MKS Quality Care

Type of visit: Case Management - Incident

On 11/09/2023 Licensing Program Analysts (LPAs) Cheyenne Ratajczak and Cassie Yang arrived at the facility unannounced to do a case management regarding an incident report that the department received. LPAs met with caregiver Carise Swaby and explained the purpose of the visit. LPAs and caregiver discussed the incident that occurred on 10/28/2023 regarding R1s fall. Caregiver informed LPAs that the fall occurred shortly before her shift but she contacted emergency medical services right away at approximately 7:05 AM. During todays visit LPAs spoke with R1 who reported to be recovering well. LPAs observed R1 to have a cast on her right arm. R1 informed LPAs there are no concerns at the moment. LPAs obtained a copy of R1s 601 and 602. Exit interview conducted and a copy of report left.the state’s words, verbatim · CDSS document, Nov 9, 2023

Allegation investigated: Resident sustained a fracture while in care. Staff did not allow resident to have family visitation. Staff are making health decisions for residents without the consent of the resident's authorized person.

LPA Parks arrived on Tuesday July 25, 2023, to conclude a complaint investigation regarding the above allegations. LPA met with Administrator Maria and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed the Administrator, current staff and previous staff. LPA attempted to interview Hospice employees but learned that none of the assigned hospice employees for R1 were currently employed. LPA reviewed R1’s file including R1’s physicians report, care plan, incident reports, assessments, and hospice visit notes. LPA reviewed facility staffing for the duration of R1’s time at the facility. The result of the investigation is as follows: LPA reviewed staffing schedules and learned that the facility has a maximum capacity of 15 residents. The facility staffs 3 caregivers during the day shift and one staff for the overnight shift. At the time of R1’s fall, there were only 10 residents at the facility. LPA determined that while R1 did sustain a fracture while in care, this was not the result of insufficient staffing. R1 and their spouse (R2) both lived at the facility Unsubstantiated but in separate apartments. Staff would assist R1 with visiting R2 and upon request. LPA interviewed current and former staff who were at the facility when R2 was actively passing. Interviews revealed that they assisted R1 with visitation, and at no time was visitation denied. Interview with R1’s hospice agency revealed that this decision was made by R1’s POA. R1’s POA changed hospice agencies during R1’s stay at the facility. Interview with staff stated that they are not involved with selecting a hospice agency. Based on information obtained during the investigation, LPA finds the allegations to be UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, Exit interview. A copy of this report was emailed to the Administrator.the state’s words, verbatim · CDSS document, Jul 25, 2023 · control 25-AS-20221017164805

Allegation investigated: Resident sustained injuries while in care. Resident is not given privacy. Resident suffered falls while in care.

LPA Parks arrived on Tuesday July 25, 2023, to conclude a complaint investigation regarding the above allegations. LPA met with Administrator Maria and explained the purpose of the visit. Throughout the course of the investigation, LPA interviewed two Administrator, current and previous staff, and hospice agency. LPA reviewed R1’s file including R1’s physicians report, care plan, and resident notes. LPA reviewed staffing schedules and learned that the facility has a maximum capacity of 15 residents. The facility staffs 3 caregivers during the day shift and one staff for the overnight shift. At the time of R1’s fall, there were only 10 residents at the facility. LPA determined that while R1 did sustain injuries due to a fall while in care, this was not the result of insufficient staffing. Based on interviews with current and former staff, R1 had a history of wandering around their room at night and attempting to toilet themselves. LPA interviewed current and former staff which stated that when R1 would receive phone calls on the facility phone, they would hand them the phone and then provide them privacy. Sometimes the staff would Unsubstantiated have the phone on speaker phone but would not stay to listen to the conversation. Once R1 completed their phone call, they would signal to staff to get the phone in the entryway to their apartment, or bring it out to staff. Based on information obtained during the investigation, LPA finds the allegations to be UNSUBSTANTIATED- a finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, Exit interview. A copy of this report was emailed to the Administrator.the state’s words, verbatim · CDSS document, Jul 25, 2023 · control 25-AS-20221024135603

