Haven for Mom & Dad 1

Allegation investigated: Facility is violating resident’s personal rights

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of delivering findings into the investigation of the allegation listed above. LPA was greeted and granted entry by caregiving staff after explaining the purpose of the visit. Administrator Rhoda Calma was notified via telephone and arrived shortly afterwards to assist with the visit. The initial complaint investigation visit was conducted on May 16, 2023. LPA accompanied by administrator conducted a tour of the physical plant, reviewed resident files for three of the current residents and attempted or conducted interviews with all six resident present at the time of the visit. LPA additionally conducted an interview with facility administrator along with an interview with one caregiving staff member. Additional phone interviews conducted on May 24, 2023 CONTINUED ON FORM LIC9099-C Unsubstantiated CONTINUED FROM FORM LIC9099 Regarding the allegation that Facility is violating resident’s personal rights, the following has been concluded: The resident's right to receive visitors is being respected as confirmed by a review of the facility's visitation log for a period from October 23, 2022 until May 16, 2023 showing a diversity of visitors allowed into the facility at times generally within recommended visitation hours but also later than 6pm on occasion. The resident's health condition was corroborated by observation, records reviewed including notes from hospice staff and interviews conducted and appears fully consistent with accounts made of the necessity to respect the resident's sleep schedule and increased need for uninterrupted rest as evidenced by the resident's primary care physician as well as hospice staff. It was additionally confirmed that during a visit conducted after the recommended visitation hours that occurred on May 5, 2023, one of the facility staff member proceeded to monitor and film the visit in order to confirm orders regarding the resident's rest were being followed. When the visitors requested privacy, staff member complied and later apologized to the visitors. Additionally, the facility has obtained the permission to photograph the resident (outside of promotional purposes) upon signature of the admission agreement on March 28, 2021. Based on the investigation conducted, no violation of the resident's personal rights could be evidenced. The allegation is therefore deemed to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No citations issued during today's visit. An exit interview was conducted and a copy of this report was provided to facility representative.the state’s words, verbatim · CDSS document, May 24, 2023 · control 22-AS-20230510144030

Allegation investigated: Resident was denied visitation.

Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit to deliver findings on the complaint investigation. LPA met with and discussed the purpose of the visit with Administrator, Rhoda Calma. The department investigated the above allegation and the investigation consisted of interviews, observations, and documentation. Based on the interviews conducted, the investigation revealed that resident 1 (R1) received visitors in the facility. Visitors were granted entry after completing Covid 19 screening. Visitors were directed to visit in the outside patio area designated for visitation. During Visitation, a family member was contacted regarding visitors for R1 at family’s request. The family member arrived at facility shortly after asking visitors to leave. While conducting a visit to the facility on 1/17/23 R1 was conversant and was able to express they wanted family to visit. Interviews conducted with staff revealed that three out of three staff state they have never denied resident’s visitation. CONTINUED ON 9099C. Unsubstantiated Interviews with family members revealed that Four out of Six family members expressed no issues with facility visitation, while remaining two of six family members claim their other family member is asking to be notified while R1 is being visited at facility. Due to the conflicting information obtained from various family members, staff and R1, 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, the allegation that resident was denied visitation is deemed UNSUBSTANTIATED. LPA Tirre conducted exit interview with Administrator Calma and a copy of this report was left in the facility.the state’s words, verbatim · CDSS document, Jan 25, 2023 · control 22-AS-20221018121747

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of conducting an Annual Inspection. LPA met with Administrator (AD) Rhoda Calma and discussed the purpose of the inspection. During the inspection, LPA and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, and garage and observed the following: During the inspection, LPA observed there were 2 staff present, wearing PPE. LPA observed 6 residents were present. LPA confirmed the residents were doing well and observed no health and safety issues. LPA inspected common areas, resident rooms, kitchen, and garage and observed they were clean and organized, and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed hallways and walkways were free of obstruction. LPA reviewed and confirmed facility policies and practices regarding resident screening, staff screening, visitation, COVID-19 surveillance testing, COVID-19 clearance testing, quarantine, isolation, cohorting, staffing, infection control/lead/training, PPE, staffing and staffing shortages, communication and emergency plan, and dementia. LPA requested and reviewed resident roster, staff roster, staff files, resident files, emergency plan, COVID-19 mitigation plan, and Infection Control Plan. LPA provided technical assistance regarding N95 Fit Testing and physical plant. There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.the state’s words, verbatim · CDSS document, Sep 15, 2022

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required annual inspection (mitigation). LPA was screened for symptoms of Covid-19 and granted entry. LPA explained the reason for the visit. LPA met with Administrator Rhoda Calma. LPA and Administrator toured the facility. Facility is a 2 story house with 5 bedrooms, 1 office and 6 bathrooms. Rhoda Calma's Administrator's Certificate expires 7/10/2023. LPA observed all resident bedrooms had the required furnishings and had enough space to accommodate the residents and their belongings. LPA observed all bedrooms were clean and organized. LPA observed all bathrooms were clean and operational. Smoke detectors/carbon monoxide detectors tested operational. LPA observed a 2 day perishable and 7 day non-perishable food supply in the kitchen. The kitchen is clean and organized. LPA observed knives and sharp objects are kept locked in a kitchen drawer. LPA observed medication kept locked in a cabinet. LPA and Administrator inspected the garage. The garage is kept locked and off limits to residents. The garage is used to store extra food and supplies. LPA and Administrator toured the backyard. LPA observed both exit gates are operational. No bodies of water observed. There is a covered patio and a sitting area with a table and chairs to sit outside. No obstacles or hazards observed in the backyard. Facility has submitted a mitigation plan that has been approved No deficiencies are being cited as a result of todays visit. An exit interview was conducted and a copy of the report provided.the state’s words, verbatim · CDSS document, Dec 2, 2021