Kelly's Place #2

Allegation investigated: Resident was financially abused while in care

Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced visit to investigate the above allegation. LPA met with Caregiver Amelia Ramirez. The investigation included interviews with staff, a review of facility documentation, and an inspection of the facility. The residents related to this investigation passed away prior to the concerns reported to the Department, therefore, LPA was unable to interview residents. Allegation #1 stated that a resident was being financially abused. Information was reported that Resident 1 (R1) had paid for landscaping and a freezer for the facility. Licensee denied soliciting funds from R1. Continued on LIC9099C Unsubstantiated Licensee stated prior to R1 becoming a resident, R1 donated money toward a section of pavers in the backyard; however, LPA was not able to confirm this information. R2 also provided a plaque to be placed in the garden in honor of R2’s spouse who was a former resident at the facility; however, LPA was not able to confirm this information. The Licensee stated the freezer was not purchased by R1. Licensee provided a receipt to show proof of purchase which revealed the credit card used for the freezer purchase belonged to the Licensee. Additional information provided by another witness provided conflicting information, therefore this allegation could not be corroborated. Based on staff interview and record review, the allegation that resident was financially abused, is 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 violation did or did not occur. An exit interview was conducted where a copy of this report was reviewed with and provided.the state’s words, verbatim · CDSS document, Oct 27, 2023 · control 18-AS-20211007155211

Type of visit: Required - 1 Year

On 10/19/2023, Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced annual required visit. LPA was granted entry and met with Licensee, Kelly Hentzen, who was informed of the purpose of the visit. At the time of the visit there was (2) staff and (6) residents present. The facility is a one story home with (6) bedrooms and (3) bathrooms. The residents served are elderly ages 60 and above. LPA conducted a tour of the interior and exterior and 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. 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 met the required 2-day supply of perishable and 7-day supply of non-perishable foods. 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 showed the LPA proof of a pending 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. Resident medications were reviewed, all of which were accounted for. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. The last fire drill was conducted 9/6/2023. LPA observed emergency exits and emergency supplies. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided to Licensee, Kelly Hentzen.the state’s words, verbatim · CDSS document, Oct 19, 2023

Allegation investigated: Staff did not prevent resident from eloping from the facility.

On today's date, Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initiating an investigation with the above allegation. LPAs Colvin met with caregiver Rosa Quintana. Below is a summary of the findings of the investigation: Regarding allegation "Staff did not prevent resident from eloping from the facility.": LPA Colvin reviewed the resident's (R1) facility file, including Special Incident Report submitted by the facility on 10/3/22, and conducted interviews with staff. LPA Colvin confirmed that on 10/1/22 at approxiamtely 4:00am, R1 exited from the facility without staff's (S1) knowledge, as S1 had fallen asleep on the couch in the livingroom, sometime around 2pm or 3pm. According to interviews conducted, this was the first attempt R1 had made to exit the facility since R1 moved in August 2022. Licensee reports that R1's family stated that R1 did have a hisotry of leaving prior placement, though wandering behavior is not listed on R1's Physician's Report. Due to interviews and record review, the allegation "Staff did not prevent resident from eloping from the facility" is SUBSTANTIATED. 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. Due to observations made by LPA Colvin, the facility was cited and deficiencies noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy this report, LIC 9099D, and appeal rights were provided to caregiver Rosa Quintana during the exit interview.the state’s words, verbatim · CDSS document, Oct 13, 2022 · control 18-AS-20221006150834

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2 · Plan of correction due date: Oct 14, 2022

Additional Personal Rights of Residents in Privately Operated Facilities: (a) In addition to the rights listed...residents...shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff ...to meet their needs. This was not met by: The Licensee did not comply with the above regulation with at least one resident. LPA Colvin confirmed that on 10/1/22, R1 exited the facility without staff knowledge due to S1 having falled asleep. This was an immediate health and safety risk for R1.the state’s words, verbatim · CDSS document, Oct 13, 2022

Plan of correction: Licensee agrees to formulate plan for additional duties/tasks for NOC shaft to accomplish during their shift so that they are not spending large amounts of time sitting down, where they might fall asleep. Licensee to provide LPA Colvin with plan by Plan of Correction date of 10/14/22.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with caregiver Rosa Quintana and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. LPA Colvin additionally spoke with Administrator Kelly Hentzen via telephone, and went over the questions/areas for the Infection Control annual. Below is a summary of what was observed: Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator Kelly Hentzen, who LPA Colvin found to be successfully incorporating the several aspects of COVID-19 best practices. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap and paper towel. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns), which was located in a locked the laundry room, as well as at the front door and accessible to staff and visitors. LPA Colvin observed the facility to have at least a 30-day supply of PPE. LPA Colvin went over the various recommended training for facility staff with Administrator Kelly Hentzen in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE. LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator Kelly Hentzen informed LPA Colvin that at this time staff have only been trained on donning/doffing PPE. LPA Colvin will be issuing a TA Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA Colvin will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. LPA Colvin will be providing Administrator with the information for Provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks. An exit interview was conducted with Administrator Kelly Hentzen and a copy of this report and LIC9102 TA Advisory Notes was provided to staff Rosa Quintana, who additionally signed for the report as Administrator was not present.the state’s words, verbatim · CDSS document, Oct 13, 2022

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

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 Administrator Sheena Franco. Present in the home during time of visit were two (2) staff as well as three (6) clients. There are currently no cases of COVID-19 within 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 Ms. Franco. An exit interview was conducted and a copy of this report, was reviewed with and provided to Ms. Franco. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview to review this report was conducted and a copy of this report was provided via email.the state’s words, verbatim · CDSS document, Sep 2, 2021