Agape Care Home Riverside

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced annual required visit. LPA was granted entry and met with Administrators, Alejandra Merida, who was informed of the purpose of the visit. At the time of the visit there was four (4) staff and six (6) residents present. The facility is a one story home with (5) bedrooms and four (4) bathrooms with attached garage, and pool in the backyard. The facility does not have firearms or ammunition on the premises. The clients served are elderly adults 65 years of age and older. LPA conducted a tour of the interior and exterior, reviewed facility documents and conducted interviews. LPA observed the following: Infection Control: The LPA observed the hand washing stations in the facility restrooms and kitchen had hand hygiene supplies and hand washing signs. LPA observed PPE equipment and cleaning supplies to do regular cleaning of the facility. LPA reviewed staff records and found that all staff had infection control training. Physical Plant: LPA observed resident bedrooms and staff room. Physical plant, floors, windows, and doors were observed to be clean. Fixtures and furniture were in good repair were present. The outdoor area was observed to be free of hazards. LPA observed the facility pool was surrounded by a locked gate. LPA observed outdoor furniture and shaded area for residents. 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 112F. 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. Care & Supervision/Administration: Adequate staff are present for the supervision of residents during the visit. LPA also reviewed the staff scheduled showing adequate staff coverage. Facility sketch, exit routes, personal rights, complaint information and emergency phone numbers were found posted in the facility. The listed administrator, possesses a current administrator's certificate. Record Review and Resident/Staff Files: LPA reviewed three (3) staff files and training. All staff have criminal clearance and updated training along with CPR/First Aid Certification. Three (3) client files were reviewed and possessed all required paperwork. Health Related Services/ Incidental Medical Services: All resident's medication was locked in a cabinet in the kitchen area. LPA reviewed medications for three (3) residents and found all medication listed on MARS and all required labeling was found to be in place. Disaster preparedness: LPA reviewed the facility's emergency and disaster plan. LPA reviewed documentation showing the facility's last fire and earthquake drills which was conducted 06/01/2023, which met the department requirements. LPA observed all facility exits were clear from obstructions. LPA observed emergency supplies in the garage and first aid kit with all required items. No deficiencies were cited at the time of the visit. An exit interview was conducted where a copy of this report was provided to Administrator, Alejandra Merida.the state’s words, verbatim · CDSS document, Aug 18, 2023

Allegation investigated: Staff not being paid by Licensee.

On August 11, 2023, Licensing Program Analyst (LPA), Venus Mixson conducted a visit to the facility and met with the Administrator. The visit was conducted in order to provide the findings for the investigation pertaining to the listed allegation. During the investigation, LPA Mixson conducted interviews with the Licensee, the Administrator, and staff and residents. On December 14, 2022, Community Care Licensing (CCL), received information stating the facility staff are not being paid by the Licensee. Regarding the allegation, the facility staff are not being paid by the Licensee, the information obtained from interviews and the record review, revealed the facility staff have been paid. The interviews and the record review does not corroborate the listed allegation. Based on interviews, record reviews, and observations the allegation finding has been deemed "Unfounded." An allegation finding of "unfounded," means the allegation was without merit or is false and could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to the Administrator, Daryl Lee. Unfoundedthe state’s words, verbatim · CDSS document, Aug 11, 2023 · control 18-AS-20221214110031

Allegation investigated: Facility is not clean.

On August 11, 2023, Licensing Program Analyst (LPA), Venus Mixson conducted a visit to the facility and met with the Administrator. The visit was conducted in order to provide the findings for the investigation pertaining to the listed allegation. During the investigation, LPA Mixson conducted interviews with the Licensee, the Administrator, and staff and residents. On December 14, 2022, Community Care Licensing (CCL), received information stating the facility staff are not being paid by the Licensee. Regarding the allegation, the facility is not clean, the information obtained from interviews and the record review did not reveal enough information to demonstrate the listed allegation. The staff and resident interviews, and the observations, does not corroborate the listed allegation. Based on interviews and observations the allegation finding has been deemed "UNSUBSTANTIATED." An allegation finding of "unsubstantiated" means, "although, the allegation may have happened or is valid, there is not a preponderance of the evidence strand to prove the alleged violations did or did not occur." Therefore, the allegations are deemed "unsubstantiated." An exit interview was conducted and a copy of this report, along with the LIC 811, was given to the Administrator, Daryl Lee. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 11, 2023 · control 18-AS-20221214110031

Allegation investigated: Staff are not able to meet resident's medication needs. Licensee not providing activities for residents. Facility oven is broken. Staff not following prescription orders. Staff neglected resident who fell. Staff not showering residents according to Admission Agreements.

