Country Oaks Manor

Allegation investigated: Staff did not dispense medication to resident for several days

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conclude a complaint invetigation for a complaint received on 5/18/23. LPA met with Khnesha Hylton, caregiver, who contacted Alex Molitvenik, Administrator, by phone and explained purposer of inspection. Administrative said he would arrive in (20) minutes. LPA observed (2) residents to be in the common areas and (2) residents to be in their rooms at the start of the inspection. During the investigation, LPA interviewed the Administrator, a primary caregiver (S1) and (2) representatives from the Veterans Administration (VA) and reviewed pertinent documentation related to resident (R1). (R1) lived at the faciity from around 3/28/23 through 5/12/23. The complainant was anonymous and was not able to be contacted for additional information. The results of the investigation are as follows: cont on 9099C-1... Substantiated 9099A-C1...The Administrator stated (R1’s) POA called (R1) a second time, on 5/11/23, during dinner, while (R1) was eating/chewing and so he answered the phone for (R1) and told (R1) the POA that (R1) was eating chicken. The Administrator confirmed that (R1) was served pizza for lunch and chicken with salad for dinner on 5/11/23. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint 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. Allegation: Staff did not provide nutritious meals to resident in care. Complaint alleges that (R1) was admitted to hospital because the facility was not giving (R1) his medication and he was feeding him improperly. Primary staff (S1)confirmed that (R1) did have a "special diet" that included "less bread" and less potato and rice, stating "once a week we would give him frozen pizza"- usually on Thursdays when the Administrator is here. (S1) confirmed the facility serves a "routine menu" which includes serving oatmeal twice weekly on Wednesdays and Saturdays and cold cereal on Tuesdays and Fridays. The Administrator also confirmed that (R1) had a "special diet" and staff would serve meals with "low carbs and usually less bread and carbs" due to (R1’s) diagnosis of Diabetes. The Physician’s Report, dated 3/3/23, indicates that (R1) needs a special diet consisting of low carbs. The Administrator confirmed that he served (R1) pizza on Thursday, 5/11/23, which was the scheduled lunch meal that day. The Administrator stated that he picked up medication refills, in person, at the pharmacy on 5/9/23 and medication was administered as scheduled following picking up the medications. LPA observed fresh produce on hand on 9/8/23. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint 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 9099A-C2... 9099C-2-.. Allegation: Administrator did not obtain refill medication for resident in care. Complaint alleges that the Administrator did not tell the POA that (R1) needed his medication refilled and the Administrator did not refill his medication. The Administrator stated that (R1) missed scheduled medications starting on 4/28/23, due to not receiving the refills in the mail, stating he called the VA on Mon, 5/8/23, and picked up the meds on Tues, 5/9/23. The Administrator asserted that (R1) "always had an insulin pen" but "ran out of pills for approximately two weeks". A representative with the VA stated to LPA that they do not offer the option of “automatic refills” and a medication refill must be requested online, if there are refills available, or by phone, if there are no remaining refills. The representative explained the veteran or the caregiver can go online to their website to request the refill. Administrator stated called on/around 4/21/23 and requested refills of multiple medications, 7 days before the medications would run out. On 5/8/23, the pharmacy left a message that the medications mailed had returned due to a wrong address. LPA was not able to confirm any specific information with the VA pharmacy without a signed consent due to HIPPA. (R1) does not live at the facility any more and the complainant was anonymous. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint 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. Allegation: Administrator did not seek medical attention for resident in care. Administrator did not see that (R1’s) condition was changing, his sugar was high, and he had not had his medication. A primary caregiver (S1) stated Wednesday, 5/10/23, he observed (R1) to be "shaky" and "declining a bit". (S1) indicated he was not working on Thursday, 5/11/23, as it was his regular day off, but he returned and was back on shift on 5/11/23 around 8:30-9:00 pm. (S1) stated that (R1) was watching television and went to the bathroom by himself and (S1) told him to "lay down", stating 10-15 minutes later, (R1) was "still on the toilet and he was very confused". cont on 9099C-3.. 