Sunrise of Rocklin

Allegation investigated: Staff did not provide adequate supervision resulting in resident wandering away from facility. Staff did not safeguard resident's personal items. Staff did not provide authorized representative copies of resident's record.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to finish a complaint investigation and deliver findings. LPA met with Marianne Richardson, Administrator, and explained purpose of inspection. During today's inspection, LPA discussed allegations further with Administrator, Memory Care Coordinator and Business Office Director and reviewed additional documentation from resident's (R1) file. During the course of the investigation, LPA conducted additional interviews with Resident Care Director (RCD), resident's responsible person (RP), and the Ombudsman. LPA reviewed documentation pertaining to R1, including, but not limited to: physician's report, pre-appraisal, care plan, Medication Administration Record (MAR), charting notes, Power of Attorney document, email correspondences, hospital medical records, admission agreement, billing statements, and faciility visitor log. The results of the investigation are as follows: cont on 9099C(1)... Substantiated 9099C(1)...Resident (R1) moved to the facility on/around 7/13/22. Resident’s physician’s report, dated 7/6/22, notes resident has a diagnosis of Dementia, is confused/disoriented, is unable to leave the facility unattended and needs medication management due to Dementia. Pre-appraisal states that resident is ambulatory and is able to walk without any physical assistance and is able to mentally and physically follow signs. Pre-appraisal also notes that resident needs special observation/night supervision due to confusion, forgetfulness or wandering. Allegation: Staff did not provide adequate supervision resulting in resident wandering away from facility. Complaint alleges that resident was able to leave the facility unattended due to the alarm system not working and/or insufficient staffing. Staff interviews and resident charting notes document that resident first left the community unattended on 8/28/22 and again on 12/2/22. Charting notes entered on 8/28/22 note that at approximately 1:45 pm, resident left the outside garden area where she was sitting in memory care after eating her lunch. Notes also document that the Assisted Living Med-Tech heard on walkie that Memory Care caregiver announced that the alarm in Memory Care was going off and resident found way out of locked back gate in Memory Care and was walking up the hill. Charting notes entered later in the day on 8/28/22 indicate that “patio doors are locked so they will alarm if she goes out the back door…. Resident will need 1:1 care if she continues exit seeking behaviors”. All staff was advised to do frequent checks on resident to include how she is doing and her whereabouts". Charting notes entered on 12/2/22 document resident's elopement and resident's responsible person was notified by telephone voice mail and a return call was requested. Administrator stated that when resident eloped to the back enclosed parking lot, resident's 1:1 caregiver was talking to another caregiver and staff heard the delayed egress go off. Administrator confirmed there were (3) staff on shift and resident was never out of sight from staff and did not sustain any damage or injuries. Administrator confirmed an incident report (LIC624) was submitted to the Department following each elopement; however, a citation has not been issued. 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: Staff did not safeguard resident's personal items. Complaint alleges that (2) original oil paintings were missing upon resident moving out in January 2023. Resident’s representative/responsible person (RP)stated there were a total of (3) paintings that disappeared; however, the third one "suddenly appeared" on R1's bed when she was moving out on 1/6/23. described the painting as an epitaph of a Mexican man. RP stated he did not notice any of the (3) paintings to be missing until "about a week before moving out" on 1/6/23. RP confirmed the paintings were not documented in resident's initial inventory upon move in. RP stated to LPA on 2/6/23 that R1 valued the first painting at $5K and the second painting at $3K, totaling $8K. and that R1 has approximately 50 paintings of hers, and he has all but 2 currently in his possession. RP told LPA the one missing painting is of R1's mother's house and the second one is of an Afghan female woman with green eyes. RP indicated he did not file a police report at the time he noticed the paintings were not in R1's room, as he didn't think of it at the time, but later filed one on 2/14/23 and provided a copy to LPA. Memory Care Coordinator stated that "(R1) was a wonderful artist-- she had many loose canvasses and some were unframed and of different sizes-Some canvasses were under her bed and behind the bed and also a number of stacked paintings near the fridge". Administrator stated "missing paintings were never mentioned until move out" and RP visited resident regularly. The facility visitor log shows resident’s RP visited regularly from July 2022- January 6, 2023, for a total of approximately (31) visits. Progress notes, entered on 1/4/23, state that on 1/3/23, ,RP stated to MCC that a staff told him she saw another resident's family member walk away with the paintings. When MCC discussed this scenario with RP and the caregiver, the caregiver did not recall this conversation at all. Administrator confirmed the facility did not complete an initial inventory of R1's belongings, stating RP "waived it". LPA observed a blank LIC624 to be stamped "Waived" in R1's file when reviewing it. Administrator also confirmed the facility did not document the paintings that were reported as missing in January 2023 on the Resident Theft and Loss Record (LIC09060). Based on information obtained, the facility did not meet each requirement of its Theft and Loss Policy, per Health and Safety Code 1569.153. 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: Staff did not provide authorized representative copies of resident's record. Complaint alleges that R1's records were requested and not provided within (2) days as required. Resident’s representative stated he did submit a written request for copies of R1's records in December 2022 and sent it certified mail, and 2 days later, he sent a second correspondence via certified mail, giving 30- day notice. RP stated the records request stated "All records related to (R1)" and has not received any records to date. Administrator stated on 1/20/23 that RP asked verbally only for records during a phone call. MR stated that she did not tell RP the request had to be in writing and stated that RP and another individual on the phone call said they would be calling the corporate office. While reviewing R1's file, on 5/4/23, LPA observed a letter from RP, dated 12/20/22, requesting a copy of R1's file, to include specific documents. The envelope was sent via certified mail and had been opened. LPA discussed the letter with Administrator who stated she had not previously seen the request but had seen the other envelope, also sent by certified mail, giving 30-day notice. 