Afable Home Care II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the full care inspection tool. , LPA was greeted by Jett Dulay, caregiver and explained the purpose of the inspection. Administrator arrived at approximately 4:50 pm. LPA observed a second staff, Edward Valmonte, also present during the inspection. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols, wore a surgical mask and was screened per Covid-19 precautionary measures upon entering the facility. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently there is (1) resident receiving hospice services. LPA observed all residents (6) to be in their rooms resting at the start of the inspection. LPA and caregiver toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms, (1) shared resident bedroom, (1) resident bathroom, kitchen, staff room, laundry area and garage. 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, trash cans with lids and 20-second hand-washing poster. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food and locked sharps in the kitchen. LPA observed locked medications nearby and locked toxins in the outside storage area. LPA observed the inside temperature to be 72*F. The fire extinguisher was last serviced on 9/16/22. LPA observed (2) unlocked gate from the inside back patio. LPA reviewed (2) of (6) resident files and found them to contain current documentation- one care plan was updated recently but is waiting for family signature. LPA reviewed (1) of (3) staff files and found staff to be cleared and associated to the facility and to have current First Aid/CPR training and the required initial training. LPA observed current copy of RCFE Administrator Certificate #6054346740- exp 11/24/23 and #6019060740- exp 9/24/24. PPE supplies are adequate.. LPA requested an updated copy of the LIC308. LIC500 and current liability insurance during today's inspection by 4/7/23. There are no deficiencies cited during today's inspection. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Mar 30, 2023

Allegation investigated: Staff did not provide adequate supervision to resident while in care. Licensee did not do a proper assessment of resident.

On 08/12/22, Licensing Program Analyst (LPAs) Talwinder Bains and Michael Hood conducted an unannounced complaint investigation visit to deliver the findings for the above allegations and met with administrator Nicolasa Afable. Prior to initiating the complaint visit, LPAs 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. Upon arrival, completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask /N-95 mask. Additionally, LPAs was screened with temperature at the facility upon arrival. The department conducted records review and interviews. **Report continued on LIC9099-C** Substantiated Allegation: Staff did not provide adequate supervision to resident while in care. The department conducted interviews regarding resident (R1) leaving the facility unattended on 03/28/22, at approximately 5:00am. Facility administrator and staff confirmed R1 was gone approximately 30-40 minutes. Based on interviews, once staff realized R1 was missing, Facility staff found R1 about 2 blocks from the facility and brought R1 back to facility. Facility called 9-1-1 to notify of R1’s AWOL. However, once R1 was located, the facility called off EMS. Facility was aware that R1 has diagnosis of dementia and cannot leave the facility unassisted. This was the first AWOL incident for R1 since his admission to the facility. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Allegation: Licensee did not do a proper assessment of resident. The department conducted interviews and records review regarding proper assessment was not completed for resident (R1) by facility. During interview, facility administrator stated that R1 was admitted to facility on 03/27/22. Per Administrator, R1’s responsible parties were supposed to come to facility on 03/28/22 to finish all new admission paperwork. It was concluded that no pre-admission assessment or new admission paperwork was completed by facility per RCFE requirement on/before R1 admission to the facility on 03/27/22. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted with Administrator and a copy of this report and appeal rights were provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents. Allegation: Facility alarm was not working properly at the time of resident's AWOL /Elopement incident. The department interviewed facility administrator regarding this allegation.Administrator stated that facility alarm system had no issues and it was working fine. Per Title 22 regulations, RCFE does not require to have any working alarm system for facility to take care of residents in care. However, facility needs to provide proper care and supervision for residents in care, which facility did not do since R1 was able to AWOL from the facility on 03/28/22. Allegation: Facility did illegal eviction of the resident. The department interviewed facility administrator regarding this allegation. Based on record review and interviews, department has concluded that R1 was admitted to this facility on 03/27/22 and was sent out to hospital on 03/28/22 after a fall incident. Facility did not verbalize anything to the hospital or R1’s family that R1 could not come back once he got discharged from hospital. There was no notice of any eviction provided to R1 and/or R1’s responsible party. Based on interviews and records reviewed, the above allegations are found to be UNFOUNDED. A finding that the allegations are unfounded means that the allegations are false, could not have happened, and/or is without a reasonable basis. A copy of this report has been provided to facility. Exit interview conducted. Allegation: Resident has AWOL/ Elopement incident from the facility sustaining an injury to the resident. R1 was admitted to this facility on 03/27/22. Within the 24-hour time frame, R1 had two incidents; R1 AWOL’d from the facility on the morning of 3/28/2022 and was found shortly after. Facility called EMS but EMS did not take R1 to hospital after R1 was evaluated and first aid was provided. On the same day (03/28/22) around 3pm, R1 had what was believed to be a ground level fall from R1’s bed to the floor. Facility contacted 9-1-1 and R1 was taken to hospital for treatment. Upon R1’s arrival to the hospital, R1 sustained a right sided subdural hematoma, laceration on upper lip and frontal scalp hematoma. Based on medical records reviewed, it is unclear to determine if the injuries R1 sustained were due to the AWOL or the fall. Based on interviews conducted by the Department and records review, the preponderance of evidence standards has not been met. Therefore, the above allegation is found 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 was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Aug 12, 2022 · control 25-AS-20220407105548

