Kentfield Estates Ranch RCFE

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lavinia Muscan arrived on Monday 8/23/23 to conduct the annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (3) and staff files (2). All resident files contained the required paperwork. All staff files contained the required paperwork. All staff have current first aid and CPR training. Facility was clean and well organized. All required posting were observed. Staff training contained the required initial training. LPA and Caregiver Alegrine Nacar toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, and common areas and outside area.The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. All exits were unobstructed. The disaster drill is current. The administrator's certificate is current. There is a side gate for emergency access. LPA checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPA observed cleaning products and other toxins to be locked away. LPA observed the area used for medication to be locked and inaccessible to residents. LPA observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguisher is ready for emergency use. In the areas toured, there were no health or safety violations observed. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department. Exit interview conducted. A copy of this report was printed and given to Caregiver.the state’s words, verbatim · CDSS document, Aug 23, 2023

Type of visit: Required - 1 Year

On August 31, 2022, Licensing Program Analyst DeAnna Williams-Lyons arrived unannounced to conduct a 1 year annual inspection. LPA met with Alejrine Nacar, Caregiver, and informed him the reason for the visit. Prior to the inspection, LPA completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19, contacted licensee and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Mask In addition, LPA was screened by staff upon arrival. Alejrine and LPA completed the inspection tool questionnaire with no issues or advisories to report. LPA observed the following: Administrator certificate is valid, expiring 10/15/2022 First aid kit fully stocked and ready for emergency use. Fire extinguisher is fully charged . The home was 75 degrees F. Which is in the right temperature range. Common areas were clean and in good repair. Bedrooms had required furniture and lighting. Facility has required (2) day perishable supply of food and (7) supply of non-perishable food. Exterior of the home is in good repair with no bodies of water on the premises. Medications were locked up and MARS log was current and complete. As a result of this visit, no deficiencies were cited, per Title 22 Regulations, Division 6. The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file in our Regional Office. Administrator shall submit the listed documents to Licensing later than September 30, 2022. Exit interview conducted and a copy of this report given to Alejrine.the state’s words, verbatim · CDSS document, Aug 31, 2022

Allegation investigated: Staff are not adequately supervising residents

Licensing Program Analyst (LPA) Melana Llopis arrived at the facility unannounced on 08/30/2021 to deliver findings for a complaint the Department received on 07/01/2021. Prior to visit, 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; upon visit 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 was screened by Paula McDonald, staff, upon entering the facility. LPA met with Administrator, Mariam Gbaty and explained the purpose of the visit. Throughout the course of the investigation, LPA conducted multiple interviews, toured the facility and reviewed documentation pertinent to the investigation. Results are as follows: ***Continuation on LIC9099C*** Substantiated Allegation: Staff are not adequately supervising residents Complaint alleged facility staff are locking residents in their bedrooms to substitute for adequate supervision. On 07/08/2021 LPA conducted an unannounced visit to the facility and found the outer gate to be locked. LPA called the facility and staff (S1) opened the gate for LPA to enter. LPA spoke with S1 who stated the gate is locked because residents in the home have mental impairments which cause wandering. LPA spoke with Administrator during time of visit, who stated the facility did not have a waiver for the exterior gate to be locked. LPA requested to review resident's needs and service care plans. LPA reviewed a sample of two (2) of two (2) residents' needs and service plans. LPA did not find a plan in place to address resident wandering. Based on the information above, LPA finds the allegation to be SUBSTANTIATED,meaning the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of regulations, Title 22. Deficiencies are being cited on the attached LIC9099D. Exit interview conducted, copy of report provided. Allegation: Facility staff are locking residents in their rooms. Complaint alleged facility staff are locking residents in their bedrooms to substitute for adequate supervision. On 07/08/2021 LPA conducted an unannounced visit to the facility and found the outer gate to be locked. LPA called the facility and staff (S1) opened the gate for LPA to enter. LPA spoke with S1 who stated the gate is locked because residents in the home have mental impairments which cause wandering. LPA spoke with Administrator during time of visit, who stated the facility did not have a waiver for the exterior gate to be locked. LPA requested to review resident's needs and service care plans. LPA reviewed a sample of two (2) of two (2) residents' needs and service plans. LPA did not find a plan in place to address resident wandering. No further evidence could be provided. Based on the information above, 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, and the findings are unsubstantiated. An exit interview was conducted. No deficiencies were cited on today’s date. Appeal rights provided. Allegation: Staff are not adequately trained. Complaint alleged staff (S2) does not have adequate training. LPA reviewed S2's training on 07/09/2021 and found S2's training was current and adequate. LPA spoke with Administrator on 07/08/2021 who stated S2 was trained, however S2 did not meet facility's standards for the position. Administrator stated S2 was not accountable, therefore S2's employment was terminated. Allegation is UNFOUNDED. Allegation: Staff are over medicating residents. LPA conducted a medication audit for a sample of two (2) of two (2) residents in care. LPA did not observe errors upon audit. On 07/08/2021, LPA interviewed two (2) of two (2) residents in care. Residents stated they receive their medications and did not have problems with getting their medications. Allegation is UNFOUNDED. Allegation: Staff are not administering medications as prescribed. LPA conducted a medication audit for a sample of two (2) of two (2) residents in care. LPA observed no errors. On 07/08/2021, LPA interviewed two (2) of two (2) residents in care. Residents stated they did not have issues with their medications. Allegation is UNFOUNDED. Allegation: Facility is malodorous. LPA visited the facility on 07/08/2021 and observed the facility to be clean and free of foul odor. LPA spoke with two (2) of two (2) residents in care who stated the facility is kept clean and does not smell. LPA spoke with staff (S1) who stated the facility is kept clean and does not have a foul smell. LPA spoke with a key witness who stated the facility did not have a foul smell during their visits. Allegation is UNFOUNDED. Due to the information above, the Department finds the allegations to be 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, copy of report provided.the state’s words, verbatim · CDSS document, Aug 30, 2021 · control 25-AS-20210701113651

