The Waterleaf at Land Park

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct a Required - 1 Year visit on 5/5/23 at 10:30am. Administrator Certificate expires 4/25/24. LPA met with Coreen Tigley and discussed the purpose of the visit. The facility is licensed for a capacity of 78 Non ambulatory residents. Facility has a hospice waiver for 10 to receive hospice care services. There is 3 resident receiving hospice services at this time. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed and interviewed a random amount of residents who were engaged in activities and others finishing lunch during this visit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 72*F which is within the required range of 68-85*F. The hot water temperature was measured at 119.7*F which is within the required range of 105-120*F. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. LPA reviewed 5 resident files and 5 staff files during this visit. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308) Liability Insurance Administrator Certificate-Updated Personnel Report (LIC500) Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given.the state’s words, verbatim · CDSS document, May 5, 2023

Allegation investigated: Staff are aggressive towards residents. Staff cannot effectively communicate with resident's.

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the above mentioned allegations on 12/1/22 at 12:15pm. LPA met with Coreen Tigley and stated the purpose of the visit. LPA received a resident and staff roster with contact information during this visit. LPA conducted interviews of residents (R1- R12) and staff (S1-S16) during this visit. Based on interviews conducted today and all staff and residents concur that staff are not aggressive when handling residents and are able to communicate the needs of the residents. The preponderance of evidence standards has not been met. “This agency has investigated the complaint alleging, the above-mentioned allegation(s). We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.” Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited during this visit. An exit interview was conducted and a copy of this report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Dec 1, 2022 · control 27-AS-20221128135038

Allegation investigated: Facility staff are administering resident's insulin

AMENDED FROM UNFOUNDED TO UNSUBSTANTIATED Upon further review of documentation and interviews the finding is changed. Administrator agrees. Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the above mentioned allegations on 12/1/22 at 12:15pm. LPA met with Coreen Tigley and stated the purpose of the visit. LPA received a resident and staff roster with contact information durng this visit. LPA conducted interviews of residents (R1- R4) and staff (S1-S16). Based on interviews conducted today with staff and residents, who concur that staff are assisting residents with self administration of insulin and blood sugar level checks using the hand over hand method. LPA observed there is 1 resident who does not have the Libre machine attached to their skin. That resident stated that the blood sugar checks and insulin injection is self administered using the pre-filled pen as prescribed by the physician. The preponderance of evidence standards has not been met. Per the California Code of Regulations, Title 22, Div 6, Ch 8, no violations cited during this visit. Exit interview conducted copy given. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 1, 2022 · control 27-AS-20221102103332

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility staff are retaining resident's that require a higher level of care

AMENDED TO CHANGE FINDINGS SEE NEW 9099. THIS FINDING REMAINS THE SAME. Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to conduct an investigation of the above mentioned allegations on 12/1/22 at 12:15pm. LPA met with Coreen Tigley and stated the purpose of the visit. LPA received a resident and staff roster with contact information durng this visit. LPA conducted interviews of residents (R1- R4) and staff (S1-S16). Based on interviews conducted there are no residents needing a higher level of care residing in the facility at this time. The preponderance of evidence standards has not been met. “This agency has investigated the complaint alleging, the above-mentioned allegation(s). We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.” Per the California Code of Regulations, Title 22, Div 6, Ch 8, no violations cited during this visit. Exit interview conducted copy given. Unfoundedthe state’s words, verbatim · CDSS document, Dec 1, 2022 · control 27-AS-20221102103332

Allegation investigated: Resident was left unsupervised for an extended period of time while in care. Resident wandered from the facility while in care.

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 8/9/22 at 12:00pm to investigate the above mentioned allegations. LPA was met by Ana Lobo, Resident Care Coordinator and stated the purpose of the visit. LPA interviewed staff #1 (S1, S2, S4 and resident #1(R1) during this visit. The investigation revealed that R1 did not leave the property and was met by staff within minutes in the gated staff parking lot. The time frame was confirmed by video surveillance. Based on interviews and observation of the surrounding area of the facility property, the preponderance of evidence standards has not been met. “This agency has investigated the complaint alleging, the above-mentioned allegation(s). We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.” Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited during this visit. An exit interview was conducted and a copy of this report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Aug 9, 2022 · control 27-AS-20220804100057

