Rock Creek Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with administrator Carmen Balint during today's inspection. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks. LPA toured facility with administrator to ensure health and safety of residents in care. LPA toured 6 resident rooms, 1 staff room, 2 bathrooms, kitchen, common living spaces, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. Administrator stated there has been no positive COVID cases at the facility, but have an isolation room and sufficient amount of PPE. LPA toured the backyard and all exits are accessible and unlocked. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed an adequate amount of linens and found the first aid kit to be complete. LPA reviewed 2 of 4 resident files and 2 staff files. LPA reviewed medications of two residents comparing with Centrally Stored Medication Record and physician orders. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates and training completed. LPA observed a copy of current liability insurance. No deficiencies are being cited as a result of todays inspection. Exit interview conducted.the state’s words, verbatim · CDSS document, Jan 11, 2023

Allegation investigated: Facility locking residents in facility Administrator Qualifications

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint investigation received on 10/28/2022. LPA met with Elenora Latu, and Sashauna Smith, caregivers, who contacted Administrator, Carmen Balint, who arrived at approximately 1:30 PM. LPA observed (1) resident to be in the common area and (3) residents to be napping or watching television in their rooms. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols and was wearing a surgical mask and was screened per Covid-19 precautionary measures upon entering the community. During the course of the investigation, LPA interviewed Co-Administrator, Carmen, (1) Administrator Designee, (3) residents, hospice nurse and a family member of resident (R2). LPA also observed the locking mechanism on the sliding glass doors and on the kitchen drawer used for sharps. LPA reviewed documentation related to the 9-1-1 call made on 10/28/22, the approved fire clearance with facility sketch, and for residents (R1 and R2). The investigation findings are as follows: cont on 9099C(1).. Unfounded Allegation: Facility locking residents in facility. Complaint alleges that Fire Crew observed a dead bolt lock on the front door that required a key to open from the inside, locking residents in the facility. LPA reviewed a report from local authorities, dated 10/28/22. which includes a photo taken of the inside of the front entrance door showing that a skeleton key type lock had been installed on the door frame and a photo of the key that was kept in a nearby drawer. On 10/28/22, LPA took photos of the facility front door showing a small hole on the right side of the door frame where an additional lock was installed. Administrator stated that she had just installed this additional lock because the door would not close properly. On 12/15/22, LPA observed the hole on the door frame to have been filled and only (1) lock to be in place on the front door that is able to be unlocked from the inside without a key. LPA took a photo. Administrator stated to LPA on 12/15/22 that prior to receiving the facility license, the fire department approved the front entrance door as an entrance only and required (3) additional interior doors as well as (2) additional glass sliding doors to be installed to be in compliance with fire code. LPA observed exit signs posted above each glass sliding door (3) and also posted in each resident room indicating the exit route to be used to exit through the glass doors. LPA also observed an exit sign above the inside of the front entrance door. On 12/15/22, LPA observed each glass sliding door to not have a locking mechanism in place and to be able to be opened easily. Administrator stated the doors have always had this specific non-locking mechanism. LPA interviewed resident (R1), who was awake during the early morning hours on 10/28/22 when 9-1-1 was called. R1 stated he has never had difficulty opening the glass sliding door in the common area from either the inside or outside patio area of the facility. There were no additional ambulatory residents able to be interviewed. Administrator Designee stated on 12/15/22 that the front entrance door at the facility is "always unlocked from the inside and always locked from the outside". The Administrator stated on 12/15/22 that the glass doors are "never locked" from the inside or outside and the doors have "always worked this way", asserting "the front door was "not considered an emergency exit" when fire issued their facility clearance during the licensing process. Fire clearance documentation shows the facility was approved for (6) non-ambulatory residents on 11-28-2017 and shows (4) designated or approved exits. R1 stated to LPA that he is always able to open the glass door and it has "never been a problem", but he was not able to open the front door when 9-1-1 arrived on 10/28/22. LPA observed R1 to be able to ambulate without any assistive device. cont on 90099C(2).. 