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4) · Plan of correction due date: Aug 14, 2022

87705- Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by: Based on interviews conducted and record review , the Licensee did not ensure that resident (R1) was unable to leave the facility unassisted, on 03/28/22, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 12, 2022

Plan of correction: Current Licensee/Administrator conducted shall staff training on keeping a closer watch on any residents that may have a tendency to AWOL and document any changes in condition. Documentation of training sholud be provided to LPA by POC date-08/14/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Aug 26, 2022

87457(c)-Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. This requirement is not met as evidenced by: Based on record review and interviews, Licensee did not do pre admission or new admssion assessment for R1 at time of R1 admission to the facility on/before 03/27/22, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 12, 2022

Plan of correction: Licensee shall submit statement of understanding regarding this regulation in writing and submit the documents to LPA by POC date-08/26/22. Also, Licensee will make sure that pre-assessment shall be completed for all new residents prior to admission to the facility.

Allegation investigated: Facility is not releasing records to resident.

Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains arrived at the facility and met with Licensee, Nicolasa Afable, to deliver findings into the allegation listed above. Facility staff wore masks while on the premises. During investigation, the Department reviewed documentation pertinent to the investigation. The results of the investigation are as follows: Allegation: Facility is not releasing records to resident. ** Report continued on 9099-C ** Substantiated The Department obtained a copy of request for resident’s (R1’s) documents dated 6/8/2022 on behalf of R1 via relevant party. The Department obtained a death certificate for R1 indicating that R1 passed away on 4/11/2022. The Department reviewed R1’s Identification and Emergency Information to verify R1’s responsible party. The Department obtained a copy of Authorization to Handle Claim indicating R1’s responsible party as giving permission to relevant party to request R1’s records. With written consent from R1’s responsible party, the Department is requesting the facility to release R1’s records to relevant party via records request generated on 6/8/2022. Based on interviews conducted by the department and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D page. Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Licensee's signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Aug 12, 2022 · control 25-AS-20220607143656

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(c)(1) · Plan of correction due date: Aug 26, 2022

87506 Resident Records (c) All information and records obtained from or regarding residents shall be confidential. (1) (…) The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement is not met as evidenced by: Based on records reviewed, the facility did not ensure that resident R1’s records were made available via request by relevant party with authorization of R1’s responsible party, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 12, 2022

Plan of correction: Facility will release R1’s records via request from relevant party and submit proof of submission to Department. Facility will review regulation 87506 and complete a statement of understanding to Department. Facility will submit proof of submission and statement of understanding to Department by POC due date by 8/26/2022.

Allegation investigated: Facility fails to address the infestation of bed bugs

On May 19, 2022, Licensing Program Analyst,(LPA) DeAnna Williams-Lyons arrived unannounced to deliver findings for complaint # 25-AS-20220502151128. LPA met with administrator, Nicolasa, Afable, and explained the reason for the visit. Prior to the 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; 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: N-95 Masks. The licensee did advised LPA that there were bed bugs in the facility. The licensee stated she had Clark Pest Control come to the facility to treat the bed bugs. The licensee said that the pest control company has recently been to the facility a minimum of 3 times to spray bed area and carpets. To continue see 9099-C... Substantiated During this investigation LPA DeAnna Williams-Lyons did the following to resolve allegation: Received invoices from Clark Pest Control of all the treatments conducted in the last 3 months. Also received confirmation of payment of the treatment being completed by Clark Pest Control. For the foreseeable future Clark Pest Control will be performing monthly maintenance for the next 2 months. Based on LPA's observations and interviews which were conducted and recorded, the preponderance of evidence standards has been met, therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached 9099-D during this visit. Exit interview held, Appeal Rights discussed, copy of report given.the state’s words, verbatim · CDSS document, May 19, 2022 · control 25-AS-20220502151128

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: May 19, 2022

Maintenance and Operation - The facility shall be clean, safe, sanitary and in good repair at all times. The licensee did not ensure that the facility was safe from pests and rodents.the state’s words, verbatim · CDSS document, May 19, 2022

Plan of correction: The licensee has agreed to submit a report on how she will ensure that the facility is safe from pests and rodents. Licensee will submit all invoices from the pest control company POC due date is 6/19/2022.