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. Based on information obtained, LPA finds (3) allegations 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, deficiencies are being cited on the attached 9099-D pages Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Administrator's signature on these forms acknowledges receipt of these documents. 9099A-C(1). Resident's charting notes, dated 12/30/22, reflect a conversation with responsible person and a Med-Care Manager that resident's doctor just ordered new changes to R1's Seroquel order but resident will not start the new order yet since she will be moving in 2 weeks. Charting notes entered on 1/2/23 (17:33) document that another pharmacy delivered Donepezil and Buspirone to the facility and also faxed an order to taper off Seroquel. Notes indicate that the Wellness Nurse spoke to R1's responsible person and "he stated he doesn't want resident to start the medications at this time or make any changes with her medications since (R1) is moving out soon". Notes say responsible person is unsure how the other pharmacy got the orders from R1's primary care physician since he hasn't approved to start the medications yet. LPA reviewed a new order for Seroquel, dated 1/1/23, to discontinue the previous order for Seroquel and to give the following medications: Donepezil 10 mg (1/2 tablet daily for 4 weeks, then 1 tablet daily); Buspirone 5 mg- take 1 tablet by mouth, 3 times/day Seroquel 25 mg- decrease to 25 mg daily for 5 days then discontinue order. Order was signed by resident's nurse practitioner on 1/3/23 and faxed to the facility on 1/3/23 (1051). MAR records for January 2023 show that R1 was administered Buspirone and Donepezil through 1/6/23, morning dosage. MAR shows Seroquel was administered, twice daily, under the prior order on 1/1/23 - 1/2/23 and for the morning dosage on 1/3/23. A second dosage of Seroquel 25 mg was administered on 1/3/23 and on 1/4/23, the dosage was dropped to once daily. MAR shows the new order for Seroquel 25, once daily, was administered starting on 1/4/23 through 1/5/23. Resident moved out on 1/6/23. Based on documentation reviewed, the facility followed the physician's orders and administered medications as prescribed by the doctor . Resident was taken to the emergency room on 1/6/23 and was hospitalized until 1/8/23 for complaints of abdominal pain. Hospital medical records say resident was treated for colitis. It cannot be determined that because the facility followed physician orders with regard to the medication Seroquel, that resident was hospitalized. 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. cont on 9099A-C(2).... 9099A-C(2).. Allegation: Staff overcharged resident while in care. Complaint alleges that following the first elopement, resident's (R1) responsible person was informed that R1, would require a full-time, 24/7 caregiver to watch over her, but the facility did not inform him that he would be responsible for paying the sitter. On/around 12/16/22, resident/resident's responsible person was issued a bill for for the private sitter from 8/31/22 to 12/16/22. Resident’s representative stated he was not told by the facility that he or resident would have to pay for the 1:1 supervision and and assumed it was included in the basic rent charge resident was paying. Responsible person asserted that he told the facility Administrator, he "refused to pay for 1:1 after the first AWOL" at the end of August 2022. Responsible person stated he didn't know how much the 1:1 supervision cost until December, on 12/16/22, when he received a bill, at which time he gave R1's 30-day notice.. RP stated he was not aware he was being charged for 1:1 until December when he received a bill. Interviews with multiple staff managers, including the Administrator, Business Office Director, Assisted Living Coordinator and Memory Care Coordinator, confirmed that R1's responsible person was told that he would need to pay for resident's 1:1 care needed to prevent her from eloping from the facility again. Narrative charting notes, on 8/28/22 and 8/31/22, document conversations and phone calls attempts with responsible person to discuss responsible person obtaining a 1:1 care giver, 24/7 for resident. Specifically, notes entered on 8/31/22 by Assisted Living Coordinator, Elaina, that the facility is "waiting on 1:1 being set up by RP (responsible person)". Ombudsman stated in an email to LPA that responsible person was told he would have to pay for the 1:1 supervision. Administrator stated there were initial discussions with R1's responsible person about the cost of a 1:1 caregiver, 24/7, but when follow up attempts were made by phone to discuss the discussion, the phone call would "always drop" with resident's responsible person stating he "didn't know what happened'". Administrator stated resident's responsible person has a "solid ballpark idea" of the cost a 1:1 caregiver, 24/7, would cost him. The Administrator stated the facility "stepped in because the responsible person was not following through" in obtaining a caregiver. Administrator stated a 1:1 caregiver was found through a new agency they had recently started working with for registry staff. Both the Administrator and Business Office Director confirmed that when a new vendor is used, there are billing delays in the system. Billing statements provided by the facility, dated 8/31/22, 9/30/22, 10/31/22 and 11/30/22, only show each monthly charge for basic services, medication and additional charges based on the resident’s service level. The 1:1 companion care, billed starting on 8/31/22 through 11/5/22, was not charged until the statement dated 12/31/22. The following monthly statement, dated 1/31/23, list charges for companion care for the period 11/6/22-12/31/22. cont on 9099A-C(3)... 9099A-C(3)..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 with Nicole James, Director of Sales. Administrator, Marianne Richardson, attended by phone since she had to leave the facility before LPA was finished. with today's report. Copy of report left at facility.the state’s words, verbatim · CDSS document, May 4, 2023 · control 25-AS-20230118165958