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Lavinia Muscan arrived on Wednesday June 14, 2023 to conduct the annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPA reviewed resident (4) and staff files (3). All resident files contained the required paperwork. All staff files contained the required paperwork. All staff have current first aid and CPR training. Facility was clean and well organized. All required posting were observed. Staff training contained the required initial training. LPA and Caregiver Carise Swaby toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, 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. The administrator's certificate is current. There is a 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. Water temperature is within compliance. In the areas toured, there were no health or safety violations observed. LPA requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by end of the month. Exit interview conducted. A copy of this report was printed and given to Caregiver.the state’s words, verbatim · CDSS document, Jun 14, 2023

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Lavinia Muscan and LPM Laura Munoz, arrived at the facility unannounced on 07/28//2022, to conduct a case management visit. LPAs conducted COVID-19 Precautionary prescreening, and wore surgical masks while at facility. LPAs were screened by Caregiver. The purpose of today's visit is to ensure room #13 is not being utilized as a sleeping room as this room is not fire cleared for living quarters. Based on today's inspection, room #13 is being used as a office therefore the facility is in compliance with their current fire clearance. LPM spoke to one of the facility owners during today's visit who stated the licensee would be sending CCL documentation to change the facility Administrator. Based on today's inspection, no deficiencies were identified.the state’s words, verbatim · CDSS document, Jul 28, 2022

Allegation investigated: Licensee failed to report as required.

Licensing Program Analyst (LPA)s Kerry Hiratsuka and Lavinia Muscan, arrived at the facility unannounced on 05/11/2022, to conduct a Complaint Investigation Visit. LPA conducted COVID-19 Precautionary prescreening and wore surgical masks while at facility. LPA was screened by Caregiver. The department investigated the allegation " Licensee failed to report as required.” The issue is whether the facility was required to notify Community Care Licensing Division (CCLD) when the licensee received an eviction notice. After reviewing the regulations, there is no specific regulation regarding if the licensee is required to notify CCLD that the licensee received an eviction notice from the landlord for reasons not related to CA Health and Safety Code 1569.686. Unsubstantiated CA Health and Safety Code 1569.686 Licensee notification of specified events; department initiation of compliance plan, noncompliance conference, or other appropriate action; penalties; exception states: (a) A licensee shall notify the department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their legal representatives, in writing, within two business days, and shall notify all applicants for potential residence, and, if applicable, their legal representatives, prior to admission, of any of the following events, or knowledge of the event: (1) A notice of default, notice of trustee's sale, or any other indication of foreclosure is issued on the property. (2) An unlawful detainer action is initiated against the licensee. (3) The licensee files for bankruptcy. (4) The licensee receives a written notice of default of payment of rent described in Section 1161 of the Code of Civil Procedure. (5) A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not more than 15 days of the notice. CCLD has not been able to determine if the notice given to the licensee by the landlord meets the criteria above. Because of this the allegation cannot be proved or disproved if the licensee was obligated to notify CCLD.the state’s words, verbatim · CDSS document, May 11, 2022 · control 25-AS-20220228145015

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) K.. Hiratsuka and L. Muscan, arrived at the facility unannounced on 05/11/2022 to conduct an unannounced annual visit using the infection control tool visit. LPA met with Facility Caregiver Tatleen Lewis 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; contacted Facility Representative and completed a facility risk assessment. 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 Caregiver 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 Caregiver completed the infection control domain and facility was found to be in substantial compliance for the infection control. While touring the facility, the following was observed: -medication cabinets were found not locked. The medications were found with a lever on the bottom of the cabinet that when pushed up the medications are accessible. Title 22 regulations require medications to be locked. This is an immediate risk to residents. -storage room that stores all the cleaning chemicals located in the second hallway and is across from the laundry room was found unlocked during visit. Per Title 22 regulations all chemicals shall remain locked when not in use by a staff person. The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6.the state’s words, verbatim · CDSS document, May 11, 2022

Allegation investigated: Licensee did not provide a refund according to admission agreement terms.

