Infinite Love & Care Homes

Allegation investigated: Facility staff failed to provide requested resident's documents to Responsible Party Facility staff discontinued administration of resident's medication without permission/order

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unanounced in order to initiate an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator/Licensee Erika Ramos. Below is a summary of the complaint investigation findings: Regarding allegation "Facility staff failed to provide requested resident's documents to Responsible Party": LPA Colvin interviewed relevant parties, reviewed resident's (R1) file, and text messages and emails between relevant parties. LPA Colvin confirmed that R1's Power of Attorney (POA) requested multiple documents from R1's file from Administrator/Licensee Erika on 3/8/22, and while some doucments (such as oldest Physician's Report) was provided propmptly, the other records were not provided until yesterday, 3/29/22. Therefore, based on interviews and record review, the allegation "Facility staff failed to provide requested resident's documents to Responsible Party" is SUBSTANTIATED. Substantiated Regarding allegation "Facility staff discontinued administration of resident's medication without permission/order": LPA Colvin reviewed R1's file at the facility, including the history of administration of R1's prescribed PRN ("as needed") medications. LPA Colvin observed that R1 is prescribed two PRN medications, and that the facility staff were administering these medications daily to R1 for a period of months in 2021. LPA Colvin inquired as to why the PRN medication for sleep was no longer being administered to R1, and LPA Colvin was informed that it is because R1 had been sleeping better. LPA Colvin reviewed R1's Physician's Report which indicates that R1 is unable to make their needs known. LPA Colvin interviewed Administrator/Licensee Erika about how these medications are administered and if there is a statement on file from the doctor regarding whether or not R1 can state their symptoms and need for the PRN medication. Erika stated that there is not a statement or form on file due to having submitted it to R1's doctor and not having gotten a response. LPA Colvin concluded that the facility staff are making the determination on when to administer the PRN medications to R1 without communicating with the prescribing doctor. Therefore, based on record review and interviews, the allegation "Facility staff discontinued administration of resident's medication without permission/order" is 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 Licensee/Administrator Erika Ramos during the exit interview. Due to lack of evidence, the allegation "Facility Administrator not communicating updates on resident's care with Responsible Party" is UNSUBSTANTIATED. A finding of 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. An exit interview was conducted with Administrator/Licensee Erika Ramos and a copy of this report was providedthe state’s words, verbatim · CDSS document, Mar 30, 2022 · control 18-AS-20220324152458

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Apr 13, 2022

Additional Personal Rights..in Privately Operated Facilities: (a) In addition to the rights listed...residents...shall have all of the following personal rights: (19) To have prompt access to review all of their records...Photocopied records shall be provided within two (2) business... This requirement was not met by: Based on interviews and record review, the Licensee did not comply with the above regulation with one resident (R1). LPA Colvin confirmed that R1's POA requested all records for R1 on 3/8/22, but was not provided with all documents until 3/30/22. This is a potential personal rights violation of R1.the state’s words, verbatim · CDSS document, Mar 30, 2022

Plan of correction: Licensee agrees to review Title 22 Regulations section 87468,2 regarding personal rights of residents, and write a statement confirming review of the regulation section and understnading of the expectation of records being provided within 2 business days. Plan of Correction date is 4/13/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(d)(1) · Plan of correction due date: Apr 13, 2022

Incidental Medical and Dental Care: (d) If the resident is unable...to communicate his/her symptoms clearly, facility staff...shall be permitted to assist the resident...provided all of the following requirements are met: (1) Facility staff shall contact the resident's physician prior to each dose...This requirement was not met by: Based on record review and interviews, the Licensee did not comply with the above regulation with at least one resident (R1). Facility staff have been deciding when to administer PRN medication to R1 without consulting with R1's doctor before each dose. R1 is unable to communicate needs. This is a health risk to R1.the state’s words, verbatim · CDSS document, Mar 30, 2022

Plan of correction: Licensee agrees to ensure a written statement is provided from each resident's doctor regarding their ability to communicate need or symptoms, prior to administering any PRN medications. Licensee to provide LPA Colvin with statement of understanding regarding this requirement. Plan of Correction Date is 4/13/22.

Allegation investigated: Resident was diagnosed with dehydration at the hospital. Resident has an unstaged pressure injury. Food service is inadequate. Staff yell at family member in front of the resident. No activities are provided. Staff are not treating the resident with dignity. Staff does not wash the resident's face after a meal.