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4) · Plan of correction due date: May 26, 2023

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by: Based on interviews conducted and documentation reveiwed, the Licensee did not ensure that resident (R1) was not able to leave the facility on 8/28/22 and on 12/3/22, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 4, 2023

Plan of correction: Licensee/Administrator implemented a 1:1 caregiver, 24/7 for R1. Follow up training was conducted in September 2022 regarding resident elopments. Licensee/Administrator agree to conduct a follow up training regarding resident elopements. Documentation to be provided to Dept by 5/26/23 that trainiing has been completed.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87218 · Plan of correction due date: May 26, 2023

87218 Theft and Loss (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative.(2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to meet each requirement specified in Section 1569.153. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that each requirement was met per HSC 1569.153 to safeguard resident's paintings that were reported missing, which posed a personal rights violation to residents in care.the state’s words, verbatim · CDSS document, May 4, 2023

Plan of correction: Licensee/Administrator agree to conduct training again on following the facility's Theft & Loss Policy, as listed in the Admission Agreement, per HSC 1569.152-1569.154. Documentation to be provided to Dept by 5/26/23 that trainiing has been completed. Also provide updated Resident and Loss Record, LIC9060.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: May 26, 2023

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities- (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(19) To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. This requirement is not met as evidenced by: Based on documentation reviewed in resident's (R1) file, the Licensee did not ensure that records from (R1's) file were provided to R1's responsible person, within (2) days of receiving the written request on/around 12/22/22, which posed a personal rights violation to residents in care. . Letter was date stamped 12/20/22 by USPS.the state’s words, verbatim · CDSS document, May 4, 2023

Plan of correction: Licensee/Administrator agree to provide copies of requested records by 5/26/23. Submit documentation to the Department by 5/26/23.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melissa Parks arrived on Monday March 20, 2023 to conduct the annual inspection. LPA wore a surgical mask during todays visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA Parks reviewed resident (5) and staff (8) files. All resident files contained the required paperwork. All staff files contained the required paperwork and training. LPA Parks and Administrator Marianne toured the facility together to ensure the health and safety of residents in care. The areas toured included resident apartments, kitchen, hallways, memory care apartments, memory care dining room/kitchen, and memory care common areas. Water temperatures in the apartments toured were within the required range of temperature. LPA observed the facility's emergency food and water storage and PPE storage. In the areas toured, there were no health or safety violations observed. LPA Parks reviewed fire drills from December 2022 - March 2023. All required postings were observed in the lobby area. LPA requested the facility to update their LIC500 and email to LPA by April 15, 2023. No deficiencies cited. Exit interview conducted. A copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Mar 20, 2023

Allegation investigated: Facility staff failed to protect resident from financial abuse.

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 01/12/2023 to provide complaint findings. LPA met with manager on duty and explained the purpose of the visit. Prior to initiating the visit, LPA completed the Department’s required COVID-19 protocols. Upon arrival LPA completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility. LPAs reviewed resident records, facility records and conducted interviews. The department finds that facility met Tittle 22 requirements. Video evidence provided to the department, on 1/6/23, by a local retailer showed a person who likely completed/ knew who completed the fraudulent use of R1’s credit card on 10/3/22 as a person known to R1 but who is not a staff... Report continued... Unfounded of this facility. R1 willingly met with the alleged person as they had known the person for some time. The person of interest has been identified to local law enforcement for further investigation. 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, Jan 12, 2023 · control 25-AS-20221027102234

Allegation investigated: Residents personal belongings were not safeguarded while in care.

On 09/12/22, Licensing Program Analyst (LPA) Talwinder Bains conducted an unannounced complaint investigation visit to deliver the findings for the above allegation and met with Marianne Richardson, Executive Director. 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. Upon arrival, completed a facility risk assessment. 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 with temperature at the facility. The department conducted records review and extensive interviews. **Report continued on LIC9099-C** Substantiated Allegation- Residents personal belongings were not safeguarded while in care. The department conducted Interviews and record review to investigate this allegation. During record review, department observed documentation regarding the allegation concerning R1’s missing eyeglasses. Facility Executive Director (ED) was notified by R1’s family on 02/02/2022 that R1’s eyeglasses were missing. ED followed up on R1’s missing item and issued a one-time refund of $330.00 on 02/03/22 to the family. This was the only missing item that was mentioned for R1. Although the facility provided R1’s family a refund for R1’s missing glasses, the facility did not safeguard R1s personal belongings while in care at the facility therefore the allegation is 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 deficiency is cited on 9099-D, per Title 22 Regulations, Division 6. Exit interview with Marianne. Appeals rights provided. Copy of the report left at the facility. Allegation- Residents ADLS were not met by facility staff. The department conducted Interviews, facility inspection and record review to investigate this allegation. Chart notes indicate that the resident's needs - bathing, grooming, oral care, dressing, eating, diet, toileting, escorting, transfers appear to be addressed and notated / documented by on facility staff. During facility observation on 04/13/22, department has observed that residents appeared to be well groomed and in good care. UNFOUNDED Allegation- Residents are not getting a sufficient amount of food while in care. The department conducted Interviews, facility inspection and record review to investigate this allegation. Records review of menus that are posted in the common area of the facility list nutritious meals that are offered to the residents that meets regulations requirements. During staff interviews, staff stated that residents do complain about the quality of food sometimes. During residents’ interviews, residents stated the food that is served is good quality. Record review also indicate that facility staff follow any resident’s dietary needs per physician’s orders. During facility observation for lunch on 04/13/22, department observed that residents were served a nutritious meal with sufficient portion sizes. During record review for R1, there is no evidence to suggest that R1 was losing weight due to food provided by the facility. Facility was checking R1s weight on monthly basis and department did not observe any weight loss during record review for R1. UNFOUNDED Allegation- Facility staff retaliated against resident's responsible party. The department conducted Interviews and record review to investigate this allegation. Based on facility record review and interviews, it has been concluded that facility did not retaliate against R1’s responsible party in any manner. R1 was admitted to the facility on 01/26/2018 and expired on 02/27/22. It was determined through the investigation that the facility made accommodations such as monthly care meetings, informing R1s doctor, family for any health updates/changes and addressing any other concerns in timely manner. R1s family was invited to attend several care plan meetings and facility provided all that information to department while doing record review for R1. UNFOUNDED **Report continued on LIC9099-C** Allegation- Resident developed an infection while in care. The department conducted Interviews and Record review to investigate this allegation. Department has reviewed the records for this complaint investigation for R1 regarding developing infection while at the facility. Upon records review, department observed care notes from the facility which indicated that on 02/09/22, Home Health (HH) saw R1 at the facility for a right toe infection and marked the wound as stage 2. HH provided R1 with appropriate treatment including antibiotic therapy as indicated in 02/08/22 in facility care notes. Upon records review, department observed care notes for R1 from facility from 01/01/22 through 02/27/22, which indicated facility staff and HH were aware about R1's buttock's wounds. Per record review, HH documented the treatment for all of R1’s wounds, including cleansing with wound cleanser and applying calmoseptine ointment. All of R1’s wounds were documented as stage 2 wounds. Per facility records, on 02/25/22, HH advised facility and family that it would be beneficial for R1 to be admitted to a skilled facility until R1’s wounds healed however R1s family declined and expressed that family would like R1 to stay at the facility. Per physician orders and family's consent, R1 was admitted on Hospice care on 02/26/22 and R1 expired on 02/27/22. Per facility records, R1’s physician, family and facility staff were aware about R1's change in health condition and care plan, therefore it has determined that resident did not developed infection due to facility’s lack of care. UNFOUNDED Allegation- Insufficient staff to meet residents needs. The department conducted Interviews, facility inspection and record review to investigate this allegation. Chart notes indicate that the resident's needs - bathing, grooming, oral care, dressing, eating, diet, toileting, escorting, transfers appear to be addressed and notated / documented by on facility staff. During facility observation on 04/13/22, department has observed that residents appeared to be well groomed and in good care. UNFOUNDED Based on records reviewed, Interviews and observation , the above all allegations are found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit interview was conducted with Marianne and a copy of this report was provided to the facility. No deficiencies cited. The signature of Marianne on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Sep 12, 2022 · control 25-AS-20220405152840

