Dulce Villa I

Type of visit: Required - 1 Year

On 10/17/2023, Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Staff, Lorena Guillen, who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (3) residents present. The facility is a one story home with (5) bedrooms and (3) bathrooms and attached garage. No pools or firearms are at the facility. The residents served are elderly ages 60 and above. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted a staff and resident interviews. LPA observed the following: Infection Control: The LPA observed hand washing stations with hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. The facility has a plan to train and follow infection control guidelines. Physical Plant: Physical plant was observed to be clean and in good repair. The indoor and outdoor areas were observed to be free of hazards. Laundry equipment was observed to be in good working condition. The sharp and dangerous objects were observed to be locked and inaccessible to residents. The smoke detector and carbon monoxide was operational, and the hot water temperature was recorded at 105F. LPA observed cameras in the facility common area and spoke with the licensee who stated they did not have consent forms for the residents. Deficiency will be cited for this. A plan of correction was created with the licensee to update their plan of operation and admission agreement to reflect this. Food Service: LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. LPA observed the facility did not met the required 2-day supply of perishable and 7-day supply of non-perishable foods. Plan of correction was made with the staff and licensee. Record Review and Resident/Staff Files: LPA reviewed (2) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. The listed administrator has a current administrator's certificate. Two (2) resident files were reviewed, and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All client medication was locked in kitchen pantry. LPA reviewed resident medications, and found Resident #1 (R1)'s PRN medication for pain was not filled at the facility. LPA was informed by staff that they primary c are provider would be coming the next day to fill the medication as it had previously expired. Deficency was cited and plan was correction was created with licensee. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. The last fire drill was conducted 9/23/23. LPA observed emergency exits and emergency supplies. An exit interview was conducted where a copy of this report along with LIC809-D page, and appeal rights were reviewed and provided to staff, Lorena Guillen.the state’s words, verbatim · CDSS document, Oct 17, 2023

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Oct 31, 2023

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons." This requirment was not met as evidenced by: Based on observation, record review and interview it was found that there were no consent forms for (3) cameras placed in common areas. This poses a potential health, safety, or personal rights risk.the state’s words, verbatim · CDSS document, Oct 17, 2023

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Oct 31, 2023

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirment was not met as evidenced by: Based on observation, the facility did not meet the required amounts of food items. This poses a potential personal rights, health or saftey risk to residents in care.the state’s words, verbatim · CDSS document, Oct 17, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Chinwe Nwogene made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by caregiver Hilda Ramos who called Administrator, Nikul Mody on the phone. Nikul Mody arrived at the facility shortly after. LPA also met with Lead caregiver Lorena Guillen who was informed of the purpose of the visit. At the time of visit there was 3 staff and 3 residents present. The facility currently has zero positive or suspected Covid-19 cases. During today's visit, LPA toured the facility inside and out with Lorena and made observations regarding the infection control measures that the facility has implemented. LPA observed Covid-19 postings posted throughout the facility. The facility has an adequate amount of hand hygiene supplies (soap, hand sanitizer and paper towels) in all restrooms. LPA did not observe any pools or bodies of water within the premises. The facility has a plan in place to monitor residents regularly for any changes in condition, which includes daily temperature checks. The Facility will contact the resident's physician should there be any event of COVID-19 related illnesses. The facility has a designated infection control lead. The facility also cleans and disinfects the highly touched surfaces during each shift, and as needed. LPA observed PPE supplies. LPA was informed that no weapons or ammunition is maintained at the home. Administrator, Nikul was informed of the licensing fees due. Nikul stated a check has been mailed to the CDSS office weeks ago. During the tour of the laundry room, LPA Nwogene observed cabinet with laundry detergents not adequately secured. The cabinet was immediately locked by caregiver, Hilda Ramos. Therefore, based on the observations made during today’s visit, one #1 deficiency was cited per Title 22, Division 6 of the California Code of Regulations. See LIC 809D. An exit interview was conducted, and this reported was reviewed and provided along with appeal rights to Nikul Mody.the state’s words, verbatim · CDSS document, Oct 19, 2022

Allegation investigated: Resident sustained stage 3 pressure injury while in care. Facility did not ensure changes in resident's condition were reported to a physician in a timely manner. Staff did not assist residents with medications as needed.