9099C(2)..Based on information obtained during the investigation that there were/are (3) additional designated unlocked exits, LPA finds the allegation to be UNFOUNDED- meaning that the allegations are false, could not have happened and/ or is without reasonable basis. An Advisory Note is being issued today. Allegation: Administrator Qualifications. Regulation 87405 Administrator - Qualifications and Duties, was reviewed. LPA confirmed that the Administrator of record, Pavel P. Balint, has been a certified Administrator since on/around 2016 and holds a current RCFE Administrator Certificate- # 6043137740 with an expiration date of 1/8/2023. Administrator, Carmen, stated the renewal paperwork was recently submitted to the Department. There is a second Administrator, Carmenuta "Carmen" D. Balint, who has a current RCFE Administrator certificate- #6036317740- exp 8/13/2023. Carmen indicated she has been a certified RCFE Administrator since on/around 2015. LPA confirmed that Administrator has (3) current Administrator Designees in place. LPA spoke to one Designee on 12/15/22 when she arrived at the facility before Administrator arrived for the inspection. Administrator stated she is aware of her responsibilities of being an Administrator, including but not limited to, complying with all licensing requirements and regulations and if she isn't sure, she will contact CCLD for additional guidance. Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegations are false, could not have happened and/ or is without reasonable basis. Exit interview. Copy of report provided to facility. 9099A-C(2).. LPA observed a kitchen drawer with both sharp knives and non-sharp or table knives to have a magnetic locking mechanism in place on 10/28/22 and on 12/15/22. LPA did not observe any sharp knives or other sharps to be unlocked in the kitchen or other areas of the facility during both inspections. LPA reviewed R1's current physician's report, dated 8/2/22, which notes R1 has a diagnosis of Parkinson's Disease, muscle weakness, Pneumonitis, and cognitive communication deficit. The physician's report does not indicat that R1 has Mild Cognitive Impairment (MCI) or Dementia. Administrator stated that sometimes R1 is forgetful and confused. Administrator stated that residents will use a table knife only during meals. LPA asked R1 if he can access sharp knives that are kept in a drawer in the kitchen. R1 stated he "doesn't know where everything is kept and if he did, he is not sure of what kind of locking system there is in place". LPA reviewed a report dated 10/28/22 written by local authorities. The report notes resident (R1) "was standing in the kitchen using a knife to cut an apple" when 9-1-1 arrived at approximately 01:05 hours . The fire report for the same incident indicates that fire personnel took the knife away from R1 when he was observed to be using it to cut an apple and after he stated he wasn't "allowed to have a knife". The report does not specify what kind of knife R1 was using and LPA was unable to confirm this information with fire personnel. R1 and Administrator stated R1 and resident R2 were the only ones awake when 9-1-1 was called on 10/28/22, while the local authorities report that there were (3) residents awake. R2 passed on/around November 2022 and was not able to be interviewed during a follow up inspection on 12/15/22. LPA was able to interview (1) additional resident (R3) who indicated he was asleep when 911 arrived and (1) other resident (R4) who stated the lights woke her up but she was unable to get out of bed. Administrator stated that sharps are always locked up and she was at the facility until 11:00 pm on 10/27/22 and is certain there were no sharps or sharp knives left out in the kitchen unlocked. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that a complaint allegation is unsubstantiated means 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. Exit interview. Copy of report left at facility.the state’s words, verbatim · CDSS document, Jan 4, 2023 · control 25-AS-20221028101128

