A Tender Touch Senior Living

Allegation investigated: Resident sustained unexplained burns while in care.

Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Florence Mojica at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 02/22/2023 at 12:20 PM to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews, and a review of pertinent documentations. The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The allegation indicates that due to neglect/lack of supervision, Resident sustained unexplained burns while in care. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Records review and interviews with staffs and residents indicated that staffs regularly check and monitors all residents at least every two (2) hours or more if needed at the facility to ensure that all residents were provided care and supervision and no incident at the facility happened where a resident sustained unexplained burns while in care. *** Continuation in LIC9099C *** Unsubstantiated In addition, staff interviews revealed that during the incident last 01/04/2022, R1 accidentally spilled hot tea on R1’s thigh at the facility and staff immediately helped and assessed R1, provided first aid to R1 and reported the incident to R1’s home health nurse. Residents interviews indicated no incident happened at the facility where a resident sustained unexplained burns while in care. Home Health Nurse reported to LPA Brown that R1 had no unexplained burns during a skin with R1 and no incident happened at the facility where R1 had unexplained burns due to staff neglect and lack of supervision. LPA Brown reviewed R1’s facility documents, home health care notes, hospital records, skilled nursing facility records and LPA Brown did not find evidence that R1 had unexplained burns due to staff neglect or staff lack of supervision. Based on the evidence, the allegation that Resident sustained unexplained burns while in care is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 was discussed and provided to Licensee/Administrator Florence Mojica.the state’s words, verbatim · CDSS document, Feb 22, 2023 · control 18-AS-20220106082752

Allegation investigated: Resident sustained burns while in care.

Licensing Program Analyst (LPA) Melody Brown met with Administrator Florence Mojica at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 02/22/2023 at 12:20 PM to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation. The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The allegation indicates that due to neglect/lack of supervision, Resident sustained burns while in care. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Records review and interviews with staffs and residents indicated that staffs regularly check and monitors all residents at least every two (2) hours or more if needed at the facility to ensure that all residents were provided care and supervision *** Continuation in LIC9099C *** Unsubstantiated and no incident happened at the facility where a resident sustained unexplained burns while in care. In addition, staff interviews revealed that during the incident last 01/04/2022, R1 accidentally spilled hot tea on R1’s thigh at the facility and staff immediately helped and assessed R1, provided first aid to R1 and reported the incident to R1’s home health nurse. Residents interviews indicated no incident happened at the facility where a resident sustained unexplained burns while in care. Home Health Nurse reported to LPA Brown that R1 had no unexplained burns during skin check with R1 and no incident happened at the facility where R1 had unexplained burns due to staff neglect and lack of supervision. LPA Brown reviewed R1’s facility documents, home health care notes, hospital records, skilled nursing facility records and LPA Brown did not find evidence that R1 had sustained burns while in care due to staff neglect or staff lack of supervision. Based on the evidence, the allegation that Resident sustained burns while in care is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 was discussed and provided to Licensee/Administrator Florence Mojica.the state’s words, verbatim · CDSS document, Feb 22, 2023 · control 56-AS-20230111154610

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Florence Mojica at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 02/22/2023 at 12:20 PM PM to initiate a Case Management Office Visit. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of interviews and a review of pertinent documentation. LPA Brown reviewed documents and interviewed staffs and it indicated that Staff #4 (S4) started working at the facility 08/01/2021 without criminal background clearance. LPA Brown reviewed Guardian website and it indicated that S4 was granted criminal background clearance last 09/07/2022. LPA Brown will issue a citation for this issue as this pose immediate health, safety and personal rights risk to resident in care. Civil penalty was assessed with the amount of $500.00 during the Office Visit for allowing S4 to work at the facility without Criminal Background Clearance. An exit interview was conducted where this report (LIC809), LIC809D, LIC421BG and Appeal Rights were discussed and provided to Licensee/Administrator Florence Mojica.the state’s words, verbatim · CDSS document, Feb 22, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Feb 23, 2023

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working...(1) Obtain a California clearance... This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by allowing Staff #4 (S4) to work at the facility without criminal background clearance since 08/01/2021 which pose immediate health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Feb 22, 2023

Plan of correction: Licensee stated to submit Signed Statemanet of Understanding on CCR 87355(e)(1) to LPA Brown by POC due date. Licensee confirmed S4 was granted criminal background clearance last 09/07/2022. POC cleared.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Florence Mojica at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 02/22/2023 at 12:20 PM to initiate a Case Management Office Visit. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of interviews and a review of pertinent documentation. LPA Brown reviewed documents and interviewed staffs and it indicated that R1 does not have Pre-Admission Appraisal. The Licensee failed to interview R1 and R1's responsible person for facility admissions. LPA Brown will issue a citation for this issue as this pose potential health, safety and personal rights risks to resident in care. In addition, LPA Brown observed that R1 only have one (1) LIC602A Physician Report with physician signature date 12/24/2019 and the facility failed to conduct R1's medical assessment annually to reassess R1's dementia care needs. Moreover, LPA Brown also observed that no reappraisal was done by the Licensee annually for R1 to reassess R1's dementia care needs. LPA Brown will issue a citation for this issue as this pose immediate health, safety and personal rights risks to resident in care. An exit interview was conducted where this report (LIC809), LIC809D, and Appeal Rights were discussed and provided to Licensee/Administrator Florence Mojica.the state’s words, verbatim · CDSS document, Feb 22, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(5) · Plan of correction due date: Feb 23, 2023

