Sunrise Senior Care

Allegation investigated: Neglect/Lack of Care and Supervision- Staff ignored resident's calls for assistance Staff does not serve food in consideration of resident's religious background. Staff violated resident's religious rights.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver partial complaint findings to a complaint received on 8/9/23. LPA met with Steve Heydon, caregiver/Administrator Designee, and explained purpose of inspection. Also present was Ram Pratap, caregiver. During the investigation, LPA interviewed the Administrator, (2) caregivers at this facility and (2) caregivers at a related facility where resident (R1) lived prior to transferring to this facility. LPA reviewed documentation pertaining to (R1) including, but not limited to, hospice medication records, patient agreement, hospice assessment and plan of care and facility personnel report. The results of the investigation are as follows: cont on 9099C-1.. Unsubstantiated 9099C-1... Allegation: Neglect/Lack of Care and Supervision- Staff ignored resident's calls for assistance. Complaint alleges that NOC shift staff, (S1), ignored resident's calls for assistance, stating "he is not paying enough" to answer his calls. The Administrator stated on 8/17/23 she had never heard staff (S1) state that (R1) was not paying enough for staff to answer his call button and asserted that (R1) "locked several iPhones" and so would use the call button to request assistance from staff. (S1) confirmed with LPA on 8/17/23 that he knew prior resident, (R1), stating (R1) lived at the facility for approximately 5-6 months. (S1) indicated he would regularly check on (R1) and change him as needed, and sometimes (R1) would ask for hep in the middle of the night, between 2-3 am, and confirmed he (S1) was awake until until around 11:00 pm when all residents were asleep. (S1) asserted, "he was well cared for at night and during the day" and never needed a second care person adding that "(R1) would ask for candies and sometimes wanted to sit in a wheelchair in the morning". (S1) was adamant that he never said (R1) was not paying enough to answer his calls, commenting that (R1) was taken to appointments and staff used ointments on his skin. (S1) confirmed he provided ADL's including feeding, changing and administering PRN meds to (R1) and sometimes assisted "am" staff with transferring (R1) and using the hoyer lift, and the daytime care staff provided bathing to (R1). (S1) stated that over the last 3-4 weeks, before he passed, (R1) was "not clear in his speech" and that previously before declining, (R1) could use his cell phone, the call button and move himself from side to side, but about 4-5 weeks ago, (R1) forgot his password on his cell phone and it became "locked". (S1) stated that over the last month, (R1) was not able to ask for help as he "slowed down, especially with his movement". Hospice records show (R1) was admitted on 7/27/23. LPA was unable to contact staff (S2) who also worked at the facility when (R1) lived there,to speak with him regarding the allegation. Based on interviews conducted, LPA finds the above allegation 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. 9099C-2... 9099C-2... Allegation: Staff does not serve food in consideration of resident's religious background. Complaint alleges that staff continue to serve resident (R1) pork (bacon, ham and pork and beans) which is not permitted under the Muslim religion. The Administrator Designee/caregiver stated on 8/17/23 that (R1) was not supposed to eat pork and staff was aware that (R1) shouldn't be served pork and staff was "able to give other things". This staff was adamant that (R1) "was not served any other food" with pork and he had a discussion with staff about this, explaining that ever since (R1) moved to this location from a related facility, (R1) requested to not be served pork, so staff would mostly serve (R1) chicken, fish and turkey bacon. LPA was shown a package of turkey bacon in the refrigerator during the interview and confirmed it to be 100% turkey meat. LPA also observed an almost finished bag of frozen turkey sausage links. This staff confirmed that the facility does buy and serve "pork and beans", but