Yellowtail Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Talwinder Bains arrived on 08/28/23 to conduct the annual inspection. LPA met with administrator, Lui Ying (Ruby) 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). All residents files have required paperwork. LPA observed incomplete paperwork for staff (S1,S2) files as mentioned in 809D. 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 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. Hot water temperature was observed to be 112 degrees F, which is within the regulation range of 105-120 degree. LPA observed that staff left cabinet open by kitchen which contain disinfectants and cleaning supplies and were accessible to residents. LPA observed that facility has one (1) fire extinguisher which was last serviced in 2020. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by 09/05/23.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 28, 2023

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff did not provide resident medications as prescribed.

Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 05/16/23 to do the complaint investigation for above allegation. LPA met with administrator Lui Ying (Ruby) and explained the purpose of the visit. LPA wore the following Personal Protective Equipment (PPE) during today's visit-surgical mask. LPA was screened by facility staff upon entry. The department conducted records review ,facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Substantiated ***continued from LIC9099.............. Allegation---Staff did not provide resident medications as prescribed. Department conducted staff interview, record review for MAR and resident file review for R1 to investigate the complaint allegation. From the record review and staff's interview, it has been observed that the staff was providing R1s medications Sertraline and Amlodipine incorrectly. Staff was given 100 MG of Sertraline which should have been provided 50 MG and staff was giving 5 MG of Amlodipine which should have been provided 10 MG. From the record review, it has been observed that facility staff marked that all residents medications are administered till 05/19/23 with their initials in MAR, which is falsifying the records . Furthermore, from MAR review , it has been found out that facility was not documenting correct dose, month, year for any residents medications including R1 which is immediate health and safety concerns for residents in care. Based on LPA interview conducted, and record(s) reviewed, the preponderance of evidence standard has been met, therefore the allegation that staff did not provide medication to residents as prescribed is SUBSTANTIATED. found to be SUBSTANTIATED. California Code of regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted with Ruby. A copy of this report and appeal rights were provided. Ruby ’s signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, May 16, 2023 · control 59-AS-20230509161044

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: May 17, 2023

87465(a)(4) Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4)The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidence by: Based on records review and interviews conducted, the facility did not ensure R1 had prescribed medication. This poses an immediate health and safety risk to residentsthe state’s words, verbatim · CDSS document, May 16, 2023

Plan of correction: Licensee will complete a statement of understanding indicating that the facility is aware of regulation 87465 and will also complete a training regarding medication administration. Facility will submit statement of understanding and schedule for training to department by POC date-05/17/2023.

Type of visit: Case Management - Incident

Licensing Program Analysts (LPA) Talwinder Bains arrived at the facility unannounced on 02/07/2023 to conduct a case management to follow up on an incident that occurred on 10/25/2022 in which R1 eloped from the facility which resulted in R1’s untimely death. LPA met with facility Administrator- Ying Lui (Ruby) and explained the purpose of the visit. LPA ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn surgical mask. Department conducted an investigation which included a medical records review, residents and staff interviews regarding R1’s elopement from the facility on 10/25/22. On 10/25/2022, R1 left the facility in the afternoon to go to the store. When R1 did not return, the facility contacted local law enforcement. The facility was notified by law enforcement that R1 was in a car accident on 10/26/2022 which resulted in R1 passing away. Per R1’s Physician’s Report dated 12/16/2020, R1 was Ambulatory and notes as needing physical assistance with Activities of Daily Living(s). R1’s physician’s report indicated R1 was not confused of disoriented, did not have wandering or sun downing behavior, was able to follow simple instructions, able to communicate simple needs and was able to bathe, groom, feed, and toileting with supervision. During the investigation, it was noted that R1’s physician did not indicate whether R1 was able to leave facility unassisted. Interviews with staff indicated throughout R1’s stay at the facility, R1 would leave and come back to facility numerous times unassisted prior to this incident. Based on the investigation, R1 was alert and able to leave unassisted therefore, the facility is not liable for R1’s elopement which resulted in R1’s untimely death. No deficiency issued during this visit. Exit interview conducted and copy of the report left at the facility.the state’s words, verbatim · CDSS document, Feb 7, 2023

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Talwinder Bains and Lavinia Muscan arrived at the facility unannounced on 11/07/2022 to conduct a case management to follow up on a recent incident about R1s missing incident and death report . LPAs met with facility administrator-Ying Lui (Ruby) and explained the purpose of the visit. LPAs ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn surgical masks. LPAs were screened upon entry by Ruby. During today's visit, LPAs toured the facility and interviewed administrator-S1,1 staff-S2 and 3 residents (R2,R3 and R4) regarding R1s missing incident around 10/25/22 from facility and death report for R1 which facility reported to CCL on 11/01/22. No deficiency issued during this visit. Exit interview conducted and copy of the this report left at the facility.the state’s words, verbatim · CDSS document, Nov 7, 2022