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible... (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually...This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by not having annual medical assessment and a reappraisal done at least annually for R1 which pose immediate health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Feb 22, 2023

Plan of correction: Licensee stated to submit signed Statement of Understanding on CCR 87705(c)(5) to LPA Brown by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87457(a) · Plan of correction due date: Mar 1, 2023

87457 Pre-Admission Appraisal – General (a) Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions. This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by not having a completed Pre-Admission Appraisal for R1 which pose potential health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Feb 22, 2023

Plan of correction: Licensee stated to submit signed Statement of Understanding on CCR 87457(a) to LPA Brown by POC due date.

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced Health & Safety check at this facility. Upon arrival LPA met with Dawn Hebert and she was informed of the purpose of the visit. During LPA visit the manager Teresita Espinoza arrived and she was also informed of the purpose of the visit. The Health and Safety check included an overall observation of the facility inside, and outside including food supply, physical plant, clients in care, and staffing. The tour of the facility included residents’ bedrooms, bathrooms, and kitchen. LPA Allen observed a 7-day supply of non-perishable and 3-days of perishable food supply. Dawn confirmed that there are 6 clients at the facility. LPA observed five (5) clients during the visit there were two (2) clients in the TV room and the other three (3) clients were in their bedrooms. Dawn said that one client was at a doctors appointment. During the visit LPA observed and interviewed support staff and there was one staff member (S1) that was not cleared or associated to work at the facility. There was one deficiency cited during today's visit An exit interview was conducted where this report LIC809 ,LIC 809-D and LIC421BG was discussed and provided to Teresita Espinoza at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 13, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jan 14, 2023

87355. Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing, or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record..This requirement is not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above by allowing S1 to work at the facility for one (1) day without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 13, 2023

Plan of correction: The licensee has agreed to read regulation 87355 entirely and send LPA self-certify letter that the regulation was read and understood. The licensee has agreed to remove S1 from the facility and not allow S1 to work at the facility until S1 has a criminal background clearance. POC is due 12/14/2023

Allegation investigated: Facility placed an audio surveillance device in resident's bedroom

Licensing Program Analysts (LPAs) Melody Brown and Michelle Echeverria met with Licensee/Administrator Florence Mojica at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 12/21/2022 at 10:00 AM to deliver findings for the allegation listed above. LPAs Brown and Echeverria explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews and review of pertinent documentations. Through the information gathered during the investigation, it was confirmed by documents review and interviews that Facility placed an audio surveillance device in resident's bedroom. Interviews with residents and staff indicated knowledge of the audio surveillance device in resident’s bedroom. During the tour of the facility last 12/21/2021, LPAs Brown and Lama observed audio surveillance device placed in the bedroom of Resident 1 (R1), Resident 2 (R2) and Resident 3 (R3). *** Continuation in LIC9099C *** Substantiated Licensee/Administrator Mojica reported that if a resident is non-ambulatory, the bedroom has audio surveillance device for the staff to appropriately monitor the non-ambulatory residents in care. Moreover, though Licensee/Administrator Mojica indicated that responsible party of Resident 3 (R3), Resident 1 (R1) and Resident 2 (R2) provided consent on audio surveillance device on R3, R1 and R2's bedroom. Interviews with both R3, R1 and R2's responsible party revealed they both did not provide consent to the audio surveillance device in their family’s bedroom. LPA Brown will be issuing a deficiency for this issue as this pose potential health, safety and personal rights risk to residents in care. Based on LPAs Brown and Echeverria's observations and interviews, the preponderance of evidence standard has been met, therefore the allegation Facility placed an audio surveillance device in resident's bedrooms found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 8) is being cited on the attached LIC9099D. An exit interview was conducted where this report, LIC9099, LIC9099D, and Appeal Rights were discussed and provided to Licensee/Administrator Florence Mojica. Moreover, per LPA Brown's review of Hospice Care Notes, incident last 10/04/2021 was reported to hospice and R3 was assessed, being treated for wound care and wound was reported to R3's physician. LPA Brown also noted R3's Weekly Progress Report on R3's wound care. The second allegation indicates facility did not update resident's records. Staff interviews and documents review indicated residents’ records were all updated by Licensee/Administrator Mojica. LPA Brown reviewed R3’s records during the visit last 12/21/2021 and LPA Brown observed that R3’s records were all current and updated at the facility by Licensee/Administrator Mojica. The third allegation indicates facility did not meet residents’ nutritional needs. Interviews with residents and staffs and documents review indicated residents were served healthy breakfast, lunch, dinner and snacks. In addition, interviews with staffs and residents revealed that adequate meals were always served and on time. Also, during LPAs Brown and Lama's tour of the facility last 12/21/2021, adequate supply of perishable (more than three (3) days) and non-perishable foods (more than seven (7) days) were observed. Based on interviews and records review, the allegation Resident sustained wounds while in care (Allegation #1), facility did not update resident records (Allegation #2), facility did not meet residents’ nutritional needs (Allegation #3), are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, where this report (LIC9099) was discussed and provided to Licensee/Administrator Florence Mojica.the state’s words, verbatim · CDSS document, Dec 21, 2022 · control 18-AS-20211217160328