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Sep 26, 2022

87217 (b)-Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not safeguard R1s personal belongings, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 12, 2022

Plan of correction: Administrator will complete a statement of understanding indicating that the facility is aware of regulation 87217 and its responsibilities to safeguard residents’ cash, personal property and valuables. Facility will submit statement of understanding and schedule for training to department by POC due date-09/26/22.

Allegation investigated: Resident not provided medical care in a timely manner. Resident is dehydrated. Resident has lost a lot of weight. There was no supervisor at the facility. Facility administer wrong prescribed medication (ointment) to resident which belong to another resident.

On 09/12/22, Licensing Program Analyst (LPA) Talwinder Bains conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Marianne Richardson, Executive Director. 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. Upon arrival, completed a facility risk assessment. 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 with temperature at the facility. The department conducted records review and extensive interviews. **Report continued on LIC9099-C** Unfounded Allegation- Resident not provided medical care in a timely manner. The department conducted interviews regarding this allegation. Interviews indicated that staff were aware of R1’s need based on R1’s needs and service plan. A review of documentation and interviews conducted revealed that staff were following R1’s needs and service plan as documented. After R1 medical records review and file review, department also concluded that facility nursing staff did communicate with R1 doctor, family and other required agencies for any health concerns for R1. Facility also notified CCLD for R1’s health updates per department reporting protocol. Department concluded that facility did seek medical help for R1 in timely manner to address any health-related concerns for R1, therefore this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Allegation-Resident is dehydrated. The department conducted interviews and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. Upon R1s records review, it was mentioned on when R1 was sent out to hospital by facility on 04/13/22 after a fall incident however R1 was diagnosed with severe UTI(Urinary Tract Infection) and dehydration in hospital (dehydration is one of the common symptoms related to UTI for seniors). Upon R1 records review, department found out that R1 was taking antibiotics for UTI prior to 04/13/22 and was tolerating it well as shown in facility’s documentation. Based on the records review, it has not determined that R1 was dehydrated due to facility’s care or neglect, therefore this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. **Report continued on LIC9099-C** Allegation-Resident has lost a lot of weight. The department conducted interviews and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. During interviews, facility residents stated that facility staff check resident’s weight based on physician orders and/or if there is an indicated need of a specific resident to have their weight taken. Department reviewed weight records for R1. R1 had weight recorded as 164 lbs on 11/11/19 at the time of admission. R1s weight was recorded as 160 lbs in April 2022. It has been found out that R1s weight was checked monthly per orders and there was no indication of any significant weight loss, therefore this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Allegation-There was no supervisor at the facility. The department conducted interviews, facility observation and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. During staff interviews conducted on 05/12/22, facility staff stated that managers and supervisors are available to address any questions/concerns from residents, staff or resident’s family. During residents’ interviews conducted on 08/29/22, facility residents stated that there are no issues if they wish to speak to any managers/supervisors to address any concerns. A review of staff schedule indicated that there is a manager available during all shifts. Based on this information, department has concluded that this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. **Report continued on LIC9099-C** Allegation- Facility administer wrong prescribed medication (ointment) to resident which belong to another resident. The department conducted interviews and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. During investigation, Facility staff and residents stated that there are no concern/issues with medication administration. Facility staff also denied that facility administered any wrong medication to any residents. Facility residents verbalized that their medications are administered mostly on-time with no issues. Based on this, department has concluded that this allegation is UNFOUNDED . A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. Exit interview was conducted with Marianne and a copy of this report was provided to the facility. No deficiencies cited. The signature of Marianne on these forms acknowledges receipt of these documents. Allegation-Resident was given alcohol that could have caused serious health issues. The department conducted interviews and record review to investigate above allegation. Department conducted several interviews with facility staff and residents to investigate this allegation. During facility staff and residents’ interviews conducted on 05/12/22 and 08/29/22, staff and residents stated that residents can request wine at the facility. During staff interviews and R1s record review, it has been found out that R1 use to enjoy red wine with another resident during dinner time but according to family, R1 did not like wine. Based on R1’s medication documentation, there were no documented medical reasons that indicated R1 was unable to consume alcohol and/or that R1’s consumption of alcohol would impact R1’s medical conditions. Department has concluded that there was a possibility that R1 did order wine with meals. There was no documentation in facility notes regarding any ill effects on R1s health by consuming wine, Therefore, the above allegation is 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. Allegation-Staff is not providing care of resident agreed to in the level of care agreement. The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with facility staff and residents, it has been discovered that facility is providing appropriate care to the residents per their needs. During residents’ interview on 08/29/22, residents stated that facility has enough staff and their care needs are met. During staff interviews on 05/12/22, staff stated that there are enough staff to work at the facility to meet resident’s care needs. During record review for R1, records indicated that facility did provide all required care and assistance to meet R1s needs per R1’s needs and service plan. During department visits on 04/19/22 and 08/29/22, department observed that residents appeared to be well groomed and in good care ,therefore, the above allegation is 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. **Report continued on LIC9099-C** Allegation-Staff are not able to meet the needs of the residents. The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with facility staff and residents, facility is providing appropriate care to the residents according to resident’s needs and service plans. During residents’ interview on 08/29/22, residents stated that facility has enough staff and their care needs are met. During staff interviews on 05/12/22, staff stated that there are enough staff to work at the facility to meet resident’s care needs. During record review for R1, records indicated that facility did provide all required staffing and assistance to meet R1s care needs. During department visits on 04/19/22 and 08/29/22, department observed that residents appeared to be well groomed and in good care, therefore, the above allegation is 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. Allegation- Staff is not assisting resident with hygiene. The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with facility staff and residents, facility is providing appropriate care to the residents according to resident’s needs and service plans. During residents’ interview on 08/29/22, residents stated that facility has enough staff and their care needs are met. During staff interviews on 05/12/22, staff stated that there are enough staff to work at the facility to meet resident’s care needs. During record review for R1, records indicated that facility did provide all required staffing and assistance to meet R1s care needs. During department visits on 04/19/22 and 08/29/22, department observed that residents appeared to be well groomed and in good care, therefore, the above allegation is 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 Marianne and a copy of this report was provided to the facility. No deficiencies cited. The signature of Marianne on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Sep 12, 2022 · control 25-AS-20220413093321

Allegation investigated: Facility failed to issue a refund. Facility did not conduct an initial assessment for resident. Facility did not follow resident's care plan. Facility is advertising for services that are not being provided.

On 08/02/22, Licensing Program Analyst (LPA) Talwinder Bains conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Marianne Richardson, Executive Director. 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. Upon arrival, 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 Mask. Additionally, LPA was screened with temperature at the facility upon arrival. **Report continued on LIC9099-C** Unsubstantiated Allegation: Facility failed to issue a refund. Department reviewed facility records for the allegation from this complaint regarding refund from the facility to the family. Per allegation, facility refused to pay the proper refund to the family after R1 moved out from the facility. Records review revealed that R1 stayed at the facility from 02/27/22 till 03/10/22. After R1 moved out from facility on 03/10/22, facility offered to pay $4751 as remainder to the family but family refused that amount and want the full amount back due. Per record review, facility did offer to pay the remainder to the family as courtesy, but family refused amount. Allegation: Facility did not conduct an initial assessment for resident. The department conducted interviews regarding this allegation. Facility staff stated that initial assessment was completed on 02/27/22(Sunday), the day R1 was admitted to the facility. All staff, including caregivers, were aware of R1s needs and service plan. Department reviewed R1’s initial assessment documentation conducted by the facility. Allegation: Facility did not follow resident’s care plan. The department conducted interviews regarding this allegation. Interviews indicated that staff were aware of R1’s need based on R1’s needs and service plan. A review of documentation and interviews conducted revealed that staff were following R1’s needs and service plan as documented. After R1 medical records review and file review, department also concluded that facility nursing staff did communicate with R1 doctor, family and other required agencies for any health concerns for R1. Facility also notified CCLD for R1’s health updates per department reporting protocol. **Report continued on LIC9099-C** Allegation: Facility is advertising for services that are not being provided. The department conducted interviews regarding the facility services to residents in care. During these interviews, residents and staff stated they are aware about all the services offered by facility and did not express any concerns or issues. Department also reviewed facility’s advertisements on social media, printed facility brochures and other modes of advertisements regarding facility’s offered services to residents in Assisted Living unit and Memory care unit. Department concluded that facility is advertising only those services which they are capable of within their scope of practice per Licensing requirements for Department of Social Services. As a result of this investigation, LPA finds all above allegations to be 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. No deficiencies are cited during today’s visit. Exit interview conducted and a copy of report left with Marianne Richardson, Executive Director.the state’s words, verbatim · CDSS document, Aug 2, 2022 · control 25-AS-20220328120243

Allegation investigated: Staff verbally abusing residents. Facility not safeguarding resident belongings. Not enough dining staff to serve residents. Administrator not addressing resident concerns.

