Lakeside Senior Living of Granite Bay

Type of visit: Collateral

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct a collateral visit. LPA met with caregiver during today's visit and they informed administrator of LPA's visit. LPA arrived today to interview a resident concerning an issue that was not related to this facility. In the areas that were evaluated, no deficiencies were observed at the time of the visit. Exit Interview conducted.the state’s words, verbatim · CDSS document, Aug 23, 2023

Allegation investigated: -Staff is financially abusing resident in care.

Licensing Program Analyst (LPA) Angela Hood arrived unannounced on July 18, 2023, to complete and deliver findings to a complaint received on 7/5/2023. LPA met with caregiver and explained the purpose of the visit. LPA spoke with Administrator, Adriana, by phone. Administrator indicated that caregiver can sign report. Throughout the course of the investigation, LPA Parks interviewed the Administrator and R1. LPA Parks reviewed R1’s banking transaction history with the Administrator and the Ombudsman. LPA Parks learned that R1 moved into this facility on 2/2/2023. Prior, R1 lived at another residential facility in Rocklin. While at the previous facility, the owner held possession of R1’s banking card. Fraudulent charges began on 2/8/2023, showing repeated charges including rideshare companies and restaurants. These transactions began from 2/8/2023 – 7/3/2023 until the current Administrator noticed fraudulent changes and notified R1’s banking institution. ***************************************Continued on LIC9099C************************************************* Unfounded The fraudulent charges totaled $4,577.73. Due to these charges, R1 was unable to make their rent requirement of $1,100 per month at their current facility. LPA Parks was able to verify that these fraudulent charges were not done by any staff at R1’s current facility. The Administrator has since filed a police report due to the fraudulent charges. A complaint will be drafted for R1’s previous facility regarding staff financially abusing a resident. Based on the evidence provided, the preponderance of evidence standards was not met, therefore, the above allegation is 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 provided.the state’s words, verbatim · CDSS document, Jul 18, 2023 · control 59-AS-20230705092044

Type of visit: Required - 1 Year

LPA Parks arrived on Monday June 12, 2023 to complete the unannounced annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed resident (6) and staff files (2). All resident files contained the required paperwork. Staff files contained the required paperwork and training. LPA Parks and Administer Adriana toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, garage, and outdoor area. Water temperatures in kitchen and bathrooms were within the required range of temperatures. Facility has a fire extinguisher with a current inspection. First aid kit is fully stocked. Facility meets the perishable and nonperishable food requirements. In the areas toured, there were no health or safety violations observed. Exit interview conducted. A copy of this report was emailed to Facility.the state’s words, verbatim · CDSS document, Jun 12, 2023

Type of visit: Required - 1 Year

On August 17, 2022, at 8:30am, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived to conduct a 1 year required annual inspection. LPA met with the licensee, Adriana Lordoache-Stir, and explained the reason for the visit. 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, 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 staff upon arrival. Currently, the facility has 6 residents residing in the home. The home was 76 degrees F. LPA and Adriana completed the Infectious Control Questionnaire with no issues or concerns to report. LPA Observations:. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food. There’s appropriate lighting throughout the facility. First aid kit was present and complete. Fire extinguisher is maintained and ready for emergency use. The sink, toilet, bathtub and shower operate properly. Washer and dryer was present and operating properly. Toxic substances, laundry and cleaning supplies are inaccessible. There’s a centralized storage area for resident’s medication. Medication cabinet was locked. The facility Medication Administration Record was reviewed as well as the dispensing log and was complete and current. To continue see 809-C... Living room, dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident bedrooms and bathrooms were toured. There are 5 Bedrooms and 2 bathrooms for residents. All rooms had the required items of furniture. Window screens were on and in good repair. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mats. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610E the Emergency Disaster Plan, and copy of your current Liability Insurance to update the facility file in our Regional Office. Administrator shall submit the listed documents to Licensing no later than September 17, 2022. Exit interview conducted and a copy of this report was given.the state’s words, verbatim · CDSS document, Aug 17, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst’s (LPAs) Konnor Leitzell and Michael Hood arrived at the facility unannounced on 8/5/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPAs met with Adriana Stir (Administrator) and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs 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 licensee and completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPAs was screened by Adriana Stir and answers were documented in their visitor screening log. LPAs and Admin toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, four (4) of four (4) resident bedrooms, one (1) of one (1) staff room/office, three (3) of three (3) bathrooms, kitchen, garage, laundry room and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and admin completed the infection control domain and facility was found to be in substantial compliance at this time. LPAs are requesting the following documents to be submitted to Community Care Licensing (CCL) by COB 8/13/2021 via email at konnor.leitzell@dss.ca.gov: Personnel Report (LIC500); Designation of Administrative Responsibility (LIC308); Affidavit Regarding Resident Cash Resources (LIC400); Surety Bond (LIC 402); Administrator certificate ; Partnership Agreement; Articles of Incorporation; Control of Property; Limited Liability Insurance; and Neighborhood Complaint Policy. 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 5, 2021