Brookdale Mirage Inn

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that one hundred and twenty (120) clients live at this Residential Care Facility for the Elderly (RCFE) and there are currently eighty-seven (87) staff members employed. The Administrator, Denise Flores conducted the facility tour. There is an Infection Control Plan on file. Client Records-Incident Reports/Clients Rights-Information/Dental- LPA reviewed client records. Five (5) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/and Staffing- LPA began review of employee records- Five (5) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Food Service- Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. (Continued on LIC809C) (Continuation from LIC809) Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 108.0 degrees F. Laundry is done in the laundry room. There is a locked room for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is not a fireplace at this facility. There is a gated pool at the facility. Medication- Medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The Riverside County Fire Inspection last compliance inspected for the facility was on May 19, 2023. Based on the information received during this visit today in the areas reviewed, there are zero (0) deficiencies observed per Title 22, Division 6 of The California Code of Regulations Article 06. This LIC 809 was reviewed with, and a copy will be provided to the Administrator, Denise Flores.the state’s words, verbatim · CDSS document, Aug 14, 2023

Allegation investigated: Staff inappropriately touched a resident while in care

Licensing Program Analyst (LPA) Anna Bueno conducted a subsequent unannounced visit to the facility to continue the complaint investigation and deliver findings on the above allegations. LPA met with executive director (ED) Denise Flores who was informed of the purpose of today’s visit. The investigation consisted of staff and resident interviews and review of relevant records. LPA was unable to corroborate the allegation that Staff 1 (S1) inappropriately touched Resident 1(R1). Interview with R1 stated that they do not know who touched them, where they were touched, or how they were grabbed. During the interview with Department staff, R1 was not aware of current events, current date, and personal information about themselves due to their cognitive condition. Department staff interviewed facility staff who stated that S1 has worked at the facility for 10 years. Interview with S1 denied they inappropriately touched R1 or any residents. S1 stated that R1 needed prompting during showers, toileting, and grooming but R1 mostly will not remember how to use grooming and shower items or how to dress themselves. Interviews conducted with S1, R1, and facility staff revealed there were no witnesses to corroborate the mentioned allegation. Unsubstantiated Based on the information obtained during this investigation, the above allegations are therefore unsubstantiated. A finding that the allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and provided to ED Flores.the state’s words, verbatim · CDSS document, Jun 15, 2023 · control 18-AS-20210503144834

Allegation investigated: Resident sustained a pressure injury while in care. Licensee did not ensure changes of resident's condition were reported to a physician in a timely manner. Licensee did not answer communications promptly and appropriately to the resident's representative. Licensee did not follow facility policy concerning refunds. Resident was charged for services not received. Staff did not meet resident's showering needs.

Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with Executive Director III Denise Flores and explained the purpose of the visit. The investigation consisted of file reviews and interviews with relevant parties. Allegation #1 “Resident sustained a pressure injury while in care”. The allegation alleged that On August 9, 2020, resident # 1 (R1) with bedsore. The reporting party (RP) stated that the stage of the bedsore is unknown. LPA Nickolas’ facility file review revealed that the facility communicated with R1’s physician throughout their stay there. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation # 2 “Licensee did not ensure changes of resident's condition were reported to a physician in a timely manner”. The allegation alleged that an unknown nurse from the facility’s corporate offices visited, saw R1, and immediately sent R1 to the hospital. The allegation alleged that the RP spoke with facility staff that day and was advised that R1 was doing well. Unsubstantiated LPA Nickolas’ facility file review revealed that on August 9, 2020, the facility notified R1’s physician of changes in R1’s condition. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation # 3” Licensee did not answer communications promptly and appropriately to the resident's representative”. The allegation alleged that between March and August, the RP called the facility frequently to check on the resident, and the facility staff stated that R1 was doing well. The allegation alleged that an unknown nurse from the facility’s corporate offices visited, saw R1, and immediately sent R1 to the hospital. The allegation alleged that the RP spoke with facility staff that day and was advised that R1 was doing well. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation #4 “Licensee did not follow facility policy concerning refunds”. The allegation alleged that the facility’s former administrator told the RP that they would refund R1’s money paid through the end of September. The allegation alleged that at the point this allegation was received by Community Care Licensing Division (CCLD), the facility owed the resident $4,000. LPA Nickolas’ interview with Executive Director III revealed that R1 was a resident at the facility from March 7, 2020-September 26, 2020. LPA Nickolas’ review of R1’s “Account History Report” revealed that the facility refunded R1 $1,843.87. This refund included care credit and basic service rate. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation #5 “Resident was charged for services not received”. The allegation alleged that R1 was initially supposed to receive two (2) showers weekly. In April, R1’s showers increased from twice a week to daily, and the facility started charging an additional month each month for the shower increase. The allegation alleged that while moving R1 out of the facility, the RP discovered a sign on the wall instructing caregivers to shower the resident only two (2) times a week. LPA Nickolas’ interview with Executive Director III revealed that caregivers follow the facility's "personal service plan," not a sign on the wall. LPA Nickolas' review of R1's "Account History Report" revealed that R1 was refunded $994.00 in care credit. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation # 6 “Staff did not meet resident's showering needs.” The allegation alleged that R1 was initially supposed to receive two (2) showers weekly. In April, R1’s showers increased from twice a week to daily, and the facility started charging an additional month each month for the shower increase. The allegation alleged that while moving R1 out of the facility, the RP discovered a sign on the wall instructing caregivers to shower the resident only two (2) times a week. LPA Nickolas’ interview with Executive Director III revealed that caregivers follow the facility's "personal service plan," not a sign on the wall. LPA Nickolas’ file review revealed that R1’s "personal service plan" was updated to daily showers on June 28, 2020, not April 2020. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. 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 and copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 10, 2023 · control 18-AS-20201102093836