9099C-3.. (S1) indicated that resident (R1) was sent to the Emergency Room on 5/12/23, when he was working. (S1) explained that he observed (R1) Friday morning, around 7:30 and (R1)'s condition was "more serious" and was "shaking every minute and more confused" so he called the Administrator. (S1) explained that (R1) was not able to give himself the normal insulin injection. (S1) explained that the Administrator called 9-1-1 around 8:15 am as (R1’s) condition "definitely got worse" and this was right before the daughter called. (S1) commented that on Wednesday, 5/10/23, (R1) "seemed at baseline" and then on "Friday morning, I really noticed" a change. The Administrator stated that (R1) was seen by a home health nurse on Thursday morning, 5/11/23 and (R1) was appearing to be a "little confused" at that time, but the nurse who checked him said it wasn’t necessary to call 9-1-1 but to monitor (R1). The Administrator stated (R1) was "not like usual but it was not alarming". Documentation shows that (R1’s) blood sugar was taken in the morning on 5/11/23 and was “200”. It was not taken again until the morning of 5/12/23, when it read “225”. (R1’s) blood sugar measured “147” on 5/9/23 and “157” on 5/10/23. Administrator stated (R1's) blood sugar was around 140-160 usually in the morning but it was high around 200-225 on 5/10/23 and 5/11/23 after receiving the refilled medications. (R1) was admitted to the hospital on 5/12/23. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint 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. 9099C-1.. Allegation: Staff did not dispense medication to resident for several days. Complaint states that when the POA told the Administrator that (R1) would not be returning to the facility, the Administrator indicated (R1) did not have his medication for a couple of days. The Administrator stated that usually (R1’s) medications are sent by regular USPS and are received within 5-7 days and confirmed that the VA would send a 30-day supply of each medication and they usually reach out when they are mailed. The Administrator stated that he phoned in a refill for multiple medications on/around 4/21/23 when there was approximately (7) days supply remaining on the medications. Administrator stated that when the medications had not arrived by/around 4/28/23, he called the VA pharmacy again and (R1’s) POA to advise the medications were late and was informed by the pharmacy the medications were sent to a prior address for (R1). (R1’s) POA indicated she would look into the address VA had on file and request it be updated. On 5/19/23, LPA listenedd to a voice message received on the facility land line on 5/8/23 from the "outpatient pharmacy" at the VA Mather location. LPA heard the caller state that "the prescription was mailed but returned back to us" and advised the Administrator to contact them at the number provided. The Administrator stated that on the morning of 5/9/23, he went to pick up the medications in person at the VA pharmacy, and (R1) was then administered medications as scheduled. The Administrator confirmed that (R1) did not have scheduled medications from on/around 4/28/23- 5/9/23; however, he always had a supply of insulin. The facility does not maintain a Medication Administration Record (MAR) currently. The Administrator stated that (R1’s) son picked up his belongings, including unused medications on 5/17/23 and an ending medication inventory count was not taken but the bottles were almost full since they had been picked up on 5/9/23. There is a separate citation issued for this deficiency. The Administrator stated that (R1’s) physician was not contacted to advise (R1) did not receive medication during the (2) week period because it is difficult to get in contact with VA physicians, but the pharmacy was aware and the POA was also. LPA finds the allegation to be SUBSTANTIATED- meaning that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies (2) are cited per Title 22 and the Health and Safety Code. Appeal Rights provided, exit interview conducted.the state’s words, verbatim · CDSS document, Sep 8, 2023 · control 59-AS-20230518135637

