Silverado Senior Living-Tustin Hacienda

Type of visit: Case Management - Other

On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a collateral visit. LPA was greeted and granted entry into facility by Executive Director Erin Light and explained the reason for the visit. During the visit LPA Mendivil interviewed Resident 1. No deficiencies noted. An exit interview was conducted and a copy of this report and provided.the state’s words, verbatim · CDSS document, Sep 19, 2023

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced case management visit to follow up on an incident report dated 09/20/2022. LPA was greeted and granted entry into the facility and explained the reason for the visit to Charge Nurse Malinda Smith. Senior Administrator Erin Light arrived at 2:30 PM Incident report indicated Resident 1 (R1) had an altercation with Resident 2 (R2) Per interview with staff 1 (S1) S1 stated R1 approached R2 and another resident at 7:30 am on 09/18/2022. R1 reached for the side of R2's neck ,R2 then grabbed R1's hand and pinched R1. R1 then hit R2 on the forehead with an open hand. R2 then hit R1 3 times on R1's chest with a closed fist. R1 then tried to walk around R2 and reached for R2's neck area where it meets the shoulder. R1 was redirected and both residents were assessed. No injuries notated for either resident. R1 was given 1:1 caregiver until a bed was available at behavioral health hospital. R2 was taken to hospital for psych evaluation. Both are currently at the hospital. R1 and R2's responsible parties and physicians were notified. Both R1 and R2 are diagnosed with dementia based on LIC 602 dated 05/27/22 for R1 and 05/17/22 for R2. During the visit, LPA reviewed LIC 602, incident report and services plans for both R1 and R2. 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, Sep 22, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit, LPA met with Administrator Dwight Dunagan, and stated the purpose of the visit. LPA toured the facility and observed six residents in care in the TV room doing pet club; three residents doing arts and crafts and three residents engaged in music therapy in the dining area. Activities were supervised by staff members. Two residents were observed in the outdoor features of the facility. After the tour, LPA conducted random interviews and file review. For this visit, no deficiency was noted in areas observed. No citation was issued. LPA Marin conducted an exit interview with AD Dunagan and copy of this report was left in the facility.the state’s words, verbatim · CDSS document, Jul 13, 2022

Allegation investigated: Facility staff failed to provide requested resident information in a timely manner. Facility staff mismanaged resident's medication.

Licensing Program Analyst (LPAs) Albert Marin and Celine De Perio conducted unannounced visit to deliver the findings for the complaint filed against this facility last January 5, 2022. LPAs met with Administrator (AD) Dwight Dunagan and stated the purpose of this visit. On allegation that facility staff failed to provide requested information in the timely manner, it was reported that on December 29, 2021, a verbal query was made on the health status Resident 1; and facility missed to provide information to inquiring party. On file review, On September 10, 2021, the Superior Court ordered stipulation and order regarding settlement for identified parties. Settlement Section 15.2 describes the sole legal authority to act on behalf the resident; and to make financial and medical decisions for Resident 1 (R1). Section 15.8 describes that parties may obtain verbal information from on-site staff regarding resident’s condition. Based on interviews 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. (Continuation in Page 2) Unsubstantiated On allegation that facility staff mismanaged resident's medication, the following are the findings. On April 23, 2021, the physician ordered six units of insulin lispro injection to be given by subcutaneously before meals. According to medlineplus.gov Insulin lispro injection products are a short-acting, man-made version of human insulin. Insulin lispro solution is usually injected within 15 minutes before a meal or immediately after a meal. Resident 1 is also receiving insulin Insulin glargine. It is a long-acting, man-made version of human insulin. Based on file review and interviews, In December 29, 2021, Resident got up late. Blood sugar level and insulin lispro were given prior to first meal served; and was recorded around 11:00 AM. The next blood sugar check and dose of insulin was given around the dinner meal service which starts around 5:30 PM. On the course of the investigation, LPA also reviewed medications ordered to be given at bedtime were given around 7:00 PM to 7:30 PM. Based on medlineplus website, both medications have peak blood concentration of about 2 hours following an oral dose. 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 LPAs Marin and De Perio conducted an exit interview with AD Dunagan and copies of this report were left in the facility.the state’s words, verbatim · CDSS document, Jun 2, 2022 · control 22-AS-20220105170058

Allegation investigated: Staff spoke to resident in an inappropriate tone.

Licensing Program Analysts (LPAs) Albert Marin and Celine De Perio made an unannounced visit to this facility. LPAs met with Administrator (AD) Dwight Dunagan and stated the purpose of this visit. On allegation that staff spoke to resident in an inappropriate tone, it was reported that On July 12, 2021 Resident 1 (R1) sought assistance from staff member. Staff 1 came in to assist the resident but during the interaction, Staff spoke to R1 in an inappropriate tone. Based on file review and interviews, LPA determined that Staff 1 did not use any foul or demeaning comments towards the resident. 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. LPAs Marin and De Perio conducted an exit interview with AD Dunagan; and copy of this report was left in the facility. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 2, 2022 · control 22-AS-20210713153033