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced to follow up on the open complaint with the allegation above. LPA Colvin met with Administrator/Licensee Erika Ramos and advised of the purpose of today's visit. Below is a summary of the findings of the investigation: Regarding allegation "Resident was diagnosed with dehydration at the hospital": The complaint allegation was submitted without any specifics as to the name of the resident of concern or other identifying information. In order to investigate the allegation, LPA Colvin interviewed residents, staff, and reviewed the files for all current residents at the facility. There were no records of any hospital admissions for dehydration in any of the residents’ files, and none of the residents interviewed reported having been to the hospital in the last year. Therefore, due to lack of evidence and information, the allegation "Resident was diagnosed with dehydration at the hospital." is UNSUBSTANTIATED. Regarding allegation "Resident has an unstaged pressure injury.": This allegation was also submitted without Unsubstantiated identifying information. LPA Colvin interviewed staff an inquired as to if any residents had been receiving wound care, to which LPA Colvin was informed that none were at this time. LPA Colvin reviewed resident files (including hospice files for resident currently on hospice) and did not observe any notes or medical documents stating that any of the residents has a pressure injury or had one recently. LPA Colvin additionally interviewed residents and inquired about if they had any pain that they were suffering from, and none was reported. Therefore, due to lack of evidence and information, the allegation Resident has an unstaged pressure injury." is UNSUBSTANTIATED. Regarding allegation "Food service is inadequate": LPA Colvin reviewed the facility's perishable foods during the initial inspection on 1/28/22 and observed there to be a variety of eggs, vegetables, meat, and other perishable items required to cook balanced meals for the residents. Today, LPA Colvin interviewed some of the residents (1 of 4 not interviewed due to asleep during inspection) and inquired about the facility's food. There were no complaints regarding food from parties interviewed by LPA Colvin. Therefore, due to observations and interviews, the allegation "Food service is inadequate." is UNSUBSTANTIATED. Regarding allegation "Staff yell at family member in front of the resident.": The allegation was submitted anonymously, so LPA Colvin was unable to interview the reporting party to take a statement. LPA Colvin interviewed some of the residents regarding this allegation, and it was consistently stated that staff are friendly and respectful to the residents' visitors. Therefore, due to lack of evidence and interviews conducted, the allegation "Staff yell at family member in front of the resident." is UNSUBSTANTIATED. Regarding allegation "No activities are provided.": LPA Colvin interviewed staff and residents regarding the allegation, and it was reported by staff that activities are available for the residents, though their participation varies. LPA Colvin learned from further interviews that residents spend their time reading, sitting outside (when it is warm enough) watching tv, playing cards, or visiting with family and other residents. LPA Colvin did not receive any complaints from anyone interviewed regarding lack of activities being provided, and from interviews conducted, residents tend to participate in individual activities that they enjoy, rather than group activities. Therefore, due to interviews conducted, the allegation "No activities are provided." is UNSUBSTANTIATED. Regarding allegation "Staff are not treating the resident with dignity.": The complaint allegation was submitted without any specifics regarding incidents or examples, or residents or staff of concern. LPA Colvin interviewed residents at the facility and inquired as to how staff treats them and if they felt respected and treated well. LPA Colvin did not receive any evidence from these interviews to suggest that residents are not treated with dignity. Additionally, the complaint was submitted anonymously, so LPA Colvin was unable to reach out to the reporting party for additional information to follow up on or investigate. Therefore, due to interviews and lack of evidence, the allegation "Staff are not treating the resident with dignity." is UNSUBSTANTIATED. Regarding allegation "Staff does not wash the resident's face after a meal.": This allegation was also submitted without any specifics as to the name of the resident of concern or other evidence to support the allegation. During both of LPA Colvin's visits to the facility (1/28/22 and 2/15/22), LPA Colvin observed the residents to appear clean and well-kept, and without visible debris on their faces. During today's inspection, LPA Colvin interviewed residents and inquired as to if staff does not assist them with cleaning their faces after meals. Of those residents interviewed, it was reported that they do not require assistance with cleaning their faces. These statements were found to be unreliable, as the residents' Physician's Reports state that they need assistance with grooming. However, this does not change the fact that there is no evidence provided to or observed by LPA Colvin to suggest that any of the residents are not assisted with grooming, if needed. Therefore, due to lack of evidence and observations, the allegation "any specifics as to the name of the resident of concern or other" is UNSUBSTANTIATED. A finding of 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. An exit interview was conducted with Administrator/Licensee Erika Ramos and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 15, 2022 · control 18-AS-20220126105203

