Silvana Senior Care 4

Allegation investigated: Licensee did not provide comfortable living accommodations and privacy for the staff who resided in the facility

On 9/29/23, Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with caregivers to deliver investigation findings. Administrator arrived to assist LPA reviewed staff records and facility records. LPAs also conducted inspections and conducted interviews. LPA finds that facility met Tittle 22 requirements. The staff alleged to have not been provided reasonable living accommodations, no longer work at the facility. Phone contact to one staff was not responded to. An email for another staff mentioned was no longer active. R2, who has continually worked at the home was interviewed. The Department has conducted various inspections during the time the staff accommodations violations are alleged to have occurred. Inspections, records and interviews found that when staff have stayed at the facility for non-work times, they have been provided reasonable break and living accommodations. This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted and report provided. Unfoundedthe state’s words, verbatim · CDSS document, Sep 29, 2023 · control 59-AS-20230814143452

Allegation investigated: Residents are chemically restrained with medication Facility staff not fingerprint-cleared Staff are using drugs while on duty Facility staff are abusing residents

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to continue investigation into allegations listed above. LPA met with Krisztina Ivascu during today's inspection. LPA investigated allegation, "Residents are chemically restrained with medication". LPA reviewed 4 of 4 resident medications, comparing with physician orders. Administrator stated all medications are dispensed as ordered by the physician and medications are never given to chemically restrain residents. LPA interviewed 2 of 4 residents that were able to be interviewed, and residents reported they are given their correct medications daily. Due to the information gathered LPA finds allegation to be UNFOUNDED. Continuation on 9099-C. Unfounded LPA investigated allegation, "Facility staff are not fingerprint cleared". LPA reviewed staff files, and reviewed facility association list. LPA observed that all staff are associated to the facility roster, and have valid ID's. Due to information gathered, LPA finds allegation to be unfounded. LPA investigated allegation, "Staff are using drugs while on duty". LPA interviewed 2 caregivers and conducted a facility tour. LPA did not observe any illegal drugs or evidence of drug use. LPA interviewed caregivers on shift, and caregiver stated they have not used drugs or seen other staff members use drugs while on duty. LPA interviewed administrator in which she stated she has not had any staff use drugs while on duty. Due to information gathered LPA finds allegation to be UNFOUNDED. LPA investigated allegation, "Facility staff are abusing residents". LPA interviewed 2 caregivers and administrator and interviewed 2 residents in care. Residents stated they have not been hurt or abused by staff in any way. Residents reported they feel safe at the facility. LPA interviewed caregivers and administrator in which they stated they have not abused residents in anyway and they have not observed any other staff member abuse residents. Due to the information gathered, LPA finds allegation to be UNFOUNDED. The allegation is 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.the state’s words, verbatim · CDSS document, Jul 6, 2023 · control 59-AS-20230328165009

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with administrator Krisztina Ivascu 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 5 resident rooms, 1 staff room, 2 bathrooms, kitchen, common living spaces, backyard and the garage area. 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, 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 3 of 6 resident files and 2 staff files. LPA reviewed medications of one resident comparing with 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 completed and file drills are being completed. LPA observed a copy of current liability insurance. During today's inspection LPA observed S1 did not have their yearly training in 2022 completed. Deficiencies cited on 809-D. Exit interview conducted.the state’s words, verbatim · CDSS document, Apr 4, 2023

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: **Amended** Staff did not provide proper care and supervision to residents in care.

** Amended** Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 11/22/22 to deliver complaint findings. LPA met with caregivers and explained the purpose of the visit. Prior to initiating the complaint 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 completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility. Administrator arrived to assist with the visit The department reviewed client/resident records and conducted interviews and inspections. The department finds that the allegations cited above are substantiated. Substantiated ** Amended** Records reviews conducted 10/14/22 by LPA Mknelly for R1 found that R1 did not have a care plan documented. The facility only had a pre-appraisal on file. The pre-appraisal, from 11/10/21, identified R1 as experiencing Dementia with short and limited long term memory, is active with a use of a walker, occasionally needs assistance with transfers. R1’s physician report dated 11/2/21 notes Dementia with confusion and aggression at times. R1’s injuries, supervision level and strategies for her to move safely were not communicated to staff in a written care plan. Interviews with staff found that staff had a informal plan of attending to R1 (and they reported to engage with R1 often). However, the strategy by staff was to remind R1 to move safely and call for assistance as needed. R1’s poor memory was not accounted for in the plan and therefore did not address R1’s care and supervision needs. 87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed with Administrator . Copy of this report and appeal rights provided. ** Amended** The event of R1 found to have a medication still in their mouth following a medication time was an unusual event for that resident. LPAs observed staff to wash their hands and interview statements are that staff are disciplined in hand hygiene Residents alleged to be in soiled clothing for extended time was reported for a time when R1 was in the hospital. No additional incidents were found. Inspections found the facility odor free Staff interviews, records found notification of resident’s authorized representative of resident’s change in condition were regular and often. Interviews of residents did not support that staff do not respond to resident’s call for help Staff interviews and records reviews found that resident’s hygiene needs appear to be met. Allegations Resident sustained multiple injuries while in care and Resident sustained a fracture while in care found that R1 did, in fact, sustain injuries and a fractured wrist (3/27/22) while at the facility. However, the allegation, as written, does not attribute fault to staff care or lack of care. R1’s fracture was due a unwitnessed fall from bed as reported by R1 to staff. R1 stated that they informed staff of pain. Medical care was sought timely. R1’s other bruises and skin tears often were unwitnessed events when R1 was moving independently throughout the home. Therefore no violation is noted for these events at this time. As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint 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. Report provided. On 12/6/22, LPA emailed licensee amended report to licensee for signature to be in facility file reported outbreak but one did not occur at this residence during the period alleged. This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted and report provided.the state’s words, verbatim · CDSS document, Nov 22, 2022 · control 25-AS-20220520084919

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Dec 13, 2022

Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. This requirement was not met based on records review and interviews. This posed a potential risk to resident.the state’s words, verbatim · CDSS document, Nov 22, 2022

Plan of correction: Licensee will submit completed and current needs and services plan for all current residents in care (as of 11/22/22) by the POC date of 12/13/22.