it was "never served to (R1) to my knowledge". The Administrator stated on 8/17/23 that (R1) used to order his own food and "he had a lot of food in his room". The Administrator explained that (R1) "was going back and forth" between being a Christian and Muslim and (R1) did ask for pork as he was told it's okay by an Islam guy who visited him (R1). The Administrator said she called the Muslim priest and told him (R1) is still asking for pork, and was told "it's okay, it will take him time to change". The Administrator commented (R1) was "served turkey bacon and sausage and because he (R1)) loved pork bacon and sausage so much, he went on a hunger strike" telling staff, "I'll stop eating pork next week". (S1) explained that when (R1) moved in, he ate "normal food" like "fried eggs and toast",but the last 2-3 weeks (R1) lived, it was hard for him to swallow, even water, and he called hospice out. (S1) stated "No, (R1) never said he didn't want pork, but Steve told me he didn't want any", explaining that most of the time, normally chicken and meatballs are served to residents and they don't use bacon much, stating it has too much grease in it. A staff at a related facility stated (R1) could eat anything and did not have any food preferences while living there; a second staff stated (R1) liked to eat - a lot of food and did not have any restrictions when she worked with him and confirmed (R1) "used to eat pork" Based on interviews conducted, LPA finds the above allegation 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. cont on 9099C-3... 9099C-3...Allegation: Staff violated resident's religious rights. Complaint alleges facility staff violated resident's Muslim rights. The Administrator Designee/caregiver, stated on 8/17/23,"I didn't know about a conversion either way" and explained that he found out about (R1) converting to Islam after he passed, explaining there was one caregiver at the related facility who converted (R1) to Islam. This staff stated that it was his understanding that "sometime in the spring, he (R1) converted back to Christianity which was news to us", asserting "we really didn't know what his religious preference was". Staff (S1) was interviewed and stated "No, he never mentioned his religious preference- I think he had a Bible in his closet". The Administrator stated on 8/17/23 she has no documentation of (R1) changing to Islam religion and commented "it happened probably" at the related facility. One staff who works at a related facility commented that she believes (R1) "used to be Christian and was converted to Islam by a staff member". A second staff at that facility stated "I heard" (R1) was converted to Islam", but she is not sure if it's true as she went on leave for several months in 2023. LPA reviewed admission paperwork for (R1), specifically LIC601, dated 8/18/22, which does not list any religious preference. The Administrator Designee stated that on 8/8/23, someone from the Mosque talked to (R1). LPA was provided with copies of Home Health notes entered on 8/10/23, by the Chaplain indicating that (R1) was Muslim and converted to Christianity under his (Chaplain's) care. (R1) began receiving hospice services on 7/27/23 and passed on 8/9/23. Notes were entered by the Hospice Chaplain on 7/28/23, when the initial assessment was made. Notes say that (R1) is Christian. There are nursing notes entered on 8/3/23 and on 8/5/23. The Administrator stated (R1) "was going back and forth" between being a Christian and Muslim and he called the Chaplain through the hospice company to say he wanted to be a Christian, adding (R1) said he wanted to eat pork as he was told it's okay by an Islam guy who visited him (R1). The Administrator asserted "Everything came as a surprise and without me- it never happened with me there" and stated the Chaplain spoke to her months back, when (R1) was previously on hospice in May, and (R1) was Christian at that time and commented "I was never sure what to do". Based on interviews conducted, LPA finds the above allegation 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. Exit interview. Copy of report provided to the facility.the state’s words, verbatim · CDSS document, Nov 9, 2023 · control 59-AS-20230809091944