Allegation investigated: Facility staff caused bruising to resident. Facility staff handled resident in a rough manner. Facility staff yells at residents.

Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with Executive Director III Denise Flores and explained the purpose of the visit. The investigation consisted of file reviews and interviews with relevant parties. Allegation #1 “Facility staff caused bruising to resident”. The allegation alleged that staff #1 (S1) grabbed resident # 1 (R1) on the resident’s right forearm, leaving a visible bruise. LPA Nickolas' facility file review revealed that S1 no longer works at the facility, and R1 moved out on January 1, 2022. Therefore, both parties were not interviewed during this investigation. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation # 2 “Facility staff handled resident in a rough manner”. The allegation alleged that S1 grabbed resident R1. LPA Nickolas’ investigation into this incident revealed that S1 no longer works at the facility, and R1 no moved out of the facility on January 1, 2022. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Unsubstantiated Allegation # 3” Facility yells at resident”. The allegation alleged that according to the reporting party (RP) interview with the facility’s administrator, the administrator admitted to the RP that R1 had a history of yelling at the residents; however, R1 had no prior incidents of physical abuse. LPA Nickolas' interview with the former administrator revealed that S1 was suspended for yelling at another resident while the facility's investigation was underway. The former administrator stated that this incident occurred before this allegation about R1 was received. However, S1 quit while placed on suspension, and the facility investigation into the incident revealed no evidence that S1 was yelling at that resident. The former administrator stated that I explained this history to the RP when an inquiry about S1 yelling at R1 was made. LPA Nickolas' facility file review revealed that S1 no longer works at the facility, and R1 moved out on January 1, 2022. Therefore, both parties were not interviewed during this investigation. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. 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 and copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 10, 2023 · control 18-AS-20201102163741

Allegation investigated: Resident sustained multiple pressure injuries while in care.

Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations LPA met with Executive Director III Denise Flores and explained the purpose of the visit. The investigation consisted of file reviews and interviews with relevant parties. The allegation alleged that resident #1 (R1) was admitted to the hospital on July 8, 2020. The allegation alleged the client had pressure injuries on their back and right calf. LPA Nickolas’ facility file review revealed that R1 was non-ambulatory, according to R1’s physician’s report. However, facility staff could not find all R1’s medical records because R1 moved out of the facility on July 30, 2020, and their files were archived. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. 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 and copy of this report was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 10, 2023 · control 18-AS-20200709152202

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct an annual inspection with emphasis on infection control. LPA met with Executive Director Usbaldo Martinez and explained the purpose of today’s visit. The facility has an approved Mitigation Plan Report on file as required. During the inspection, LPA observed appropriate postings at the facility front entrance, including COVID-19 symptoms postings and visitation procedures which were in accordance with the Department's guidelines. LPA observed that the facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). LPA observed facility staff wearing appropriate face coverings. The facility has a designated infection control lead person/infection preventionist who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring staff are trained in the facility's infection control procedures, and ensuring infection control measures are implemented. The facility has a plan in place which follows Department guidelines for COVID-19 testing, isolation, and properly caring for residents and staff with COVID-19 positive results and/or exposures. 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, emergency personnel, and responsible party in the event the resident presents with any COVID-19 symptoms. No deficiencies were observed during today's visit. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 15, 2022

Allegation investigated: Staff failed to respond to call system in a timely manner

Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegation. The LPA met with Executive Director (ED), Usbaldo Martinez, and informed him of the purpose of her visit. On this date staff/resident interviews were conducted, records were reviewed and copies of pertinent documentation were obtained. Regarding the allegation, "Staff failed to respond to call system in a timely manner," it was alleged Resident One (R1) sustained a fall on or around June 02, 2022, activated their pendant for staff assistance and did not receive a response for thirty minutes. Executive Director (ED) Usbaldo Martinez and Assistant Director (AD), Denise Flores, were interviewed. Flores reported staff are to respond within zero to twenty minutes after the call system is activated. Flores reported she was present for the incident involving R1. She reported R1 sustained a fall on June 03, 2022 and, when staff responded, the resident was refusing assistance. A log of the call system was obtained; the report shows a call was activated for R1 and was responded to within seventeen minutes. R1 was interviewed and reported staff responded within ten to Unsubstantiated fifteen minutes. Therefore, based on interviews and records, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation occurred. This report was reviewed with Martinez and a copy was provided.the state’s words, verbatim · CDSS document, Jun 14, 2022 · control 18-AS-20220608144855

Allegation investigated: Staff neglect resulted in resident sutaining a pressure injury. Resident's toileting needs not being met. Food services are inadequate. Staff pushed resident while in care.

Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct a complaint investigation into the allegations listed above. LPA met with Receptionist Marcy Rios and explained the purpose of the visit. LPA then conducted a tour of the facility. The investigation consisted of interviews with confidential sources, a review of records, and interviews with staff, and residents. It was alleged that Resident One (R1) had a bed sore on their left butt cheek, which had not been reported by facility staff. During an interview with a confidential source, it was noted that the abrasion to R1’s buttocks was not a pressure wound. It was deemed shearing that caused friction to sustain an abrasion, but not an open wound. Facility record review indicated that the facility staff was caring for the abrasion. Thus, this allegation was Unsubstantiated. It was alleged that Resident Two (R2) needs to wait to have assistance with the toilet. Interviews with residents stated that staff are very attentive to their needs, and often check on them in-between button pushes of their pendant. Resident interviews further revealed that staff make the residents feel comfortable when needing assistance in toileting, and mobility. Thus, this allegation was Unsubstantiated. It was then alleged that Resident Two (R2) needs to wait for staff to serve their food, and to assist them. Record review indicated that R2 needs mobility assistance to and from the dining room and/or community activities as needed. Staff interview revealed that when residents push their call button, each resident is retrieved (who needs assistance) based off of when staff receive the call. When the residents are done eating, the servers will let caregiver staff know and each is prioritized to when they finish eating for retrieval back to their rooms. Interviews with residents stated that staff are punctual in responding to residents who need assistance with getting to/from the dining room. Additionally, LPA observed numerous servers walking throughout the dining hall, and caregivers consistently coming into the dining hall to respond to residents who were done eating to respond to the resident’s needs. Thus, this allegation was Unsubstantiated. R2 was alleged to have been pushed by a staff member causing them to lose their balance. Interview with staff indicated that when they ask R2 to turn their body to get into their room, sometimes R2 gets confused, and says not to push (assist) him. Staff will encourage R2 to face the caregivers so that R2 knows what is happening as he is assisted so that he does not feel confused in someone pushing him into his room. Thus, this allegation was 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 with Executive Director Denise Flores where a copy of this report was discussed and provided. This is an amended version of this report dated October 27, 2021. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 27, 2021 · control 18-AS-20211021164216

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility for a required annual inspection, with an emphasis on the infection control domain. LPA met with Jessalette Castro, Business Office Manager, who confirmed there are no active Covid-19 cases in the community. LPA toured the facility with Castro and Marcus Buckles, Maintenance Director. The facility submitted a mitigation plan to Community Care Licensing (CCL) to mitigate the spread of COVID-19 in the facility. Entry points open to the main lobby and a sign-in policy has been designated for universal entry screening. The facility also documents daily temperature and COVID-19 symptom checks for all visitors while residents are subject to routine symptom screening and regular observation for any change in condition. Continued weekly routine testing for staff is still observed. LPA observed all staff are properly fitted with face coverings. LPA Bueno toured the facility’s common rooms and an empty private apartment. Buckles verified that the smoke detectors and fire alarms are maintained on a call system and monitored by an outside vendor. Buckles stated the systems were checked about 2-3 months ago and the carpets are cleaned at least once a month. Charged fire extinguishers are checked monthly, the most recent inspection was on 7/29/21. LPA observed hand sanitizer throughout the facility, mostly situated next to common bathrooms. Castro also confirmed the facility has an adequate supply of Personal Protective Equipment (PPE) and cleaning and disinfectant provisions. LPA Bueno observed no health and safety concerns at the time of visit. Based on 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 of this report was also provided to Castro at the conclusion of the inspection.the state’s words, verbatim · CDSS document, Aug 24, 2021