Mama Claudia's Loving Nest

Allegation investigated: -Staff did not ensure that a written resident personal property inventory was established upon admission and retained during the resident’s stay. -Staff did not safeguard resident's belongings while in care. -Staff emotionally abused resident while in care.

Licensing Program Analyst (LPA) Angela Hood arrived at the care home on 9/20/2023 and met with the caregiver, Obriana Graydon, to deliver findings into the above listed allegations. During the course of the investigation, LPA conducted interviews and reviewed documentation pertinent to the investigation. ********************************************Continued on LIC9099-C************************************************* Unsubstantiated Allegation: Staff did not ensure that a written resident personal property inventory was established upon admission and retained during the resident’s stay. The complaint is regarding the facility not keeping an inventory of resident (R1’s) belongings. Interview with the Administrator indicated that, anytime there is an admission to their facility, they offer to have the Client/Resident Personal Property and Valuables LIC621 form completed. The Administrator indicated that R1’s responsible party took all the admission documentation home to review when R1 was admitted to the facility. Interview with the Administrator also indicated that R1’s responsible party declined to complete the LIC621. R1’s LIC621 indicated that R1 has no property or valuables and arrived at the facility with “a few clothing items”. Allegation: Staff did not safeguard resident’s belongings while in care. The complaint is regarding R1 missing items upon discharge from the facility and facility staff not ensuring R1’s clothing was not worn by other residents. Interviews with the Administrator and staff (S1) indicated that R1’s responsible party would often arrive at the facility with a bag to exchange out clothing items in R1’s room. Interview with S1 indicated that there was an incident when hospice arrived to provide care for resident (R3) and, when they changed R3’s clothing, the hospice staff accidentally put one of R1’s shirts on R3. S1 indicated that R1 and R3 shared a dresser and closet. S1 indicated that they changed R3’s shirt as soon as it was noticed they were wearing R1’s clothing. S1 indicated that this was the only occasion that R3 was wearing R1’s clothing. Interview with relevant party indicated that R1 was missing several items upon discharge such as the footrests from R1’s wheelchair, a pillow, electric toothbrush, and purple garment. Interview with Administrator indicated that they attempted to provide the footrests to R1’s responsible party. Administrator indicated that they purchased a new pillow and electric toothbrush for R1 and dropped it off at R1’s new residence. Interview with relevant party indicated that the footrests were not the correct footrests for R1’s wheelchair, the pillow was not the same brand or value, and the electric toothbrush was not the same brand as the original toothbrush so refills could not be used. The items that the relevant party indicated were missing were not listed on R1’s Personal Property and Valuables LIC621. *********************************************Continued on LIC9099-C************************************************ Allegation: Staff emotionally abused resident while in care. The complaint is regarding concern that the Administrator and other facility staff were emotionally abusing R1. Interviews conducted with resident (R2) and S1 indicated that they have never witnessed any abuse of any kind at the facility. Interview with R2 indicated that they have never experienced emotional abuse from staff and never witnessed staff mistreating R1. During the interview with R1, their responsible party was present. R1 indicated that they were scared and upset when the Administrator informed R1 they were moving out of the facility. Interviews with hospice staff indicated that they were able to speak to R1 privately at the facility on several occasions so that R1 could be open about any concerns. Hospice staff indicated that R1 would always indicate that they were happy at the care home. Hospice staff had also conducted a welfare check at the facility and spoke with R1 privately. Hospice staff indicated that R1 seemed comfortable, smiled, and indicated that they were happy. Interview with hospice staff also indicated that there were no indications of R1 being neglected or abused, neither verbal nor any other. Interview with outside agency representative indicated that they have stayed at the facility often and have interviewed all the residents. The outside agency representative indicated, from what they have observed, there were no signs of emotional abuse with any of the residents in care. Based on interviews conducted and documentation reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. No deficiencies are being cited during this visit. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 20, 2023 · control 59-AS-20230718154908

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Angela Hood arrived at the facility unannounced on 8/31/23 to conduct a Post Licensing Inspection. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are five (5) bedrooms and two (2) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition, properly maintained, and the hot water temperature was observed to be 105.1 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required (2) two-day perishable and (7) seven-day non-perishable food supply on hand. LPA observed knives, cleaning products and other toxins to be locked away and inaccessible to residents. LPA observed the outdoor area and perimeter of the care home to be free of clutter and debris and there appeared to be no potential safety hazards to the residents in care. Smoke detectors and carbon monoxide detector are hard wired and operational. Fire extinguisher and first aid kit are maintained and ready for emergency use. LPA checked medication storage and found medications to be locked away and inaccessible to the residents. LPA reviewed two (2) resident files and also reviewed two (2) staff files. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Aug 31, 2023

Allegation investigated: Unlawful eviction.

