Yellow Orchid

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit. LPA Moleski met with facility administrator Sumeet Bhade and explained the purpose of the visit. LPA Moleski interviewed Bhade and a staff member (S1), and reviewed R1's file. No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Bhade.the state’s words, verbatim · CDSS document, Oct 5, 2023

Allegation investigated: False statement

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with Kirendeep Bhade and explained the purpose of the visit. This investigation consisted of interviews with three staff members, a resident, a resident’s friend, two medical center employees, and review of resident records and facility records. LPA Moleski reviewed a letter of agreement between this facility and a medical center. The agreement was signed by S2 on 4/19/23. The agreement arranged for R1 to be discharged from the medical center and admitted to this facility, with the medical center paying for R1’s residency from 4/24/23 to 6/24/23. The letter of agreement does not make any provisions regarding R1’s placement after that period of time. [continued on 9099-C] Unsubstantiated LPA Moleski reviewed a letter written by a medical center representative (M2) discussing payment arrangements for R1 between 6/24/23 and 7/24/23. The letter was signed by S2 on 4/24/23. The letter does not make any provisions regarding R1’s placement after that period of time. LPA Moleski reviewed R1’s admission agreement. R1 signed the admission agreement on 4/24/23. The admission agreement describes payment arrangements as described in the medical center letter of agreement and the letter written by M2. The admission agreement does not make any provisions regarding R1’s placement after 7/24/23. LPA Moleski interviewed a friend of R1 (F1). F1 said that, during a conversation with S2 prior to R1’s admission, S2 said R1 would be placed at a medical center after three months if R1 was unable to pay for continued residency. LPA Moleski interviewed S1-S3. S1 did not have information about the aforementioned conversation. S2 said that, during that conversation, S2 said staff would try to see if the medical center would accept R1 after three months if R1 was unable to pay, but did not make any promises regarding R1’s placement after that period of time. S3 corroborated S2’s narrative. LPA Moleski interviewed a medical center discharge planner (M1). M1 said there were no arrangements to send R1 back to the medical center, and that R1 was responsible for R1’s future placements. LPA Moleski interviewed a medical center interim social service director (M2). M2 said S2 contacted M2 to discuss potential future placement at the medical center. M2 said R1 was denied placement as the placement was determined to be not medically necessary. The department has determined the following as it relates to the allegation of false statement: Based on interviews and record review, the above allegations are UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. No deficiencies were cited during this visit. An exit interview was held and a copy of this report was left with Bhade.the state’s words, verbatim · CDSS document, Sep 8, 2023 · control 27-AS-20230824133745

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct an annual inspection. LPA Moleski met with facility administrator Kirendeep Bhade and explained the purpose of the visit. LPA Moleski reviewed two resident files (R1-R2) and two staff files (S1-S2). S3 was not associated to the facility roster. LPA Moleski reviewed the Licensing Information System and saw that S3 had been removed from the roster on 7/3/23. Regional Office staff were contacted, and they informed LPA Moleski that an incomplete fingerprint reminder was sent out on 6/27/23. R3's LIC 602 indicated that R3 is bedridden. The facility's fire clearance is for 6 ambulatory or non-ambulatory only. LPA Moleski toured the facility with Bhade and inspected common areas, the kitchen, bedrooms, bathrooms, and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. LPA Moleski observed fully-charged and up-to-date fire extinguishers, and carbon monoxide/smoke detectors. LPA Moleski observed a minimum 2-day supply of perishable food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked cabinet for the storage of medication. LPA Moleski observed locked cabinets for the storage of cleaning solutions and knives. LPA Moleski interviewed one staff member (S1). This facility is being cited per HSC section 1569.17(c)(1)(A) and 22 CCR section 87202(a)(2). An immediate civil penalty of $500 for each violation was assessed. An exit interview was held. Appeal rights and a copy of this report were left with Bhade.the state’s words, verbatim · CDSS document, Jul 11, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jason Lund arrived at the above facility unannounced to conduct a required/annual inspection. LPA Lund met with staff who contacted Administrator Karen Bhade who arrived a short time later. Census 6 LPA and Administrator Karen Bhade walked the facility. The physical plant was tour inside and outside to ensure the safety of the residents. All required furniture was observed. LPA observed residents engaging in activity. LPA observed the facility conducts fire drills monthly. All bedrooms contained a dresser, bed, and nightstand. LPA observed the thermostat 74*F temperature inside the facility hallway was measured at 74 *F which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C). LPA observed the centrally stored medications area to be locked and inaccessible to clients. The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed there were food supplies for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. LPA observed the backyard area in good condition. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, there were no deficiencies cited during this visit. Exit interview held and a copy of report was given.the state’s words, verbatim · CDSS document, Aug 10, 2022

Type of visit: Required - 1 Year

On 9-17-21 Licensing Program Analyst (LPA) Tirzah Hubbard and Licensing Program Manager (LPM) Stephen Richardson arrived unannounced to conduct a Required – 1 Year inspection. LPA contacted the facility to ask follow up questions in regard to Covid-19. LPA spoke with the Administrator Karen Bhade to ask follow up questions for Covid-19 symptoms. Karen stated, " The facility has not tested positive for Covid-19 in the last 14 days. All residents are vaccinated and all staff are vaccinated at this time". LPA and LPM proceeded to approach the facility to conduct the Annual after the facility was cleared. All required COVID measures were not observed. LPA observed S1 and Administrator not wearing mask upon entry. LPA and LPM asked Administrator and Licensee to put their mask on for the duration of the Annual visit. The Administrator took the temperature of LPA and LPM but did not screen for symptoms. Administrator stated, the facility verbally ask the Covid-19 questions to ensure visitors are negative upon entry after they take temperature. The Administrator and Licensee agreed to create a document that provides the Covid-19 questionnaire to provide proof of each visitors symptoms. LPA met with Administrator Karen Bhade and Licensee Narinderpal Bhade, and stated the purpose of today’s visit. LPA and LPM were allowed entry into the facility that is licensed to serve a total capacity of 6 clients. LPA interacted with a random number of residents during this visit. The physical plant was tour inside and outside to ensure the safety of the residents. All required furniture were observed. LPA observed residents engaging in activity, wearing a mask and practicing social distancing. LPA observed the facility conducts fire drills monthly. All bedrooms contained a dresser, bed, and night stand. The flooring of the facility has been replaced. LPA observed the thermostat 73*F temperature inside the facility hallway was measured at 74 *F which is within the required range of 68 degrees F (20 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat the maximum shall be 30 degrees F (16.6 degrees C) less than the outside temperature. The hot water was measured at 106 *F which is not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C) as per Title 22 regulations. LPA observed the centrally stored medications area to be locked and inaccessible to clients. LPA observed 3 of 3 medications counted properly labeled and stored, matching medication administration records (MAR). The first aid kit was found in compliance containing at least the following: a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, sterile first aid dressings, bandages or roller bandages, adhesive tape, scissors, tweezers, thermometers, and Antiseptic solution. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, central heating and air in the facility. LPA observed there were food supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days which shall be maintained on the premises at all times. LPA observed the backyard area in good condition. LPA spoke with caregivers about the cleanliness of the facility. Mitigation Plan was submitted and approved. Upon a file review the following items were discussed to be submitted with any changes annually: Criminal Record Clearances LIC536 Administrative Organization LIC309 Designation of Administrative Responsibility LIC308 Personnel Report LIC500 Qualifications of Administrator/Facility Manager- Administrator certificate Emergency Disaster Plan LIC610D Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, there were no deficiencies cited during this visit. Exit interview held and a copy of report was given.the state’s words, verbatim · CDSS document, Sep 17, 2021