Allegation investigated: Staff did not seek timely medical care for resident Staff did not notify authorized representative of incident Resident did not have sheets on the bed Resident did not have a mattress pad on the bed Staff are sleeping in the garage Staff did not re-order resident's insulin needles timely

Licensing Program Analyst (LPA) Jacob Williams arrived at the facility unannounced on 10/05/2022 to deliver findings of the complaint investigation for above allegations. LPA met with administrator Ruby Lui and explained the purpose of the visit. Prior to the visit , LPA completed required COVID-19 testing protocols and the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA wore the following Personal Protective Equipment (PPE) during today's visit-surgical mask. The department conducted records review, facility observations and interviews to investigate the complaint. **Report continued on LIC9099-C** Unsubstantiated Allegation: Staff did not seek timely medical care for resident Based on interview, administrator and care staff deny any claims from RP that R1 ever had a fall while residing at Yellowtail Home Care. There is no proof that a fall ever occurred nor an injury sustained, thus medical care was not required to be sought out. Allegation: Staff did not notify authorized representative of incident This allegation is referencing an alleged fall by the RP (previous allegation); based on interview, administrator and care staff deny any claims from RP that R1 ever had a fall while residing at Yellowtail Home Care. There is no proof that a fall ever occurred thus preponderance of evidence is not met and an incident or notifying authorized representatives was not required. Allegation: Resident did not have sheets on the bed Based on observation and interview, all beds in Yellowtail Home Care had sheets. There were no beds observed to not have mattress or sheets. Administrator states that if a bed did not have sheets at any point, it would've been because the sheets had been removed to be washed. All bedrooms were clean and contained all the necessary components on the occasions that LPA toured facility. Allegation: Resident did not have a mattress pad on the bed Based on observation and interview, all beds had sheets and the residents who needed a plastic covering had a plastic covering. There were no beds observed to not have mattress. Allegation: Staff are sleeping in the garage Based on observation and interview, the facility does not have a garage. In the front area of the facility are two rooms containing the staff room and staff office. The Administrator sleeps in the staff room, which is not a violation of Title 22 regulations. **Report continued on LIC9099-C** Allegation: Staff did not re-order resident's insulin needles timely R1 admits to stealing R1's resident file when arriving to move R1 out of the facility on 08/05/2022. Analyst made two attempts to obtain the file from RP's home but was unsuccessful both times. LPA asked RP to drop off file at Regional Office but RP refused. Thus the department was not able to view any medical information for R1, including information regarding R1's insulin needles. Through interview, Administrator and RP both state they were in communication and RP was planning on bringing new insulin needles to the facility for R1. These needles were never received due to RP moving R1 out. Administrator states R1 still had insulin needles remaining on the date R1 moved out, and that she gave the remaining insulin needles to RP on that night. Based on interviews conducted by the Department, facility observations and records review, the preponderance of evidence standards has not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation 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. No citations were issued today. Exit interview was conducted with Administrator and a copy of this report was provided via email. The signature of the Administrator on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Oct 5, 2022 · control 25-AS-20220809075522

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Oct 12, 2022

Incidental Medical and Dental Care (a) (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by records and interviews that found R1 and R1 did not received medications as prescribed and orders by their physicians. This posed an immediate health risk to residents. This requirement was not met as evidenced by interviews that found R1 did not receive medications as prescribed and orders by their physicians. This poses an immediate health risk to residents.the state’s words, verbatim · CDSS document, Oct 5, 2022

Plan of correction: Licensee shall train all staff on medication adminstration. Licensee will provide a summary of training and attendance sheet of those who attended the training by the POC date of 10/12/2022.

Type of visit: Required - 1 Year

On 8/16/2022 Licensing Program Analyst (LPA) Jacob Williams arrived unannounced to conduct an annual inspection visit. LPA met with Administrator Ruby Liu and explained the purpose of the inspection. Prior to initiating the inspection, LPA completed required COVID-19 testing protocol, daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured he applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA toured the facility inside and out including but not limited to living room, dining room, kitchen, bathrooms, resident rooms & outside areas. Facility has enough paper and hygiene supplies. Medications are centrally stored in a locked area that is inaccessible to residents and refilled every 30 days. Facility has enough 2-day perishable and 7-day non-perishable food supply. Signage is posted throughout the facility. While in facility, LPA also conducted investigation for a separate complaint matter. LPA and staff reviewed and completed the infection control domain. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report emailed to Administrator.the state’s words, verbatim · CDSS document, Aug 16, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Williams arrived at the facility unannounced on 07/19/2021 to conduct a Required 1- Year Inspection utilizing the infection control domain. LPA met with Administrator, Ying Lui, 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 licensee and completed a facility risk assessment. LPA ensured he 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 and staff toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, six (6) resident bedrooms, three (3) bathrooms, kitchen, and backyard. 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. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Jul 19, 2021