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(I)(6) · Plan of correction due date: Aug 31, 2021

87705 Care of Persons with Dementia (l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (6) Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents. This requirement was met as evidenced by: Licensee locked perimeter fensces to assist with supervising residents who wander in the community. This put an immediate personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 30, 2021

Plan of correction: Licensee unlocked fence during initial visit when LPA found the outer fence to be locked. LIcensee understands the perimeter fence needs to remain unlocked wihtout a proper waiver Licensee agrees to submit a detailed plan of action that will include the faciltiy staff plan to ensure the safety of residents who are wander risks. Licensee will submit plan to CCL by POC date provided.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Angela Hood and Michael Hood arrived at the facility unannounced on 8/20/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPAs met with Mariam Soumahoro, Licensee, and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs completed required COVID-19 testing protocols, the 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 to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPAs were screened by staff upon entry and signed visitor log with temperatures. LPAs toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: 4 bedrooms and 2 bathrooms for residents, common area, dining room, kitchen, outdoor area, and viewed PPE supplies. In the areas toured no immediate health, safety, or personal rights violations were observed. LPAs and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Aug 20, 2021

Type of visit: Post Licensing

Licensing Program Analysts (LPAs) Angela Hood and Michael Hood arrived at the care home today and met with the Licensee, Mariam Soumahoro, to conduct an annual required and post licensing visit. For more information on the post licensing visit please see LIC 809 dated 8/20/21. No deficiencies cited for the post licensing visit.the state’s words, verbatim · CDSS document, Aug 20, 2021

Allegation investigated: Resident AWOLed due to neglect and lack of supervision. Facility issued unlawful eviction of resident.