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Ram Pratap, caregiver and explained the reason for the inspection. Also present was caregiver, Francis Iroko. LPA spoke to the Administrator, Anita, and lead caregiver, Steve, by phone who were not able to attend today's inspection,but provided assistance in locating binders/documentation for review. The facility is licensed for (5) residents currently and has a hospice waiver for (3). There is (1) resident currently on hospice. LPA observed (2) residents watching tv in the common area and (3) residents to be in their rooms. LPA and Ram, caregiver, toured the interior and exterior of the facility including the common areas, (2) shared resident rooms, (2) private resident rooms, (2) resident bathrooms, kitchen, staff room and garage/locked laundry area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps in the kitchen. Locked medications are kept in a separate cabinet nearby and locked toxins are kept in the garage. The inside temperature to be 73*F. Fire extinguisher was last serviced 5/25/23. Hot water temperature measured 116*F in the kitchen. There is a complete First Aid kit on site and sufficient paper products and PPE. All required postings are posted, including a blank Admission Agreement, Resident Personal Rights and Theft and Loss Policy. The Administrator agreed to complete the Infection Control Plan (LIC9282). LPA reviewed the Emergency Disaster Plan that was last updated in July 2023. LPA observed (1) unlocked gate outside and covered patio seating. There are no pools or bodies of water. LPA reviewed (2) resident files and found them to be organized, current and complete. Meds were reviewed for (1) resident -orders matched meds being administered. LPA reviewed all staff files - all staff have current First Aid/CPR certification and have completed required initial or ongoing training through an approved on-line vendor. LPA requested an updated copy of LIC500, LIC308 and of the current liability insurance by 10/18/23. There are no deficiencies issued, but there is a Technical Violation being issued. Exit interview with Administrator. Copy of report provided.the state’s words, verbatim · CDSS document, Oct 11, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to a deficiency observed on 8/8/23. LPA met with Steve Heydon, caregiver/Administrator Designee, and explained purpose of inspection. Also present was care staff, Ram Pratap and Francis Iroko, who is in training. LPA observed (1) resident watching television in the common area and was informed (1) resident was currently in the hospital and (1) resident was out of the facility. On 8/8/23, LPA observed (2) residents to be residing in room #1, (1) of whom (R1) is non-ambulatory and uses a walker to ambulate. The second resident (R2) is able to ambulate without a walker, but Administrator Designee indicated R2 prefers to use one at times. On 8/17/23, LPA was informed the same (2) residents reside in room #1; however, resident (R1) is currently in the hospital. LPA observed R2 to be in the room. LPA discussed the last fire clearance issued on 9/23/22 for the newly converted room (#1), which is approved for (2) ambulatory residents only. LPA discussed the current deficiency with Administrator, by phone. LPA stated R1 needs to move to a room approved for a non-ambulatory resident. Administrator Designee stated R4 will move to the shared room so R1 can occupy R4's current room if/when R1 returns from the hospital. R3 stated she is waiting for final approval to move to another location. R1 moved to the facility on 8/1/23 and resided in rm #1 until 8/14/23 when resident was sent to the ER. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency are being cited on the attached 809-D page. Exit interview was conducted with Administrator Designee. A copy of this report and appeal rights were provided. Administrator's signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Aug 17, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(1) · Plan of correction due date: Aug 18, 2023

