Spring Glen Elderly Care Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 7/20/23 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 118.4 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPA checked medication storage and found medication to be locked away and inaccessible to the residents. LPA reviewed three (3) resident files and two (2) staff files. Facility has a current copy of certificate of liability insurance and LPA obtained a copy. As a result of today's inspection, a deficiency is being cited pursuant to California Code of Regulations, Title 22, Section 87202(a)(2) due to the retention of a bedridden resident without fire clearance approval. Deficiency is listed on 809-D. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jul 20, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Teka Thomas, and Mureen Williams, caregivers, and explained purpose of inspection.. Glenn Bilog, Administrator, arrived to the facility at approximately 3:15 pm. LPA observed (4) residents to be in their rooms at the start of the inspection. LPA was informed that (1) resident has been out of the facility for (2) weeks and will be returning next week. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (3) residents. Currently, there are no residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA was screened per Covid-19 precautionary measures upon entering the facility.and the following Personal Protective Equipment (PPE) was worn: N95 mask. LPA and caregiver toured the interior and exterior of the facility including the common areas, resident bedrooms, resident bathrooms (3), kitchen,medication room, staff room and laundry. LPA observed the facility to be clean, in good repair and to have sufficient furniture and lighting.. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels- Admin to ensure hand-washing posters are placed near every sink. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, locked sharps in the kitchen and locked toxins in the laundry room. LPA observed the inside temperature to be 80*F. Fire extinguisher was last serviced 7/27/2021- Administrator to complete annual servicing by 7/27/2022. Discussed vaccination status of residents/staff, eligibility for second boosters and visitation protocols. All staff are cleared/associated. Administrator certificate #6047388740- current through 2/16/2024. All required postings and various Covid posters are posted. LPA requested an updated copy of LIC500, LIC308, copy of the current liability insurance and the facility's Infection Control Plan by provided to the Department by 7/30/2022. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Jul 22, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to issue an additional deficiency discovered during a recent complaint investigation. LPA met with Marlene Duncan, caregiver, who contacted the Administrator, Lani, by phone. LPA spoke to Administrator and explained purpose of inspection. LPA also observed caregiver, Fredricka Quarrie to be present. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask. LPA observed (5) residents to be napping/awake in their rooms at the start of the inspection. (1) resident was sent to the ER this morning and will be returning today. During the investigation of complaint 25-AS-20220128094750, it was discovered that resident records were not maintained for resident (R1) following resident's stay at the facility from 1/22/22 - 1/24/22. Administrator indicated that resident's responsible person requested that resident's records be shredded and disposed of due to containing personal information. LPA discussed with Administrator today the requirement to maintain resident records of reach resident for a minimum of (3) years, even if a resident or their representative requests they be shredded. LPA and Administrator discussed possibly redacting personal information such a social security number on the copies maintained at the facility. The additional deficiencies issued on 5/26/2022 were cleared during today's inspection as documentation of training was received by the Department on 5/27/22. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is being cited on the 809D page. Exit interview. Copy of report and appeal rights to be e-mailed to the Administrator following today's inspection.the state’s words, verbatim · CDSS document, Jun 1, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(e) · Plan of correction due date: Jun 15, 2022

87506 Resident Records (e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident.This requirement is not met as evidenced by: Based on interview conducted with Administrator, records for resident (R1) were not maintained at the facility following resident moving out on 1/24/22, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 1, 2022

Plan of correction: Licensee/Administrator agrees to read Regulation 87506 and provide the Department with a signed statement that it is understood. Statement to be faxed to the Department by 6/15/22.

