Golden Hills Care Home

Allegation investigated: - Staff did not provide adequate supervision resulting in a resident wandering away from facility.

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced 08/31/2023 to deliver final finding for a complaint Community Care Licensing (CCL) received on 06/13/2023. LPA met with staff, Louie Dixon, and explained the purpose of the visit.Throughout the course of the complaint investigation the Department conducted interviews and obtained pertinent documents, such as resident’s physician’s report and appraisal/needs and services plan. According to complainant, complainant observed R1 wandering the road on 06/13/2023. Shortly after observing R1 wandering, the facility staff were seen searching in the neighborhood and running down the street. Continue on page LIC9099-C. Substantiated The Department requested for R1’s physician’s report. According to R1’s physician’s report, R1 has dementia and is not able to leave the facility unassisted. The Department received interview statements from a total of three (3) facility staff and R1's responsible party. Interview statement received from administrator indicated, administrator was not working when R1 eloped on 6/11/2023. R1 eloped and was found at an elementary school located about six (6) minutes away from the facility due to staff’s lack of supervision. R1 was located by a mail lady. It took staff approximately 22-30 minutes to locate R1. R1's RP indicated there is sufficient staffing to meet R1's needs and that staff are attentive to R1. This incident was a one time occurrence. Based on evidence obtained during the investigation, the preponderance of evidence standard has been met, therefore, the above allegation are found to be SUBSTANTIATED. California Code of Regulations, (Title 22), is being cited on the attached LIC9099D. Exit interview conducted and report provided. Appeal rights were provided.the state’s words, verbatim · CDSS document, Aug 31, 2023 · control 59-AS-20230613163958

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Sep 1, 2023

87411(a) Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: It was determined that staff did not provide adequate care and supervision to R1 which resulted in R1 eloping to an elementary school six minutes away from the facility. It took staff approxmiately 22-30 minutes to locate R1 which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 31, 2023

Plan of correction: The administrator agrees to provide a detailed plan explaining how they will ensure facility staff are competent and aware of how to properly provide care and supervision to residents. Proof of completion shall be sent to the licensing agency by 9/1/2023.

Allegation investigated: Licensee allows staff to work without criminal record clearance. Staff do not have required immunizations. Staff do not receive required training prior to providing care.

Licensing Program Analysts (LPAs) Talwinder Bains and Lavinia Muscan arrived at the facility unannounced on 06/06/23 to do complaint investigation for above allegations. LPAs met with administrator Vivek Mahajan and explained the purpose of the visit. The department did facility record review and staff interviews for complaint investigation. ***report continue on LIC9099C....... Unfounded ***report continued from LIC9099...... Allegation- Licensee allows staff to work without criminal record clearance. The department did facility record review and staff interviews for complaint investigation. Staff interviews indicated that all staff associated with facility have criminal record clearance and no staff were working at facility without criminal record clearance. Administrator interview indicated that facility was aware about this requirement and they do not allow any staff working at the facility without criminal record clearance. Record review for all staff files showed that all staff working at the facility were fingerprint cleared and associated with facility, therefore this allegation is UNFOUNDED. Allegation- Staff do not have required immunizations. The department did facility record review and staff interviews for complaint investigation. Facility record review indicated that facility staff have all required immunization which staff need to have upon hiring per their physician. Also, CCL does not have any current guidelines regarding staff immunization to work at any licensed facility , therefore this allegation is UNFOUNDED. Allegation- Staff do not receive required training prior to providing care. The department did facility record review and staff interviews for complaint investigation. Facility staff record review indicated that facility staff have all the required training per department guidelines except for 2 staff members who start working with facility since 05/16/23. Per CCL regulation 87412.c.1 ,facility have 4 weeks time to finish the required on boarding training with staff from their hiring date so facility will finish all required training for those 2 staff members till 06/16/23 and notify department once completed, therefore this allegation is UNFOUNDED. Based on the investigation, the preponderance of evidence standards has not been met. Therefore, the above all allegations is 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. No citations were issued today. Exit meeting conducted with administrator. A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Jun 6, 2023 · control 59-AS-20230601160353

Allegation investigated: Facility staff did not properly change resident's diaper. Facility staff did not respond to resident's call button.

Licensing Program Analysts (LPAs) Talwinder Bains and Lavinia Muscan arrived at the facility unannounced on 06/06/23 to deliver complaint investigation findings for above allegations. LPAs met with administrator Vivek Mahajan and explained the purpose of the visit. The department did facility record review, staff and residents interviews and facility observations for complaint investigation. ***report continue on LIC9099C....... Unsubstantiated ***report continued from LIC9099........... Allegation- Facility staff did not properly change resident's diaper. Department interviewed 2 staff and 2 residents during complaint investigation. Department has reviewed facility records, including charting notes, staff schedule, and resident records. Interviews and record review indicated that resident’s ADL’s which includes residents showering, incontinence and care needs are met as required and documented accordingly. Residents’ interviews indicated that staff were providing care in a professional manner and did not express any concerns. The department conducted interviews, facility observation and record review to investigate above allegation. During interviews with facility staff and residents, it has been revealed that facility is providing care to residents according to resident’s needs and service plans. During residents’ and staff interviews, it has been concluded that facility has enough staff to meet the needs of the residents in care. During department visits, department observed that residents appeared to be well groomed and in good care, therefore, the above allegation is found to be UNSUBSTANTIATED. Allegation- Facility staff did not respond to resident's call button. The department investigated allegation, “Facility staff did not respond to resident’s call button.” The department interviewed staff, administrator, and residents in care. During residents’ interview, residents stated that staff respond to their call buttons in timely manner however sometimes there is a delay in response due to staff assisting other resident’s needs. During staff interviews, staff stated that they always tried their best to answer all residents call buttons as soon as they can, but some residents get upset if they have to wait. During call button log review, department did not observe any long/extended wait time from staff to respond to residents call button, therefore this allegation is UNSUBSTANTIATED. A finding that the complaint allegations is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No citations were issued today. Exit meeting conducted with administrator. A copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Jun 6, 2023 · control 59-AS-20230511155138

