Loving-Kindness Carehome

Allegation investigated: - Resident developed pressure injuries while in care. - Resident had a serious decline in health while at facility.

On 04/12/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to deliver final findings Community Care Licensing received on 1/12/2023. LPA met with Administrator, Derbbie Ninobla, and explained the purpose of the visit. During the course of investigation, the Department interviewed facility staff, individuals involved, and obtained pertinent documents relevant to the complaint investigation such as, resident’s (R1) physician’s report, admission agreement, appraisal/ needs and services plan, medication list, SOC 341, register of facility residents, identification and emergency information, medical records, and medication list. Continue on page LIC 9099-C. Unsubstantiated Allegation: Resident developed pressure injuries while in care. – Unsubstantiated. According to complainant, R1 was admitted to the hospital on 1/7/2023. Complainant’s concern is regarding R1’s significant decline in health which resulted in pressure injuries and hospitalization. The Department received and reviewed R1’s medical records. On 1/7/2023 at approximately 1056 hours, R1 was admitted to Kaiser Permanente Medical Center Roseville via ambulance. On 1/8/2023, medical staff performed a wound assessment and located an unstageable pressure injury on R1’s coccyx (bony prominence). The wound’s length and width was 0.5 centimeters by 0.5 centimeters with full thickness tissue loss and slough. The etiology of the wound is “community acquired pressure injury.” R1’s discharge doctor explained that the term “unstageable” is used when the exact state of a wound cannot be identified accurately. R1’s doctor stated, according to R1’s hospital notes, would determine R1’s pressure injury as “probably stage 2.” The Department interviewed and received statement from R1’s home health nurse (HHN). On 01/05/2023, R1 was last seen by HHN two days prior to hospital admission. During R1’s head to toe check on 01/05/2023, HHN stated R1 was “clean” from any pressure injuries but was at high risk for those types of injuries. HHN did not recall seeing pressure injuries on R1 days before hospital admission. The Department gathered statement from facility administrator. On 1/07/2023, administrator gave R1 a sponge bath approximately three (3) days before 1/07/2023. Administrator recalled observing R1’s buttocks being red but did not see an open wound. Allegation: Resident had a serious decline in health while at facility. – Unsubstantiated. According to complainant, R1’s significant decline in health which resulted in R1’s severe weight loss. According to Home Health records, R1 was taking five (5) or more medications, had two (2) more hospitalizations in the past six (6) months, and required “around the clock” care. Home Health noted R1 as “failure to thrive” as of December of 2022. HHN described R1 as “frail” during start of care visit on 12/30/2022. HHN requested the facility staff to weigh R1 daily to ensure R1 was not losing weight too fast and in an unhealthy manner. Interview statement received from administrator indicated, staff were unable to weigh R1 daily due to lack of mobility and refusal. Administrator indicated R1 did not have a big appetite and needed to encourage R1 to eat regularly. R1 was able to walk without assistance and would take walks around with block with administrator. Approximately three (3) days before R1’s admission to Kaiser Permanente on 1/07/2023, R1 began declining in health. R1 stopped walking approximately five (5) days before 1/07/2023. R1’s discharge doctor explained that a failure to thrive diagnosis can be the “natural progression” of a patient’s decline in health. Doctor explained there is no way to combat the “process of aging” and some symptoms can be lack of appetite and weight loss. Due to the information above, CCL finds the allegations to be UNSUBSTANTIATED meaning 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 cited during today’s visit. Exit interview conducted with administrator, copy of report was provided. Allegation: Financial abuse. – Unfounded. According to complainant, the facility called Kaiser to inform them that R1’s medication and rent payments were unable to be processed. R1 was unable to recall pertinent bank information. Complainant called the facility to gather more information about R1’s bank information. Facility’s administrator told complainant that R1 was ‘settled up” with payments and the check bouncing issues occurred a month prior. Complainant was concern that there may be financial fraud occurring and found it “odd” that the facility would bring up payment issues when R1 was currently up to date with rent and medication payments. The Department investigated the alleged allegation. R1 went to the hospital and was moved to a higher level of care. R1’s belongings were left at the facility. R1’s responsible party (RP), contacted new facility to pack up and take all R1’s belongings which includes, purse with checkbook. The Department subpoenaed bank records and no issues concerning the licensee or staff from Loving-Kindness Carehome LLC were identified. Based on records reviewed and interviews, the above allegation 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 deficiencies have been cited during today’s visit. Exit interview conducted and report was provided to the facility.the state’s words, verbatim · CDSS document, Jul 11, 2023 · control 25-AS-20230112151253

Allegation investigated: - Facility staff did to address issue with scabies.

