A1 Magnificent Home

Allegation investigated: -Staff is allowing resident to smoke where oxygen is in use.

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today, 10/11/23, and met with the caregiver to deliver findings into the allegation of staff are allowing resident to smoke where oxygen is in use. During the course of the investigation, LPA conducted interviews and obtained documentation pertinent to the investigation. Interview with the Administrator and staff (S1) indicated that they do not encourage or allow resident (R1) to smoke while using oxygen. The Administrator indicated that they have put a sign on the door of R1's room as a reminder to not use oxygen when smoking outside. LPA observed the reminder sign and the oxygen in use signs in R1's room. Interview with R1 indicated that they do not use oxygen while smoking. R1 stated that they have forgotten a couple times but the Administrator and S1 always remind R1 to not use oxygen while smoking. ************************************************Continued on LIC9099-C*************************************************** Unsubstantiated Unusual Incident/Injury Report LIC624s submitted to CCL dated 9/2/22 and 3/23/23 indicated two incidents of R1 being found by staff using oxygen while smoking. The LIC624s indicated that staff will continue to closely monitor R1 to ensure they do not use oxygen while smoking. Staff will also continue to monitor R1's oxygen level. Eviction notice provided to LPA dated 8/1/23 indicated that R1 is being evicted due to noncompliance with house rules, which indicated smoking in room after constant reminders not to and smoking with oxygen on after constant reminders not to. Interviews with the Administrator, S1, and R1 indicated that R1 will be moving out of the care home to another facility soon. On 9/26/23, LPA did not observe R1 as they were at the hospital. On 10/11/23, LPA did not observe R1 using oxygen while smoking. Based on observation, interviews conducted, and documentation reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited during this visit. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 11, 2023 · control 59-AS-20230921152717

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 6/22/23 to conduct a Required-1 Year Inspection utilizing the CARE inspection tool. LPA met with Caregiver and explained the purpose of the visit . Administrator notified and arrived to assist. 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, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA advised that the sliding screen door to R2's bedroom be repaired. Kitchen locks were repaired or items relocated. LPA reviewed 2 resident files and 1 staff files. LPA found an incomplete file for R1- more training needed, transfer request has been submitted. Infection control plan is not present. Licensee will submit a copy of liability insurance. As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed with licensee . Copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 22, 2023

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 4/12/23, Licensing Program Analyst (LPA) Kevin Mknelly,conducted an unannounced inspection. LPA met with Licensee and explained the purpose of the visit. The purpose of this inspection was to follow-up on incident report and death notification, received on 4/7/23, for incidents 4/1/23 and death on 4/3/23. LPA conducted an inspection and observed residents to be assisted as needed. Interview was conducted with licensee and caregiver. On 4/1/23 R1 called for assistance on three occasions and was found on the floor. On the instances R1 reported to have no injuries and denied needing medical care. On 4/2/23, R1 was at baseline with no decrease in function and no increases in pain. On 4/3/23, R1 signed out of the facility at 10:50 am for a supposed Dr. appt. By report of the friend, there was not an actual Dr. appt. scheduled for 4/3/23. R1's friend returned with R1 at approximately 5:50 and informed caregiver that R1 was unresponsive in the friend's vehicle. Emergency responders were notified, CPR was administered. Emergency responders pronounced R1 deceased. The death does not appear related to the falls of 4/1/23 at this time. LPA asked that licensee resubmit the death report and ID/ Emergency form. As a result of today’s inspection, no deficiencies were noted. This report was reviewed and copy provided.the state’s words, verbatim · CDSS document, Apr 12, 2023

Allegation investigated: Facility staff slapped resident in care Facility staff handled resident in an inappropriate manner Facility staff spoke inappropriately to resident in care

LPA Williams arrived on Wednesday October 5, 2022 to conclude a complaint investigation regarding the following allegations: Facility staff slapped resident in care, facility staff handled resident in an inappropriate manner, and facility staff spoke inappropriately to resident in care. Prior to the visit, LPA completed the required COVID-19 testing protocols and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA Williams spoke with Administrator Leonida Gaerlan and expained the findings. Throughout the course of the investigation, LPA interviewed staff and residents. Unfounded Additionally, LPA reviewed R1’s admission agreement, progress notes, physicians report and staff notes. R2 was the only other resident residing at A1 Magnificent Home, states that they have never seen staff be verbally or physically abusive to the resident, but has witnessed the resident be abusive to staff on many occasions. R1 was dealing with a well-documented substance abuse problem which has led to mood swings and outbursts. In addition, R1 recently returned to A1 Magnificent Home after living in a SNF briefly, and upon return R1 stated that the allegations are untrue, that he doesnt know who filed the allegations. Based on LPAs interviews and review of documentation, the preponderance of evidence standards was not met, therefore, the above allegations are found to be UNFOUNDED. An unfounded allegation means that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview conducted. A copy of this report emailed to Administrator.the state’s words, verbatim · CDSS document, Oct 5, 2022 · control 25-AS-20220902150607

Type of visit: Required - 1 Year

On 6/30/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator, Leonida Gaerlan, 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. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility. LPA observed the interior of the facility. LPA observed (3) residents present at the facility. LPA was informed by residents that the facility "allows their dignity to grow". LPA observed all areas to be clean, in good repair and to be odor free and the bathrooms and kitchen to have paper towels, soap, trash cans with lids and Covid posters. LPA observed multiple Covid posters and hand sanitizers throughout and required postings displayed. Discussed vaccination protocols of residents and staff and visitation protocols in place. LPA and Administrator completed the Infection Control Domain regarding Covid protocols in place. LPA observed the Administrator Certificates (Estrella Shortey and Leonida B. Gaerlan) to be up to date. LPA reviewed (2) resident's file. LPA requested Administrator to send a copy of the current liability insurance be emailed to CCLD by Friday 7/8/2022. There were no deficiencies observed during today's inspection. Exit interview. Copy of report provided to Administrator. Administrator informed LPA that an Incident Report was submitted regarding a conflict between two residents and one fell. Administrator informed LPA that EMS and family were informed. Administrator inquired what can she do if a resident refused medical attention. LPA responded that the facility should practice Medical Refusal Form for residents. Administrator asked LPA what is the protocol for residents with EtOH diagnosis. LPA informed Administrator she will ask her Licensing Program Manager and email a response. LPA advised Administrator to get LIC 602A to be updated for residents. Administrator asked what is the Department's practice for medical marijuana, LPA informed Administrator she will get a confirmation on this response and notify Administrator as soon as possible.the state’s words, verbatim · CDSS document, Jun 30, 2022

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Melana Llopis arrived at the facility unannounced on 09/01/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with Administrator, Leonida Gaerlan and explained the purpose of the visit. Prior to initiating the annual inspection CCL staff and LPA completed required COVID-19 testing protocols, and self-screened for symptoms of COVID-19. Additionally LPA contacted facility and conducted a pre-screening call prior to inspection. CCL staff and LPA wore the following Personal Protective Equipment (PPE) during today's visit: N95 mask. LPA utilized the facility's self-screening sheet upon arrival. LPA 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 rooms, bathrooms, pantry 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 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.the state’s words, verbatim · CDSS document, Sep 1, 2021