On August 11, 2023, Licensing Program Analyst (LPA), Venus Mixson conducted a visit to the facility and met with the Administrator. The visit was conducted in order to provide the findings for the investigation pertaining to the listed allegations. During the investigation, LPA Mixson conducted interviews with the Licensee, Administrator, and staff and residents. On December 14, 2022, Community Care Licensing (CCL), received information stating the facility staff are not able to meet the resident's medication needs, the Licensee is not providing activities for the residents, the facility oven is broken, staff are not following the prescription orders, staff neglected resident who fell, and staff are not showering residents according to the admission agreements. Regarding the allegation, staff are not able to meet the residents medication needs, the information obtained from interviews and the record review, revealed the facility staff are able to meet the resident's medication needs. The residents medication records (MARS), did not reveal the staff are not able to meet the residents medications needs. The interviews and the record review does not corroborate the listed allegation. CONTINUED ON 9099C Unsubstantiated Regarding the allegation, Licensee is not providing activities for the residents, the information obtained from interviews and the record review demonstrated the Licensee is providing activities for the residents. The Information obtained from interviews stated the residents have the right to refused to participate in an activity, and/or to participate in the activities of their choice. Regarding the allegation, the facility is not clean, the information received from interviews, and observations disclose the facility was clean at the time of the investigation. The interviews and the observations do not validate the listed allegation. Regarding the allegation, the facility oven is broken, the evidence obtained from interviews, and observations, does not support the allegation. Regarding the allegation, staff are not following prescription orders, the evidence received from interviews and the record review does not verify the listed allegation. Review of the resident’s medical administration report (MARs) does not validate the allegation. The record review shows the staff are following the prescription orders. Regarding the allegation, Staff not showering residents according to admission agreements, the information gathered from interviews and the record review do not support the listed allegation. The evidence shows the residents are being showered according to the resident's admission agreements, and the resident has the right to refuse any service. The interview with S2 stated that R1 was showered once or twice a week and if R1 refused the shower R1 was given a sponge bath. Regrading the allegation, Staff neglected resident who fell, the information obtained through interviews and the record review proved there was not sufficient evidence to determine if staff neglected a resident who fell. Regarding the allegation, Licensee not reporting incidents to Licensing, the information obtained from interviews and the records reviewed do not support this allegation. CONTINUED ON 9099-C Based on interviews and record reviews the information obtained did not corroborate the listed allegations. There was not sufficient evidence to support the listed allegations, therefore these allegations have been deemed "UNSUBSTANTIATED." An allegation finding of unsubstantiated means "although the allegation may have happened, or is valid there is not a preponderance of the evidence strand to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of this report was provided to the Administrator, Daryl Lee. This page was produced due to a technical error . No further information has been obtained at this time.the state’s words, verbatim · CDSS document, Aug 11, 2023 · control 18-AS-20221214110031

Type of visit: POC

Licensing Program Analyst (LPA) Jesse Gardner made an unannounced case management visit to follow up on a Plan of Correction that has not been received by the Department. LPA met with Caregiver Kashmir Singh and toured the facility. The initial Plan of Correction was issued on 12/20/2022 for a citation of CCR 87465(h)(5) Incidental and Medical Care. This citation was in reference to not storing medication in its original prescribed container. On today's date while conducting a tour of the facility, LPA noted that the Licensee has since discontinued pre-pouring medications (not storing them in their prescribed container). At the time of original visit on 12/20/2022, concluding the citation, Licensee agreed to provide LPA in-service training of all staff on how to manage medications by POC date, which was 1/3/2022. Additionally, LPA spoke with Licensee via telephone 1/9/2023, and Licensee ensured that POC would be completed and sent. An official extension was not received nor requested by Licensee. As of this date, POC has yet to be complete. Due to the POC not being corrected at the requested amount of time, a civil penalty was issued. An exit interview was conducted where a copy of this report was discussed and provided to Licensee Daryl Lee along with a copy of the LIC421FC, and Appeal Rights.the state’s words, verbatim · CDSS document, Jan 12, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Jesse Gardner and Jackie Shaw-Ross arrived at the facility unannounced in reference to complaint 18-AS-20221214110031. LPAs met with Licensee Daryl Lee and explained the purpose of the visit. During the tour of the facility, LPAs noted medication that was being pre-poured and stored in plastic cups. When asked, LPAs were told that Administrator Matthew Olea does the medication, and has been doing so for at least a year. Licensee advised they will discontinue pre-pouring medications. Deficiency cited. LPAs also found Caregiver Josie Perez to not have a background clearance. Deficiency cited. An exit interview was conducted, and a copy of this report was discussed along with copies of the LIC809-D, LIC421BG, and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Dec 20, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Dec 21, 2022

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 exemption as required by the Department or Based on LPA's record review, and interview, LPA found that S1 did not have a background clearance. Licensee did not follow regulation. This is an immediate health and safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 20, 2022

Plan of correction: Licensee agrees to immediately remove S1 from the facility, and obtain a background clearance prior to S1 working in the facility. Licensee to provide proof of submission of background clearance to LPA by POC date. LPAs observed S1 leaving property.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87465(h)(5) · Plan of correction due date: Jan 3, 2023

Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Based on LPA observation of pre-poured cups containing an assortment of medication, Licensee did not follow the regulation. This poses a potential health and safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Dec 20, 2022

Plan of correction: Licensee agrees to discontinue pre-pouring medication, and submit an in-service training of all staff on how to manage medications by POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Mixson met with Administrator, Daryl Lee and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Present in the facility were 6 residents and 2 caregivers. Currently there are no cases of COVID-19 within the facility. LPA Mixson observed residents have hand sanitizer available to them, and all resident bathrooms were stocked with liquid soap and paper towels. LPA Mixson observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions and the 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, and cleaning and disinfection provisions are in adequate quantities. LPA Mixson later discussed infection control practices and procedures with Administrator. An exit interview was conducted, and a copy of this report, along with the LIC 811 was provided to Administrator.the state’s words, verbatim · CDSS document, Aug 5, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Goldenberg made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA was granted entry by a caregiver. Caregiver took LPAs temperature. There is a sign in procedure in place and hand sanitizer was provided for LPA use. LPA observes that all staff are wearing face masks. LPA is informed that there are no COVID positive individuals in the home. The facility has an approved mitigation plan on file with this agency. LPA conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures. The facility was equipped with sufficient hand hygiene supplies, cleaning and disinfecting provisions. Personal Protective Equipment (PPE) supply is available. The facility continues to monitor residents regularly for any COVID-19 symptoms/ change of condition. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. LPA reviewed this report with and a copy was provided to the facility representative.the state’s words, verbatim · CDSS document, Aug 26, 2021