Bethesda

Type of visit: Annual/Random

On August 9, 2023, at 10:55am, (LPA) De Anna Williams-Lyons made an unannounced visit to conduct facilities required annual inspection. LPA Lyons met with administrator, Victor Burachek whose Administrator certificate expires September 29, 2023. LPA and Victor completed the infectious Control questionnaire with no issues. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. Bathrooms and bedrooms were clean and in good repair. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were checked and in good working order. Fire drills are conducted as required. LPA observed an adequate amount of linens and found the first aid kit to be complete. Hot water temperature measures at 114 degrees F. LPA reviewed 1 resident records and 1 staff records. Resident files were found to be complete and current. A review of staff records indicates that all facility staff have received criminal record clearances and/or are associated to this facility. Staff records reviewed indicated current first aid certificates. Facility is conducted staff training as required. In the areas that were evaluated, no deficiencies were observed at the time of the visit. An exit interview was conducted and a copy of this report was given tothe state’s words, verbatim · CDSS document, Aug 9, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 12/28/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Licensee, Victor Burachek, 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. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: four (4) bedrooms and four (4) bathrooms for residents, common area, dining room, kitchen, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Licensee completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Dec 28, 2022

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on 12/16/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Licensee, Victor Burachek, and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms, and contacted facility to complete a facility risk assessment. LPA ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. LPA toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: 4 bedrooms and 4 bathrooms for residents, common area, dining room, food supply, laundry room, PPE supply, and outdoor area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Licensee completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Dec 16, 2021

Allegation investigated: Allegation is unlawful eviction.

On 08/10/2021 at 3:05 PM , Licensing Program Analysts (LPAs) Sarena Keosavang and Michael Hood arrived at the facility to deliver a complaint finding Community Care Licensing (CCL) received on 05/06/2020. LPA Keosavang requested for staff to notified Administrator that LPAs are present at the facility to deliver final finding. LPA spoke with Administrator, Victoria Cardona, and explained the purpose of the visit. Administrator is unable to meet LPAs at the facility. LPAs went over complaint findings via telephone. Administrator gave staff permission to sign report. Throughout the course of the complaint investigation, the Department obtained documents such as resident’s (R1) Physician’s Report, Admission Agreement, Functional Capability Assessment, Appraisal, Consent for Medical Emergency Form, Identification and Emergency Information Form, Centrally Stored Medication, Medical Documents, and Unusual Incident Report. The Department received an interview statement from the Licensee regarding the allegation above. Licensee stated he was contacted by a placement agency for temporary housing for R1. ********** Continue on page LIC 9099-C ************** Substantiated Licensee stated, while R1 was staying at the facility for about 4-5 months, the facility did not receive any form of payment for R1. Licensee stated he had reached out to the placement agency for R1 and requested payment. Licensee stated he had received a payment from the placement agency, however, it was not in the full amount. Licensee stated he had contacted R1’s POA regarding payments and moving R1 to another facility. The Department requested for an eviction letter for review. Licensee stated he did not submit an eviction letter to CCL or gave notice to R1 or R1’s POA. Licensee stated all communication with R1’s POA was verbal. Per facility’s eviction policy, the agreement must specify that a written notice that includes specific facts concerning the date, place, witnesses, and circumstances for eviction will be provided to the resident. Specific conditions under which a resident may be evicted must be worded exactly as written in the applicable law or regulations. “The licensee may, upon 30 days written notice to the resident, evict the resident for one or more of the following reasons.” An Unusual Incident Report was submitted to CCL. On 05/03/2020, R1 complained of pain on wrist in both hands and was taken to Kaiser Morse ER by Licensee. Licensee stated he had spoken to the Physician that was caring for R1 and indicated that he did not have the resources to care for R1 anymore. Licensee stated the Physician told Licensee that the hospital will place R1 in a Nursing Home. Licensee stated, “Based on his words, I left.” After Licensee had left Kaiser Morse ER for about 30 minutes, Licensee received a call from Kaiser discharge planner to make arrangement to have R1 picked up from the hospital. Licensee explained to Kaiser discharge planner that the Physician will place R1 in a nursing home due to lack of resources. Kaiser discharge nurse notified Licensee what he was doing is considered abandonment. Licensee stated he would only agree to take R1 back to the facility if they would pay him. The Department asked Licensee for clarification from Licensee that R1 did not return to the facility. Licensee stated R1 was not discharged back to the facility and that R1’s POA picked up R1’s belongings. While R1 failed to pay for services provided, facility did not provide a 30-day notice. Due to this information CCL finds the allegation to be SUBSTANTIATED. – A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies are cited on the attached LIC 9099-D. Appeal rights were provided. An exit interview was conducted, and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Aug 10, 2021 · control 25-AS-20210506085518

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Aug 11, 2021

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This requirement is not met as evidenced by: Based on interviews, facility did not ensure that R1 was evicted with a written 30-day notice, which poses an immediate health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Aug 10, 2021

Plan of correction: Licensee agrees to write a statement of understanding regarding regulation 87224(a) and submit to CCLD by POC due date.