Young at Heart RCFE No.4

Allegation investigated: Resident was inappropriately touched by staff in a sexual manner

Licensing Program Analyst (LPA)s Jamie Ivey Canady arrived at the facility unannounced to deliver complaint investigation findings. LPA Ivey Canady explained the purpose of the visit and was met by Glenda Molinyawe. The investigation was conducted by the Department. The investigation consisted of resident medical and file review, in addition to facility incident reports and file review. The Department has determined the following as it relates to the allegations: Resident was inappropriately touched by staff in a sexual manner. Continued on LIC 9099 - C... Unsubstantiated On 11/06/2023 LPA Ivey Canady reviewed Department findings regarding current allegations. The Department findings are based on staff, resident and witness interviews as well as facility and medical file documents. Based on facility file documents dated 9/12/2023, R1 was admitted to the hospital on 09/08/2023. According to witness statements, medical documentation and medical file review, R1 has a history of dementia. On 9/12/2023, the Department received a report of possible abuse to R1 from the facility. On 9/08/2023 the facility contacted the Sacramento County Sheriffs Office and made a report of possible abuse to R1. On 9/14/2023 RP contacted the Department to recant current facility allegations. According to facility physician’s report dated 7/25/2023 R1 has a diagnosis of dementia and is listed as nonambulatory with both a physical and mental condition. According to witness statements, medical file documents and facility staff interviews, it was learned that R1’s family history and medical diagnosis include bi-polar and schizophrenia diagnosis. Based on facility staff interviews, and facility file review, R1’s incontinence care has been performed by a skilled and trained staff with no history of abuse and no abuse has been imparted on R1. Based on interviews, file reviews to include physician reports and behavior intervention plans, the Department has deemed the allegation Resident was inappropriately touched by staff in a sexual manner to be Unsubstantiated. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, no deficiencies cited. Exit interview was held and a copy of report was given to Administrator Glenda Molinyawe.the state’s words, verbatim · CDSS document, Nov 8, 2023 · control 27-AS-20230911150119

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Avelina Martinez and Pang Lee made an unannounced visit to this facility to conduct an annual inspection on 07/26/2023 at 11:00 AM. LPAs met with Glenda Molinyawe and stated the purpose of today’s visit. LPAs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate. The facility is licensed for five non-ambulatory residents and has a hospice waiver for two. There are currently 6 residents who reside at this facility. LPAs toured the facility with Glenda Molinyawe on 07/26/2023 at 12:00 PM. LPAs reviewed 3 resident files and 3 staff files. All files were complete and maintained. LPA's reviewed 3 Medication Administration Records (MAR), and the MARs and medications were maintained and complete. The facility has a first aid kit. The fire extinguishers, smoke detectors and carbon detectors are in good repair. The last fire drill was completed on July 1, 2023. The facility has an adequate food supply, and the kitchen was sanitary and clean. All common areas, resident bathrooms, and resident bedrooms were furnished and in good repair. The facility water temperature measured at 105 degrees. The exterior of the facility is clear of debris, and the emergency exit gate was in good repair. Furthermore, all required postings were posted throughout the facility. As a result, of this annual visit, there were no deficiencies cited. An exit interview was conducted, and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Jul 26, 2023

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Avelina Martinez and Pang Lee made an unannounced visit to this facility to conduct an annual inspection on 07/26/2023 at 11:00 AM. LPAs met with Glenda Molinyawe and stated the purpose of today’s visit. LPAs inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, activity room, and outside courtyards of the facility to ensure compliance with Title 22 regulations. Administrator holds current certificate. The facility is licensed for five non-ambulatory residents and has a hospice waiver for two. There are currently 6 residents who reside at this facility. LPAs toured the facility with Glenda Molinyawe on 07/26/2023 at 12:00 PM. LPAs reviewed 3 resident files and 3 staff files. All files were complete and maintained. LPA's reviewed 3 Medication Administration Records (MAR), and the MARs and medications were maintained and complete. The facility has a first aid kit. The fire extinguishers, smoke detectors and carbon detectors are in good repair. The last fire drill was completed on July 1, 2023. The facility has an adequate food supply, and the kitchen was sanitary and clean. All common areas, resident bathrooms, and resident bedrooms were furnished and in good repair. The facility water temperature measured at 105 degrees. The exterior of the facility is clear of debris, and the emergency exit gate was in good repair. Furthermore, all required postings were posted throughout the facility. As a result, of this annual visit, there were no deficiencies cited. An exit interview was conducted, and a copy of this report was provided to facility.the state’s words, verbatim · CDSS document, Jul 26, 2023

Type of visit: Case Management - Health Checks

On 9/22/22 at 1:12 PM Licensing Program Analyst (LPA) Chris Hopkins made an unannounced visit to conduct a health and safety check. A risk assessment call was performed prior to entry verifying there were no active covid cases. LPA met with Administrator Glenda Molinyawe. This facility has a census of 5 residents. LPA toured the facility and observed two caregivers on duty not including Administrator, 2 residents in their room, one resident at the dining table and two residents watching television. The facility is free of odor, clean, and in good repair. Health and Safety check today included overall safety of the facility including well-ness of staff and residents. Staff are sufficient in numbers and are doing fine. Residents are being well cared for and are happy residing in this facility. The current facility temperature is 72 degrees. The facility has sufficient seven-day non-perishable and two-day perishable food supplies. No deficiencies were observed pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Sep 22, 2022

Type of visit: Prelicensing

On July 25, 2022 at 2:08pm Licensing Program Analyst (LPA) Chris Hopkins arrived at Young at Heart RCFE NO.4 Inc, for the purpose of conducting an unannounced Pre-Licensing inspection. LPA was screened for COVID-19 symptoms and temperature taken prior to being allowed entry into the facility. LPA met with Administrator Glenda Molinyawe and together conducted a tour of the home. Licensee Lillian Sisayan showed up at a later time. LPA inspected the kitchen, resident bedrooms, resident bathroom, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 106 degrees F which meets the 105-120 degree Fahrenheit regulation. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. LPA observed sufficient seven-day non-perishable and two-day perishable food supplies. First aid kit was checked and is complete. LPA observed centrally stored medications locked. Cleaning supplies kept locked in laundry room and locked in storage closet. LPA observed a sufficient supply of towels and linens able to meet the needs of the residents. The facility has an approved LIC 808 mitigation plan on file and uploaded into FAS. The facility currently has 6 residents residing at the home at this time. LPA reviewed the Component III orientation with Licensee. Component III orientation successfully completed. LPA recommends moving forward with licensure. Exit interview was conducted and a copy of report provided to facility representative.the state’s words, verbatim · CDSS document, Jul 25, 2022

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB COMP II Participants: SISAYAN, LILLIAN Facility Type: RCFE Application Type: CHOW Capacity: 6 Census (if any clients in care): Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Jun 22, 2022