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 Administrator/Licensee Erika Ramos and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. 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/Licensee Erika Ramos who LPA Colvin found to be successfully incorporating the several aspects of the facility's Mitigation Plan. Residents have hand sanitizer available to them (through staff), and the bathrooms were stocked with hand soap and paper towels. 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 LPA Colvin observed to be sufficient for a 30-day supply. LPA Colvin went over the various recommended training for facility staff with Administrator/Licensee Erika Ramo 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/Licensee Erika Ramos informed LPA Colvin that at this time staff have not been fit tested. LPA Colvin will be issuing a Technical Assistance 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 the Licensee with the information for Provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks. In addition to going over the facility's policy for testing staff and residents for COVID-19, LPA Colvin also inquired about if the facility is still screening their residents daily for COVID-19 symptoms. Administrator/Licensee Erika Ramos confirmed that staff are continuing to monitor residents’ symptoms, and was able to identify what COVID-19 symptoms require emergency medical attention. The licensee additionally stated that both staff and visitors are screened for COVID-19 symptoms prior to entering the facility, and that staff is checking visitors' vaccination cards, in accordance with the updated Public Health order regarding visitation in Long-Term Care Facilities. An exit interview was conducted with Administrator/Licensee Erika Ramos and a copy of this report and LIC9102 TA Advisory Note was provided.the state’s words, verbatim · CDSS document, Feb 15, 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.

Allegation investigated: Some facility doors are not working properly. Facility temperature is not within the regulated range.

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unanounced in order to initiate an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator/Licensee Erika Ramos. Below is a summary of the complaint investigation findings: Regarding allegation "Some facility doors are not working properly": LPA Colvin contducted a partial tour of the facility during today's inspection and observed that the screen door for the back door of the facility, located in the kitchen, was difficult to open and close. LPA Colvin struggled closing the screen door, which the Licensee witnessed and stated " I just leave it like that (partially open). It's tricky". LPA Colvin attempted several times to slide the door completely shut, and was unsuccessful. Therefore, based on observations, the allegation "Some facility doors are not working properly." is SUBSTANTIATED. Substantiated Regarding allegation "Facility temperature is not within the regulated range": LPA Colvin conducted a partial tour of the facility and observed that the thermostat in the living room read at 71 degrees. According to Title 22 Regulations, the temperature should be no colder than 78 degrees. Licensee Erika informed LPA Colvin that the residents have heaters in their bedrooms and there is another small heater available for use in the living room. However, since the temperature on the thermostat in the living room was reading at 71, LPA Colvin sustained the findings. Therefore, based on observations, the allegation "Facility temperature is not within the regulated range." is 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 Licensee/Administrator Erika Ramos during the exit interview. LPA Colvin did not observe any mold anywhere in the kitchen, and only could locate some dust in the windowsill. Therefore, based on observations, the allegation "Facility has mold." is UNSUBSTANTIATED. A finding of 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. An exit interview was conducted with Licensee/Administrator Erika Ramos and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 28, 2022 · control 18-AS-20220126105203

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 11, 2022

Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met by: Based on observations, the Licensee did not comply with the above regulation with at least one aspect of the facility's physical plant. LPA Colvin observed that the screen door for the back door of the facility was difficult to open and close, and failed trying to close it. This is a potential safety risk to residents.the state’s words, verbatim · CDSS document, Jan 28, 2022

Plan of correction: Licensee agrees to have screen door repaired or replaced so that residents can open and close the door without difficulty. Licensee may self-certify to LPA Colvin once complete. Self-certification to LPA Colvin due by Plan of Correction date of 2/11/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(b)(2) · Plan of correction due date: Jan 31, 2022

Maintenance and Operation: (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C)... This requirement was not met as evidenced by: Based on observations, the Licensee did not comply with the above regulation in at least one room. LPA Colvin observed that the thermostat in the living room read at 71 degrees F. This is a potential personal rights violation to all residents.the state’s words, verbatim · CDSS document, Jan 28, 2022

Plan of correction: Licensee agrees to immediately increase the tempurature to at least 78 degrees. LPA Colvin additionally reccomends for the Licensee to place a sign above the thermostat to remind staff that the tempurature must remain at least 78 degrees. Photo evidence of correction to be submitted to LPA Colvin by 1/31/22.

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.