Allegation investigated: Resident's personal rights violated.

LPA conducted interviews with residents and staff, reviewed records and conducted several inspections during this investigation. LPA finds that facility met Title 22 requirements and found no evidence that can prove that residents’ personal rights were violated. Based on interviews conducted by LPAs with facility residents, staff members and facility tour (03/17/22 and 04/19/22), the above allegation is found 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. We have therefore dismissed the complaint. Exit interview with Administrator. Unfoundedthe state’s words, verbatim · CDSS document, May 20, 2022 · control 25-AS-20220307135328

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.

Allegation investigated: Staff is not following public health mask requirement.

On 03/17/22, during interview with administrator, administrator stated that he was under the impression that with the new guidelines, fully vaccinated and boosted staff for Covid-19, were not required to wear a mask inside the facility. LPAs advised the administrator that this information is not correct and wearing of face mask still required inside the facility despite vaccination status and exemption. LPAs observed during 03/17/22 visit that staff were not wearing masks while caring for residents in care. Due to interview conducted with administrator and LPAs' observation during 03/17/22 visit, per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 809-D page. Exit interview was conducted with Administrator and a copy of this report and appeal rights were provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents. Substantiatedthe state’s words, verbatim · CDSS document, May 20, 2022 · control 25-AS-20220307135328

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87470(a)(5) · Plan of correction due date: May 27, 2022

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: During inspection conducted by CCLD on 3/17/2022, LPAs observed staff not wearing face masks while inside the facility, which poses a potential health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, May 20, 2022

Plan of correction: Administrator will conduct an in-service training for staff regarding COVID-19 precautionary measures, including proper face covering practices and screening. Facility will submit to LPA information regarding training, including time and date of training and training material, by POC due date 05/27/2022

Allegation investigated: Staff lack of care and supervision resulted in resident's unexplained injuries.

On 5/20/2022, Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analysts (LPAs) Talwinder Bains and Lavinia Muscan arrived at the facility and met with Administrator, Andrei Dumitriu, to conclude a complaint investigation into the allegation listed above. LPM and LPAs wore surgical masks and was screened by facility upon entry. Facility staff wore masks while on the premises. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: staff lack of care and supervision resulted in resident's unexplained injuries ** Report continued on 9099-C ** Unsubstantiated LPA conducted extensive interviews with residents and staff. LPA reviewed resident records. Based on facility records review for R1 and interviews conducted, it was found that R1 had not experienced any falls or any injuries while residing at the facility. The resident was admitted to the facility on 02/26/22 and was discharged from the facility 03/03/22 due to a change in condition. R1 was not identified as fall risk resident upon admission to facility on 02/26/22. From R1’s Medical Records review, it was also discovered that R1 was in the hospital multiple times prior to his admission to the facility due to his previous medical condition. Interviews indicated that R1 had a bruise on their hand at the time R1 was admitted to facility. LPA concluded that facility did not provide any actions which would harm or injured R1 while at facility. Based on interviews conducted by LPAs, observations during inspection, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found 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 was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 20, 2022 · control 25-AS-20220307135328

Type of visit: Post Licensing

Post Licensing visit is conducted in today's inspection. No deficiencies are cited. See 809 for Annual visit for 04/19/22 for details. Exit interview done and copy of the report left at facility.the state’s words, verbatim · CDSS document, Apr 19, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst Talwinder Bains arrived at the facility unannounced on 04/19/22 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator , Andrei Dumitriu , and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA wore the following Personal Protective Equipment (PPE) during today's visit: surgical mask. LPA was screened by facility staff before entry to facility. LPA and Administrator toured facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to: kitchen, common areas, six (6) bedrooms , three (3) bathrooms, medication closet , garage, laundry room and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain together and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of today's inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Apr 19, 2022

Type of visit: Office

An Office Meeting was conducted at 11:00 AM on 3/25/2022 at the Sacramento North Regional Office virtually via Microsoft Teams. Present for the meeting was: Administrator Krisztina Ivascu Staff Andrei Dumitriu LPM Laura Munoz LPM Troy Ordonez LPM Maribeth Senty LPM Anthony Perez LPA Kevin Mknelly LPA Talwinder Bains LPA Jacob Williams The purpose of the Office Meeting was to discuss the situation surrounding Silvana Senior Care, Inc. The Department has concerns stemming from site inspections on multiple dates during the year 2021 and 2022. Issues discussed during the meeting were: regulations regarding selling a business, Andrei Dumitriu advertising that he is owner/administrator on business cards when he is not owner/administrator, false information listed online & removing advertising with the name "Anca", state license is non-transferrable, whenever there is more than a 50% change of ownership a new license is required, number of facilities Krisztina Ivascu is acting Administrator, Nanny's Nest change of ownership from Staci Barnes to Krisztina Ivascu, the required time administrator must spend at each facility (roughly ~20 hours). CCL is requesting LIC500 & LIC308 for each Silvana Senior Care, Inc. facility. Copy of report provided via email.the state’s words, verbatim · CDSS document, Mar 25, 2022