Bethesda Senior Care

Type of visit: Case Management - Incident

On 11/08/23, LPA Bains conducted an unannounced case management visit to the facility to follow up on an incident which happened at facility on 05/31/23 related to 2 facility staff members. LPA met with administrator, David Bostanchyan and explained the purpose of today’s visit. The department conducted a record review to investigate this incident. Based on the records reviewed, it has been determined that the facility did not report an incident to the Department where staff, S1 made inappropriate sexual conduct to staff S2 on 05/31/23. Law enforcement was called and S1 got arrested due to this incident. Per facility records, S1 and S2 were ‘live-in’ staff at the time of incident. The facility should have reported this incident to CCL as required by Title 22. Although this incident did not involve residents but S1 and S2 were on duty at the facility and were responsible for the care and supervision of the residents ultimately putting the residents’ health and safety at risk. Additionally, it has been concluded that administrator was aware about this incident which happened at the facility between staff, S1 and S2 but administrator did not comply with reporting requirement. During today's visit, administrator stated that facility send SIR (LIC624) for this incident to CCL via Fax but facility could not provide any verification to prove it when LPA requested. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 809-D page. Exit interview conducted. Appeal Rights and copy of this report has been provided to facility.the state’s words, verbatim · CDSS document, Nov 8, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Nov 9, 2023

87211(a)(1)(D) -Reporting Requirement- Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse …. This requirement is not met as evidenced by; Based on the records reviewed, it has been determined that the facility did not report an incident where staff, S1 made inappropriate sexual conduct to staff, S2 on 05/31/23 which poses an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Nov 8, 2023

Plan of correction: Licensee shall send a written statement to CCL of understanding of regulation for 87211 for reporting requirements and shall do training with staff. POC documents should be sent to CCL by POC date-11/09/23.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(d)(2) · Plan of correction due date: Nov 9, 2023

87405- Administrator - Qualifications and Duties(d)(2)- Knowledge of and ability to conform to the applicable laws, rules and regulations….. This requirement is not met as evidenced by; Based on the records reviewed and interviews, it has been determined that the administrator did not report an incident where staff, S1 made inappropriate sexual conduct to staff, S2 on 05/31/23 which poses an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Nov 8, 2023

Plan of correction: Administrator agreed to submit a self-certification of understanding the regulation ,87405 (d)(2) and will make sure to report any reportable incidents to CCL as required and submit proof to CCL by POC date-11/09/23.

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Talwinder Bains arrived on 08/17/23 to conduct the annual inspection. LPA met with administrator, David Bostanchyan and explained the purpose of today's visit. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (2) and staff files (2). Facility was clean and well organized. All required posting were observed. LPA and Administrator 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. Grab bars were present at the toilet and in the shower. All exits were unobstructed. 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. Hot water temperature was observed to be 116 degrees F, which is within the regulation range of 105-120 degree. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by 08/31/23. Deficiencies are cited on LIC809D per Title 22. Exit interview conducted. Appeal Rights and copy of this report left at facility.the state’s words, verbatim · CDSS document, Aug 17, 2023

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Office

An informal office meeting was held today, 8/17/2022, via Microsoft Teams to address topics listed in this report. The following Licensing staff were present: Licensing Program Manager (LPM) Laura Munoz and Licensing Program Analyst (LPA) Michael Hood The following representatives present: Licensee, David Bostanchyan The following topics were covered during today's meeting: Substantiated complaint allegations from 7/19/2022 pertaining to resident being left outside facility without supervision from staff and facility not reporting incident to CCL or responsible party Facility agrees not to repeat actions that resulted in incident discussed in today's meeting. LPA may follow-up with Licensee to ensure all the information discussed in this meeting has been implemented. An exit interview was conducted and a copy of this report will be provided to the facility via email. A copy will be signed and returned to CCL. The signature of the Licensee on this form acknowledges receipt of this document.the state’s words, verbatim · CDSS document, Aug 17, 2022

Allegation investigated: Resident was left unattended without care and supervision. Facility did not notify resident's responsible party that resident left the community.