Allegation investigated: Resident sustained multiple falls while in care. Staff did not respond timely to a resident's alerts

Licensing Program Analysts (LPAs) Albert Marin and Celine De Perio made an unannounced visit to this facility. LPAs met with Administrator (AD) Dwight Dunagan and stated the purpose of this visit. On allegation that resident sustained multiple falls while in care, the following are the findings. Resident 1 (R1) was admitted in the facility on January 24, 2022. On admission, R1 was observed agitated that required transfer to hospital for further evaluation and management. R1 came back inthe facility on February 2, 2022. On February 7, 2022, R1 was found on the floor with skin tear; February 9, 2022 R1 had a witnessed fall with reopened skin tear; and February 17, 2022, R1 had a witnessed fall with no apparent injuries. R1 was checked and monitored after each incident. On February 18, 2022 R1 triggered a tag alarm. R1 was observed on the floor and evaluated to have suspected head injury. R1 was transferred to the hospital for further evaluation and management. 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. Continuation on Page 2 Unsubstantiated On allegation that staff did not respond timely to a resident's alerts the following are the findings. Resident 1 (R1) was admitted in the facility on January 24, 2022. On admission, R1 was agitated. Staff evaluated resident and determined the need to transfer resident to hospital for further evaluation and management. On February 2, 2022, R1 was discharged back to the facility. Since then R1 had three fall incidents wherein R1 sustained skin tear. Staff evaluated the resident and administered first aid treatment when necessary, and placed resident under observation. On February 18, 2022 R1 had an unwitnessed fall. Staff evaluated the resident and determined the need to transfer resident to hospital for further evaluation and management. 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. LPAs Marin and De Perio conducted an exit interview with AD Dunagan and copies of this report were left in the facility. Page 2/2the state’s words, verbatim · CDSS document, Jun 2, 2022 · control 22-AS-20220222110011

Type of visit: Case Management - Other

Licensing Program Analysts (LPA) Celine De Perio and Albert Marin conducted an unannounced visit to facility and met with Administrator (AD) Dwight Dunagan. In this visit, during file review, LPAs De Perio and Marin observed that staff 1 (S1) has an expired Basic Life Support (BLS) certification. Certification issue date was on 4/21/2020, and renewal date was on 04/2022. First-Aid certification also was not found in S1's files. LPA De Perio and LPA Marin discussed with AD Dunagan CCR Section 87411 (c)(1). No citation was issued during this visit. LPAs De Perio and Marin conducted an exit interview with AD Dunagan.the state’s words, verbatim · CDSS document, Jun 2, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Andrea Mendivil conducted an unannounced case management visit to follow up on an incident report dated 04/19/2022. LPA was greeted and granted entry into the facility and explained the reason for the visit to Dwight Dunagan, Administrator and Ashley Guerra RN, Director of Health Services. Incident report indicated Resident 1 (R1) had an un-witnessed fall on 04/15/2022. At 12:00pm R1 was found on the floor by LVN Melinda Smith. Nursing was notified and assessment was conducted. R1 had pain above the knee. X-ray was performed in house and results were shared with R1 physician and family. R1 family elected to have R1 placed on hospice care. Hospice visits twice a week and as needed. During the visit LPA reviewed LIC 602, Hospice admission form and staff list from 4/15/2022. No deficiencies noted during today's visit. An exit interview was conducted and a copy of this report was left at the facilitythe state’s words, verbatim · CDSS document, Apr 28, 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) Dwight Dunagan and stated the purpose of this visit. The facility is a single level structure and licensed for 42 non-ambulatory and with hospice waiver for 18. For this visit, there was one resident under hospice care. About 11:00 AM, LPA Marin was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedure. LPA toured the interior and exterior portions of the facility. LPA observed posted activities and menu in common areas. LPA observed about ten residents in participating in the morning activities with staff members on the floor. There were 18 private and 31 shared resident's rooms. Rooms were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke alarm and sprinkler system were last inspected in September 2, 2021 by a contracted company; and systems were tested to be operational. LPA randomly observed carbon monoxide detectors present in resident's rooms and tested to be operational. Alert or call system in Rooms 4 and 30 were tested and observed to be operational. Staff members came in within about two minutes to reset the system. Bathrooms were observed to be in good repair; and provided with handrails and non skid floor surfaces Hot water was measured between 110 - 115 degrees Fahrenheit. Kitchen appeared clutter free. LPA received and reviewed the copy of the Dietitian Report issued last February 16, 2022. Facility met the minimum two-day perishable and seven-day non-perishable food stock requirements. Medications are stored in the medication room. Cleaning and laundry supplies were rendered inaccessible to residents in care. Fire extinguishers were mounted and charged. For the exterior portion, facility had outside furniture in good repair. Delayed egress doors and auditory exit alarms were tested to be operational. Facility vehicle was inspected and observed to have fire extinguisher and first aid kits in place. 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 advised AD Dunagan to use the general email address:CCLASCPOrangeCountyRO@dss.ca.gov LPA Marin conducted an exit interview with AD Dwight Dunagan and copy of this report was left in the facility.the state’s words, verbatim · CDSS document, Feb 17, 2022