On 5/13/22, Licensing Program Analyst (LPA) Jacob Williams conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Marianne Richardson, Executive Director. 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. Upon arrival, completed a facility risk assessment. 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 with temperature at the facility. The department conducted records review and extensive interviews. The department is unable to find and or meet the preponderance, per policy. **Report continued on LIC9099-C** Unsubstantiated Allegation: Staff verbally abusing residents. The facility had been using supplemental agency staff since May of 2021. The department interviewed several residents and staff members regarding the interactions of the agency staff. Of those interviewed, one single individual (R1) had noticed verbal abuse from an agency staff person. The consensus is that while the facility may be understaffed at times, the staff try to serve the residents with respect and dignity. Allegation: Facility not safeguarding resident belongings. The department interviewed several residents and staff members regarding safeguarding residents belongings, with emphasis on laundry. Through interviews and documents reviewed, it is determined that the facility encourages residents to label their clothes but does not require it. The facility also has a lost & found for laundry and other belongings. Of those interviewed, two residents had had their laundry lost at some point, but one received it back two weeks later, and another never received it again. Allegation: Not enough dining staff to serve residents. The department interviewed several residents and staff members regarding the facility not having enough dining staff to serve residents. R1 states staff only wake them up when they ring their pendant, and R2 once noticed two residents complaining because they were not brought to the dining room in time for breakfast. Of the others interviewed, they had no issues. S1, S2, S3, and S4 stated that residents are given the option for a room service trey if they cannot make it down to the dining hall, and S3 and S4 stated continental breakfast is offered at any time, even after 9am breakfast time. **Report continued on LIC9099-C** Allegation: Administrator not addressing resident concerns. The department interviewed several residents and staff members regarding the Executive Director not addressing resident concerns. S1 and S5 stated the Executive Director does not have or make time to fix issues with residents, but majority had no issues with the way she handles concerns. It is understood that the facility has been understaffed at times, and R3 stated the Executive Director has begun assisting in the dining room when needed. As a result of this investigation, LPA finds allegation to be 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. Exit interview conducted and a copy of report left with Marianne Richardson, Executive Director. Allegation: Residents needs are not being met. Through document review, R1 pays for showers three times per week; during time of interview R1 stated it had been 6 days and counting since last shower, and that they once had to go 12 days without a shower. R3 pays for showers two times per week; states they do not receive two, and has to fight for the showers they do get. R4 pays for showers three times per week; states they rarely, if ever, receive that amount and claimed to have a breakdown the morning of interviews because it had been four days and counting without being bathed, and has not had his clothes changed in the same amount of time. R2 states his bed was not changed that week because staff never came to collect his dirty laundry on the past laundry day. It is understood that when clients press their pendant for assistance, it can take anywhere from 45 minutes to multiple hours for staff to respond. The department believes the facility being understaffed is a large reason for the aforementioned incidents. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. Exit interview was conducted and a copy of this report and appeal rights were provided to Marianne Richardson, Executive Director.the state’s words, verbatim · CDSS document, May 13, 2022 · control 25-AS-20210914155804

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: May 16, 2022

87411(a) Personnel Requirements – General-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based upon observation and interview the Licensee failed to ensure staff are sufficient in numbers and competent to provide services necessary to meet resident needs. This poses an immediate Health, Safety and/or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, May 13, 2022

Plan of correction: Licensee to provide CCL with a plan by 5/16/2022 to ensure personnel will be sufficient in numbers and competent.

Allegation investigated: Facility did not observe changes in resident's physical condition. Facility did not allow resident's physical therapist into facility.