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. (1) Nonambulatory persons. This requirement is not met as evidenced by: Based on observation and record review, including the most recent fire safety inspection request (STD850), dated 9/23/22, the Licensee did not ensure that room #1 only housed ambulatory clients, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 17, 2023

Plan of correction: Licensee/Administrator agree to review the fire clearance approved on 9/23/22 and Regulation 87202 and submit a signed statement to the Department acknowledging their understanding. Also R1 needs to locate to a room approved for a non-ambulatory resident within 24 hours of returning to the facility from the hospital.

Allegation investigated: Staff are abusing resident in care. Staff are not background cleared to care and supervise residents in care. Staff are stealing resident's medications. Staff are financially abusing resident in care.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to commence a complaint investigation. LPA met with Danielle Fabyunkey Lawrence, caregiver, and identified herself. LPA spoke with the Administrator, Anita, by phone, and explained purpose of inspection. Administrator arrived to the facility at approximately 12:15 pm and caregiver, Steven Heydon, arrived at 12:20 pm. LPA observed (1) resident finishing lunch in the kitchen area and (5) residents to be in their resident rooms. During the investigation, LPA interviewed the Administrator and caregiver, Steve Heydon about the allegations. LPA was able to interview (3) residents who were not sleeping. LPA reviewed documentation pertaining to resident (R1) who is the subject of the complaint and staffing files. LPA also discussed the complaint allegations with an Ombudsman. The results of the investigation are as follows: cont on 9099C-1.. Unfounded 9099C-1.. Allegation: Staff are abusing resident in care. Complaint alleges that the Administrator and another staff are abusing resident (R1) because resident he doesn't have sufficient funds to pay for all of the amenities he needs. The Administrator and caregiver stated there is no abuse of any kind towards resident (R1) or any other resident. LPA observed R1 to be resting in his room and unable to express his words. The Ombudsman also tried to communicate with R1 on 7/31/23, and the resident was unable to verbally communicate or in writing. The Administrator stated that resident was recently admitted to hospice. LPA confirmed this information with the hospice binder. LPA did not observe any bruising or other signs of abuse on R1. LPA observed a hospice nurse arrive to check on R1 during the inspection at approximately 3:00 pm. All (3) residents who were interviewed indicated they enjoy living at the facility, and staff is always kind and helpful to them and there is no abuse. LPA did not observe any bruising or other signs of abuse on the other (5) residents. Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Allegation: Staff are not background cleared to care and supervise residents in care. Complaint alleges that the facility hires staff that are not authorized to work in the facility and do not have a background clearance. There is a specific staff mentioned (S1). The Administrator stated that S1 last worked at her related facility, through last week, and is no longer employed by her. Administrator indicated that S1 was not illegal but did not have fingerprint clearance. LPA reviewed staff clearance with the Administrator and caregiver and obtained an updated LIC500 during today's inspection. LPA observed that the Administrator and (3) staff (S2, S3 and S4) are fingerprint cleared and S3 is associated. Administrator and caregiver stated there were glitches in the Department's background clearance on-line system where attempts were made to associate S2 and S4. Administrator to ensure that all staff are associated as soon as possible and any new staff are fingerprint cleared. Because S1 was not associated to this facility, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. cont on 9099C-2... 9099-C-2... Allegation: Staff are stealing resident's medications. Complaint alleges that Morphine for hospice residents have been stolen and administered by workers. Administrator and caregiver, Steven, indicated that there are currently (2) residents under hospice care, and there has not been any missing morphine. LPA observed morphine supply for resident (R1) and was informed resident (R2), has not been provided with any morphine or "comfort kit" at this time, as R2 was newly admitted to hospice. LPA observed(3) pre-filled syringes of morphine for R1 that were provided by the hospice company. Administrator indicated that hospice staff informed the Administrator she/staff are able to administer the morphine as a PRN when resident shows signs/symptoms of being restless or frowning, in pain. Interviews with (3) residents, who are not on hospice, revealed that there are no medication issues or concerns with residents receiving the correct medications on a daily basis. Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Allegation: Staff are financially abusing resident in care. Complaint alleges that the Administrator took R1's bank card and check book since resident owes the facility. Administrator stated to LPA that resident (R1) does owe her funds for additional amenities such as incontinent products and medications, as she has been paying for them herself, due to resident's monthly budget. Administrator confirmed that R1's bank card, or debit card, was missing from the related facility about 4-5 months ago, and R1 got another card but then spent all of his funds. LPA observed a debit card in R1's name in the wallet caregiver showed LPA. Administrator stated that R1 has his check book, and LPA could check R1's room. Care staff was initially unable to locate the check book at this location and stated he would follow up with the Administrator. Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview. Copy of repot provided to caregiver who is authorized to sign today's reports.the state’s words, verbatim · CDSS document, Aug 1, 2023 · control 59-AS-20230728121345

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct an inspection related to a complaint. LPA initially met with Danielle Fabyunkey Lawrence, caregiver, and then met with Anita Heydon, Administrator and Steve Heydon, caregiver who arrived shortly after LPA did. While reviewing staff files, LPA observed there was not any documentation related to staff training for staff (S1 and S2) and the last training documentation on file for staff (S3) was from 2021. Per Health and Safety Code §1569.69 and §1569.626, the following (2) citations are being issued. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Aug 1, 2023