Type of visit: Required - 1 Year

Licensing Program Analyst(LP A) Victoria Brown arrived unannounced to conduct a Required - Annual visit on 7/7/22 at 8:15am. Administrator Certificate expires 11/25/23 for Paul Cimino. LPA met with Coreen Tigley and discussed the purpose of the visit. The facility is licensed for a capacity of 78 Non ambulatory residents. Facility has a hospice waiver for 10 to receive hospice care services. There is 0 resident receiving hospice services at this time. LPA toured and inspected the physical plant inside and outside to ensure there are no safety hazards to residents. LPA observed and interviewed a random amount of residents who were engaged in activities and others finishing breakfast during this visit. Breakfast consisted of toast, sausage, eggs, juice, hot cereal, and fruit. LPA observed 2-day perishables and 7-day non-perishables. The temperature inside the facility was observed to be at 75*F which is within the required range of 68-85*F. The hot water temperature was measured at 117.7*F which is within the required range of 105-120*F. LPA observed a pull alarm system, fire extinguisher(s), smoke and carbon monoxide detectors, and central heating and air in the facility. LPA observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, thermometers, antiseptic solution and guide. Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308) Liability Insurance Administrator Certificate-Updated Personnel Report (LIC500) Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies observed or cited. Exit interview held, copy of report given.the state’s words, verbatim · CDSS document, Jul 7, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on a subsequent visit on 7/7/22 at 8:15am. LPA met with Coreen Tigley and stated the purpose of the visit. This visit is to conduct a Case Management visit regarding an incident report received by Community Care Licensing (CCL) on 6/14/22 indicating that resident #1 (R1) was found by the Fire Department walking down the street from the facility. LPA interviewed the Administrator regarding the incident during todays visit. LPA received and reviewed the most current LIC602 Physician report for R1. The Physician report indicated that R1 has a diagnosis of Dementia and is unable to leave the facility unassisted. The investigation revealed that the facility did not supervise R1 which allowed R1 to elope from the facility. The preponderance of the evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, a copy of the report was given.the state’s words, verbatim · CDSS document, Jul 7, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(k)(6) · Plan of correction due date: Jul 7, 2022

Care of Persons with Dementia Without violating Section 87468, Personal Rights, facility staff shall ensure the continued safety of residents if they wander away from the facility. This requirement is not met as evidenced by: A review of submitted SIR and confirmation of Administrator R1 AWOL'd on 6/14/22. Based on interview the Administrator did confirm the AWOL on 6/14/22. This possess an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 7, 2022

Plan of correction: Licensee provided a wander guard for resident and put in place more frequent safety checks on residents. POC cleared prior to todays visit.

Allegation investigated: Resident sustained an injury while in care Resident sustained multiple falls while in care

Licensing Program Analyst(s) (LPA) Victoria Brown and Jamie Ivey Canady arrived unannounced to conclude the investigation of the above mentioned allegations on 12/23/21 at 9:00am. LPAs was met by Coreen Tigley and stated the purpose of the visit. LPA requested and reviewed the following documents regarding resident #1 (R1): Hospital After Visit Summary, Facility Narrative Charting by staff and physcian, Physician report, Updated Physcian's Orders on medications, Admission Agreement, door documentation and survellance footage of the incident, Incident reports for R1 of falls for 2021. LPAs interviewed residents and staff during this visit. Unfounded Regarding allegation, “Resident sustained an injury while in care”, LPA conducted interviews of the staff and the Physician of R1, the Principal Inspector for Commercial Buildings, representative for Allegion (LCN), Code Enforcement and reviewed the video of the incident in which Resident #1 (R1) was involved in on 9/8/2021. LPA observed that R1 was visiting the Assisted living side of the building and was coming through the door. While talking to other residents, R1 did not remove hand from the door jamb of the door as it was closing. In speaking with a representative of Allegion (LCN), it was stated that “ low energy models, sensors are not required, and the closing force is 9lbs from the hinge edge which means 9lbs of force to be placed to counteract the door”. The investigation revealed that although R1 sustained an injury while in care the facility was deemed to not be at fault. Regarding allegation, “Resident sustained multiple falls while in care” LPA observed medical documentation that R1 was seen at the hospital for a fall on two occasions that was not witnessed. The dates were 5/11/21 where a contusion of the head occurred and 8/21/21 where there was a laceration repair. A review of the most recent physician report does not indicate that R1 is a fall risk. R1 ambulates without assistance of any device on a daily basis. The preponderance of evidence standards has not been met. “This agency has investigated the complaint alleging, the above-mentioned allegation(s). We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.” Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were cited during this visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 23, 2021 · control 27-AS-20210920112902