Nellie's Angels Home Care

Allegation investigated: - Staff not administering resident's medication as prescribed. - Facility does not have enough staff to meet the needs of residents in care. - Staff did not provide adequate food service to resident in care. - Facility staff was not adequately trained.

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 09/21/2023 to deliver complaint finding Community Care Licensing (CCL) received on 03/21/2023. LPA met with Administrator, Nellie Johnson, and explained the purpose of the visit. During the course of investigation, the Department interviewed facility staff, residents in care, and obtained pertinent documents relevant to the complaint investigation such as, resident’s (R1) physician’s report, appraisal/needs and services plan, identification and emergency information, medication list, physician’s orders, medication administration records (MAR), staff trainings, fire clearance, employee roster, and resident roster. Continue on page LIC9099-C. Unsubstantiated Allegation - Staff not administering resident's medication as prescribed. - Unsubstantiated. The Department interviewed facility staff, residents in care, and obtained pertinent documents relevant to the complaint investigation such as, resident’s (R1) physician’s report, appraisal/needs and services plan, medication list, physician’s orders, medication administration records (MAR). The Department reviewed R1’s medication records for January 2022- October 2022. Medication records indicated, R1 did not receive medication Quetiapine on 7/31/2022. According to physician’s order, Quetiapine is to be given 1 tablet by mouth everyday at bedtime. Interview statement received from administrators, Nellie and Stephanie, indicated R1 was receiving all of R1's medication. R1 has never refused medication. Administrator Stephanie stated Quetiapine was given to R1 but administrator forgot to sign off on the medication log. The Department interviewed a total of 2 residents in care. Interview statement received from residents indicated staff are consistently assisting residents with their medications. The Department conducted medication count for two (2) residents in care. Medications are centrally stored, locked, and appear to be given per doctor order. LPA compared medications to those being given for 2 residents and found no discrepancies. Complaint was filed against the facility on 3/21/2023. The Department was unable to conduct R1's medication count with the facility for R1's July 2022 medications. The Department is unable to determine if medication was provided to R1. Allegation - Facility does not have enough staff to meet the needs of residents in care. – Unsubstantiated. According to interviews conducted, there is one (1) staff per nine (9) residents. The Department requested and reviewed R1’s physician’s report, appraisal, and service plan. According to R1’s physician’s report, R1’s primary diagnosis is Dementia. R1 has bowel, bladder, and motor impairment. R1 needs assistance with bathing, dressing/grooming, feeding, toileting, and medication. According to personnel Report (LIC 500), the facility staff consists of two (2) administrators and three (3) caregivers. Interview received from administrator, Stephanie Reid, indicated there are 2 caregivers working from 6AM to 6PM and 1 staff working from 6PM to 6AM. Interview statement received from administrator, Nellie Johnson, indicated that R1 needed 1:1 care and the facility had provided that for R1. Administrators are the ones who are providing care to residents with higher level of care. R1 had a change of condition. R1 was receiving wound care by a specialist for bed sore. Bed sore was healing. The main concern was that R1 was bending over while using the bathroom and the wound. Administrator contacted R1’s PCP due to R1 having muscle stiffness. PCP notified administrator the cause of R1 bending over is due to neurological or from nerve. Administrator provided records of the facility’s communication with R1’s RP. The Department interviewed a total of three (3) facility staff who indicated there is sufficient staffing to meet the needs of residents in care. The Department interviewed two (2) residents in care. Residents indicated staff are meeting their needs. Allegation - Staff did not provide adequate food service to resident in care. Unsubstantiated. According to complainant, the facility fed R1 puree food and liquid foods for over a year. Facility was providing R1 with a gram of liquid ensure which is not sustainable. R1 was losing a lot of weight and the facility did not keep records of R1’s weight. The facility did not receive doctor’s orders for liquid foods. The Department reviewed R1’s physician’s order. Physician’s order indicated to change R1’s diet to full liquids. “May try soft foods/puree as tolerated. R1 is not allowed to have rice, corn, lettuce, raw veggies, bread, and dry foods such as, popcorn, peanuts, and chips. The Department interviewed a total of four (4) facility staff. Interview statement received from staff were consistent. R1 was provided with liquid ensure, yogurt, Jell-o, pudding, Mac & Cheese, spaghetti, fruits, vegetables, mash potatoes, and more. Staff indicated R1 was receiving about 2-3 liquid ensure per day along with 3 meals a day. The Department received and reviewed R1’s care log. The facility’s care log was written by staff to indicate what services were provided to R1 from 6/14/2022 through 10/03/2022. R1’s care logs indicated R1 was receiving meals and ensure between meals for snacks. Interview statement received from administrator, Nellie Johnson, indicated there was no physician’s order to weigh R1. Staff indicated, R1 had remained at a steady weight and did not observe R1 losing weight. LPA toured the facility to ensure that the facility was providing adequate food service to residents in care and observed food supplies of non-perishables for a minimum of one (1) week and perishable foods for a minimum of two (2) days. The Department interviewed a total of two (2) residents in care. Interview statements received from residents indicated meals are provided to all residents in care three times a day and snacks in between. Allegation - Facility staff was not adequately trained. The Department requested for three (3) staff’s training records for review. Staff has training in dementia care, medications, first aid and CPR, and other various areas of care provision. There are no records of staff training for food service. Interview statement from two (2) staff indicated that staff were provided food service training from administrator, Nellie Johnson. Staff stated staff were provided video training and online training on special diets. The Department finds the allegations to be UNSUBSTANTIATED, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, and the findings are unsubstantiated. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Sep 21, 2023 · control 59-AS-20230321112340

Allegation investigated: - Residents are chemically restrained with medication. - Facility staff not fingerprint-cleared. - Staff are using drugs while on duty. - Facility staff are abusing residents.

