Pacific Coast Care Homes

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melissa Parks arrived on Monday September 18, 2023 to conduct the unannounced annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed resident (5) and staff files (3). All resident files contained the required paperwork. All staff files contained the required paperwork and training. First aid kit was fully stocked. Facility had a full supply of PPE including face shields, surgical masks, N95s, and gowns. Facility was clean and well organized. Facility is current on fire drills. All required posting were observed. LPA Parks and staff Alex toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, common areas, and backyard. In the areas toured, there were no health or safety violations observed. No deficiencies cited. Exit interview conducted. A copy of this report was emailed to the facility.the state’s words, verbatim · CDSS document, Sep 18, 2023

Allegation investigated: Incomplete medication training for staff unsecured gun on premises

LPA Parks arrived on Tuesday December 27, 2022 to conclude a complaint investigation regarding the above allegations. Prior to the visit, 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; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Throughout the course of the investigation, LPA interviewed the Licensee and staff. LPA obtained medication training records. LPA was able to determine that staff have sufficient medication training. Additionally, while the Licensee's husband does have a gun, it is kept in a locked case and in a seperate living quaraters inaccessible to residents and staff. Unfounded Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. A copy of this report was left at the facilitythe state’s words, verbatim · CDSS document, Dec 27, 2022 · control 25-AS-20220927075627

Type of visit: Case Management - Other

On Thursday October 27, 2022, Licensing Program Analyst (LPA) Melissa Parks conducted a case management visit to the facility for the purpose of delivering an Order to Individual of Immediate Exclusion from all facilities and the Order to Licensee/Facility of Immediate Exclusion from Facility. Prior to initiating the visit, 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. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95. LPA completed the facility screening questionnaire. LPA Parks spoke with Administrator Maria Zaidi on the phone and explained the purpose of today's visit. Maria explained that this employee was terminated from this facility in July 2021. Maria gave permission for staff Oscar to sign this report. Sa A Tuli, Staff Person is excluded as of this date 10/27/2022. LPA Parks handed the Order to Licensee/Facility of Immediate Exclusion from the Facility and explained that staff person Sa A Tuli cannot be allowed to work, be present and/or live in a Community Care Licensing (CCL) licensed facility or have contact with clients in any residential facility or child day care licensed by the California Department of Social Services. Exit interview conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 27, 2022

Allegation investigated: Staff living in garage

LPA Parks arrived on Wednesday October 5, 2022 to open a complaint investigation regarding the above allegation. Prior to the visit, 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; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. LPA spoke with Maria over the phone regarding the allegations. LPA interviewed the staff who were on shift at the facility. As LPA and Staff Oscar were entering the garage, LPA observed a staff member, later identified as Alex, leaving the garage. LPA observed the following items in the garage: full bed, dresser, shoe rack filled with shoes, personal items, additional bedding, dresser filled with clothes, television, hats, and various food/drink. Based on observation, LPA has concluded that the allegation is true. Substantiated As a result of this investigation, the Department finds the allegation to be Substantiated. A finding that the complaint is Substantiated means that the allegation are valid because the preponderance of the evidence standard has been met. Deficiency is cited on 9099-D, per Title 22 Regulations, Division 6. Exit interview conducted. Appeal rights were given. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 5, 2022 · control 25-AS-20220927075627

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Oct 6, 2022

Fire Safety 87203: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met based on evidence of a livable space including furniture and personal belongings of staff living in the garage.the state’s words, verbatim · CDSS document, Oct 5, 2022

Plan of correction: Licensee to provide photographic proof that garage is no longer being used as a bedroom for staff

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: Required - 1 Year

LPA Parks arrived on Monday August 15, 2022 to conduct the annual inspection. Prior to the visit, 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; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. LPA was screen prior to entry into the facility. LPA and Administrator Maria completed the infection control domain together and facility was found to be in substantial compliance at this time. LPA and Administrator toured facility together to ensure health and safety of resident in care. LPA requested updated copies of LIC500, LIC610, and current liability insurance to be faxed to LPA by end of the month. No deficiencies are being cited as a result of todays inspection. Exit interview conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 15, 2022

Allegation investigated: Resident's care needs not being met.

Licensing Program Analyst (LPA) Konnor Leitzell arrived at the facility unannounced on 8/31/2021 to deliver findings for a complaint Community Care Licensing (CCL) received on 6/4/2021 which alleged that “Resident's care needs not being met”. LPA met with Nited (Denisse) Perea (Administrator) and explained the purpose of the visit. Prior to entering, 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPA was screened by staff and answers were documented in their visitor screening log. CONT LIC9099C Unsubstantiated Throughout the course of the investigation, CCL conducted interviews, toured facility, and reviewed documents. Interviews were conducted with Staff, Administrator, Residents and R1’s Responsible Party (RP). When receiving the complaint, CCL was informed resident calls out for help and no one assist, and that their incontinence care needs are not being met. Through interviews conducted, it was stated R1 would be routinely checked on roughly every twenty (20) minutes, as all residents are. It was also stated when R1 would call out for help, staff would assist R1 with their needs if not immediately, then within five (5) minutes. Interviews with resident’s stated the care staff treat them well, going on to state staff provide good care to facility residents. LPA noted when reviewing document, R1 did have incontinence care needs along with other ADL’s that were to be performed by the facility. Documents provided indicate R1 had Home Health come in as well to assist with physical therapy. When at facility conducting facility tours, LPA Leitzell noted care staff continuously monitoring residents and assisting residents with their care needs. LPA failed to see any residents go unattended or neglected during facility visits. Through interviews conducted, documents reviewed, and facility visits performed; CCL finds the allegation of Resident’s Care Needs Not Being Met to be UNSUBSTANTIATED. A finding that the 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. There are no deficiencies being cited per Title 22 Regulations, Division 6, Chapter 8. Exit interview conducted. A copy of this report was left at facility for review. Through the course of the investigation, CCL conducted interviews, toured facility, and reviewed documents. Interviews were conducted with Staff, Administrator, Residents and R1’s Responsible Party (RP). When receiving complaint, it was stated admin takes days to respond to phone calls; and the request to provide transfer documents had not been provided. Through reviewing documents provided, CCL was able to determine that Admin provided transfer documents to future facility on the same day as written request was provided via text. In addition, documents provided indicated admin did not forgo any messages from R1’s RP, and conducted a total of three (3) successful phone calls between 5/17 and 6/4. Interviews conducted with admin further indicated facility complied with resident’s POA’s requests, and did so in a timely manner. During interview conducted with staff regarding residents accessibility to the home telephone, CCL was informed that the facility has a cordless telephone that is used often by residents. Staff informed CCL that when resident’s receive a phone call, staff will answer and provide the resident with the phone. Staff indicated they assist with telephone calls when needed, but gives resident’s privacy. Further interviews indicated when residents request to make a call, and the phone is available they provide it to them, assisting with dialing the numbers occasionally. Based on information obtained, CCL finds the above allegation to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted. A copy of this report was left at facility for review.the state’s words, verbatim · CDSS document, Aug 31, 2021 · control 25-AS-20210604114111

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Konnor Leitzell arrived at the facility unannounced on 08/19/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with Nited (Denisse) Perea (Administrator) and explained the purpose of the visit. Prior to initiating the annual 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; contacted admin and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPA was screened by Denisse and answers were documented in their visitor screening log. LPA and Denisse toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, five (5) of five (5) resident bedrooms, three (3) of three (3) bathrooms, kitchen, laundry room, garage and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. Admin contacted Maria Zaidi (Licensee) via facetime, and LPA, admin and licensee completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Aug 19, 2021