Licensing Program Analyst (LPA) Stephanie Williams made an unannounced visit to the facility in order to deliver findings for the above allegations. LPA Williams identified herself to Caregiver, Manuel Ramas, who was also informed of the purpose of the visit. LPA Williams discussed the findings with the Administrator via telephone. The Department investigation included records review and interviews with staff, residents, and witnesses. In regards to allegation #1, the Department's investigation revealed that facility staff neglected to assist Resident #1 (R1) in meeting care needs. According to the investigation, in late March 2020, R1 experienced an unwitnessed fall. Following the fall, R1 experienced weakness and needed additional assistance with incontinent care and mobility. Department staff interviewed Staff #1 (S1) who stated that after R1’s fall, R1 preferred to stay mostly in bed. According to additional staff interview, staff observed multiple pressure “ulcers” on both of R1 buttocks. Staff reported that they notified S1 of what was observed approximately three weeks before R1 hospitalization on 4/8/2020. Investigation revealed that despite S1 indicating that R1's Substantiated Primary Care Physician (PCP) was contacted about the “ulcers,” there is no documentation on file to support that the PCP was notified nor that R1 was receiving any treatment for the “ulcers.” Furthermore, according to PCP interview, no contact was made by S1. In addition, PCP reported that R1 had history of pressure ulcers and needed two-persons to assist in transferring R1 in and out of bed. After the fall in March 2020, R1 needed incontinent care to be provided by staff at night (NOC) shift and needed to be repositioned. However, staff reported that they did not consistently reposition R1 nor change R1 incontinent care product during the NOC shift. On or around 4/8/2020, the PCP was sent a photo of R1’s ulcers. Following receipt of the photo, PCP requested emergency medical services be sought. On 4/8/2020, 911 Emergency services were called and R1 was sent to the hospital. Medical records revealed that there were four pressure injuries; (1) a 5cm Stage III pressure injuries to R1’s right lower buttock and (2) Stage III pressure injury to upper posterior thigh and (3) 1-2cm Stage II pressure injuries on right buttock and (4) Stage II pressure injuries on left buttock. Based on sufficient evidence to corroborate neglect caused by the facility staff to the resident, the allegation is substantiated. Due to immediate health and safety risk posed to resident in care, an Immediate Civil Penalty of $500 is being assessed. The licensee was also informed that an enhanced civil penalty may be assessed based on Health and Safety Code 1569.49(f). In regards to allegation #2, Department staff interviewed R1’s primary care physician who stated, “I have never had contact in my life with facility staff.” R1’s primary care physician stated that the office only learned of R1’s pressure ulcer when a photo of the pressure ulcer was sent to the office from R1’s phone. In addition, there was no documentation provided by the facility which indicated that R1's primary care physician was aware of R1's pressure injury. Based on interviews and records review, there was sufficient evidence to corroborate the allegation; therefore, the allegation is substantiated. In regards to allegation #3, Department staff reviewed residents' Medication Administration Records (MAR) at 0930 hours. During the review, Department staff reported that one resident's MAR was marked as completed in advance by facility staff at 2000 hours. Department staff questioned the Administrator about the discrepancy, to which the Administrator stated that the MAR was marked as completed in advance because they were unaware if they would be present later. Based on the Administrator's statement and review of MAR, there was sufficient evidence to corroborate the allegation; therefore, the allegation is substantiated. Based on the evidence gathered during the course of the investigation, the three allegations as stated above are SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report (LIC 9099, 9099C, & 9099D) and appeal rights were discussed and a copy was provided to Ramas at the conclusion of the visit. An exit interview was conducted where this report(LIC 9099 & 9099C) were discussed and a copy was provided to Ramas at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 24, 2022 · control 18-AS-20200504114244

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(8) · Plan of correction due date: Jan 25, 2022

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) ...l care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation.... This requirement was not met as evidenced by: Based on interviews and records review, the Licensee did not ensure the personal rights of R1 to be free of neglect. The Licensee did not seek medical attention for pressure injury sustained by R1. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 24, 2022

Plan of correction: An immediate civil penalty for $500 is being assessed for neglect resulting in the injury/illness of resident in care. In addition, the Licensee shall conduct training on the personal rights of all residents for all facility staff and send proof to the Department by POC date of 1/25/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Jan 25, 2022

87466 Observation of the Resident- The licensee shall ensure that residents are regularly observed for changes in physical... the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician.. This requirement was not met evidenced by: Based on interviews and records review, the Licensee did not ensure changes in resident's condition were documented and reported to R1’s physician in a timely manner. This posed an immediate Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 24, 2022

Plan of correction: The Licensee shall conduct training on regulation 87466- Observation of the Resident for all facility staff and send proof to the Department by POC date of 1/25/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(5) · Plan of correction due date: Jan 31, 2022

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed.. The plan shall encourage routine medical care.. provide for assistance in obtaining such care, ... (5) The licensee shall assist residents with self administered medications as needed. This requirement was not evidenced by: Based on interviews and records review, the Licensee did not ensure that resident medications were dispensed appropriately and as prescribed. This posed a potential Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 24, 2022

Plan of correction: The Licensee shall conduct medication training and documentation for all staff in accordance with regulation 87465. Proof of the training shall be sent to the Department no later than POC date of 1/31/2022.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA Gardner met with Caregiver Eligio Ramos. Present in the home during time of visit were 3 clients. There are currently no cases of COVID-19 within the facility. While touring the facility, Administrator Nikul Mody arrived in the facility. During today's visit, LPA Gardner toured the facility and made observations pertaining to the facility's infection control measures. LPA Gardner observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE and overall infection control. During the inspection LPA Gardner discussed infection control practices and procedures with Mr. Mody. An exit interview was conducted and a copy of this report, was reviewed with and provided to Mr. Mody.the state’s words, verbatim · CDSS document, Oct 7, 2021