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.626 · Plan of correction due date: Aug 22, 2023

§1569.626 (a) All residential care facilities for the elderly shall meet the following training requirements, as described in Section 1569.625, for all direct care staff: (1) Twelve hours of dementia care training, six of which shall be completed before a staff member begins working independently with residents, and the remaining six hours of which shall be completed within the first four weeks of employment. All 12 hours shall be devoted to the care of persons with dementia. The facility may utilize various methods of instruction, including, but not limited to, preceptorship, mentoring, and other forms of observation and demonstration. The orientation time shall be exclusive of any administrative instruction. (2) Eight hours of in-service training per year on the subject of serving residents with dementia. This training shall be developed in consultation with individuals or organizations with specific expertise in dementia care or by an outside source with expertise in dementia care. In formulating and providing this training, reference may be made to written materials and literature on dementia and the care and treatment of persons with dementia. This training requirement may be satisfied in one day or over a period of time. This training requirement may be provided at the facility or offsite and may include a combination of observation and practical application. This requirement is not met as evidenced by: Based on documentation reviewed, the Licensee did not ensure that staff (S1, S2 and S3) completed initial and/or continuing required training requirements, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 1, 2023

Plan of correction: Licensee/Administrator agree to have staff complete any required intial and/or continuing training requirements. LPA provided a copy of copy of RCFE Training Guide which can be completed as each required training topic is completed.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.69 · Plan of correction due date: Aug 22, 2023

§1569.69 Employees assisting residents with self-administration of medication; training requirements. (a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements:(2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Based on documentation review, the Licensee did not ensure that staff (S1, S2 and S3) had completed the required initial medication training, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 1, 2023

Plan of correction: Licensee/Administrator agree to have any staff handling medications complete the required initial and annual medication trainings. Administrator agrees to reach out to CCLD for names of approved vendors who can provide on-line trainings if desired.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Danielle Fabyunkey Lawrence, caregiver and explained purpose of inspection. LPA met with Anita Heydon, Administrator who arrived at 11:15 am and spoke to Licensee by phone regarding newly converted resident room. Also, House Manager, Ram Pratap, arrived also at 11:15 am from grocery shopping. LPA observed (2) residents in the common area and (2) residents to be in their rooms at the start of the inspection. The facility is currently licensed for (5) non-ambulatory residents; however, was approved on 9/23/2022 by the fire department for (6) residents- (2) ambulatory (rm #1- newly converted room, currently vacant) and (4) non-ambulatory residents. Currently there are (0) residents receiving hospice services. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and was screened per Covid-19 precautionary measures upon entering the facility. and was wearing a surgical mask. LPA and Administrator toured the interior/exterior of the facility including common areas, resident bedrooms (5), resident bathrooms (2), kitchen, and laundry area/garage. LPA observed the facility to be clean, in good repair and odor-free, and the bathrooms to have grab bars, non-skid flooring, paper towels and 20-second hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food. LPA observed multiple toxins to be unlocked below the kitchen sink and the drawer containing sharps to be currently unlocked. LPA observed medications, including those needing refrigeration, to be secured nearby. LPA observed the inside temperature to be 76*F. Fire extinguisher last serviced 6/6/2022. Discussed vaccination status of residents/staff, boosters and visitation protocols- booster flyer provided. LPA observed multiple Covid posters throughout and other required postings. LPA observed (1) unlocked gate from the inside back patio.LPA observed sufficient incontinent products and PPE. LPA requested an updated copy of LIC500, LIC308, LIC200 and current liability insurance be provided to the Depart by 10/14/22. Per California Code of Regulations, Title 22, Division 6, Chapter, 8, the following (1) deficiency is cited on the 809D page. Exit interview. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 7, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to continue post-licensing inspection. LPA met with administrator Anita Heydon during today's 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks. Additionally, LPA was screened by staff upon entering the facility. LPA toured the facility and inspection 4 resident rooms, 2 bathrooms, garage area, backyard, kitchen and common living spaces. LPA observed the garage area, and saw it is only used as a storage area. LPA observed the facility to be free of odor, clean and in good repair. LPA observed sufficient furniture and lighting throughout the facility. LPA reviewed 2 of 4 resident files and 2 staff record. LPA reviewed medications of 2 resident comparing with Centrally Stored Medication Record and physician orders. Resident files were found to be complete and current. LPA observed the following posted in each resident room: Resident Council Rights, See Something Say Something complaint poster, Resident Bill of rights, Resident Personal Rights, Evacuation Routes and facility license were all posted as required. LPA observed the following deficiencies: Administrator is pre-pouring medication over 24 hours in advance. Administrator did not transfer caregiver fingerprints from sister facility to this facility. Deficiencies cited on 809-D. Exit interview conducted and appeal rights given.the state’s words, verbatim · CDSS document, Nov 18, 2021