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Lavinia Muscan and Talwinder Bains arrived on Tuesday June 6, 2023 to conduct the annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPAs reviewed resident (2) and staff files (2). All resident files contained the required paperwork. All staff files contained the required paperwork. All staff have current first aid and CPR training. Facility was clean and well organized. Facility is current on fire drills. All required posting were observed. Staff training contained the required initial training. LPA and Administrator Vivek Mahajan toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area.The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. The disaster drill is current. The administrator's certificate is current. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use. Water temperature is within compliance. In the areas toured, there were no health or safety violations observed. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by 06/30/23. Exit interview conducted. A copy of this report was printed and given to Administrator.the state’s words, verbatim · CDSS document, Jun 6, 2023

Allegation investigated: Facility staff did not report injury to resident's responsible person.

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings for allegation listed above. LPA met with Administrator Vivek Mahajan during today's inspection. LPA investigated allegation, "Facility staff did not report injury to resident's responsible person". LPA interviewed administrator in which he stated R1 moved into the facility on 12/09/22. Resident was dropped off at the facility by a medical transport vehicle and the driver, not an employee, was pushing R1 in a wheelchair toward the facility. During transport by the driver R1's leg was bumped and R1 was in pain but no injury was noted. Administrator stated he does not remember if he reported that incident to responsible party and no documentation was available. Continuation on 9099-C. Substantiated Administrator stated there were no other incidents or injuries that occurred during R1's stay at the facility. LPA interviewed home health agency in which they stated in January 2023 they observed a pressure injury to R1's shin. R1 was seen by a wound specialist in which they stated the injury came from a incident that caused the injury. Home health spoke to R1 at the time and learned that during a transfer from bed to wheelchair the caregivers hit her shins on medical equipment. Responsible party stated this incident was not reported to her. 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 and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 1, 2023 · control 25-AS-20230221102112

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Jun 9, 2023

87211 Reporting Requirements. (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement is not met as evidenced by: Based on interviews the licensee did not report incident which lead to R1's pressure injury which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 1, 2023

Plan of correction: Administrator agrees to review 87211 reporting requirements and send into LPA a statement of understanding. Statement to be sent into CCL by 6/09/23. Since incident occurred facility has begun to complete thorough documentation for each resident.

Allegation investigated: Facility staff did not meet resident's incontinence care needs.

*This document was AMENDED. Additional information has been obtained regarding the allegation of Facility staff did not report injury to resident's responsible person. And LIC9099 dated 06/01/23 addresses the updated findings to this complaint allegation. Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to continue investigation into allegations listed above. LPA met with Administrator Vivek Mahajan during today's inspection. LPA investigated allegation, "Facility staff did not meet resident's incontinence care needs." Relevant party stated the facility staff refused incontinence care to R1 on one occasion. R1 was unable to be interviewed. LPA interviewed a caregiver in which they stated they have never refused any care to R1. Continuation on 9099-C. Unsubstantiated Caregiver stated they provided incontinence care throughout the day and night, and anytime the resident requests. LPA interviewed administrator in which he stated he is unaware of a time that staff refused care to R1 or any other residents in care. LPA interviewed 2 residents in care in which they stated that staff are helpful and have not refused them care. Due to the information gathered, LPA finds allegation to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are unsubstantiated. An exit interview was conducted. A copy of the report was provided to facility administrator.the state’s words, verbatim · CDSS document, May 11, 2023 · control 25-AS-20230221102112

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct a case management visit. LPA met with Administrator Vivel Mahajan 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 arrived to facility to discuss incident report that was sent into CCL by Administrator. Incident report indicates R1 was sent out to the hospital due to R1's wound being staged a stage 3. Homehealth was following resident and recommended R1 to be transported to a higher level of care. Administrator set R1 out to the hospital that afternoon. LPA requested several documents related to R1. No deficiencies are being cited as a result of todays inspection. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 28, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility announced on 6/20/22 to conduct a Pre-licensing referencing the infection control domain. LPA met with licensee and applicant and explained the purpose of the visit. Prior to initiating the pre-licensing inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and 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. LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Vivek completed the infection control recommendations and facility was found to be in substantial compliance at this time. Component III review completed. Facility is in significant compliance License pending approval. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Jun 20, 2022

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): COMP II by CAB successfully completed Method: Telephone call COMP II Participant: VIVEK MAHAJAN Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. Identification of the applicant and administrator was verified by photo ID . During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. During COMP II, CAB analyst confirmed Applicant/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, 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, Control of propertythe state’s words, verbatim · CDSS document, May 27, 2022