On 7/19/2022, Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Assistant Administrator, Jacob Bostanchyan, to deliver findings regarding a complaint investigation into the allegations listed above. LPA wore an N-95 mask and was screened by facility upon entry. Facility staff wore masks while on the premises. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Resident was left unattended without care and supervision. ** Report continued on 9099-C ** Substantiated Interviews with relevant parties indicated that, on 2/1/2022, owner of facility dropper resident (R1) off at their house, which was 20-30 percent damaged due to a fire. Neighbors saw R1 inside the house by themselves and brought them back to their home. The police were then contacted (interviews are inconsistent with who contacted the police). Interview with Administrator indicated that R1 was taken to home by Administrator to retrieve a cell phone charger, which was found at their home. Administrator stated that they left R1 with the their neighbors while they went around the corner to get gas. Administrator stated that they were gone for 45 minutes and returned to the neighbors that had R1. When Administrator returned to the home, they found police had been contacted. Administrator stated that they did not know R1’s neighbors prior to excursion. R1’s Physician’s Report (LIC 602) dated for 12/16/2021 indicated that R1 has a primary diagnosis of dementia and is unable to leave the facility unassisted, with a note indicating that “due to dementia patient at risk for not remembering the way back.” Allegation: Facility did not notify resident's responsible party that resident left the community. Interview with relevant party indicated that they were not notified that R1 was leaving the facility and did not know of their absence until notified by R1’s neighbors. As of inspection conducted on 7/19/22, an incident report has not been completed for incident that occurred on 2/1/2022. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. Exit interview was conducted with Assistant Administrator. A copy of this report and appeal rights were provided. The Assistant Administrator’s signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Jul 19, 2022 · control 25-AS-20220202142731

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4) · Plan of correction due date: Jul 20, 2022

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (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 is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure that resident (R1) was properly supervised during outing, which poses an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 19, 2022

Plan of correction: Administrator will complete a statement of understanding regarding regulation 87705 and submit statement to Department by POC due date of 7/20/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 3, 2022

87211 Reporting Requirements (a) Each licensee shall furnish (...) (1) A written report (...) to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. (...) (D) Any incident which threatens the welfare, safety or health of any resident, such as (...) unexplained absence of any resident. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not report R1's unsupervised absence from the facility, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 19, 2022

Plan of correction: Administrator will complete a statement of understanding regarding regulation 87211 and submit statement to Department by POC due date of 8/3/2022.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) K.. Hiratsuka, arrived at the facility unannounced to conduct an unannounced annual visit using the infection control tool visit. LPA met with Facility Administrator Assistant Jacob Bostanchyan, and explained the purpose of the visit. Prior to initiating 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. LPA ensured they used hand sanitizer shortly after entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by Caregiver. LPA and Administrator Assistant toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, and common restrooms. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. A couple of topics were discussed. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facilitythe state’s words, verbatim · CDSS document, Jul 14, 2022

Allegation investigated: - Staff over charged a resident for services not received. - Staff ignored residents call alerts. - Staff slept during night shift hours. - Staff did not ensure residents were properly fed.

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 3/22/2022 to deliver complaint findings. LPA met with Licensee, David Bostanchyan, and explained the purpose of the visit. Prior to initiating the complaint 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 and LPA completed a facility risk assessment at the facility. 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. Throughout the course of the complaint investigation the Department conducted interviews and obtained pertinent documents relevant to the allegations listed above.The Department had requested the facility to submit staff roster, resident roster, Resident’s Physicians Report (R1), Admission Agreement, Identification and Emergency Information, Kaiser’s invoice, Appraisal/Needs and Services Plan, and Plan of Operation. Continue on page LIC 9099-C. Unsubstantiated Allegation: Staff over charged a resident for services not received. – Unsubstantiated. Through the course of the complaint investigation the Department conducted interviews and reviewed pertinent documents relevant to the allegation listed above. Interview statement received from R1’s RP indicated that the facility charged for services such as TV channels and incontinence supplies which Licensee told R1’s RP it was included prior to R1 moving in. R1’s RP paid a total of $30.00 for additional TV channels for two months and a total of $30.00 for wet wipes. The Department reviewed R1’s admission agreement and facility’s plan of operation, it does not indicate under additional basic services that TV channels or incontinence supplies will be provide by the facility. According to Licensee, the facility provides incontinence supplies to residents in care. Hospice also supplies incontinence supplies for residents that are on hospice. Allegation: Staff ignored residents call alerts. – Unsubstantiated. The Department requested for the facility to submit a call log for review; however, the facility was unable to provide it. According to R1’s RP, Licensee notified R1 that the facility would provide 24- hour care. All R1 had to do is press the call button and a staff will come to R1’s aid. R1’s RP stated Licensee was advertising it but didn’t provide it. The response time is over 30 minutes. Facility has lived in staff that provides care and supervision to all residents in care. Interview statement from S1, S2, and S3 stated when a resident uses the call button the response time is immediately and instant because it can be an emergency. Allegation: Staff slept during night shift hours. – Unsubstantiated. The Department reviewed the facility’s plan of operation. In the plan of operation under B-7 Program Description with Dementia Care Plan section: Visiting hours it states, Bethesda Senior Care provides care and supervision, 24 hours a day, 7 days a week. R1’s RP stated staff were always asleep during their night shift. R1 uses the bathroom about 2-3 times an hour at night and need assistance to the bathroom. R1 indicated that staff are asleep at night and would tell R1 to pee in R1’s depends. Interview statement from three (3) facility care staff indicated that there are live in staff who provides care to residents 24 hours a day. S1, S2, and S3 stated when a resident uses the call button the response time is immediately. S1, S2, and S3 stated night shift staff are awake at night to care for residents. Interview statement received from R2’s RP indicated that night staff are up all night caring for R2 and has not witnessed night staff sleeping during their shifts. Allegation: Staff did not ensure residents were properly fed. – Unsubstantiated. Through the course of the complaint investigation the Department conducted interviews with three (3) facility staff, two (2) residents, and R2’s RP. Interview statement received from R1 indicated that the facility did not provide nutritious food. R1 stated facility provided meals such as spaghetti with hot dogs, fat free protein, skim milk instead of whole milk, and PB&J sandwiches for dinner. Fruits and vegetables were served occasionally. It was discovered through interviews with S1, S2, S3, and R2’s RP that food is adequately provided, three meals a day with a range of items being served. This agency has investigated the above listed allegations. Although the allegation may have happened of is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred therefore, we have found the allegations to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of this report left at the facility.the state’s words, verbatim · CDSS document, Mar 22, 2022 · control 27-AS-20210329155751