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Jan 3, 2023

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents… This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by placing an audio surveillance device in R3, R2 and R1’s bedroom without R3, R2 and R1’s responsible party’s consent which poses potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 21, 2022

Plan of correction: Licensee stated to train all staff on CCR 87307(a) and will submit Training Log to LPA Brown by POC due date. Licensee will submit a Statement of Understanding on CCR 87307(a) to LPA Brown by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Melody Brown and MIchelle Echeverria met with Licensee/Administrator Florence Mojica at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 12/21/2022 at 10:00 AM to initiate a Case Management Office Visit. LPAs Brown and Echeverria explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews and a review of pertinent documentation. During the facility visit last 12/21/2021 at 12:30 PM and per documents review, LPAs Brown and Lama did not find any Special Incident Report (SIR) that the facility submitted to Community Care Licensing Division (CCLD) to report that R3 had a wound on right arm while hospice staff is giving R3 a shower. LPA Brown will issue a citation for not reporting the incident at the facility to CCLD as this pose potential health, safety and personal rights risk to resident in care. An exit interview was conducted where this report (LIC809), LIC80D, and Appeal Rights were discussed and provided to Licensee/Administrator Florence Mojica.the state’s words, verbatim · CDSS document, Dec 21, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Jan 3, 2023

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1) A written report shall be submitted to the licensing agency... This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by not submitting Special Incident Report (SIR) that R3 had a wound on right arm while hospice staff is giving R3 a shower. This pose potential health, safety and personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Dec 21, 2022

Plan of correction: Licensee stated to train all staff on CCR 87211(a)(1) and submit proof of Staff Training Log to LPA Brown by POC due date. Licensee will submit Signed Statement of Understanding on CCR 87211(a)(1) to LPA Brown by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the facility to initiate annual inspection, LPA was greeted and granted entrance to the facility by caregiver Imelda Majam who called Florance Mojica- Administrator. LPA observed that the facility has a mitigation plan to mitigate the spread of COVID-19 in the facility. One central entry point and sign-in policy has been designated for universal entry screening. Routine symptom screening has been initiated at entry for all staff, clients, and visitors. Facility also documents daily temperature and COVID-19 symptom checks, and any change in condition for staff and clients. LPA toured the facility inside and out and there were no health and safety concerns. The facility has charged fire extinguishers, operating smoke alarms, and carbon monoxide detectors. The outdoor and indoor hallways were also free of obstruction. Cleaning supplies are locked in a cabinet in the laundry area LPA’s observed a two (2) day supply of perishable food items and seven (7) day supply of non-perishable food items. The facility menu was available for review. The client rooms had the required furniture and sufficient lighting. The bathrooms can accommodate the needs for bathing and showers/tubs with non-slip flooring. The facility had a supply of additional linen and extra hygiene items for the clients. LPA measured the hot water temperature 105.8 F. in the bathroom at the entry point of the home. Based on interviews and observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report was discussed, and a copy was provided to Florance Mojica at the conclusion of the visit.the state’s words, verbatim · CDSS document, Oct 19, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to commence a health and safety check. LPA Brown identified herself and discussed the purpose of the visit with caregiver Tara Hinojosa due to complaint # 18-AS-20220106082752. Residents in care were present during visit. No imminent health and/or safety concerns observed at the time of visit. LPA observed no health and/or safety hazards inside the facility. LPA inspected the outside perimeter of the facility and observed no health and/or safety hazards. LPA observed sufficient staff present at the facility to provide care. LPA inspected facility food supplies and observed an adequate supply of perishable and non-perishable food. The needs of the residents in care appear to be met during this inspection. An exit interview was conducted where this report (LIC809) was discussed and provided to caregiver Hinojosa.the state’s words, verbatim · CDSS document, Jan 7, 2022

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Melody Brown made an unannounced visit to the facility to conduct an annual inspection, with emphasis on infection control. LPA Brown was greeted and granted entrance by caregiver Ermalinda Alfaro and explained the purpose of today's visit. Caregiver Alfaro accompanied LPA Brown on a tour of the inside and outside of the facility. Administrator Florence Mojica was contacted and reported that she was out of town and unable to come to the facility for the inspection. During today’s visit, LPA Brown made observation pertaining to the facility’s current infection control measures. LPA Brown observed a screening area, proper signages throughout the facility, sufficient hand hygiene supplies, cleaning supplies, and sufficient supply of Personal Protective Equipment (PPE). The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, cleaning and disinfection are in adequate quantities, and that staff are trained in overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas/surfaces. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident’s physician and to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and a copy of this report was provided to caregiver Ermalinda Alfaro.the state’s words, verbatim · CDSS document, Oct 18, 2021