Licensing Program Analyst (LPA) Melana Llopis arrived at the facility unannounced on 07/20/2021 to deliver complaint findings for a complaint the Department received on 03/26/2021. LPA met with Administrator, Mariam Gbaty Soumahoro and explained the purpose of the visit. Prior to the visit, 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; contacted licensee 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: N-95 Masks. Throughout the course of the investigation, the Department conducted interviews, obtained and reviewed documentation pertinent to the allegations listed above. The results are as follows: ***Continuation on LIC-9099C*** Substantiated Allegation: Resident AWOLed due to neglect and lack of supervision The Department received a complaint on 03/26/2021 alleging resident (R1) eloped the facility due to staff neglect and lack of supervision. On 07/14/2021 and 07/15/2021 LPA spoke with Administrator who stated on 03/23/2021 R1 eloped the facility. Administrator stated staff did not go after resident because there were three (3) other residents in the home to tend to and R1 was acting aggressive toward staff. Administrator stated staff (S1) called R1's family and the local law enforcement. Administrator stated R1 was found in the morning at their father's house the following day. On 07/15/2021 LPA reviewed R1's resident file. Though Administrator stated to LPA that R1 had known elopement behavior, R1's needs and service plan did not address how staff will ensure safety of resident if resident tries to elope the facility. This allegation is found to be SUBSTANTIATED. Allegation: Facility issued unlawful eviction of resident The complaint alleged the facility did not accept resident (R1) back into the facility after their elopement on 03/23/2021. LPA interviewed Administrator on 07/14/2021 and 07/15/2021 who stated they did not agree to take back R1 after R1's elopement on 03/23/2021 due to unknown COVID-19 exposure. Administrator confirmed a written notice was not provided to R1 or their representative. This allegation is found to be SUBSTANTIATED. Due to the above information the Department finds the allegations listed above to be SUBSTANTIATED meaning the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies being cited can be found on LIC-9099-D, per California Code of Regulations, title 22. Exit interview conducted, copy of report and appeal rights provided. Allegation: Staff do not serve nutritional food Complaint alleged the facility staff was not serving nutritious meals to residents in care. On 07/08/2021 LPA reviewed facility menu and pictures provided by Administrator of resident meals. LPA observed the facility to provide three (3) meals a day with two (2) snacks in between. LPA observed meals to consist of fruits and vegetables as well as protein and healthy starches. LPA spoke with two (2) of two (2) residents on 07/08/2021 who stated the food was good. Residents did not state they had issues with food. No further evidence could be provided. LPA finds the allegation to be UNFOUNDED. Allegation: Staff speak harshly to residents Complaint alleged staff (S1) yells and is rude to residents in care. LPA spoke with two (2) of two (2) residents in care on 07/08/2021. Residents stated the staff treat them fine. Residents stated they did not hear yelling. LPA spoke with Home Health Nurse on 07/08/2021 who stated their patient did not voice any concerns with his care and is happy with his care. LPA interviewed staff and Administrator on 07/08/2021 and 07/15/2021 who stated staff do not yell at residents. No further evidence could be provided. LPA finds the allegation to be UNFOUNDED. Allegation: Facility failed to issue a refund Complaint alleged the facility did not issue a refund to R1 after being evicted. On 07/08/2021 LPA spoke with R1's placement agent who stated they received confirmation from R1's representative that R1 did receive a full refund in April 2021, the same month R1 left the facility. LPA finds the allegation to be UNFOUNDED. Allegation: False claims On 07/08/2021, LPA interviewed two (2) of two (2) residents in care who did not report facility providing false statements to residents. LPA spoke with key witnesses who did not believe the facility was providing false statements or claims. No information or evidence could be provided by key witnesses that facility is providing false claims. LPA finds allegation to be UNFOUNDED. Based on interviews, records review and facility visit observations, LPA finds the allegation(s) listed above to be UNFOUNDED meaning Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 20, 2021 · control 27-AS-20210326083547

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(a)(4) · Plan of correction due date: Jul 21, 2021

87705 Care of Persons with Dementia (a) This section applies to licensees who accept or retain residents diagnosed by a physician to have dementia. Mild cognitive impairment, as defined in Section 87101(m), is not considered to be dementia. (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement was not met as evidenced by: R1 eloped the facility on 03/23/2021 and there was not a staff member available to ensure R1's safety.the state’s words, verbatim · CDSS document, Jul 20, 2021

Plan of correction: Licensee understands the importance of ensuring there are adequate staff to support each resident's specific needs. Licensee stated R1 is no longer residing at the facility. Licensee agrees to send to CCL their new plan to accommodate the needs of residents with elopement behavior. Licensee to send this plan to CCL by POC date provided.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Jul 21, 2021

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This requirement was not met as evidenced by: The Licensee evicted R1 without providing R1 with a written thirty (30) day notice. This immediately put R1's safety and personal rights at risk.the state’s words, verbatim · CDSS document, Jul 20, 2021

Plan of correction: Licensee stated R1 is living with their family. Moving forward, Licensee agrees to review regulation 87224 Eviction Procedures in its entirety and send CCL a letter of understanding by the POC date provided.