Licensing Program Analyst (LPA)s Kerry Hiratsuka and Lavinia Muscan, arrived at the facility unannounced on 04/21/2022, to conduct a Complaint Investigation Visit. LPA conducted COVID-19 Precautionary prescreening, and wore surgical masks while at facility. LPA was screened by Caregiver. The department investigated the allegation "Licensee did not provide a refund according to admission agreement terms." The department interviewed staff and reviewed resident admission agreement. Per the CA health and safety code a faclity may charge a pre-admission fee. There is a refund schedule for the pre-admission fee regarding how long a resident stays. Manager Maria Cucicea, admitted that she did not refund the pre-admission fee per the CA health and safety code. Based on the above, the allegation is substantiated. The following deficiencies were cited on 909-D, per Title 22 Regulations, Division 6. Appeal rights left with facility representative. Substantiatedthe state’s words, verbatim · CDSS document, Apr 21, 2022 · control 25-AS-20211118152214

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.651(i)(1) · Plan of correction due date: May 20, 2022

Preadmission fee or deposit for elderly at residential care facilities; written statement describing costs and stating whether fee is refundable; conditions for refund; refund rate schedules. Notwithstanding subdivision (g), if a resident is evicted by a facility pursuant to subdivision (a) of Section 1569.682, the resident or the resident's legal representative shall be entitled to a refund of preadmission fees in excess of five hundred dollars ($500) in accordance with all the following. This was not evidenced by: Manager admitted she did not refund per the schedule. This is a potential risk to residentthe state’s words, verbatim · CDSS document, Apr 21, 2022

Plan of correction: By 05/20/2022, the licensee shall submit in writing how they are going to ensure they are going to follow the refund policy per the health and safety code regarding pre-admission fees.

Allegation investigated: Resident was not accorded dignity

Licensing Program Analysts (LPAs) Kerry Hiratsuka and Lavinia Muscan arrived at the facility unannounced and conducted a Complaint Investigation Visit. LPA conducted COVID-19 Precautionary pre screening, and wore a surgical mask while at facility. The department investigated the allegation "Resident was not accorded dignity". The department interviewed staff and reviewed resident records. LPAs interviewed caregivers. One caregiver admitted there was one time a resident was changed with the door open. The resident was not afforded dignity and respect due to being changed with the door open and not given any privacy. Caregiver stated it has not happened since. Based on the above, the allegation is substantiated. The following deficiencies were cited on 909-D, per Title 22 Regulations, Division 6. Appeal rights left with facility representative. Substantiated The fracture was found by an x-ray at the hospital and the doctor interviewed stated the exact cause and time of the injury could not be determined due to the health condition of the resident. The resident was seen the day after the fall during a routine visit by an RN from a home health care agency and the nurse did not observe any conditions that warranted the resident be sent to the hospital. 2. Records show the resident had multiple visits for physical and occupational therapy, and home health care agency nurses over the course of 13 days. Staff reported two days prior to hospitalization that resident was lethargic and less active but was not severe enough to seek medical attention. When the condition did not improve, and the resident appeared flushed the resident was sent to the emergency room. Based on all the above the department could not prove or disprove the allegations and the allegations are unsubstantiated. LPAs Hiratsuka and Muscan, investigated the following allegation: 3 Facility did not properly screen visitors according to COVID-19 protocols. Interviews with caregivers stated they screen all visitors and ensure the visitors are wearing masks, taking temperatures, and signing all visitors in. Complainant stated the staff didn't always check the visitor in, but did make sure the visitor was wearing mask. During today's visit a visitor did arrive and was screened. Based on the above, the allegation cannot be proved or disproved. Allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Apr 13, 2022 · control 25-AS-20211118152214

