Silver Pines Care Home I

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio and Policy Analyst (PA) Melody Bradley arrived to the facility unannounced to conduct an annual required inspection. LPA met with Licensee/Administrator Debbie Loesch, and explained the purpose of the visit. LPA Valerio, PA Bradley, and Licensee Debbie Loesch toured the physical plant to ensure compliance of Title 22 regulations. LPA Valerio observed resident bedrooms. Resident bedrooms were fully furnished and free from odors. Resident bathrooms were fully stocked with paper towels, toilet paper, handrails, skid mats, soap, and hand sanitizer. Hot water was measured at 106.3*degrees F. The temperature inside the home was 73*F. Common areas were observed to be clean, organized, and free from debris. LPA observed central heating and air, fully charged fire extinguisher, and first aid kit. The facility had a adequate supply of food to meet the requirements of two days of perishables and seven days of non-perishables. An emergency supply of food and water were observed in the garage. Medications, cleaning supplies, and toxins were observed to be locked away and inaccessible to residents in care. The facility has a backyard with a large outdoor sitting areas for visits, has pet goats that are secured behind a locked fence, a place for gardening, and 2 sheds. The sheds were observed to be used for storage. No health or safety concerns observed. LPA reviewed 3 staff files. Staff files were observed to be up to date with current training. LPA review 3 resident files. Resident files were up to date with required documents. Residents were observed in their room, eating breakfast, and watching television. Staff were observed fixing breakfast, assisting residents, and completing chores LPA requested the following documentation: LIC 500, LIC 308, Liability Insurance, and LIC 610D Per California Code of Regulations (CCR) - Title 22, Division 6, Chapter 8, no deficiencies were observed. An exit interview was held, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 28, 2023

Allegation investigated: Facility staff hit resident

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannouced to conduct a 10-Day Complaint Investigation and deliver complaint findings. LPA met with Administrator Debbie Loesch, and explained the purpose of the visit. Administrator Debbie Loesch self reported an incident to the regional office on 12/12/2022. On 12/12/22, a staff member, Staff 1 (S1), made physical contact with a resident, Resident 1 (R1). S1 was assisting R1 in the shower. R1 bit down on S1's upper arm. S1 reacted by slapping R1 in the head with hand. The assistant administrator immediately removed the S1 from the shower was suspended. Police and family were contacted. R1 has a dx of dementia and could not remember what happened when asked by police and/or staff. Administrator gave voicemail of S1 admitting to the incident, a written report from staff, and case number for Elk Grove Police Department. Per California Code of Regulations, Title 22, deficiences are being cited on LIC 9099-D. Failure to correct deficiences may result in civil penalities. An exit interview was held, and a copy of the report was provided. Substantiatedthe state’s words, verbatim · CDSS document, Dec 20, 2022 · control 27-AS-20221213145103

From the deficiency page — Deficiency type: Type B · Section cited: CCR 97468.1(a)(3) · Plan of correction due date: Dec 21, 2022

87468.1 Personal Rights of Residents... (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... This requirement was not met as evidenced by: Based on records review and interviews, the licensee did not ensure 1 out of 6 residents were free from physical abuse by staff 1. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 20, 2022

Plan of correction: Licensee stated the staff member was immediately removed from the facility by management staff. Licensee gave LPA internal documents of investigation. Licensee held an in-service training with all staff on Elder Abuse. LPA to receive the in-service sign in sheet by POC due date. This report was amended to change the deficiency type from a Type A to Type B.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to conduct an annual inspection. LPA Valerio met with facility staff, and stated the purpose of today’s visit. Licensee arrived at the facility shortly after LPA. The physical plant was toured inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. The infection control tool was completed during the visit. The facility has an Infection Control Plan and a Monkey Pox Infection Control Plan on file that meets department regulations. Staff training are up to date. LPA observed the temperature inside the facility was measured at 74 *F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 105.6 *F. Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA Valerio observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, central heating, and air in the facility. A first aid kit and an emergency supply of food/water was observed. LPA observed the tool sheds in the backyard. Tools and sharps were observed to be locked up. Facility licensee sent LPA required annual documentation prior to inspection. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed or cited. Exit interview held with Administrator Debbie Loesch, and a report was left at the facility.the state’s words, verbatim · CDSS document, Sep 26, 2022

Type of visit: Case Management - Incident

On 06/23/2022, Licensing Program Analyst (LPA) T. White conducted case management visit regarding incident submitted to CCLD on 06/22/2022. LPA spoke with Administrator, Debbie Loesch and explained the purpose of the visit. Based on incident report, Resident #1 (R1) returned to the facility on 06/15/2022, less then 24 hours later was sent to the Emergency Department. R1 was found with blood in her depends. R1 was not at baseline. Administrator informed R1's family member. R1 passed away on 06/16/2022. Based on interview with Administrator, R1 was taken to the hospital on 05/21/2022 regarding a fall. R1 stated she was sent to a Skilled Nursing Facility (SNF) for rehab following the hospital visit on 05/21/2022. Administrator stated, R1 returned to the facility the afternoon of 06/15/2022 from SNF. R1 was sent to the hospital the morning of 06/16/2022 due to bleeding in R1's depends. Based on documentation,R1 was admitted to the hospital on 05/21/2022 and was discharged from SNF on 06/15/2022. No deficiencies cited during inspection. Exit interview conducted with Administrator and a copy of report given.the state’s words, verbatim · CDSS document, Jun 23, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Christina Valerio arrived at the facility unannounced to conduct a case management visit. LPA Valerio was met by Administrator Debbie Loesch. Administrator confirm zero residents and staff that have displayed any signs or symptoms of COVID-19 in the last 10 days. LPA Valerio reviewed facility file for resident 1. LPA Valerio observed an LIC 602 dated June 2021 and an updated LIC 602 dated 12/08/2021. Resident 1 was admitted to the facility 08/08/21 due to moving out of another licensed facility. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held, a copy of the report was given, and a copy was left with Administrator Debbie Loesch.the state’s words, verbatim · CDSS document, Dec 13, 2021

Type of visit: Required - 1 Year

On 07/28/21 at 10:00 AM, Licensing Program Analyst (LPA) Christina Valerio arrived at this facility unannounced to conduct an annual inspection visit. LPA Valerio introduced herself, explained the purpose of the visit, and was met by Administrator Debbie Loesch. LPA Valerio was screened for COVID-19 symptoms with temperature prior to being allowed inside the facility. The physical plant was toured inside and outside to ensure the safety of the residents and compliance with Title 22 regulations. LPA also conducted the infection control domain tool. The facility has a LIC 808 mitigation plan and uploaded into FAS. LPA observed the facility to have COVID-19 informational signs, social distancing signs, hand washing signs posted throughout the facility. The facility is able to designated and dedicated a Covid-19 bedroom, bathroom, and isolation area if needed. LPA observed the temperature inside the facility was measured at 75*F, which is within the required range of 68 degrees F and 85 degrees F. The hot water was measured at 116.1 *F , which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). Facility has nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. LPA observed the centrally stored medications area and cleaning supplies to be locked and inaccessible to clients. Resident rooms was sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher is up to date with last check on 11/06/2020. Backyard was observed to have a large shaded area for visiting, gardening, and feeding the goats. All emergency exits were clear from obstructions. LPA requested updated copies of documentation: LIC 500 personnel report, LIC 610E Emergency Disaster Plan, and Liability Insurance Per California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies were observed during this visit. An exit interview was held, and a copy of the report was left with Administrator Debbie Loesche.the state’s words, verbatim · CDSS document, Jul 28, 2021