Allegation investigated: Resident not administered medication as prescribed. Facility did not assess resident prior to admission.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete and deliver findings to a complaint received on 1/28/2022. LPA met with Fredricka Quarrie, Maureen Williams, Marlene Duncan, caregivers, who contacted the Administrator, Lani, by phone. LPA spoke to Administrator and explained reason for visit. Administrator stated she is not able to be at the facility during today's inspection but would request that Co-Administrator, Glenn, stop by and caregivers could assist LPA also. Co-Administrator, Glenn Bilog, arrived at facility around 3:30 pm. Caregivers confirmed there are (6) residents currently, and there are (0) residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. LPA observed (6) residents to be napping/awake in their rooms at the start of the inspection. The results of the investigation are as follows: cont on 9099C(1).. Substantiated During the investigation, LPA interviewed (2) Administrators and (3) caregivers and a family member and reviewed documentation pertaining to medication administration for (3) current residents. Resident (R1) moved to the facility on 1/22/22 around the afternoon time and moved out on 1/24/22 early in the morning. Allegation: Resident not administered medication as prescribed. Allegation is resident (R1) is required to take melatonin once a day at 10:00pm but instead was being administered two melatonin at noon. Interview with (2) Administrators indicated that resident (R1) refused medications starting on Sunday, 1/24/22 and would only accept from family members. One staff stated "(R1) refused medications- she spit them out- we put them in applesauce and she still spit them out". A second staff stated he was not aware of any medication issues, and a third staff stated "I never gave her medications- I was off work".Administrator confirmed there is no documentation on file as resident's family requested that any documentation be shredded after resident moved out and the placement agency took some documents also. LPA and staff (S1) reviewed medications for (3) residents (R2-R4) on 5/26/2022, including physician's orders, Centrally Stored Medication Record (LIC622) and Medication Administration Record (MAR) for May 2022. It was determined that resident (R2) had not received Docusate on 5/26/22, due to waiting for a refill, but had received it from 5/1/22- 5/25/22. For resident (R3), Klor-Con-8-MEQ and Docusate 200mg were last administered on 5/25/22 in the morning, due to waiting on a refilled supply. Additionally, LPA observed an empty bottle of Atorvastatin-Calcium 40 mg, filled on 8/16/2021, and an opened bottle of Melatonin 10mg, to be stored with R3's current medications; Neither medication was listed on the May 2022 MAR and prescription orders, dated 8/25/2021 show that each medication is scheduled to be taken once daily. For resident (R4), LPA and S1 counted 23 tablets of PRN Alprazolam 0.5 mg, filled on 5/15/22, and determined that 7 tablets were administered since 5/15/22; however, there is no documentation on file as required. New orders were written on 5/24/22 to discontinue Alprazolam and start PRN Haloperidol 2 mg. Administrator confirmed that the medication Alprazolam, was given but not documented. cont on 9099C(2).. Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- A finding that the allegation is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Allegation: Facility did not assess resident prior to admission. Allegation is resident (R1) was not physically assessed prior to residing at the facility and placement agency and Licensee agreed to accept resident to move in. Administrator stated on 2/2/22 that she did not evaluate resident in person, prior to admission, and asked skilled nursing for paperwork, including resident's physician's report. Administrator further stated that she talked to resident's daughter before admitting her. Administrator confirmed there was also no paperwork kept on file after resident moved out. LPA was not able to contact placement agency representative to confirm the pre-appraisal process used. Based on information obtained, LPA finds the allegation to be SUBSTANTIATED- A finding that the allegation is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulation, Title 22, Division 6, Chapter 8, the following (2) deficiencies are issued on the 9099D pages. Exit interview. Copy of report and appeal rights provided to Administrator. 9099C(1).. Resident's family member said one Administrator stated there were (2) melatonin in a picture family member texted to Administrators but could not explain why there were (2) "pre-poured" for resident. Family member also stated that when she visited on Sunday, 1/23/22, in the morning, R1 was asleep in the chair in the living room and staff stated "I guess she took her medications". Another staff stated that resident woke him up at 4 am and wouldn't sleep. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff administered incorrect medications. Allegation is when R1's family member requested to see R1's medication. RP stated staff (S2) brought out a white basket full of medications with R3's name on it and none of the medications belonged to R1. It is unclear how long R1 was being administered R3's medications. LPA interviewed staff (S2) and asked if there was a medication mix-up with R1's medications and another resident's medications. S2 stated "No, there was not a mix-up with the medications"- the "Medications are already in a pocket", ready to administer. S2 showed LPA the small walk-in closet with shelves where resident medications and binders are kept. LPA observed multiple residents' medications, each in a labeled basket. LPA asked how S2 may have grabbed the wrong basket if each basket has a name on it. S2 then spoke quickly, stating that during the video call R1's family member pointed to the white basket and said "that basket" when asked which basket has R1's medications. S2 further stated that R1 took medications once only, from 1/22/22 through 1/24/22, when her family member gave them to her. Resident moved out on 1/24/22. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, May 26, 2022 · control 25-AS-20220128094750

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 10, 2022

87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on documentation review, medications were not administered for residents, R2 and R3, per physician's orders, as medication exhausted before a refill was obtained. Additionally, MAR does not document that R3 received Atorvastatin-Calcium 40 mg, or Melatonin 10mg as ordered, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 26, 2022