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Apr 14, 2022

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This was not met as evidenced by: a caregiver admitted she didn't close the door one time when a resident had to be changed. This poses an immedate risk to residents.the state’s words, verbatim · CDSS document, Apr 13, 2022

Plan of correction: By 04/14/2022, Licensee shall at mimimum schedule resident personal rights' training for all staff and submit the training schedule to Licensing.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Kerry Hiratsuka and Lavinia Muscan arrived at the facility unannounced and prior to visit LPAs conducted COVID-19 Precautionary pre screening, and wore a surgical mask while at facility. LPAs were screened at the front door by Caregiver. While investigating complaint, 25-AS-20211118152214, several issues were found that were not allegations, but found to be violations of the regulations. The complaint regarded a resident who fell while at this facility. The resident fell in between staff checks. The resident was here after suffering falls at the previous living location and had back surgery prior to moving in. The resident had a history of falls and was a fall risk. There was no written plan of care addressing the resident's fall risk. The resident's room had a bed alarm, a mat to alert people the resident stood up, and did check on resident, but nothing in writing. Each facility is required to have a written plan of care for each resident to address their needs and how the facility is going to meet their needs. The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. Appeal rights left with facility representative.the state’s words, verbatim · CDSS document, Apr 13, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87467(a) · Plan of correction due date: Apr 14, 2022

Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility. This requirement was not met as evidenced by: there was no written plan of care to address a resident who was a fall risk. This posses an immediate risk to residents.the state’s words, verbatim · CDSS document, Apr 13, 2022

Plan of correction: By 04/13/2022, the licensee shall submit a written plan of correction on how he shall ensure the written plan of care for the residents adequately addresses all their health issues and how the facility is going to meet their needs.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Kerry Hiratsuka and Lavinia Muscan arrived at the facility unannounced and prior to visit LPAs conducted COVID-19 Precautionary prescreening, and wore a surgical mask while at facility. LPAs were screened at the front door by Caregiver. When LPAs arrived at the facility and requested a document from the caregiver who greeted LPAs at the door, LPAs observed that caregiver telling the other two caregivers on duty Licensing arrived and pointed at her face while walking to a cabinet to get the requested document. LPAs observed two caregivers not wearing masks as required by the CA Dept. of Social Services Community Care Licensing Division due to the current pandemic. One caregiver (S1) was eating and the second caregiver(S2) was sitting in a recliner facing the front and walked over to the cabinet that stores the personal protection equipment (PPE) and put a surgical mask on. All caregivers were in the presence of the residents during this time. The following deficiencies were cited on 809-D, per Title 22 Regulations, Division 6. Appeal rights left with facility representative.the state’s words, verbatim · CDSS document, Apr 13, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Apr 14, 2022

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: LPAs walked in and observed a caregiver sitting in a recliner while with residents and not wearing a mask. LPAs observed a second caregiver telling the first one that Licensing was present and to put a mask on. This is an immediate risk to residents.the state’s words, verbatim · CDSS document, Apr 13, 2022

Plan of correction: By 04/14/2022, all staff and management shall have training on current mandates regarding the current pandemic and the licensee shall also submit in writing how he shall ensure all staff follow the mandates.

Type of visit: Case Management - Other

On 11/22/2021 LPA Tryon arrived at the facility to open a complaint. LPA met with Administrator Iana Voitehovschi. While at the facility, LPA learned that there are numerous staff working at the facility whose fingerprints are not currently associated to the facility in the CCL systems (Guardian and LIS). When LPA met with Administrator Voitehovschi, LPA learned that she had sent transfer requests on ALL the staff. She provided copies of documents that were submitted and/or letters of clearance that are associated to the facility. It is unclear why none of the staff are showing up on the system as associated, but the facility has clearly made multiple attempts to have staff associated. Therefore, LPA will assist the facility to look into the issue. At this time, no deficiencies are issued as the facility has clearly made attempts to comply with regulations. Exit interview conducted.the state’s words, verbatim · CDSS document, Nov 22, 2021