On 5/17/23, Licensing Program Analyst (LPA) Kevin Mknelly spoke with licensee to deliver complaint findings for the above allegation. LPA reviewed resident records, facility records and conducted extensive interviews. LPA finds that the allegations cited above are substantiated. On 3/29/23, licensee confirmed that they had sent a text message stating an eviction of R1. LPA was shown the text message. LPA informed the licensee that the eviction failed to meet the criteria for eviction as it pertained to the interactions between R1’s representative and the licensee. Thus, R1 would not be evicted for the reason given. R1 is found to have fees paid on time, complied to laws, complied with house rules and was able to have their needs met by the facility. Substantiated R1’s representative was informed that the eviction was invalid. R1’s representative removed the resident from the home sighting the eviction notice. However, there were other factors involved in the decision to move as well. 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. do so. Specific to R1, R1’s physicians report and hospice care plan had recommendation to be out of their wheelchair and safely seated for skin breakdown prevention. Interviews with R1 found that they were assisted to move from bed when requested. This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted and report provided.the state’s words, verbatim · CDSS document, May 17, 2023 · control 59-AS-20230323152857

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(d)(1) · Plan of correction due date: May 31, 2023

Eviction Procedures (d) The licensee shall set forth in the notice to quit the reasons … (1) The notice to quit shall include the following information…This requirement was not met based on observation and statements that the eviction notice was not issued lawfully. This posed potential risk to R1’s personal rights.the state’s words, verbatim · CDSS document, May 17, 2023

Plan of correction: Licensee will submit a statement of understanding of the requiremtns in 87224 by the POC date of 5/31/23.

Allegation investigated: Facility staff refusing to allow resident to have visitor.

On 5/17/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with Licensee. LPA conducted records review and extensive interviews. LPA is unable to find and or meet the preponderance, per policy. Statements received from relevant parties during the course of the investigation found that, while R1 was receiving care at the level defined by their hospice agency, the relationship between the facility staff and R1's responsible party was often contentious. Efforts by the hospice agency, CCL, law enforcement and the Long-term Care Ombudsman were unsuccessful in resolving the relationship between the representative and facility staff. R1's representative had visited the facility often. On the date of the reported event, 3/14/23, the hospice MD, was reported to have, directed the representative to go outside in order to examine R1 without distraction. Unfounded During the period of the investigation, between 3/15/23 to 4/19/23, R1’s representative and licensee provided numerous communications and reports of the others’ alleged behaviors. In those reports, it appears that R1 would be provided the opportunities for visitation when the visiting party was not disruptive to the care and well being of others. All other residents were reported to not have visitation restrictions. R1 reported that they believe that they are allowed visitation. This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview with administrator.the state’s words, verbatim · CDSS document, May 17, 2023 · control 59-AS-20230315105130

Allegation investigated: Resident sustained severe pressure injuries due to staff neglect Staff did not notify resident’s authorized representative of injuries Staff are retaliating against resident for filing a complaint Staff are threatening resident

On 5/17/23 , Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with licensee to deliver investigation findings. The department reviewed facility records, resident records, conducted interviews and conducted 4 facility visits. LPA finds that facility met Tittle 22 requirements. Resident sustained severe pressure injuries due to staff neglect- In Hospice records review and interviews is was found that R1’s pressure injuries had resolved to stage one as of 3/22/23. According to hospice records, as of 03/20/2023, all of R1's pressure injuries are stage two or one. Hospice provides wound care of the pressure injuries and no neglect or questionable practices by facility staff were reported by hospice records or statements. Unfounded Staff did not notify resident’s authorized representative of injuries- Records and statements found that R1’s authorized representative was informed of pressure injuries though there may have been some miscommunication between the licensee, representative and hospice between the time the wounds were discovered, 3/9/23 and hospice MD assessment on 3/14/23. Staff are retaliating against resident for filing a complaint- R1 did not file a complaint. Staff and R1 report no retaliation of decrease in quality of care by staff for R1. Statements found a dispute between R1’s representative and the licensee regarding R1’s requests of the facility staff. Staff are threatening resident- Observations and interviews found staff to have supportive and professional interactions with residents. This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted and report provided.the state’s words, verbatim · CDSS document, May 17, 2023 · control 59-AS-20230313144204

