Bonita Home Care

Allegation investigated: Questionable Death

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings regarding allegations listed above. LPA met with Administrators Anna and Alena Polyakova during today's inspection. The Department investigated allegation of questionable death. During the course of the investigation, the Department obtained hospital documentation, hospice documentation, and interviewed facility staff and relevant parties. Medical records indicate R1 was admitted to the hospital on 4/7/2020 with a chief complaint of a pressure injury. It was determined by hospital staff that R1 had a stage 3 pressure injury on the right sacral area and stage 1 and stage 2 pressure injuries on bilateral heels. R1 was placed on hospice and passed away in May 2020. Continuation on 9099-C. Unsubstantiated The Department obtained a copy of R1’s death certificate and observed immediate cause of death was Alzheimer’s dementia. 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. Upon physical exam by hospital staff at admittance, it was determined that R1 had a stage 3 pressure injury on the right sacral area and stage 1 and stage 2 pressure injuries on bilateral heels. The Department interviewed licensee, in which licensee stated R1’s pressure injury to their coccyx worsened over a “couple days” after it was discovered by staff. Licensee stated they attempted to get R1 an appointment to see their primary care physician but was unsuccessful and therefore sent R1 to the Emergency Department for treatment. Licensee stated that the pressure injuries to R1’s heel and coccyx happened “within hours” of each other. The Department interviewed R1’s primary care physician in which they stated it is “doubtful” that R1’s pressure injuries worsened to the extent they were upon admittance to the hospital, over a period of one or two days. The pressure injury on R1’s coccyx appeared deep, as in something that occurred over a “longer period of time". Due to the information gathered, the Department finds allegation to be SUBSTANTIATED. The Department investigated allegation of Facility retained a resident that required a higher level of care. During the course of the investigation, the Department obtained hospital documentation, hospice documentation, and interviewed facility staff and relevant parties. Medical records reflect that R1 was admitted to the hospital on 04/07/2020 with a chief complaint of a pressure injury to their buttock and sacrum. Emergency Department notes that R1 arrived directly from Bonita Facility for treatment of a pressure injury on the right sacral area and bilateral heels that were identified by facility staff about a week prior. Continuation on 9099-C. Upon physical exam by hospital staff at admittance, it was determined that R1 had a stage 3 pressure injury on the right sacral area and stage 1 and stage 2 pressure injuries on bilateral heels. Due to the information gathered, R1 had a stage 3 pressure injury which pursuant to CCR, Title 22 §87615 is considered a Prohibited Health Condition. LPA finds allegation to SUBSTANTIATED. The Department investigated allegation of staff did not inform resident’s authorized person of a change in health condition. During the investigation the Department obtained hospital documentation and interviewed facility staff and relevant parties. LPA interviewed licensee and administrator in which they stated they informed R1’s representative of all changes and incidents that occurred with R1 at the facility. Licensee sent LPA emails that were sent between facility staff and R1’s representative. LPA interviewed relevant parties in which they stated facility did not inform R1’s representative of a fall that occurred (4) four days prior to R1’s hospitalization on 04/07/2020. The relevant party indicated facility did notify R1’s representative that R1 had (1) one wound and that R1 was going to the hospital but facility did not notify them of the severity of R1’s condition. LPA reviewed hospital documentation and learned on 04/06/2020 a caregiver called the medical advice line and indicated R1 fell from their wheelchair (4) four days prior to hospitalization. Due to the information gathered LPA finds that R1 had a fall and facility staff did not inform R1’s representative. LPA finds allegation to be SUBSTANTIATED. Continuation on 9099-C. 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, May 4, 2023 · control 25-AS-20220914175632

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 record review R1 sustained a pressure injury while in care 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: Administrator agrees to attend a training from an outside agency with all care staff on skin care and repositioning residents. The training date to be submitted into LPA on 5/05/23. Once training is complete, administrator to send into LPA subject matter of the training and sign in sheet of who attended the training.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: May 5, 2023

