Cali Care Retirement Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Pang Lee arrived at the facility to conduct an unannounced inspection on 08/01/2023 at 8:00 AM. LPA Lee met with two caregiver Ma Theresa Mata and Grace Roguel and explained the purpose of the visit. Ma Theresa, called administrator Cynthia Mojica who arrived approximately 30 minutes later. Administrator assisted with today’s visit. Administrator certificate # is 6006532740 and expires on 11/04/23. This facility is a single story building licensed to serve five (5) non-ambulatory residents with one (1) bedridden resident and approved for four (4) hospice waiver. LPA Lee inspected the physical plant including but not limited to the common area, kitchen, dining area, resident bedrooms, resident bathrooms, laundry room and outside courtyards of the facility to ensure compliance with Title 22 regulations. The facility has one public telephone in the dinning area and one in the kitchen. The facility has the required posters posted in the facility. LPA Lee observed the facility to be free of odor, clean and in good repair. LPA Lee observed bedrooms to be properly furnished with appropriate bedding and lighting. There are no bodies of water present. LPA Lee observed sufficient seven days non-perishable and two days perishable food supplies. The resident bathroom water temperature measured at 109.5 degrees Fahrenheit which is within the required regulation of 105 to 120 degrees Fahrenheit. Fire extinguishers, smoke and carbon monoxide detectors are in good repair. Fire extinguisher was last serviced on 11/21/2022. Facility thermostat observed at 74 degrees Fahrenheit. LPA Lee checked medication storage and found medication to be locked away and inaccessible to clients. LPA Lee reviewed 5 out of 5 medication administration record (MAR) and 4 out of 5 MAR was not complete. First aid kit was checked and it was not complete. LPA Lee requested resident file for review. LPA Lee reviewed 5 out of 5 resident files and it was complete. LPA Lee reviewed 5 out of 10 staff files and 3 out 10 staff files were not complete. LPA Lee reviewed staff criminal record clearances and a review of staff records indicates that one (1) facility staff is fingerprint cleared, but not associated to the facility. As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809 D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, LIC 421GB and Appeals rights were provided to the facility.the state’s words, verbatim · CDSS document, Aug 1, 2023

Allegation investigated: Staff are not meeting resident’s hygiene need. Staff does not ensure resident has clean linens. Staff are not following physician's orders. Staff are not providing incontinent care to resident.

On 03/03/2023 at 11:19 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced to deliver complaint findings. LPA met with Theresa during today’s visit and explained the purpose of today's visit. Throughout the course of this investigation, LPA Martinez conducted interviews and reviewed facility records. Based on four out five resident interviews, LPA Martinez was informed the facility is sanitary and clean. In addition, the four out of five residents did not have any complaints about care and supervision, and they are satisfied with the care they are receiving. In addition, during facility visits, LPA Martinez observed the facility to be clean and residents' linens were cleaned. Futhermore, LPA Martinez did not smell any foul odors at the facility during visits. Continued... Unsubstantiated Moreover, it was learned resident 1 (R1) is no longer residing at this facility and whereabouts are unknown. LPA Martinez was informed R1 was transferred to a facility that could provide R1 a higher level of care. However, LPA Martinez reviewed R1's facility file. Based on facility records review, it was learned R1 had a history of refusing hygiene care, incontinent care, and transferring care. Facility records indicated R1 was encouraged to accept care and at times R1 agreed to receive care. Additionally, witness 1 (W1) reported having no issues or concerns with the care R1 was receiving at the facility. W1 also reported that facility staff were informing them of any refusal of care. Due to the above noted information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated.the state’s words, verbatim · CDSS document, Mar 3, 2023 · control 27-AS-20230112115006

Allegation investigated: Financial Abuse: Staff made unauthorized transactions on resident's credit card

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Cali Care Retirement Home (RCFE) on 10/19/22 at 3:40pm to deliver findings regarding the allegation above. LPA met with Administrator and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated because LPA was unable to locate and interview the alleged victim regarding the allegation. The alleged victim is a former resident of the facility who lived at the facility for a short time in 2019. LPA attempted to call and texted the alleged victim with no response. The only address the reporting party had for the former resident was a PO box address. LPA was unable to locate the alleged victim to gather more information regarding the allegations. All staff interviewed denied the allegations. Report Continued on LIC 9099-C Unsubstantiated Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Financial Abuse are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited per California Code Regulation, TITLE 22 Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Oct 19, 2022 · control 27-AS-20220907124313

Allegation investigated: Staff did not address a resident's needs while in care. Resident sustained pressure injuries while in care.

On 10-11-2022 at 11:20 am, Licensing Program Analyst (LPA) Avelina Martinez conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA Martinez met with Emmanuel A Mojica and explained the purpose of today's visit. Throughout the complaint investigation, LPA Martinez reviewed documents and conducted interviews. It was learned resident 1 (R1) has a history of pressure injuries. R1 developed a pressure injury on their foot last year in 2021. In addition, R1 developed a pressure injury on their buttocks 11 days ago. Moreover, During a 10/04/2022 facility visit, it was learned the facility had not conducted a reassessment due to R1's newly developed pressure injury. LPA Martinez was also informed the facility did not report the pressure injury to R1's primary care physician. Additionally, at the 10/04/2022 visit, the facility staff did not know the stage of the pressure injury, and R1 was not being provided wound care. Continued... Substantiated At the 10/04/2022 visit, LPA Martinez advised staff 1 (S1) to get in contact with R1's primary care physician in regards to the newly developed pressure injury. LPA Martinez also advised (S1) to obtained wound care directives from R1's primary care physician and to obtain information on the stage of the pressure injury. It was not until 10/10/2022 that R1 had a medical appointment, and at this appointment it was learned R1 has a stage 2 pressure injury and home health was ordered. As a result of this investigation, the Department finds the allegations to be Substantiated. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted, and a copy of this report was provided to the facility.the state’s words, verbatim · CDSS document, Oct 11, 2022 · control 27-AS-20220930164204