Type of visit: POC

Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains arrived at the facility and met with Administrator, Nicolasa O Afable, to conduct a Plan of Correction (POC) visit. Facility currently does not have any COVID-19 positive cases. LPAs wore N-95 masks and were screened by facility upon entry. Facility staff wore masks in the care home. Prior to visit, LPAs obtained a picture of fixed and locked drawer used to hold knives, a copy of receipts for food purchases, pictures of labeled food items, pictures of debris cleared in backyard area, and materials for PPE in-service training for staff. During today's visit, LPAs inspected food supply and observed a 2-day perishable and 7-day nonperishable food supply at the facility. LPAs also observed debris cleared from backyard. POCs were cleared during today's visit. No additional deficiencies were issued during visit. Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on this form acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 1, 2022

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains arrived at the facility and met with Administrator, Nicolasa Afable , to follow-up on an Unusual Incident Report (IR) received by the department on 3/29/2022. Facility currently does not have any COVID-19 positive cases. LPAs wore N-95 masks while in the facility. LPAs were screened by facility staff upon entry. IR received on 3/29/2022 stated that resident (R1) was transported to the hospital on 3/28/2022 due to an un-witnessed fall and AWOL incident from the same day . Per IR, R1 is in Mercy San Juan hospital in Sacramento and in a coma at this time. LPAs requested medical records for R1 from facility and administrator will send all required documents to department by 04/04/22 . At this time, this case management needs further investigation. Exit interview was conducted with Administrator . The signature of the Administrator on this acknowledges receipt of this document.the state’s words, verbatim · CDSS document, Apr 1, 2022

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Michael Hood and Talwinder Bains arrived at the facility unannounced on 3/1/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPAs met with Administrator, Nicolasa Afable, and explained the purpose of the visit. Prior to initiating the annual inspection, LPAs 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. LPAs ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. LPAs toured the facility to ensure the health and safety of residents in care. Areas toured include but are not limited to: 6 bedrooms and 3 bathrooms for residents, 1 staff bedroom, common area, dining room, food supply, PPE supply, storage, garage, medication closet, and outdoor area. LPAs and Administrator completed the infection control domain. Upon entry of the facility, LPAs observed that staff were not wearing face coverings while providing care to residents. During visit, LPAs observed backyard of facility contained debris, drawers containing knives were unlocked and accessible to residents in care, and food supply containing a large amount of expired food items, unlabeled and undated food items, and open food packages. As a result of today's inspection, deficiencies are cited pursuant to California Code of Regulations, Title 22, Section 80072(a)(2) regarding staff wearing face coverings while inside the facility, Section 87555(b)(8) regarding food supply, Section 87705 (f)(1) regarding accessible knives, and Section 87303(a) regarding debris in backyard. Deficiencies are listed on 809-D. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. The Administrator’s signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 1, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Mar 16, 2022

80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement is not met as evidence by: During inspection conducted by CCLD on 3/1/2022, LPAs observed staff not wearing face masks while inside the facility, which poses an potential health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Mar 1, 2022

Allegation investigated: Failed to provide timely medical care

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 10/12/21 to provide complaint findings. LPA met with staff and explained the purpose of the visit. Prior to initiating the 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. Upon arrival LPA 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. Additionally, LPA were screened by facility staff upon entering the facility. LPA requested for staff to notify Administrator that LPA is present. LPAs reviewed hospital records, facility records and conducted interviews. The department finds that facility met Tittle 22 requirements. During the course of the investigation, LPA interviews, review of medical records and the incident report submitted for the incident in question in this complaint, it was found that while a caregiver may have not effectively communicated the event to others, the Administrator and medical personal stated that appropriate and timely care was provided to R1 on 8/6/21. Unfounded 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. There are conditions under Covid-19 waivers, the facilities Covid 19 mitigation plan and direction by R1’s conservator under which visitation may be required to be scheduled, time limited and supervised. The protections for visitations are for residents’ rights to be upheld. In this instance, R1’s wishes are not known. R1’s conservator deferred to the facility’s policies. Therefore, a determination is inconclusive. As a result of this investigation, LPA finds allegation to be (US)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 conducted and report provided.the state’s words, verbatim · CDSS document, Oct 15, 2021 · control 25-AS-20210820121519

Type of visit: Required - 1 Year

On 8/30/21 Licensing Program Analyst (LPA) Praveen Singh arrived unannounced to conduct an annual required inspection utilizing the infection control domain. LPA met with Administrator and explained the purpose of the inspection. 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; contacted Facility Representative and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA toured the facility including but not limited to living room, dining room, kitchen, bathroom, and resident rooms. Medications are centrally stored in a locked area that is inaccessible to clients and refilled every 30 days. Facility has enough 2-day perishable food and 7-day non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents and visitors. A thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a mitigation plan. LPA and Administrator completed the infection control domain. See LIC809-C for continued report LPA observed the following violations during inspection: LPA observed that facility has a sign-in policy with only names and dates of visitors, however symptom screening information is not logged. Facility does not document daily temperature and COVID-19 symptom checks, and/or any change in condition for staff and residents in order to track spread and why facility took certain steps to prevent and mitigate spread in the facility. LPA observed S2 did not wash her hands after using the restroom. LPA observed cockroaches in vacant resident room, in R2's room, in hallway, bathrooms and other living space areas. Updated copies of the following documents were requested for facility file and are to be sent to CCL by 09/7/21: • LIC500- Personnel Report • LIC308- Designation of Facility Responsibility • LIC610E- Emergency/Disaster Plan • Evidence of Liability Insurance Deficiencies cited from California Code of regulations, Title 22, and citations are listed on the attached LIC809-D. If the deficiency is not corrected by the noted due date civil penalties may be assessed. Exit interview conducted and appeal rights provided.the state’s words, verbatim · CDSS document, Aug 30, 2021

The state marks this report as 10 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.