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 11, 2023

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the LIcensee did not ensure that (R1) was administered scheduled medications, from approximately 4/28/23 through 5/9/23 (morning), while waiting for the medications to be delivered, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 8, 2023

Plan of correction: Licensee/Administrator agree to read regulation 87465 and submit a signed statement of its understanding and also to consider using a Medication Administration Record (MAR) to log every dosage that is administered. Documentation to be submitted to the Dept by 9/11/23 by email/Fax.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(i) · Plan of correction due date: Sep 22, 2023

87465 Incidental Medical and Dental Care (i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of according to the hospice’s established procedures or which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following: This requirement is not met as evidenced by: Based on interview, the Licensee did not document an ending medication inventory and obtain a signature when (R1's) medications were picked up on 5/17/23. The medications picked up on 5/9/23 were not logged on the LIC622-the state’s words, verbatim · CDSS document, Sep 8, 2023

Plan of correction: Licensee/Administrator agree to read regulation 87465 and submit a signed statement of its understanding. Admin agrees to review all current residents' files and ensure that all medication is written on the LIC622.

Allegation investigated: Residents needs are not being met due to a lack of staff

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conclude a complaint investigation. LPA met with Alex Molitvenik, Administrator, and explained purposer of inspection. LPA observed (2) residents in the common area and (2) residents to be resting in their rooms. There are currently (4) residents residing at the community. The facility is approved for (6) non-ambulatory residents. Durinig the inveestigation, LPA interviewed Administrator, (1) staff and reviewed documentation related to staffing schedules, pre-appraisals and physician's report for (4) residents (R1-R4). The results of the investigation are as follows: The complaint alleges that staff has to focus so much attention on (1) resident that the needs of other residents cannot be met. Administrator stated he is at the facility at least 4-5 hours daily and from 6 am- 9 pm once weekly. In additionl, there is a live-in staff that works at the facility, 6 days per week. Administrator stated that in addition to him and the live-in caregiver, there are other individuals on-call for night coverage, if needed. LPA observed names of additional staff listed on the LIC500 that are noted as being "on-call". **cont on 9099C(1)... Unsubstantiated 9099C(1).. Administrator stated that all residents receive at least (2) showers weekly, and more if requested, and he will assist in giving showers, and a shave. . Additionally, residents' laundry is completed daily. There was no shower documentation available to review, but Administrator will document now. R4 receives care, including showers, from hospice nurses, several times per week. Residents receive (3) meals daily with snacks also, and assistance with toileting is provided when needed. LPA did not observe any odors to be present in the facility on 4/16/23 or on 5/18/23 when conducting an inspection. LPA reviewed physician's reports for residents (R1-R4). Resident (R1) is the only resident with a diagnosis of Dementia and the physician's report was last updated 4/23/23. Physician's report for R1 notes resident is confused, ambulatory and wanders. Physician's reports for residents (R2-R3) note residents have a diagnosis of Mild Cognitive Impairment. Reports were dated from 2020 and 2017. Administrator stated he has attempted to get updated reports multiple times but has been unable to. Administrator agreed to ask Conservator to reach out again and request an update for the last medical appointment and maintain in resident's file. Resident (R4) remains on hospice at this time. Administrator stated that none of the (4) residents are regularly awake at night. Administrator commented "(R1) sleeps pretty good,, (R2) doesn't get up and R3 will stay up until 11 pm- 12 am." There were (6) residents about a month ago, but one resident who was only at the facility for (2) weeks . Another resident went to a higher level of care. Administrator advised to always ensure there is sufficient staffing to meet resident's needs. LPA toured the facility and observed each room to be clean, odor free and with clean laundry folded. LPA also trash cans to be emptied and a load of laundry that was recently washed ready to be placed in the dryer. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint 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 Administrator. A copy of updated license showing hospice approval for (4) was printed today.the state’s words, verbatim · CDSS document, May 18, 2023 · control 59-AS-20230403110023