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Oct 25, 2022

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement was not met as evidence by: Based on record review and interviews, the licensee did not ensure staff provided the appropriate assistance and care and supervision to meet R1's newly developed pressure injury needs. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, Oct 11, 2022

Plan of correction: Administrator agrees to conduct Observation of the residents training for all staff by POC date 10/25/2022. Administrator will email LPA Martinez training documents by 10/25/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(1) · Plan of correction due date: Oct 25, 2022

87464 (f) (1) Basic Services: Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidence by: Based on record review and interviews, the licensee did not ensure that staff addressed R1's pressure injury and report pressure injury to R1's primary care physician and did not ensure R1 received proper pressure injury care. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, Oct 11, 2022

Plan of correction: Administrator agrees to conduct Basic Services training for all staff by 10/25/2022. Administrator will email LPA Martinez training documents by POC Date 10/25/2022.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a case management visit on 10/04/2022. LPA met with Emmanuel A Mjica and explained the purpose of the visit. The purpose of today's visit is in response to learned deficiencies. It was learned the facility did not conduct a reappraisal, after resident 1 (R1) had a change in health condition. In addition LPA Martinez reviewed R1's facility file, and there was not an admission agreement in R1's file. LPA Martinez requested R1's admission agreement during a visit, and the facility staff was not able to find or provide the admission agreement. As a result, deficiencies were cited per California Code of Regulations, Title 22, and California Health and Safety Code, and the citations can be found on the 809 D page. An exit was conducted interview, and a copy of this report and appeal rights given were given to the facilitythe state’s words, verbatim · CDSS document, Oct 4, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87463(a)(3) · Plan of correction due date: Oct 5, 2022

87463(a)(3) Reappraisals: the pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes...reappraisals shall document changes in the resident's physical, medical, mental, and social condition...Any illness, injury, trauma, or change in the health care needs This requirement was not met as evidence by: Based on observation, interviews and record review, the facility did not conduct a reappraisal after R1 developed a pressure injury. This posed an immediate health and safety risk to R1.the state’s words, verbatim · CDSS document, Oct 4, 2022

Plan of correction: Administrator agrees to conduct a reappraisal and review change of health condition with Alta Regional Center. Administrator agrees to contact R1's Physician to report R1's change in condition. Administrator will email LPA Martinez reassessment by 10/05/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87507(a) · Plan of correction due date: Oct 18, 2022

Admission Agreement (a) The licensee shall complete an individual written admissions agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement was not met as evidence by: Based on observation, interviews and record review, the facility did not ensure R1 had a completed admission agreement in their file. This posed a potential health and safety risk to R1.the state’s words, verbatim · CDSS document, Oct 4, 2022

Plan of correction: Administrator agrees to complete an admission agreement for R1 by POC 10/18/2022. The administrator agrees to email the admission agreement LPA Martinez by POC Date 10/18/2022.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection on 08/02/2022. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyard of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate. The facility is licensed for five non-ambulatory residents and 1 bedridden resident. There are currently 5 residents who reside at this facility. There is one resident on hospice. The LPA toured the facility with Theresa Mata on 08/24/2021 at 8:50 AM. The facility is sanitary and clean, and the furniture is spaced 6 feet apart. The facility has a seven day food supply. Resident bedrooms are sanitary and furnished. The facility bathrooms are sanitary. The facility smoke detectors, carbon detector, and fire extinguisher are in good reair. LPA Martinez reviewed one resident file and one employee file. One resident file was complete. Staff 1's (S1) file did not have first aid/CPR training certificate. The exterior of the facility was clean and clear of debris. The emergency exterior gate is in good repair. The facility had required postings throughout the facility. The facility has a 30 day supply of PPE. The facility has one main screening entry point. The facility has covid-19 postings throughout the facility. Based on this annual visit, there was one deficiency. The deficiency can be found on the 809-D page. An exit interview was conducted, and a copy of this 809 report, 809-d page, appeals rights were given to the facility.the state’s words, verbatim · CDSS document, Aug 4, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c)(1) · Plan of correction due date: Aug 18, 2022

87411Personnel Requirements - generally RCFE (c)(1) staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. this requirement was not met as evidence by Staff 1 did not complete First Aid training. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 4, 2022

Plan of correction: Facility staff agrees to train all staff on first aid by POC date 08/18/2022.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Avelina Martinez made an unannounced visit to this facility to conduct an annual required inspection on 08/24/2021. LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyard of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate #6006532740 and expires on 11/04/2021. The facility is licensed for five non-ambulatory residents and 1 bedridden resident. There are currently 5 residents who reside at this facility. There is one resident on hospice. The LPA toured the facility with Theresa Mata on 08/24/2021 at 4:00 PM. The facility has submitted a mitigation plan to CCLD. The mitigation plan has been approved by CCLD. The facility has one central entry point for universal entry screening. All visitors are screened for Covid-19 symptoms. Moreover, hand hygiene postings are posted in bathrooms. The facility has hand sanitizer dispensers throughout the facility. The facility conducts hourly disinfection cleaning. Facility common areas are furnished and furniture is spaced 6 feet apart. The facility smoke and carbon detectors are in good repair. The facility is in compliance with California Code of Regulations, Title 22 and Health and Safety Code, there were no deficiencies cited at this time. Exit interview held and a report given at the end of the visit.the state’s words, verbatim · CDSS document, Aug 24, 2021