Majestic Care Villa

Allegation investigated: / Staff did not seek timely medical attention for resident. 2/ Resident was not regularly observed for changes in condition.

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced inspection visit to deliver findings in the investigation of the allegations stated above. LPA was greeted and granted entry by Robert and Gaile Aquino, caregivers after explaining the purpose of the visit. Administrator was notified by phone and arrived later to assist with the visit. It was alleged that Staff did not seek timely medical attention for resident and Resident was not regularly observed for changes in condition. During course of the investigation, the Department interviewed staff and witnesses as well as reviewed and obtained pertinent documentation. Regarding the allegations that staff did not seek timely medical attention for resident and Resident was not regularly observed for changes in condition the following was concluded: A review of the records and interviews concluded Resident 1 (R1) sustained a fall incident on 07/18/2020 which resulted in a hospitalization with a diagnosis of a closed hip fracture which was not surgically addressed due to an unfavorable risk assessment made by the health care providers at the time. CONTINUED ON FORM LIC9099-C Unfounded After the fall incident, medical records obtained confirm R1 was seen at least once every four weeks by their attending physician, as documented in visits dated 07/14/2020, 08/25/2020, 09/03/2020, 09/17/2020, 10/01/2020, 11/10/2020, 12/07/2020 and 12/29/2020. Monitoring of R1's skin condition is documented on each report and confirms the absence of sores or decubiti injuries until report dated 01/28/2021. Per medical records obtained, R1 was documented as having a newly occurred wound on the lower right posterior leg, followed up by a consultation on 02/03/2021 due to the wound worsening. Following the medical assessment of the wound in late January/early February 2021, a referral for a wound care intervention was put into motion. Surveillance notes obtained from the wound care specialists note that caregivers reported that the wound occurred in January of 2021 and showed no progress since onset. The wound specialist notes further indicate that the wound incidence is “unavoidable due to Advanced Age; Decreased mental awareness; Fragile skin; Friction; Immobility or limited mobility; Medical Comorbidities; Vascular Factor.” Resident was attended by home health regularly in addition to bi-weekly wound care continuously after that initial referral. Complete progress notes were obtained with detailed monitoring of the resident's condition throughout by a Home Health agency. Hospital records obtained dated 7/25/2022 show that R1 was hospitalized after the Home Health agency noted R1 had an altered level of consciousness. While at the hospital R1 was diagnosed with necrotizing fasciitis of the right vulva extending to the right inguinal region requiring surgery for debridement. At the time of incident R1 had a foley catheter in place which was being monitored by R1’s Home Health agency. Although documentation obtained reveals R1 sustained a wound while in care, records obtained confirm facility staff ensured R1 received regular treatment for wound from Home Health Agency and sought medical treatment the same day Home Health nurses noted R1’s altered level of consciousness. Two of two staff interviewed confirmed R1 was receiving services from skilled medical professionals while at the facility. R1 was unable to be interviewed at the time of investigation due to being on a ventilator. Based on the evidence gathered during the investigation, the allegations Staff did not seek timely medical attention for resident and Resident was not regularly observed for changes in condition are deemed to be unfounded, meaning the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted with the facility representative and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Nov 7, 2022 · control 22-AS-20220804103041

Type of visit: Required - 1 Year

On 08/01/2022 at 11:00am, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection centered on Infection Control measures. LPA arrived at facility, was greeted and granted entry by Robert Christian Aquina, caregiver after explaining the purpose of the visit. Administrator Miguelito Fajardo was also present to assist with the visit. At approximately 11:10am, LPA accompanied by Administrator toured the physical plant of the facility. LPA observed a check-in station where visitor temperatures are being documented. There are currently four (4) residents in care, one (1) of which is receiving hospice care. Residents are observed relaxing in the common areas or in their bedroom and appear clean and well taken care of. The five (5) bedrooms include all necessary components. The resident on hospice is observed to have full bed rails while another resident's bed is equipped with half rails for postural support. No written order for the support is present in the resident's file. LPA issues a Technical Advisory requiring the licensee to obtain the written order in question. Bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected. Sharp instruments are stored in a kitchen drawer, however the magnetic lock is observed to be non-functional. LPA observed a sufficient supply of food and water. A 30-day supply of medication is centrally stored and locked in a cupboard. Cleaning supplies are located in the locked laundry room. During the visit however, the door leading to the laundry room was observed to be unlocked, as was the cabinet where cleaning chemicals are stored. LPA observed the facility has COVID-19 Precautions posters and all required department postings as well as hand-washing signs in the bathrooms. Facility has an approved LIC808 Mitigation Plan on file. LPA provides consultation with licensee on the requirement to submit an updated Infection Control Plan to the Department. Facility has an adequate supply of PPE. Fire extinguishers are observed to be operational and charged. CONTINUED ON FORM LIC809-C CONTINUED FROM FORM LIC809 Staff present is adequately associated in Guardian. LPA toured the outside of the facility and observed it to be free of obstructions. The perimeter gate is self-latching and can easily be opened in an evacuation. There are no bodies of water on the premises. Based on the observations made during today’s visit, one (1) type B deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report along with appeal rights was provided and left at facility.the state’s words, verbatim · CDSS document, Aug 1, 2022

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Jenifer Tirre visited this facility for the purpose of conducting a Pre-Licensing evaluation. Facility is a single story residential home. LPA along with Administrator Miguelito "Bing" Fajardo toured facility. Fire clearance approval was received on 07/06/21. Structure: Facility is a one story, 6 bedroom (5 Residents bedrooms and 1 live in staff bedroom) 2 bathroom house with no garage and a gray exterior. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms meet Licensing requirements. Bathrooms: All resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars and non-skid surface in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan posted on wall. Food Service: Facility has 2 day perishables as well as 7 day non-perishables in the pantry/ refrigerator, as well as emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Fire extinguisher is mounted and charged. Facility has 2 extinguishers. Facility has audible alarms on all sliding/exit doors. Appliances: Electric Stove and refrigerator are operational. Toxins: LPA observed toxins secured in laundry storage area.. Water Temperature: Tested and recorded at 114.9 degrees F. in facility bathrooms. Reading Material Games, and Equipment: facility does exercises, puzzles and trivia card games. Medications, First-Aid Kit & Book: Facility has first aid kit present at the facility. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on both sides of facility as required. LPA observed shaded outdoor seating. CONTINUED ON LIC 809C Administrator's Certificate observed on wall expiring March 9,2023. Component III Orientation was waived during this pre-licensing visit due to Administrator presently operating several facilities. No deficiencies noted during todays visit. The pre-licensing visit has been completed. This location is ready for licensure. An exit interview was conducted with Administrator and a copy of report was left at facilitythe state’s words, verbatim · CDSS document, Sep 22, 2021

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): 6 COVID Mitigation Plan discussed? Yes Method: Telephone call with CAB COMP II Participants: Administrator/ Licensee Miguelito Fajardo Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Aug 9, 2021