being met as evidenced by: Based on observations and interviews conducted LPA determined the facility is not providing comfortable living accommodations and privacy for the residents as a resident bedroom is being used as a passageway to another room and bathroom. This poses an immediate Health and Safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 23, 2022

Plan of correction: Administrator moved R1 and R2 to a new bedroom until bedroom is ready. Bedroom is currently not occupied. Administrator acknowledges that bedroom bathroom will only be used by occupied residents. Administrator has determined R1 will no longer occupy previous bedroom and stay in new bedroom. R1 is in agreement.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Nov 24, 2022

Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requiement is not being met as evidence by: based on observation and interview R1 was not provided sifficient room to comfortably and safety accomodate to resident due to wall and door installed didn't allow for heat and air ventilation to circulate to the whole bedroom. This poses an immediate Health and Safety risk to clients in care.the state’s words, verbatim · CDSS document, Nov 23, 2022

Plan of correction: Administrator moved R1 to a new bedroom and will not return to previous bedroom. Installed door that accompanied wall installed has been permanently removed and will not be reinstalled which will allow flow of heat or air ventilation to flow throughout the bedroom. Note: Licensee is currently obtaining a building permit for modification to bedroom. In order to have resident occupy bedroom.

Allegation investigated: Licensee did not obtain a building permit prior to physically altering the facility.

Licensing Program Analyst (LPA) Kimberly Lyman along with Code Compliance Supervisor Rafael Perez, and Code Compliance Officers Ines Guzman, Antonio Olivos, and Adam Davis conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA and Code Compliance were greeted and granted entry into the facility by Administrator Bindi Shah and explained the reason for the visit. Licensee Jitendra Shah arrived during the visit. During the visit, LPA and Code Compliance toured the facility with Administrator Bindi as well as interviewed staff and resident. Regarding the allegation that Licensee did not obtain a building permit prior to physically altering the facility, the investigation revealed the following: Administrator and Licensee state a wall was put up to split a resident room into two private rooms and a permit was not pulled. LPA reviewed facility floor plan which shows the floor plan does not match the actual physical plant.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, Chapter 8), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to facility administrator along with appeal rights Substantiatedthe state’s words, verbatim · CDSS document, Nov 21, 2022 · control 22-AS-20221115083100

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87305(a) · Plan of correction due date: Nov 22, 2022

Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure a building permit was obtained before making changes to the facility. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 21, 2022

Plan of correction: Licensee to obtain a building permit and forward proof to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kimberly Lyman along with Code Compliance Supervisor Rafael Perez, and Code Compliance Officers Ines Guzman, Antonio Olivos, and Adam Davis conducted an unannounced case management visit in conjunction with complaint visit 2-AS-20221115083100. LPA and Code Compliance were greeted and granted entry into the facility by Administrator Bindi Shah and explained the reason for the visit. Licensee Jitendra Shah arrived during the visit. During the course of the complaint visit, it was determined through interview with Administrator that Licensee did not notify Community Care Licensing of intent to perform construction in order to alter Resident 1's (R1) room by building a wall in the center of room. The purpose of the construction was to make two private rooms instead of one shared room. LPA along with City of Orange Code Compliance Officers observed the alteration currently in place. Based on the observations made during today's visit, deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with Administrator and a copy will be provided as well as appeal rights.the state’s words, verbatim · CDSS document, Nov 21, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Dec 5, 2022

Each licensee shall furnish to the licensing agency such reports as the Department may require..Any incident which threatens the welfare, safety or health of any resident...This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to notify Community Care Licensing of intent to perform construction to alter a room. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 21, 2022

Plan of correction: Licensee to submit a statement of understanding regarding the regulation and forward to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michelle Reed made an unannounced visit to the facility to conduct an Annual visit. Upon arrival LPA met with Staff Leticia Solis and Arlene Molina. Administrator Bindi Shah was spoken to via telephone. The focus of the visit was Infection Control. LPA toured the facility with Ms. Solis and the following was observed: Covid signs were posted at the front entrance of facility with a sanitization station. LPA's temperature was taken upon arrival and a sign in sheet was available. Facility has required Department postings. Administrator Certificate for Bindi Shah expires on 6/27/23 . Restrooms observed contained soap, paper towels and toilet paper. Hand sanitizer, soap, wipes and gloves were present and in sufficient supply. The Licensee has at least a 30 day supply of PPE. LPA observed an outside visitation area with ample shading. The swimming pool meets Title 22 regulation at this time. Residents were resting in their rooms and others watching tv. Social distancing and masks for staff were observed. Licensee has required Mitigation plan and Emergency Disaster Plan. Facility has emergency food and water supply. Facility has a secured medication closet for resident medication and files. All residents have at least a 30 day supply of medications. During the visit, LPA consulted with staff regarding the importance of maintaining a 30 day supply of PPE on site. Additionally, LPA advised the importance of mask wearing and hand washing for staff. Administrator is reminded to review PINS in regards to Visitation, Dining, Group Activities, Non-essential services, Outings, New Admissions and Entertainment. as well as Staff Testing and Masking Guidelines. All staff have had vaccines and the booster shot. All residents but 1 have received vaccines. Only 1 resident has had the booster. An exit interview was conducted and a copy of this report was provided to Staff Leticia Solis.the state’s words, verbatim · CDSS document, May 6, 2022