Allegation investigated: Staff does not ensure residents receive assistance with activities of daily living Staff does not ensure residents special dietary restrictions are being followed Staff does not ensure food is of good quality

On (Date) , Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with licensee to deliver investigation findings. LPA reviewed facility records, resident records, conducted interviews and conducted 5 facility visits. LPA finds that facility met Tittle 22 requirements. Staff does not ensure residents receive assistance with activities of daily living- On all facility visits conducted, residents were found to be clean and well groomed. Residents interviewed who were able to recall events reported being happy with the care they received. Staff does not ensure residents special dietary restrictions are being followed- R1’s hospice care plan was reviewed and hospice agency staff were interviewed. Care plan identified regular diet with no restrictions. R1 is identified as having diabetes. Interviews conducted found staff had followed guidance Unfounded to encourage R1 to consume limited carbohydrates and sugars. However, Staff file reviews found that proof of restricted health condition training, diabetes, were not present in the records provided to the department. Staff does not ensure food is of good quality- Facility food was found during inspections to meet regulation requirements for nutritional value, food safety and quality. This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted and report provided.the state’s words, verbatim · CDSS document, May 17, 2023 · control 59-AS-20230307081733

Type of visit: Case Management - Deficiencies

On 5/17/23, Licensing Program Analyst (LPA) Kevin Mknelly, conducted a case management visit while delivering complaint findings and met with caregiver . Licensee was notified and arrived to assist. On 3/7/23, the department received a complaint alleging R1's dietary restriction are not followed. Inspections and interviews found that R1 was provided appropriate foods and dietary guidance by caregivers. However, Review of staff records found that S1 and S2 did not have proof of diabetes training in files provided to the department prior to hospice documented training on 3/20/23. Therefore, licensee did not meet the training requirement in CCR 87613. 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. Copy of report and appeal rights providedthe state’s words, verbatim · CDSS document, May 17, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87613(a)(2) · Plan of correction due date: May 31, 2023

General Requirements for Restricted Health Conditions (a)(2) Ensure that facility staff who will participate in meeting the resident’s specialized care needs complete training provided by a licensed professional sufficient to meet those needs. This requirenment was not met based on records reviews and interviews that found S1 and S2 did not proof of diabetes training on file while a resident with diabetes was in care. This posed a potential risk to R1.the state’s words, verbatim · CDSS document, May 17, 2023

Plan of correction: Licensee will submit proof of staff training of S1 and S2 for Diabetes by the POC date of 5/31/23.

Type of visit: Case Management - Other

On 4/19/23, Licensing Program Analyst (LPA) Kevin Mknelly conducted an unannounced visit to follow-up on a call received by LPA on 4/19/23 and met caregiver. Prior to initiating the complaint visit, LPA completed the Department's COVID-19 precautions. LPA spoke by phone with the licensee regarding the issues associated with a relocation of R1 today. R1 was assisted in R1's move out by R1's responsible party. LPA interviewed the caregiver regarding recent issues emailed to LPA by R1's responsible party concerning R1's personal belongings and storage space for R1's personal belongings. LPA observed the home to be clean, safe and sanitary. Current residents appear to have their care needs met by the caregiver present. As a result of today's visit, no deficiencies are noted. Report reviewed and copy provided.the state’s words, verbatim · CDSS document, Apr 19, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility announced on 2/24/23 to conduct a Pre-licensing referencing the infection control domain. LPA met with staff designee and explained the purpose of the visit. Prior to initiating the pre-licensing 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 they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical Mask. 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 no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control recommendations and facility was found to be in substantial compliance at this time. Component III topics were review.. Facility is in significant compliance License pending approval. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Feb 14, 2023

Type of visit: Office

Facility Type: RCFE Application Type: INITIAL Capacity: 6 Census (if any clients in care): COMP II by CAB successfully completed Method: Telephone call COMP II Participant: CLAUDIA MIHAI Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. Identification of the applicant and administrator was verified by photo ID . During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. 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, Jan 31, 2023