Dolce Vita Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with administrator Natalya Andreyea during today's inspection. LPA toured facility with Administrator to ensure health and safety of residents in care. LPA toured 6 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. 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 6 resident files and 2 staff files. LPA reviewed medications of two residents comparing with Centrally Stored Medication Record and 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, Oct 16, 2023

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 neglect led to resident sustaining pressure injury Staff left resident unattended in 2 soaking wet diapers and a pad for extended periods

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings. LPA met with Natalya Andreyea during today’s inspection. The department investigated allegation, “Staff neglect led to resident sustaining pressure injury”. The department interviewed relevant parties and reviewed medical documentation. On 2/10/23, R1 was admitted to home health for reasons unrelated to her skin/pressure injuries. On 3/7/23, redness was noted on R1 by home health. During R1’s weekly home health visit on 3/14/23, home health staff noted that R1 had a stage three pressure injury on her coccyx. Between 3/7/23 and 3/14/23, facility staff did not report the pressure injury or the worsening of the pressure injury to home health. Facility staff indicated that they were not aware of R1’s pressure injury until late March. Continuation on 9099-C. Substantiated Facility staff had no documentation or record indicating that home health was contacted regarding the pressure injury. Facility staff were responsible for R1’s activities of daily living that included bathing/showering. Due to the information gathered, LPA finds allegation to be SUBSTANTIATED. The department investigated allegation, “Staff left resident unattended in 2 soaking wet diapers and a pad for extended period”. The department interviewed relevant parties and reviewed medical documentation. On 3/29/23 R1 was seen by home health to provide wound care. Home health worker observed R1 to be wearing three sets of diapers/briefs and two of three were wet. Home health worker indicates R1 was probably sitting in the wet depends for a couple of hours due to the amount of urine that was observed. The department interviewed administrator in which she stated resident was never in 2 depends, however staff do use a depend and a pad inside the depend during the night. Due to the information gathered, LPA finds allegation to be SUBSTANTIATED. As a result of this investigation, LPA finds allegations 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. Deficiencies cited on 9099-D. Exit interview conducted.the state’s words, verbatim · CDSS document, May 4, 2023 · control 59-AS-20230330080535

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: May 5, 2023

87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, 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 and record review, R1 had a stage three pressure injury and did not report worsening of pressure injury to home health which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 4, 2023

Plan of correction: Administrator agrees to complete a training from an outside vendor for all care staff concerning wound and skin care. Date of training to be sent into LPA by 5/05/23. Once completed, a copy of training documentation and sign in sheet of what staff attended to be sent to LPA.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: May 19, 2023

87625 Managed Incontinence . (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Based on interviews, the licensee did not keep R1 clean and dry for 1 resident which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 4, 2023

Plan of correction: Administrator agrees to complete a training from an outside vendor for all care staff concerning continence care. Copy of training documentation and sign in sheet of what staff attended to be sent to LPA by 5/19/23.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Natalya Andreyeva, Administrator, and explained purpose of inspection. LPA observed caregivers Artur Beinoev and Olga Papoean, also present. LPA observed (6) residents to be in their rooms at the start of the inspection. Currently, there is (1) resident on hospice. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (4). Updated license to be sent. Prior to initiating today's inspection, LPA completed required COVID-19 protocols. LPA was screened per Covid-19 precautionary measures upon entering the facility. and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA and-Administrator toured the interior and exterior of the facility including the common areas, (6) resident bedrooms, (3) full bathrooms, (3) shower rooms, kitchen, staff room and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters posted. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps in the kitchen and medications and toxins to be secured also.. LPA observed the inside temperature to be 71*F. Fire extinguisher was last serviced 10/12/2022 and facility conducts quarterly fire drills. Discussed vaccination status of residents/staff, eligibility for boosters and updated visitation protocols. Booster flyers provided. LPA observed multiple Covid posters posted throughout as well as other required postings. LPA observed (1) unlocked gate from the inside back patio with covered patio seating. There are no pools or bodies of water. LPA observed copy of RCFE Administrator certificate #6062966740-exp 5/15/2024. Facility offers variety of activities, including art, music, and games. LPA observed ample supply of PPE. LPA requested an updated copy of LIC500, LIC308 and be provided by 11/10/2022. LPA obtained a copy of the current liability insurance There are no deficiencies issued during today's inspection. Exit interview with Administrator. Copy of report provided.the state’s words, verbatim · CDSS document, Nov 3, 2022

Type of visit: Prelicensing

Licensing Program Analysts (LPA) K. Hiratsuka and L. Muscan, arrived at the facility announced on 12/10/2021 to conduct an announced prelicensing visit. LPA met with Natalya Andreyea, Applicant; Shanice Frazer, Administrator Assistant; Alena Polyakova, Administratorr, and explained the purpose of the visit. Prior to initiating the visit, LPAs completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Facility Representative and completed a facility risk assessment. 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 Administrator. This facility has a fire clearance for six non-ambulatory residents. The main entrance opens to a common area. To the immediate right of the main entrance to there is a hallway leading to two private resident rooms that share a full bathroom. The full bathroom is accessible by the two resident rooms. There is a second hallway on the right that leads to a caregiver room and a large private resident room that has an exit to the outside and full private bathroom. In front of the main entrance there are two private rooms. To the left of the main entrance is a full common bathroom and one private resident room. To the left of the main entrance there is a doorway that leads to the main common area that has the kitchen, dining, and sitting areas. Behind the kitchen is the locked laundry room and doorway leading to the garage. There is an exit to the outside. There is a locked storage shed to the right of the facility in the backyard and and gate on the same side as the garage. There is a gate in front of the main entrance that is to be left unlocked at all times. There are locked cabinets for medications in the kitchen area. Component III orientation was conducted.. LPA did not find any deficiencies during this visit. LPA is going to submit this application to the application's specialist for their final review.the state’s words, verbatim · CDSS document, Dec 10, 2021

Type of visit: Office

COMP II by CAB successfully completed. Facility Type: RCFE Application Type: Initial Capacity: 6 all non-ambulatory Census (if any clients in care): 0 COMP II Participants: Natalya Andreyeva, Licensee and Alena Polyakova, Administrator Interview Method: Telephone interview On December 6, 2021 at 10:00 AM, Licensee and Administrator participated in COMP II via telephone with Analyst, Celia Phomphachanh from CAB. Identification of the Licensee was verified by providing California Driver License number verbally. During COMP II, Licensee and Administrator confirmed the understanding of Title 22 and Health and Safety Codes. Component II was successfully completed. Licensee and Administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB Analyst confirmed Applicant and Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program 2. Staff Qualifications and responsibilities 3. Applicant and Administrator Qualifications 4. Program Policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical Plant and Food Service 7. Application Document Review and Technical Assistance: Criminal Record Clearance, Health Screening, Fire Clearance, First Aid/CPR Certificate, Administrator Certificate, Financial Verification, Pre-licensing Inspection, Compliance History and Control of property. Interviewed concluded with Administrator. LIC 809 will be sent via email PDF to Licensee and Administrator.the state’s words, verbatim · CDSS document, Dec 6, 2021