Allegation investigated: Uncleared staff working at facility Facility not providing night supervision Facility not providing care and supervision to residents

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct 10-day inspection. LPA met with Paulette Barnett, caregiver, who contacted Administrator, Carmen Balint, who arrived at approximately 1:30 pm. LPA observed a second caregiver, Tiffany Phillips, washing dishes in the kitchen. LPA observed (3) residents to be watching television in the common area. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols and was wearing a surgical mask. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. During today's inspection, LPA interviewed Administrator, (5) residents, a family member of resident a resident (R1) and a nurse who provides care to resident (R1). LPA also reviewed all (6) resident binders, (2) staff binders and (2) Administrator binders. LPA observed all files to be organized and contain up to date documentation, including for trainings. The results of the investigation are as follows: cont on 9099C(1).. Substantiated 9099C(1). Allegation: Uncleared staff working at facility. LPA reviewed Department records confirming (2) Administrators and staff (S1) who was working on 10/27/22 and today are cleared and associated to the facility. LPA reviewed documentation showing that staff (S2) had her fingerprints taken yesterday, 10/27/22, just prior to starting to work at the facility. Administrator stated that a fingerprint clearance has not been received yet for S2. LPA observed S2 working at the start of today's inspection. Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Allegation: Facility not providing night supervision. Complaint states that on 10/28/22 at approximately 12:49 am, crew from the local fire department responded to a 9-1-1 call and entered the house, because no one responded by opening the front door. Crew was calling out throughout the facility searching for staff. Fire Crew finally was able to locate 2 staff (S1 and S2) sleeping in a room. LPA interviewed residents (R1 and R2) who stated both stated that resident R1 needed assistance with toileting on 10/28/22 at approximately 12:45 am and was calling staff for help, but there appeared to be no one available to help R1. Administrator confirmed that she was at the facility on 10/27/22 until approximately 11:30 pm that day and had left shortly before R1 got up to use the restroom. Both R1 and R2 stated R1 had been calling for staff to assist for quite a while, approximately 15 minutes. The fire department crew had to enter through the back doors and window because no one answered the door. When fire department Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. cont on 9099C(2)... 9099C(2).. Allegation: Facility not providing care and supervision to residents. LPA interviewed residents (R1 and R2) who stated both stated that resident R1 needed assistance with toileting on 10/28/22 at approximately 12:45 am and was calling staff for help. Both residents also confirmed that resident R2 called 9-1-1 for assistance in helping R1 since there appeared to be no one else available to help R1. Administrator confirmed that she was at the facility on 10/27/22 until approximately 11:00 pm that day and had left shortly before R1 got up to use the restroom. R1's family member stated that R1 has not been sleeping well since recently moving to the facility and also has a faint voice and staff may have not heard him asking for help. R2 stated R1 had been "screaming for help" to assist for quite a while, approximately 15 minutes, but staff were sleeping. Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (3) deficiencies and civil penalty is is cited on the 9099 page. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 28, 2022 · control 25-AS-20221028101128

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87412(a)(13)(B) · Plan of correction due date: Oct 31, 2022

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:(13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). This requirement is not met as evidenced by: Based on documentation reviewed and interviews conducted, the LIcensee did not ensure that staff (S2) was fingerprint cleared and associated to the facility, prior to beginning to work, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 28, 2022

Plan of correction: LIcensee/Administrator already requested that staff S2 complete her fingerprints. Licensee/Admin is waiting for the results and will forward them to us when you. Licensee/Administrator agree to read Regulation 87412 and submit a statement of understanding to the Department by 10/31/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87415(a)(1) · Plan of correction due date: Oct 31, 2022

87415 Night Supervision (a) The following persons providing night supervision from l0:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services and shall be available as indicated below to assist in caring for residents in the event of an emergency.This requirement is not met as evidenced by: Based on interviews conducted, the LIcensee did not ensure that there was staff that was awake or on call, and able to respond to resident's (R1) call for assistance, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 28, 2022

Plan of correction: Licensee/Administrator agree to move the call light system and place it in the caregiver room and also instruct residents to call the caregiver for help instead of 9-1-1. Documentation that call light system/monitor has been moved to caregiver's room by 10/31/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Oct 31, 2022

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on interviews conducted, the Licensee did not ensure that staff provided assistance to resident (R1) on 10/28/22 at approximately 12:45 am, when he called for assistance in the bathroom, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Oct 28, 2022

Plan of correction: Licensee/Administrator agree to move the call light system and place it in the caregiver room and also instruct residents to call the caregiver for help instead of 9-1-1. Documentation that call light system/monitor has been moved to caregiver's room by 10/31/2022.

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On November 4, 2021, Licensing Program Analyst, LPA DeAnna Williams-Lyons arrived unannounced to conduct a required annual inspection. LPA met with Carmen Balint, Administrator and informed her the reason for the visit. Prior to initiating the inspection LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: mask. Additionally, LPA was screened by the front desk personnel upon arrival. LPA completed the inspection tool questionnaire with Carmen no issues or advisories to report. LPA observed the following: This is a 7 bedroom 2 bathroom home. Administrator certificate is valid and expires 8/13/2023. First aid kit fully stocked and ready for emergency use. Fire extinguishers fully charged. Smoke alarms and Carbon Monoxide detector are working Hot water temperature measured 107 degrees F. Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has required (2) day perishable supply of food and (7) supply of non-perishable food. Medication was properly stored and locked away. There are no bodies of water on the premises. To continue see 809-C... As a result of this visit, no deficiencies were cited, per Title 22 Regulations, Division 6. 10 Administrator shall submit the following documents to update the Regional Office files The following shall be updated and submitted to Community Care Licensing by 12/04/2021: -LIC 500 facility personnel or staff schedule -LIC 610 emergency disaster plan -LIC 308 designation of administrative responsibility -copy of liability insurance -updated facility sketch Exit interview conducted and a copy of this report given to Carmen Balint.the state’s words, verbatim · CDSS document, Nov 4, 2021