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 07/12/2023 to deliver complaint findings. LPA met with Administrator, Stephanie Reid, and explained the purpose of the visit. During the course of investigation, the Department interviewed facility staff, residents in care, and obtained pertinent documents relevant to the complaint investigation such as, nine (9) residents’ (R1, R2, R3, R4, R5, R6, R7, R8, & R9) physician’s report, identification and emergency information, medication list, physician’s orders, medication administration records (MAR), employee roster, and resident roster. Continue on page LIC 9099-C. Unfounded Allegation: Residents are chemically restrained with medication. Unfounded. LPA reviewed 9 of 9 resident medications, comparing with physician orders. Administrator stated all medications are dispensed as ordered by the physician and medications are never given to chemically restrain residents. LPA interviewed one (1) facility staff. S1 indicated the designated person to assist resident with medication is the administrator. LPA interviewed one (1) resident (R1) that were able to be interviewed. R1 reported R1 are given their prescribed medications daily. Allegation: Facility staff not fingerprint-cleared. Unfounded. LPA reviewed staff files, training, and reviewed facility association list. LPA observed that all staff are associated to the facility roster, and have valid ID's. Allegation: Staff are using drugs while on duty Unfounded. LPA interviewed one (1) caregiver and conducted a facility tour. LPA did not observe any illegal drugs or evidence of drug use. LPA interviewed caregiver on shift, and caregiver stated they have not used drugs or seen other staff members use drugs while on duty. LPA interviewed administrator in which she stated she has not had any staff use drugs while on duty. LPA interview one (1) resident, and R1 stated they have not observed staff on duty using drugs. Allegation: Facility staff are abusing residents. Unfounded. LPA interviewed caregivers and administrator in which they stated they have not abused residents in anyway and they have not observed any other staff member abuse residents. LPA interview one (1) resident, and R1 stated they have not observed any residents in care being abused by staff. The allegations are UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted.the state’s words, verbatim · CDSS document, Jul 12, 2023 · control 59-AS-20230328162656

Allegation investigated: Facility staff are not releasing resident's records to resident's authorized representative.

On 01/12/2023, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced to deliver final finding. LPA met with staff, Steven Johnson, and explained the purpose of the visit. LPA ensured the following Personal Protective Equipment (PPE) was worn surgical mask. LPA were screened by facility staff and washed hands prior to entering the facility. During the course of investigation, the Department interviewed facility staff and obtained pertinent documents relevant to the complaint investigation such as Clement Law Group PC’s letter written to Nellie’s Angels Home Care requesting for copies of resident’s (R1) records, authorization for release of records signed by R1’s Power of Attorney (POA), and affidavit of custodian of records. Continue on page LIC9099-C. Substantiated The Department requested and reviewed documentation relevant to the complaint investigation provided by the facility. A written request was sent to Nellie’s Angels Home Care by Clement Law Group PC’s requesting for R1’s documentation to be provided electronically on a CD or thumb drive and mail to their office. The Department reviewed authorization for release of records signed by R1’s Power of Attorney (POA) dated on 11/14/2022. Interview statement received from Administrator indicated facility’s law firm, Knox, Lemmon & Anapolsky LLP, is currently assisting the facility with redactions. Administrator stated all documents and notes that are redacted is necessary to protect the privacy of their residents before submitting documents to Clement Law Group PC for review which was completed on 12/27/2022. Administrator stated Clement Law Group PC did not provide facility with a deadline. On 12/28/2022, Administrator provided proof of R1’s records were produced but were not sent to Clement Law Group PC. On 12/29/2022, LPA Keosavang received an email from administrator to confirm R1’s records were provided. Records were not provided in a timely manner. Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Health and Safety Code, Title 22, Division 6, Chapter 3.2 are being cited on the attached LIC9099D. Appeal rights provided to the facility. An exit interview was conducted and a copy of this report will be provided to the facility via email.the state’s words, verbatim · CDSS document, Jan 12, 2023 · control 25-AS-20221220114940

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(21) · Plan of correction due date: Jan 16, 2023

1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (21) To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard for photocopies. This requirement is not met as evidenced by: Based on records review and interviews, R1's records were provided in a timely manner. This poses a potential health, safety, and personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Jan 12, 2023

Plan of correction: Admininstrator agrees to review Health and Safety Code section 1569.269 and submit to Licensing a letter of understanding by POC due date, 01/16/2023.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 01/12/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with facility staff, Steven Johnson, and explained the purpose of the visit. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility and LPA washed hands. LPA requested for facility staff to contact Administrator, Nellie Johnson, to inform her that LPA is present at the facility to conduct an annual inspection. Administrator Nellie is currently conducting a pre-licensing inspection at another facility and is unable to meet with LPA. LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, six (6) resident bedrooms, four (4) bathrooms, kitchen, garage and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. Facility staff, Steven Johnson, arrived at the facility at a later time. LPA and Administrator Nellie Johnson completed the infection control domain via telephone and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and LPA sent a copy of the repot via email.the state’s words, verbatim · CDSS document, Jan 12, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 12/14/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with facility staff, Annabelle Burton, and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA were screened by facility staff upon entering the facility. LPA requested for facility staff to contact Administrator, Nellie Johnson, to inform her that LPA is present at the facility to conduct an annual inspection. LPA spoke to Administrator on the telephone. Administrator stated she is not able to meet LPA at the facility and gave permission for staff to assist LPA and sign report. LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, six (6) resident bedrooms, four (4) bathrooms, kitchen, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and staff completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and LPA sent a copy of the repot via email.the state’s words, verbatim · CDSS document, Dec 14, 2021

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.