On 03/29/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced and met with Administrator, Derbbie Ninobla, to deliver final finding for a complaint Community Care Licensing (CCL) received on 01/03/2023. LPA wore Surgical Mask and was screened by facility upon entry. During the course of investigation, the Department interviewed facility staff and obtained pertinent documents relevant to the complaint investigation such as, resident’s (R1) physician’s report, needs and services plan, appraisals, and medical records. According to complainant, the facility has currently been found to be infested with scabies. R1 was found to have scabies across the chest area since R1 moved into the facility. Continue on page LIC 9099-C. Unfounded The Department received an interview statement from the facility’s administrator. On 12/22/2022, administrator stated R1 was sent to the hospital due to a change of condition. Administrator received a text message from R1 stating, R1 will be receiving surgery for scabies and other physical issues. The same day R1 notified administrator of scabies, administrator contacted Doctor/Nurse and confirmed there were no scabies involved and R1 was experiencing itchiness in the chest area. The Department received R1’s medical records for review. According to medical records, R1 was admitted to the hospital on 01/07/2023. Medical records does not indicate R1 was diagnosed with scabies. Based on information above, the Department concluded that all these allegations are UNFOUNDED. A finding that the allegation are unfounded means that the allegation are false, could not have happened, and/or is without a reasonable basis. No citations were issued today. Exit interview was conducted with administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 29, 2023 · control 25-AS-20230103131124

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Lavinia Muscan and Auditor Jacqueline Juarez arrived at the facility unannounced on 3/22/23 to conduct a case management visit to request documents for a facility audit. LPA and Auditor met with Administrator, Derbbie Ninobla and explained the purpose of the visit. Copy of admission agreement, physicians report and rent checks were reviewed and obtained. Needs and service plan to be emailed to CCLD. As a result of today’s visit, no deficiencies were noted or cited. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Mar 22, 2023

Type of visit: Case Management - Incident

On 01/12/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to conduct a Case Management Incident visit. LPA met with Administrator, Derbbie Ninobla, and explained the purpose of the visit. The purpose of the visit is to gather additional information regarding an unusual incident/injury report that was sent to Community Care Licensing (CCL) on 01/11/2023. The report indicates that Administrator observed R1 has not been eating for a few days, groaning, and showed signs of weakness. R1 notified Administrator they had chest pain. Administrator called for an ambulance and resident was transferred to the ER. LPA interviewed Administrator regarding incident report. Administrator stated R1 has been transferred to the hospital about seven (7) times. Administrator stated R1 had a change of condition and the facility is unable to meet R1's needs. Administrator stated R1's Social Worker has been in contact and notified Administrator R1 will not be returning to the facility and will be placed at another facility. LPA request for Administrator to follow up with R1's Social Worker and find out where resident will be placed. LPA requested for R1's incident reports, physician's report, needs and services plan, and discharge medical documents. At this time, deficiencies are not being cited. Exit interview conducted and report provided.the state’s words, verbatim · CDSS document, Jan 12, 2023

Type of visit: Prelicensing

On 11/30/2022, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility to conduct a Pre-Licensing Inspection. LPA met with Administrator, Derbbie Ninobla, and explained the purpose of the visit. LPA ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. LPA were screened by Administrator prior entering the facility. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and three (3) bathrooms. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed at 106 degrees F. LPA checked the kitchen area for the ability to prepare and store food. LPA observed at least a 2-day perishable and 7-day nonperishable food supply on hand. LPA observed sharps/ knives to be locked away and inaccessible to residents in care. 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 the perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards. The care home has smoke detectors and carbon monoxide detectors that are operable. Licensing complaint poster are posted as required. Fire extinguishers and first aid kit are maintained and ready for emergency use. Component III presentation conducted with administrator. LPA observed that the facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. Exit Interview conducted and copy of report provided.the state’s words, verbatim · CDSS document, Nov 30, 2022

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 6 Census: 5 COMP II Participant: Derbbie Ninobla, Managing Member/Administrator Interview Method: Telephone interview On 10/20/22, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements/CPMB associations & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Oct 20, 2022