On 3/25/2022, Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains arrived at the facility and met with Resident Care Director (RCD), Vandhana Devi, to conclude a complaint investigation into the allegations listed above. LPAs wore an N-95 mask 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: Facility did not observe changes in resident's physical condition ** Report continued on 9099-C ** Substantiated Resident's (R1) Weights and Vitals Summary documented by the facility indicates that R1 weighed 174.6 lbs on 1/18/2020 upon admission and weighed 138 lbs on 2/6/2021 around the time R1 moved out of the facility. R1’s Weights and Vitals Summary indicates that facility notated observations of weight change on 3/16/2020 (R1 weighed 167 lbs with 3.0% weight loss), 8/10/2020 (R1 weighed 157 lbs with 10.0% weight loss), 9/8/2020 (R1 weighed 166.4 lbs with 3.0% weight gain), 10/6/2020 (R1 weighed 158.2 lbs with 3.0% weight loss), 11/8/2020 (R1 weighed 163 lbs with 3.0% weight gain), and 1/6/2021 (R1 weighed 144 lbs with 10.0% weight loss). R1’s Weights and Vitals Summary does not document whether facility reported changes in R1’s weight to either R1’s primary care physician or responsible party. Facility’s Residency Agreement states on page 4 that “If the Resident’s condition changes so that the previously assessed Service Level is no longer appropriate, the Community will reevaluate the Resident’s needs to determine which Service Level is appropriate and notify the Resident/Responsible Party of such reevaluation.” As of today’s date, facility could not provide documentation as to whether R1’s primary care physician or responsible party was notified regarding R1’s change in condition due to weight loss, or whether a Service Level assessment was conducted for R1. Allegation: Facility did not allow resident's physical therapist into facility. On 3/25/2020, CCLD was informed that facility was not allowing medical professionals, specifically Physical Therapists (PT), to come provide services for residents. LPA Mai Thao called the facility at 11:10 AM spoke with Executive Director (ED), Scott Bracken. ED stated that the facility is allowing home health for wound care but, other than that, PT is not consider essential and the facility is denying PT access. ED stated that accepting PT inside the facility was against the company’s policy. The department informed the facility that PT is considered essential visitors. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. Exit interview was conducted with RCD. A copy of this report and appeal rights were provided. The RCD’s signature on these forms acknowledges receipt of these documents. Resident's (R1) Preplacement Appraisal Information dated 1/10/2020 does not list any pressure injuries observed prior to admission to facility. Facility care notes noted that R1 refused a skin assessment on 1/18/2020 during the time R1 was admitted to the facility. Per facility care notes, R1 had a hospital visit on 2/26/2020 with no observation of pressure sores. R1 had a hospital visit on 3/4/2020 with complaints of open sores on buttocks area. Doctor observed redness in area but no open wounds. R1 was admitted to Suncrest Hospice on 12/18/2020 with redness on coccyx area. Hospice notes dated 12/18/2020 indicated that hospice nurse educated both R1 and staff on repositioning for R1. Hospice notes for 12/18/2020 also indicated that R1 was refusing help from staff regarding repositioning. Hospice identified redness as a stage 2 pressure ulcer during visit on 12/24/2020. Hospice educated both R1 and staff on repositioning for R1. Hospice notes document multiple visits in which R1 refused to cooperate with hospice nurse’s recommendations of repositioning and refused assistance from staff with repositioning. Hospice notes document that when R1 cooperated with repositioning, pressure sores either improved or stopped progressing. When R1 refused to cooperate with hospice’s recommendations, pressure sores worsened. On 1/19/2021, Suncrest Hospice provided and placed a trapeze in R1’s apartment to assist with repositioning. R1 requested that trapeze be removed from R1’s apartment. Trapeze was removed on 2/1/2021. On 2/1/2021, Suncrest Hospice ordered halo rings to be installed on R1’s bed to help with self-repositioning. R1 requested that halo rings be removed from bed. On 2/2/2021, halo rings were removed from R1’s bed. Hospice notes indicate that R1 refused assistance with repositioning until R1 moved out of the facility. Allegation: Facility did not administer medications as prescribed. ** Report continued on 9099-C ** Interview with relevant party indicated that R1 was experiencing diarrhea for 2 weeks prior to moving out of the facility but was still receiving PRN medications for constipation. Facility’s MAR for R1 indicated that the only PRN medication administered for constipation (Docusate Sodium) was administered to R1 on 2/3/2021 and 2/8/2021. No other PRN medications assisting with constipation were administered in the month of February. Interview with Executive Director, Rouzbeh Moradhasel, on 3/3/2021, as well as R1’s charting notes indicate that R1 had six (6) bowel movements on 2/15/2021 and three (3) bowel movements on 2/16/2021. No