Misty Wood Senior Care

Allegation investigated: Staff did not provide a proper written notice of resident's rate increase to Resident's Representative.

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to continue investigation into allegations listed above. LPA met with Administrator Marina Iancu during today's inspection. LPA investigated allegation listed above. LPA conducted interviews and conducted a file review. LPA obtained a copy of letter of rate increase provided to R1's representative. R1 required a higher level of care and administrator provided a letter which explained the new care that was required for R1. The letter did not provide a itemization of the charges. Due to the information gathered, LPA finds allegation to be SUBSTANTIATED.the state’s words, verbatim · CDSS document, Sep 13, 2023 · control 59-AS-20230720161339

From the deficiency page — Deficiency type: Type B · Section cited: CCR 1569.657(a) · Plan of correction due date: Sep 22, 2023

§1569.657. Rate increase due to change in level of resident care; notice. (a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. This requirement is not met as evidenced by: Based on record review the licensee did not provide itemization of resident charges to R1's representative which poses potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 13, 2023

Plan of correction: Administrator to provide LPA a written statement of understanding to health and safety code 1569.657. Letter of statement to be provided to LPA by 9/22/23.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with administrator Marina Iancu during today's inspection. 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 is available. 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 5 resident files and 2 staff files. LPA reviewed medications of two residents 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 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, May 25, 2023

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) K.. Hiratsuka, arrived at the facility unannounced to conduct an unannounced annual visit using the infection control tool visit. LPA met with Facility Administrator Marina Iancu, and explained the purpose of 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. LPA ensured they wash hands shortly after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Caregiver. LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, and common restrooms.. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. Multiple topics were discussed. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facilitythe state’s words, verbatim · CDSS document, May 18, 2022

Allegation investigated: Illegal Eviction

Licensing Program Analyst (LPA) Kerry Hiratsuka arrived at the facility unannounced on 03/10/2022 to conduct a Complaint Investigation Visit. LPA conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility. LPA investigation the allegation "Illegal Eviction.” LPA interviewed Licensees, former resident's responsible party, and a third party. Licensee did request permission to issue a 3 day eviction notice from Community Care Licensing Division that was not granted and LPA confirmed that it was not issued. Licensee was also in the process of writing a 30 day eviction notice that was not issued. The allegation is dealing whether a verbal eviction notice was given or not. Licensee stated she thinks a third party told the responsible party there is an eviction notice given. Other interviews stated there was an eviction notice given. LPA cannot prove or disproveif a verbal eviction was issued based on the different version of events. Allegation is unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 10, 2022 · control 25-AS-20211105063835