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct a post-licensing inspection. LPA met with administrator Anita Heydon during today's 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks. LPA reviewed 2 of 4 resident files and 2 staff record. LPA reviewed medications of two resident comparing with Centrally Stored Medication Record and physician orders. LPA observed administrator is pre-pouring her medications 24 hours in advance. Resident files were found to be complete and current. Due to time constraints, LPA will return on a later date to finish inspection. Exit interview conducted.the state’s words, verbatim · CDSS document, Nov 17, 2021

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct a case management 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks. Additionally, LPA was screened by staff upon entering the facility. During today's inspection LPA toured the facility and observed 4 resident bedrooms, 2 bathrooms, garage area, common living spaces, and outdoor patio. LPA observed 2-day perishable amount of food and 7-day non-perishable amount of food. LPA reviewed 2 of 4 resident files and observed required paperwork at the facility. LPA observed signs posted throughout the facility related to covid and observed the facility to be clean and free from odor. At this time no deficiencies have been cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Nov 3, 2021

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to complete pre-licensing inspection. LPA met with administrator Steve Heydon during today's inspection. LPA met with fire inspector to review floor plan and fire clearance. Currently there are 3 residents at the facility. LPA observed facility has corrected the following: The facility has locked kitchen cabinet which stores the kitchen knives. Cleaning supplies in the garage are locked. Resident needs and service plan is completed. This report will be forwarded to the centralized application unit for continued processing. Exit Interview conducted.the state’s words, verbatim · CDSS document, Aug 30, 2021

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Bethany Huusfeldt-Mirlohi conducted a pre-licensing inspection. LPA met with Administrator Anita Heydon during today's inspection. Currently there are 3 residents residing within the facility. Fire clearance was granted on 7/20/21 for 5 non-ambulatory and 1 bedridden resident. Facility was inspected both indoors and outdoors. LPA inspected 4 resident bedrooms, 1 staff room, bathrooms, common living areas, and kitchen. Outdoor area is free from hazardous debris. Outdoor exits are clear and accessible. The emergency exiting plan was posted. First aid kit was present in the facility. Centrally stored medications will be locked in the hallway closet. The facility has adequate lighting throughout. LPA inspected resident bedrooms and the bedroom had appropriate furnishings, chair, adequate lighting and storage. Bathrooms are clean, sanitary, and in good repair. Smoke detectors and carbon monoxide detectors were checked and operational. Kitchen is clean, sanitary, and in good repair. A working telephone will be provided upon time of admission of residents. LPA observed the following corrections need to be completed: Kitchen cabinet which stores the kitchen knives needs to be fixed and locked. Cleaning supplies in the garage need to be locked and inaccessible. Resident needs and service needs to be completed. Administrator agrees to correct listed items. Component III was waived. LPA will return on a later date to finish pre-licensing once corrections have been made. Exit interview conducted.the state’s words, verbatim · CDSS document, Aug 24, 2021

The state marks this report as 5 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.