Allegation investigated: Facility staff is under the influence while providing care and supervision to residents. Facility smells of marijuana.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conclude and deliver investigative findings to a complaint received on 12/1/2022 . LPA met with Administrator, Alex Molitvenik, and explained purpose of inspection. Administrator advised LPA that staff (S1) was off work today. LPA completed required COVID-19 protocols and was screened per Covid-19 precautionary measures upon entering the facility, and LPA was wearing a surgical mask. LPA observed (2) residents to be in the common areas and (3) residents to be in their rooms at the start of the inspection. During the investigation, LPA interviewed the Administrator, (2) residents, staff (S1), a family member of one of the resident (R3), and a neighbor. LPA also observed the facility by touring on 12/9/22 and on 1/11/23. The results of the investigation are as follows: cont on 9099C-1.. Unsubstantiated Allegation: Facility staff is under the influence while providing care and supervision to residents. Complaint alleges that (1) staff person is regularly outside the facility smoking marijuana while providing care to the residents. Staff (S1) stated to LPA's on 12/9/22 that he was told by the neighbor and the Administrator that he couldn't smoke marijuana even outside at the facility and has only smoked it away from the facility and on his day off only. S1 confirmed he has not smoked marijuana near the facility and there are no other staff or any residents that smoke marijuana. LPA's explained that staff needs to be able to provide the necessary care and supervision to the residents at all times and that if (S1) was not able to provide the adequate care and supervision, due to being under any chemical influence, he could be potentially excluded for life from ever working in a facility licensed by CCLD. LPA Calzada and LPA Hood did not observe S1 to smell of marijuana smoke on 12/9/22. LPA Calzada toured the facility again on 1/11/23 and observed it to be free from any smoke odors. S1 was not at the facility during the inspection on 1/11/23 as it was his day off. One resident who was interviewed on 12/09/22 stated.."staff has always been able to provide care" and (S1) has never smelled of smoke, has "no concerns" and stated "(S1) is a good guy". The same resident stated "staff is great " and "staff is never under the influence" of anything. A second resident stated that "(S1) does a great job- there are no problems" and has "never" observed (S1) to be under the influence of a drug or alcohol. A family member who regularly visits resident (R3) stated on 1/4/23 that he is very familiar with S1 and has "never observed" (S1) to be under the influence of marijuana or alcohol and S1 and is "very attentive" and does a good job cleaning and preparing individual meals for all (6) residents, and he has only smelled tobacco smoke as some of the residents smoke outside on the back patio. A neighbor who lives nearby the facility provided specific days/times when marijuana smoke was observed to be coming over the fence into her yard when S1 was working. The Department received additional information that marijuana smoke was coming from the facility patio on 12/28/22, but no evidence was able to be provided, including video surveillance, showing the smoke was coming from the neighboring facility. cont on 9099C-2... 9099C-2... The Administrator stated he has "not personally seen (S1) smoking" at the facility and has told S1 he cannot smoke marijuana at the facility and while providing care/supervision to the residents. Administrator stated to LPA in a follow up discussion, on 12/29/22, that if he receives information that marijuana smoke is coming from the facility he will immediately follow up with S1. Administrator stated on 12/9/22 he has video surveillance on his phone and would check to see if (S1) was smoking marijuana while on duty. Administrator stated to LPA on 1/11/23 that he did not find any video surveillance showing S1 to be smoking at the facility. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- Allegation: Facility smells of marijuana. A neighbor nearby the facility stated she has smelled marijuana smoke coming over the fence into her yard on many occasions prior to 12/1/22 for over a year, off and on. The Department was provided with updated information that marijuana smoke was smelled coming from outside the facility on 12/24/22, 12/26/22 and on 12/28/22. LPA Calzada and LPA Hood toured the interior of the facility on 12/9/2023 and did not observe the facility to smell of marijuana or smoke. LPA's observed the windows in (2) resident rooms (1 was vacant) to be half open and each room to have a bottle of air freshener in the room. LPA's observed ash trays in the outside patio area and observed (2) residents to be smoking tobacco cigarettes outside during the inspection. One resident who was interviewed stated that residents that smoke will go outside to smoke. LPA Calzada toured the facility again on 1/11/23 and did not observe any smoke odors inside or outside. Administrator stated he has not personally observed staff, S1, to ever smoke at the facility and has discussed with S1 how smoking marijuana while working with residents it not allowed. A family member who regularly visits resident (R3) stated he has only smelled tobacco smoke as some of the residents smoke outside on the back patio. The Administrator stated on 12/29/22 that he is at the facility everyday and didn't notice anything about staff smoking marijuana. One resident who was interviewed stated that residents that smoke will go outside to smoke. A second resident stated he has never smelled marijuana smoke inside or outside of the facility and has never observed (S1) to smell of smoke or marijuana. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint 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 Administrator.the state’s words, verbatim · CDSS document, Jan 11, 2023 · control 25-AS-20221201084111

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Alex Molitvenik, Administrator, and explained purpose of inspection. LPA observed (2) residents to be in the common areas and (3) residents to be in their rooms at the start of the inspection. Currently, there are (0) residents on hospice. The facility is licensed for (6) non-ambulatory residents. Prior to initiating today's inspection, LPA completed required COVID-19 protocols. LPA was screened per Covid-19 precautionary measures upon entering the facility, and LPA was wearing a surgical mask. LPA and Administrator toured the interior and exterior of the facility including the common areas, (5) resident bedrooms, (2) full bathrooms, kitchen, staff room and 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, and paper towels - Administrator agrees to post 20-second hand-washing posters at each bathroom and kitchen sink. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food. LPA observed the sharps to be unsecured in the kitchen and some medications to be unsecured in resident (R1's) room and in a cabinet near the kitchen. LPA and Administrator discussed vaccination status of residents/staff, eligibility for boosters. LPA observed a few Covid posters throughout as well as other required postings. LPA observed (1) unlocked gate from the inside back patio with covered patio seating. There are no pools or bodies of water. All exit doors have alarms. LPA reviewed (2) staff files and found them to contain current training documentation, including First Aid/CPR. All staff are fingerprint cleared/associated. LPA reviewed (3) resident files and found them to be missing care plans. LPA requested an updated copy of LIC500, LIC308, and current liability insurance be provided by 11/14/2022. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (2) deficiencies are cited on the 809-D page. Exit interview with Administrator. Copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Nov 4, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Williams arrived at the facility unannounced on 11/02/2021 to conduct a Required 1- Year Inspection utilizing the infection control domain. LPA met with Administrator, Aleksander Molitvenik, and explained the purpose of the visit. Prior to initiating the annual 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 he applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Additionally, LPA was screened by facility staff upon entering the facility. LPA and staff toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, five (5) resident bedrooms, three (3) bathrooms, kitchen, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and administrator completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report left at the facility. ***NEW PHONE NUMBER: 916-792-4974 [delete current number]***the state’s words, verbatim · CDSS document, Nov 2, 2021