A-1 Elderly Care

Allegation investigated: Staff does not ensure resident has an assigned PCP.

On 4/19/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met Robert Tif. Prior to initiating the complaint visit, LPA completed the Department's COVID-19 precautions. LPA reviewed resident records, facility records and conducted interviews. LPA finds that the allegations cited above are substantiated. On 10/14/22, LPA Cassie Yang collected records and conducted and interview. On 1/25/23, LPA Kevin Mknelly conducted a further review of records and interviews. On 2/7/23, LPA Mknelly interviewed R1 and spoke with Skilled Nursing staff. 4/18/23, LPA received Skilled nursing records Report continued Substantiated Resident file reviews found that: Facility had only a Physician’s report dated 1/28/15. Statements from the licensee found that that 1/28/15 report was from R1’s prior placement and a new report was not obtained for within 12 months of R1’s admission to this facility. Furthermore, the 2015 physician’s report stated that, “will need to find a primary care physician in the community.” Also on file was R1’s Identification and Emergency Information dated 11/29/15 which listed a physician who had previously treated R1 but had retired. During R1’s stay at the facility, the licensee did not assist R1 with obtaining a primary care physician. 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. (A)This poses an immediate Health and Safety risk to clients/residents in care. (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. Staff does not ensure resident is taking prescribed medications- As R1 did not have a primary care physician while a resident at this facility, R1 also had no prescribed medication. Statements from the licensee and staff were that in 2014-2015 R1 was prescribed medications for agitation and anxiety. Statements also were that as R1 adjusted to the facility that he was in at the time, those medications were discontinued. R1 was admitted to this facility with no medications nor medication orders. Resident fell while in care- R1 was noted in records to have a fall history. On 9/24/22, R1 had a recorded fall for which R1 was transported to an area hospital for evaluation. Statements provided did not find that the fall occurred due to staff actions or inactions. Staff did not ensure resident is being repositioned- While R1 has significant motor disfunction and left hemi-paresis, R1 was able to reposition independently. Records did not indicate R1 had experienced skin breakdowns while at the facility. R1’s bed was equipped with ¼ bed rails and trapeze bar. Staff did not have proper training to transfer resident- Licensee had general training on file. Other staff training was not present at the facility during inspection. Records from skilled nursing did not indicate R1 required specialized transfer. Staff did not provide resident with eviction notice- R1 was not evicted. Statements obtained were that at the time of R1’s 9/24/22 hospitalization, the licensee and R1’s power of attorney (POA) voiced concerns regarding R1’s physical decline and a need for a higher level of care. As a result, R1 was transferred to rehabilitation where he remained for the duration of this investigation. POA stated that it was his request that an alternative placement be pursued and that R1 would not return to this facility. During the course of this investigation, additional deficiencies were found and cited on a separate report. As a result of this investigation, LPA finds allegation to be (US)Unsubstantiated - A finding that the complaint is Unsubstantiated means 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. Exit interview with licensee.the state’s words, verbatim · CDSS document, Apr 19, 2023 · control 25-AS-20221004170100

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: May 17, 2023

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility… (1)The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by records and statements. This posed a potential risk to R1.the state’s words, verbatim · CDSS document, Apr 19, 2023

Plan of correction: Licensee agrees to submit a statement of understanding of this regulation by the POC date of 5/17/23.

Type of visit: Case Management - Deficiencies

On 4/19/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced visit to provide findings discovered during the course of a complaint investigation and met licensee. Prior to initiating the complaint visit, LPA completed the Department's COVID-19 precautions. LPA reviewed resident records, facility records and conducted interviews during the course of a complaint investigation. These additional findings were noted. On 10/14/22, LPA Cassie Yang collected records and conducted and interview. On 1/25/23, LPA Kevin Mknelly conducted a further review of records and interviews. On 2/7/23, LPA Mknelly interviewed R1 and spoke with Skilled Nursing staff. 4/18/23, LPA received Skilled nursing records. Licensee did not have a physician’s evaluation for R1 dated within 12 months of R1’s admission to the facility. Resident file reviews found that: Facility had only a Physician’s report dated 1/28/15. Statements from the licensee found that that 1/28/15 report was from R1’s prior placement and a new report was not obtained for within 12 months of R1’s admission to this facility. Furthermore, records review of skilled nursing records found resident had prior history chronic pain and upon admission to skilled nursing was prescribed several PRN medications and a sleep aid. Report continued Licensee did not have a current Appraisal/ needs and services plan though stated that R1 was declining to the point that R1 needed a higher level of care. Resident records review found a partial needs and services plan for R1 dated 4/20/21. Statements by the licensee were that they sought a higher level of care are R1’s change of condition made his care at this facility difficult. However, a new appraisal/ needs and services plan was not created to reflect the increased care needs of R1 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 809-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (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, Apr 19, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: May 17, 2023

Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. This requirement was not met based on records and statements. This posed a potential risk to R1.the state’s words, verbatim · CDSS document, Apr 19, 2023

Plan of correction: Licensee agrees to submit up to date physician reports for current (5) residents by the POC date of 5/17/23.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: May 17, 2023

Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. This requirement was not met based on records and statements. This posed a potential risk to R1the state’s words, verbatim · CDSS document, Apr 19, 2023

Plan of correction: Licensee agrees to submit up to date Appraisal/Needs and Services plans for current (5) residents by the POC date of 5/17/23.

