Tuscany Villa Care Home

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 Analysts (LPAs) Lavinia Muscan and Talwinder Bains arrived unannounced to complete and deliver findings to a complaint received on 3/28/23. LPA met with Administartor Andrea Yerby and explained purpose of visit..LPAs wore surgical masks during today's visit. LPAs interviewed (1) staff and (1) resident and reviewed medications for residents. LPAs also toured the facility and observed all residents on 4/4/23 and on 5/10/23. The results of the investigation are as follows: Continued on 9099-C ... Unfounded Allegation: Residents are chemically restrained with medication. All staff and resident interviews indicated that residents are only administered medications that are ordered and generally sleep through the night. Interviews and medication review showed that one resident takes Melatonin as ordered by the doctor. LPAs observed medications to be given as ordered and no errors for residents. Also, facility is correctly documenting the scheduled and PRN medications . Based on information obtained, LPAs finds the allegation to be UNFOUNDED-means that the allegation is false, could not have happened, and/or is without a reasonable basis. Allegation: Facility staff not fingerprint- cleared. LPAs reviewed staff files for (3) staff, including photo ID, and observed that all staff are fingerprinted cleared and associated. Based on information obtained, LPAs finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis. Allegation: Staff are using drugs while on duty. Complaint alleges that staff are using drugs while on duty. Based on interviews with staff and residents and LPAs observations on 4/4/23 and on 5/10/23, staff were observed to be competently assisting residents and able to perform their jobs. Based on information obtained, LPAs finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis. Allegation: Facility staff are abusing residents. Based on interviews with staff and residents and LPAs observations on 4/4/23 and on 5/10/23, staff are not abusing or neglecting residents. Residents who were able to be interviewed stated staff provides excellent care and assists them well. LPAs observed residents watching television and doing other activities during inspections and didn't observe any physical abuse to any residents. Based on information obtained, LPAs finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis. No citations were issued during this visit. Exit interview conducted. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, May 10, 2023 · control 59-AS-20230328171224

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 01/11/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with staff (caregiver)- Sophia Barnett and explained the purpose of the visit. Sophia called administrator who gave permission to do the facility tour with LPA till administrator come in. Administrator came in later to facility to complete inspection. 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 contacted facility 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. LPA and caregiver toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathrooms, garage, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and administrator completed the infection control domain together 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 copy of report left at the facility. Administrator to send in updated copy of LIC 308 - Designation of Facility Responsibility, LIC 500 - Personnel Report, and current copy of Liability Insurance to Community Care Licensing by 01/25/2023.the state’s words, verbatim · CDSS document, Jan 11, 2023

Type of visit: Required - 1 Year

Unannounced annual visit utilizing the infection control domain was performed by LPA Michael Smith. Contact with Angela Knight. A review of staff records on 1/13/22 indicates that all facility staff and other individuals who require caregiver background checks have received criminal record clearances. As a result of this visit, there were no deficiencies. However, 6 technical advisories were issued. Exit interview conducted.the state’s words, verbatim · CDSS document, Jan 13, 2022

Allegation investigated: Facility staff did not follow reporting requirements. Facility staff did not safeguard resident's personal belongings. Resident was illegally evicted.

Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 09/08/2021 to deliver complaint findings for the allegations listed above, LPA met with staff Shantel Watson and explained the purpose of the visit. Prior to initiating visit LPA completed daily self-screening questionnaire to confirm no symptoms of COVID-19, LPA was screened by staff upon entry and wore surgical mask and applied hand sanitizer. LPA contacted administrator via telephone to go over report as they were unable to come to the facility at time of visit, verbal permission was given for staff to sign report. Throughout the course of the investigation the department reviewed documentation and conducted interviews relevant to the allegations: facility staff did not follow reporting requirements, facility staff did not safeguard residents personal belongings, and resident was illegally evicted. Through interviews it was learned that the facility utilized emergency services for a lift assist for resident (R1) and did not notify the responsible person or the department of this information as no injuries were noted or observed, responsible person was notified Report continued on LIC 9099-C Substantiated at a later date. It was also revealed that shortly after the time of the lift assist from the fire department the resident’s hearing aid went missing and was unable to be located. Hearing aid was documented on R1's inventory list upon move in, R1 moved out the beginning of April 2021 and the hearing aid was never located. Documentation reviewed revealed that R1 had a fall on or around 11/24/2020 with no injuries noted which was not reported to the department. R1 experienced a similar incident on 11/13/2020 which was reported to the department on an incomplete incident report. The department received an incident report on 03/25/2021 notifying the department that R1 had been issued an eviction notice however no copy of the notice was received until it was later requested, upon review it was found to be incomplete and therefore not valid. Due to this information 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. The following deficiencies are cited on the attached LIC 9099-D: §1569.152 Safeguard of resident property; reimbursement for failure to make reasonable efforts; preseumption; penalty (a) A residential care facility for the elderly, as defined in Section 1569.2, which fails to make reasonable efforts to safeguard resident property shall reimburse a resident for or replace stolen or lost resident property at its then current value. The facility shall be presumed to have made reasonable efforts to safeguard resident property if the facility has shown clear and convincing evidence of its efforts to meet each of the requirements specified in Section 1569.153. The presumption shall be a rebuttable presumption, and the resident or the resident's representative may pursue this matter in any court of competent jurisdiction. 87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. Report Continued on LIC 9099-C §1569.683 Eviction notices; reasons for eviction contents; service (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. In addition, the notice to quit shall include all of the following: (1) The effective date of the eviction. (2) Resources available to assist in identifying alternative housing and care options, including public and private referral services and case management organizations. (3) Information about the resident's right to file a complaint with the department regarding the eviction, with the name, address, and telephone number of the nearest office of community care licensing and the State Ombudsman. (4) The following statement: "In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing." Exit interview conducted, appeal rights provided, and copy of report to be emailed to administrator. Documentation reviewed showed that an inventory list was completed and signed by R1's responsible person shortly after admission, however interviewed conducted allege that it was not always updated as new items were purchased. Centrally stored medication log reviewed showed that R1 started a new medication shortly after arriving at the facility, the medication was logged and the medication was centrally stored and dispensed as ordered according to interview with facility administrator. Text message correspondences reviewed reveal that there was a possible shortage of the medication however the cause is unknown. According to facility administrator there was not a shortage, the medication was refilled timely by the pharmacy, and R1 never missed a dose. No documentation reviewed revealed that the resident's needs were not met, however interviews regarding staff being able to meet resident's needs resulted in conflicting information. Due to this information the department finds the allegations to be UNSUBSTANTIATED a finding of unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and copy of report emailed to administrator.the state’s words, verbatim · CDSS document, Sep 8, 2021 · control 25-NP-20210405081042

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.152(a) · Plan of correction due date: Sep 22, 2021

§1569.152 Safeguard of resident property; [...] (a) A residential care facility for the elderly, as defined in Section 1569.2, which fails to make reasonable efforts to safeguard resident property shall reimburse a resident for or replace stolen or lost resident property at its then current value. This requirement was not met as evidenced by: interviews and documentation reviewed. The licensee did not comply with the section cited above. R1's hearing aid was lost in March 2021 and was not found, This poses a potential health, safety, and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 8, 2021

Plan of correction: Licensee to create a plan to replace or reimburse R1 for their lost hearing aid. Copy of plan to be sent to Community Care Licensing by 09/22/2021 by fax.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Sep 22, 2021

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department [...]: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident [...] (D) Any incident which threatens the welfare, safety or health of any resident [...] This requirement was not met as evidenced by: interviews and documentation reviewed. The licensee did not comply with the section cited above by not reporting incidents which threatened the welfare of R1. This poses a potential health, safety, and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 8, 2021

Plan of correction: Licensee to review section 87211 Reporting Requirements and send a letter of understanding to Community Care Licensing by 09/22/2021 by fax. Additionally, licensee to ensure incident reports are completely filled out, including second page "action taken" and "licensee comments" sections.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.683(a) · Plan of correction due date: Sep 22, 2021

§1569.683 Eviction notices; reasons for eviction contents; service (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, [...] This requirement was not met as evidenced by: interviews and documentation reviewed. The licensee did not comply with the section cited above. R1 was issued an incomplete eviction notice. This poses a potential health, safety, and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 8, 2021

Plan of correction: Licensee to review eviction notices requirements and send letter of understanding to Community Care Licensing by 09/22/2021 by fax.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Wolter and Singh arrived at the facility unannounced on 07/22/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPAs met with administrator Andrea Yerby and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs 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 contacted facility and completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical masks. Additionally, LPAs temperatures were taken at entry. LPAs and administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, garage, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and administrator completed the infection control domain together 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 copy of report to be emailed to licensee. Administrator to send in updated copy of LIC 308 - Designation of Facility Responsibility, LIC 500 - Personnel Report, and current copy of Liability Insurance to Community Care Licensing by 07/29/2021.the state’s words, verbatim · CDSS document, Jul 22, 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.