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee obtained resident (R1) with a prohibited health condition, without an approved exception, 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: Administrator agrees to review 87615 prohibited health conditions. Administrator to submit a statement of understanding of what prohibited conditions are not permitted at the facility.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: May 12, 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 record review and interviews, the licensee failed to report incident to responsible party 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 provide a training to all care staff concerning reporting requirements. Administrator to send into LPA subject matter of training and sign in sheet of who attended the training by 5/12/23.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver complaint findings regarding allegations listed above. LPA met with Administrators Anna and Alena Polyakova during today's inspection. On May 4, 2023, the Department concluded a complaint investigation. During the course of the complaint investigation, it was learned that facility staff did not seek timely medical attention for R1 regarding pressure injuries. Interviews indicated staff were aware R1 had several pressure injuries that were worsening and resident had an overall decline. Resident had been less mobile over the last 3-4 days prior to being sent to hospital, staying in bed most of the time and was not eating or drinking for multiple days. Once admitted to the hospital on April 7, 2020, R1 was diagnosed with a stage 3 pressure injury to their right sacral area resulting in hospitalization. Facility staff stated they reached out to R1’s primary care physician on April 6, 2020. Staff claimed they noticed a skin breakdown worsening with an apparent odor, and waited for resident’s PCP to call back instead of bringing R1 to the hospital right away. Based on facility staff’s acknowledged observations of R1’s worsening condition, facility staff failed to provide care and supervision and delayed timely medical treatment that resulted in hospitalization for Unstageable, Stage 3 and Deep Tissue Injury. Deficiencies are being cited for violating the following California Code of Regulations (CCR) Title 22: 87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). Continuation on 809-C. Today, May 4, 2023, the Department will be issuing an immediate civil penalty in the amount of $500 shall for a violation of Section 87465 (g), and the license was informed that an additional civil penalty was still being determined and may be assessed based on Health and Safety Code Section 1569.49. A copy of LIC 421 was given to the facility representative. Exit interview conducted. Appeal Rights provided.the state’s words, verbatim · CDSS document, May 4, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: May 5, 2023

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not obtain medical attention in a timely manner 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 attend a training from an outside agency with all care staff on emergencies and emergency intervention. Training date to be submitted into LPA on 5/05/23. Once training is complete, administrator to send into LPA subject matter of the training and sign in sheet of who attended the training.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with administrator Anna Polyakova 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 toured facility with administrator to ensure health and safety of residents in care. LPA toured 4 resident rooms, 1 staff room, 2 bathrooms, kitchen, common living spaces, backyard and the garage area. In the areas toured no immediate health, safety, or personal rights violations were observed. Administrator stated there has been no positive COVID cases at the facility, but have an isolation room and sufficient amount of PPE. 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, Jan 9, 2023

Type of visit: Annual/Random

Licensing Program Analyst (LPA) K.. Hiratsuka, arrived at the facility unannounced on 01/06/2022 to conduct an unannounced annual visit using the infection control tool visit. LPA met with Facility Administrators Anna and Elena Polyakovar, and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; 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. LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, and common restrooms.. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. Multiple topics discussed. Exit interview conducted and copy of report left at the facility. The following shall be updated and submitted to Community Care Licensing by 01/31/2022: -LIC 500 facility personnel or staff schedule -LIC 610 emergency disaster plan -LIC 308 designation of administrative responsibility -copy of liability insurance No deficiencies cited.the state’s words, verbatim · CDSS document, Jan 6, 2022

Type of visit: Annual/Random

Licensing Program Analyst (LPA) K.. Hiratsuka and L. Muscan, arrived at the facility unannounced on 12/10/2021 to conduct an unannounced annual visit using the infection control tool visit. LPA met with Facility Administrators Anna and Elena Polyakovar, and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; 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. LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, and common restrooms.. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. Multiple topics discussed. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Dec 10, 2021