Plan of correction: Licensee/Administrator agree to conduct medication management training to all staff, including correct documentation on MAR, LIC622, PRN, refill process. Administrator agrees to audit the remaining (3) resident files to ensure there are no discrepancies between doctor orders and medication being administered. Documentation of training- including topics discussed and staff who attended to be faxed to the department by 6/10/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c)(1) · Plan of correction due date: Jun 10, 2022

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462 Social Factors.This requirement is not met as evidenced by: Based on interview with Administrator, the Licensee did not ensure that resident (R1) was evaluated in person prior to admission on 1/22/22, which posed a potential health and safety risk to residents in care. ,the state’s words, verbatim · CDSS document, May 26, 2022

Plan of correction: Licensee/Administrator agrees to read Regulation 87457 and provide a signed statement to the department that it is undestood. Due by 6/10/22.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete and deliver findings to a complaint investigation received on 1/28/2022. LPA met with Fredricka Quarrie, Maureen Williams, Marlene Duncan, caregivers, who contacted the Administrator, Lani, by phone. LPA met with Glenn Bilog, Co-Administrator, who arrived at the facility around 3:30 pm. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. LPA observed (6) residents to be napping/awake in their rooms at the start of the inspection. During the course of the investigation, the additional deficiency was observed as follows: During a medication record review for resident (R1) on 5/26/22, it was determined that (7) tablets of a bottle of (30) of PTN Alprazolam 0.5 mg were administered to R1 from 5/15/22 through 5/26/22; however, there is no documentation to show on what days, times, etc as required per the regulation. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is being cited on the 809D page. Exit interview. Copy of report and appeal rights provided to Administrator.the state’s words, verbatim · CDSS document, May 26, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(d)(3) · Plan of correction due date: May 30, 2022

87465 Incidental Medical and Dental Care(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: (3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: Based on record review and interviews conducted, the Licensee did not ensure that the facility maintained a record of PRN medications administered for Alpharazolam 0.5mg for resident (R3), which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 26, 2022

Plan of correction: LIcensee/administrator agree to conduct staff training oni documentation of PRN medication. Documentation to be provided to department bt 6/10/22.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a follow up case management inspection. LPA met with Denise Hall, caregiver (S3) who contacted the Administrator, Leilani, by phone. LPA spoke to Administrator and explained reason for visit. Caregiver confirmed there are (6) residents currently, and there is (1) resident on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. LPA observed (6) residents to be napping/awake in their rooms. LPA conducted an inspection on 2/2/2022 at the facility, and it was learned following the inspection that staff (S1 and S2), who were present during the inspection, did not have fingerprint clearance prior to starting their employment at the facility. LPA followed up by phone with the Administrator on 2/7/2022 to advise of the requirement that staff be fingerprint cleared before being allowed to work at the facility. Administrator advised that S1 would be having fingerprints taken that day, on 2/7/2022. Administrator provided LPA with electronic documentation during today's inspection that S1 is currently cleared and associated to the facility effective yesterday, 2/8/22. Administrator stated that S2 chose not to have fingerprints taken and no longer works for the facility. Administrator confirmed that both S1 and S2 worked at the facility starting on/around January 2022. Interview conducted with S2 on 2/2/2022 revealed that S2 worked at the facility for approximately 6 weeks. S1 did not provide an exact start date but confirmed S1 was working at the facility on/around 1/22/2022 when interviewed on 2/2/2022. Staff S3, who is fingerprint cleared is associated to this facility effective 2/9/2022. S3 was previously working for a related facility. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency (1) is cited today. See 809D for deficiency cited. Exit interview by phone with Administrator. Authorization given to caregiver to sign. Copy of report and appeal rights emailed to Administrator following today's inspection.the state’s words, verbatim · CDSS document, Feb 9, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Feb 10, 2022

87355 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. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that staff (S1/S2) obtained a criminal record clearance prior to working, residing, volunteering at the facility, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 9, 2022

Plan of correction: Staff S1 obtained a criminal record clearance on 2/8/2022 and has been associated effective 2/8/2022 to the faciilty. S2 no longer works/volunteers at the facility as of 2/7/2022. Licensee/Administrator agree to read regulation 87355 and submit a signed statement to the department by fax, by 2/10/2022, that it is understood.