Allegation investigated: Licensee did not provide at least 60 days prior written notice to the resident of any rate or rate structure change.

Licensing Program Analyst (LPA) Jacob Williams, arrived at facility to deliver findings on allegations listed above. Prior to arriving, LPA self-screened for having no known symptoms or exposure, followed facility's screening protocols, wore a surgical mask and maintained distance during the visit. Throughout the investigation LPAs Lusby and Williams reviewed resident documents and conducted interviews. It was learned that in June 2021 R1 had verbally told Administrator that he was moving out of the facility. Admission agreement states a 30 day eviction notice is to be given in writing from resident. A 30 day eviction notice was never given. Shortly after telling Administrator he was going to leave, R1 decided he was going to remain at facility. During this time, Administrator states he had a new resident lined up from a referral agency who would pay a higher monthy fee than R1 was paying. Continuation on 9099-C. Substantiated Beginning July 2021 R1 was charged the higher amount ($1400 more than the original agreed-upon monthly rate) without issuing a 60 day notice of an increase in fees. According to Title 22, Division 6 Health and Safety Code 1569.655(a): If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. Based on information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC9099D. Administrative actions may occur. Exit interview conducted, copies of report provided with appeal rights. Printer had error so documents are being emailed.the state’s words, verbatim · CDSS document, Mar 22, 2022 · control 25-AS-20210713163656

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Apr 5, 2022

1569.655 Increase in fee rates; 60 days’ written notice (a) If a licensee... increases the rates of fees... the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a description of the additional costs. This requirement is not met as evidenced by: Based on interviews and record review CCL was able to determine licensee increased resident rate without notifying R1 or his representatives 60 days in advance, which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Mar 22, 2022

Plan of correction: Administrator to review health and safety code 1569.655 Increase in fee rates for elderly residents; 60 days’ written notice stating amount of and reasons for increase. Administrator to send in a statement of understanding of rate increases. Statement to be sent into CCL by 04/05/22.

Allegation investigated: Licensee intimidated a responsible party in front of the resident

Prior to entering the facility, LPA Smith spoke with staff to pre-screen that the facility is COVID free. Analyst also self-screened for having no known symptoms or exposure. Analyst followed facility's screening protocols, wore an N-95 respirator and maintained distance during the visit. LPA Smith conducted an unannounced complaint visit and met with Terry Ann Nolan. Based on direct witness interviews, there was no "intimidation" as stated in the allegation. Based on the interviews, this allegation is UNFOUNDED. This agency has investigated the complaint alleging that licensee intimidated a responsible party in front of the resident. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Unfoundedthe state’s words, verbatim · CDSS document, Jul 27, 2021 · control 25-AS-20210716093703

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Wolter arrived at the facility unannounced on 07/08/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with administrator David Bostanchyan 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 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. Additionally, LPA was screened by facility staff upon entry. 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 bedrooms, staff rooms, bathrooms, laundry room, and outdoor area. During tour LPA observed medications unlocked and accessible to residents in two (2) resident bedrooms. LPA reviewed three (3) residents records and observed that one (1) is not allowed to store their medications, one (1) is able to store medications with assistance and one (1) did not have a completed medical assessment in their file. LPA and administrator completed the infection control domain and facility was found to be in substantial compliance at this time. Deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report and appeal rights to be emailed to administrator.the state’s words, verbatim · CDSS document, Jul 8, 2021

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.