PRN medications pertaining to constipation were administered to R1 on these dates. Interview with relevant party indicated that staff were administering PRN pain medications to R1 without asking if R1 needed the PRNs. Hospice care notes provided by Suncrest Hospice indicated that, on multiple dates, R1 requested PRN pain medications after already being on heavy pain medication. Hospice care notes dated 1/6/2021 indicated that hospice nurse educated R1 on excessive opiate use. Medical records provided by Kaiser Permanente note R1's opiate abuse due to back pain. Interview with R1 conducted on 3/20/2021 indicates that facility had staff administer medication to R1 and R1 was satisfied with the facility's administration of medication. Upon review of Centrally Stored Medication form and MAR for R1, the facility has documented that they were providing medications to R1 as prescribed. Allegation: Staff did not assist resident with ADLs. Relevant party indicated that R1 did not receive assistance with hygiene, including brushing their teeth. Needs and Services Plans dated 1/18/2020 and 1/11/2021 stated that R1 is capable of communicating care needs verbally. Preplacement Appraisal Information for R1 dated 1/10/2020 stated that R1 “can take care of [their] own teeth, but needs help showering and dressing.” Needs and Services plan dated 1/18/2020 states that R1 is independent with oral care needs. Needs and Services plan dated 1/11/2021 states that R1 needs assistance of 1 person to complete oral care needs. ** Report continued on 9099-C ** Needs and Services plan dated 1/18/2020 and 1/11/2021 state that R1 needs 1 person assist with grooming, dressing, and toileting, as well as a chair to assist with bathing. Facility charting notes indicate that R1 did not refuse any of the following services prior to leaving the facility and all services pertaining to grooming and hygiene were provided. Hospice notes provided by Suncrest Hospice indicate that no abuse or neglect by the facility was observed while receiving hospice care. Interviews conducted with staff (S1, S2) on 3/24/2022 indicated that facility includes brushing teeth with hygiene responsibilities for residents. Interviews with S1 and S2 also indicate that all residents have scheduled showers. Interviews conducted with residents (R2, R3) on 3/24/2022 stated that ADLs are being addressed and care needs are being met. Relevant party indicated that facility staff did not seek whether R1 needed assistance with eating. Preplacement Appraisal Information for R1 dated 1/10/2020 states that R1 “only needs…food cut up…Can’t use knife anymore.” Physician’s Report LIC 602 for R1 dated 1/17/2020 states that R1 is able to feed self. Interviews conducted with staff (S3, S4) on 3/16/2022 stated that they delivered food to R1 and would assist R1 with feeding and cutting food if requested by R1. Interview conducted with Dining Services Coordinator (S5) on 3/24/2022 stated that kitchen staff utilize a Point Click Care (POC) system which instructs the kitchen staff on food modifications for residents. If resident has a modification indicated on care plan, kitchen staff should be notified and prepare food according to each resident’s modifications before serving food, including cutting up food. Interview with R1 conducted on 3/20/2021 indicates that, at the time R1 was living at the facility, R1 did not need assistance with being fed. Allegation: Facility did not manage resident's incontinence needs. ** Report continued on 9099-C ** Interview with Executive Director, Rouzbeh Moradhasel, on 3/3/2021, indicated that, when R1 was experiencing multiple bowel movements on 2/16/2021, all of R1’s belongings were already transferred to new facility and Executive Director was unsure of what condition R1 was in upon admission to new facility. Facility charting notes indicate that R1 did not refuse any incontinence care services provided by the facility prior to leaving the facility. Hospice notes provided by Suncrest Hospice indicate that there were no observations that facility was not providing incontinence care to R1. Interviews conducted with staff (S1, S2) on 3/24/2022 indicated that staff conduct regular checks (1-2 hours or as needed) for residents receiving continence care. Interviews with S1 and S2 indicate that residents are offered showers if they are found to have soiled themselves. Interview with R1 conducted on 3/20/2021 indicates that R1 was experiencing constipation while living at the facility and nursing staff assisted with constipation by providing medication to resolve symptoms. Allegation: Facility did not provide food options for resident. LPA inspected food supply at the facility during visit conducted on 3/16/2022 and observed a 2-day perishable and 7-day non-perishable food supply at the facility. LPA reviewed facility’s menu and observed multiple food options for the residents. Based on interviews conducted by the Department and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is 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 RCD and a copy of this report was provided to the facility. The signature of the RCD on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 25, 2022 · control 27-AS-20210225150536