Type of visit: Case Management - Other

On 4/5/23, LPA Mknelly came to the home and met with the licensee. LPA mistakenly came to the wrong facility. LPA and licensee discussed clearance and association issues. Licensee stated understanding of the requirements. No deficiencies are cited as a result of this visit. Report provided.the state’s words, verbatim · CDSS document, Apr 5, 2023

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Kevin Mknelly and Ryan Ayers arrived at the facility unannounced on 1/25/23 to conduct a Annual Inspection utilizing the infection control domain. LPA met with Administrator and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 the department protocols. LPAs completed a facility risk assessment upon arrival. 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. 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 LPAs observed and discussed a smoke alarm that has recently malfunctioned a replacement will be installed today. Additionally LPA discussed with administrator how and when door stops may be used and that it cannot be placed permanently. Administrator will notify LPA when system is operational no sooner that 1/26/23 LPAs and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. LPA advised increased screening and documentation for visitors, employees and residents. LPA Mknelly conducted 2 resident file reviews and advised regarding incontinence care plans and medications managed by residents. 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, Jan 25, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA spoke with Desrene Hall, caregiver, and observed her to be wearing a mask. Caregiver contacted Robert Tif, Administrator by phone, who arrived shortly to the facility. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering. The following Personal Protective Equipment (PPE) was worn: N95 Mask. LPA observed (2) residents watching television in the common area and (2) residents resting in their rooms. No residents are currently receiving hospice services. LPA and caregiver toured and observed the facility to ensure the health and safety of residents in care. Areas toured include: common areas, (2) private bedrooms, (2) shared bedrooms, (2) resident bathrooms, (2) vacant private rooms, (1) staff/break room, dining room, laundry area and kitchen. LPA observed 2+day perishable and 7+day non-perishable food supply and PPE supplies for 30+days on hand. LPA observed locked toxins, medications and sharps. In the areas toured, there were no immediate health, safety, or personal rights violations observed. LPA and Administrator completed the infection control domain. Inside temperature was observed to be 73* F. LPA observed several Covid posters posted at/near the front entrance and in the bathrooms -LPA to provide additional posters to post throughout. LPA observed other required postings in place. Administrator Certificate #6047124740 posted (exp 2/9/2022)- Administrator showed proof of mailing receipt for renewal. Fire extinguisher last serviced 7/14/2021. Administrator to check his records if a mitigation plan was submitted and has not approved yet- will submit by Friday, 2/11/2022. Liability insurance was not renewed prior to expiration. Discussed vaccination status of residents and staff as well as PIN 22-04 issued 1/18/2022 regarding current testing and visitation requirements. LPA requested completed LIC308 be emailed to the Department by 2/11/22. Per California Code of Regulations, Title 22, Chapter 8, Division 6, the following (2) deficiencies were issued. See 809D for citations issued. Exit interview. Copy of report and appeal rights provided to Administrator at facility.the state’s words, verbatim · CDSS document, Feb 7, 2022

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection and post-licensing insepction. LPA met with Simona Tif, caregiver/Co-Administrator. and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, contacted the facility to confirm there are currently no positive Covid-19 diagnoses, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical Mask. There are (6) residents at the facility. A post-licensing inspection is being also conducted today since one was not conducted. LPA confirmed with Simona that the first resident(s) moved to the facility on/around early April 2021. A copy of liability insurance policy was requested on the annual inspection report completed today also.the state’s words, verbatim · CDSS document, Aug 24, 2021

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA met with Simona Tif, caregiver/Co-Administrator. caregiver and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, contacted the facility to confirm there are currently no positive Covid-19 diagnoses, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical Mask. There are (6) residents at the facility. LPA observed (3) residents to be watching television in the main room and (3) residents to be resting in their rooms during the inspection. 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, (2) shared resident bedrooms, (2) private resident bedrooms, (1) resident restroom, (1) staff restroom, kitchen, dining room, and laundry area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food on site. LPA observed PPE supplies on hand to include: N95 masks, gowns, gloves and sanitizers. LPA and caregiver completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 77* F and fire extinguisher was last serviced on 7/14/2021. LPA requested updated copies of LIC500, LIC610E and copy of liability insurance- to be faxed to the department by 8/31/2021. Current testing protocols discussed for staff and copy of PIN 21-38 issued 8/19/2021 left at facility. There were no deficiencies cited as a result of todays inspection. Exit interview conducted with Simona, caregiver, and copy of report left at the facility.the state’s words, verbatim · CDSS document, Aug 24, 2021