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Apr 8, 2022

87466 Observation of the Resident -The licensee shall ensure that residents are regularly observed for changes(...)such as unusual weight gains or losses(...)the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure that R1's physician and responsible person were notified of changes in weight, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 25, 2022

Plan of correction: Executive Director (ED) will complete a statement of understanding indicating that the facility is aware of the responsibilities to address residents' change in condition and include a copy of the facility's procedures and policies regarding changes in condition. ED will submit statement of understanding and procedures and polices to department by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(2) · Plan of correction due date: Apr 8, 2022

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall(...)provide for assistance in obtaining such care(...)(2) The licensee shall provide assistance in meeting necessary medical and dental needs. This requirement is not met as evidenced by: Based on interviews conducted, the facility did not ensure that R1's PT was able to provide medical services to R1, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 25, 2022

Plan of correction: ED will complete a statement of understanding indicating that the facility is aware of what consistutes essential medical care and include a copy of the facility's procedures and policies regarding essential medical. ED will submit statement of understanding and procedures and polices to department by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Talwinder Bains and Michael Hood arrived at the facility unannounced on 03/16/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPAs met with Executive Director- Caroline Frangieh, and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs completed required COVID-19 testing protocols, the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms, and contacted facility to complete a facility risk assessment. LPAs wore the following Personal Protective Equipment (PPE) during today's visit: N-95 masks. LPAs were screened by facility staff before entry to facility. LPAs and Caroline toured facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to: kitchen, common areas, four (4 ) bedrooms, four (4) bathrooms, laundry room, two (2) dining rooms, courtyard area and storage area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and Caroline completed the infection control domain together. 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, Mar 16, 2022

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Talwinder Bains and Michael Hood arrived at the facility and met with Executive Director- Caroline Frangieh, to follow-up on an Incident Report sent by the facility on 3-11-22 regarding resident (R1). Facility currently does not have any COVID-19 positive cases. LPAs wore N-95 mask and was screened by facility upon entry. Facility staff wore masks in the facility . During today's visit, LPAs interviewed staff members and reviewed documentation in R1's file pertinent to the incident. LPAs requested that facility obtained a death certificate for R1. LPAs will follow-up with facility regarding incident once facility obtains a death certificate for R1. At this time, further investigation is needed regarding information above. Exit interview was conducted with Caroline and a copy of this report was provided to the facility. There were no deficiencies cited during today's visit.the state’s words, verbatim · CDSS document, Mar 16, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 12/10/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Senior Executive Director, Caroline Frangieh, 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, and contacted facility to complete a facility risk assessment. LPA ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: first and second floor of Assisted Living Unit, Memory Care Unit, dining rooms, kitchen, outdoor area, lobby, PPE storage, and main restrooms. Fire extinguishers are ready for emergency use and all stairwells have evacuation chairs. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Senior Executive Director completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Dec 10, 2021

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Michael Hood met with Senior Executive Director, Caroline Frangieh, to conduct a case management visit. The purpose of the visit is to follow-up on an incident report that was received by the Department. Prior to initiating the case management visit, 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, and contacted facility to complete a facility risk assessment. LPA ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Incident report received by the Department states that, on 12/5/2021, Sutter Hospice Nurse observed resident (R1) enter the apartment of resident (R2), leading to a physical altercation between both of the residents. Both residents have a primary diagnosis of dementia and live in the Memory Care Unit of the facility. Resident's MDs and Power of Attorneys (POAs) for both R1 and R2 were contacted regarding incident. Neither R1 nor R2 have aggressive behaviors indicated in their needs and services plan. Care Notes indicated that similar altercations have occurred between R1 and R2 on 9/18/2021, 10/10/2021, and 11/14/2021. Each incident involved R1 entering R2's apartment, leading to an altercation that became physical. Care Notes indicated that MD and POAs were contacted for both R1 and R2 with each incident. Senior Executive Director stated that additional safety watch has been implemented for R1 and R2 to monitor residents' behavior to prevent R1 from entering R2's apartment. The facility will conduct a meeting with R1's family to discuss moving R1 to another apartment to prevent altercations since R1 and R2's apartments are next to each other. If R1 is unable to receive approval for a change of apartment or if change does not resolve pattern of behavior, than facility will seek 1-on-1 supervision for R1. No deficiencies are being cited at this time. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Dec 10, 2021