Walnut Home Care

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a case management visit. LPA met with Licensee, Mariana Oltean, and explained the purpose of the visit. During today's visit, LPA wore the following Personal Protective Equipment: surgical mask. LPA and Licensee conducted a tour of the facility to ensure the health and safety of residents in care. LPA observed one (1) resident in the dining room watching television. LPA observed two (2) residents present in the common area together, LPA observed another (2) residents alone in their private rooms, and (1) resident with a nurse. LPA was informed by Licensee there is no concerns at the facility at this moment. As a result of today's visit, no deficiencies cited. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Jul 26, 2023

Type of visit: Required - 1 Year

On 11/29/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Required- 1 Year annual inspection utilizing the infection control domain. LPA met with Caregiver, Dacia Fletcher, and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols and the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured to apply hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA and caregiver toured the interior and exterior of the facility including bathroom, (6) resident bedrooms, (2) caregiver room, laundry room, kitchen, backyard and common areas. In the areas toured, no immediate health, safety, and personal rights violation were observed. LPA observed the facility to have 2+ days of perishables and 7+ days of non-perishable foods. Fire extinguishers was observed to be last serviced on 10/14/2022. LPA observed the facility to have the Ombudsman and CCLD posters to be posted. LPA observed paper towels, soap and hand washing signs in bathroom. LPA observed sharps, toxics and medication to be locked and secured. LPA observed posted Administrator Certificate to be expired, Administrator informed LPA she never received the updated copy but it has been renewed. LPA confirmed via online website of CDSS Active Certificate List that Administrator Certificate #6024790740 has been renewed, expiration date of 02/23/2024. LPA completed the infection control domain and at this time the facility was found to be at substantial compliance. LPA requested copy of LIC 500, LIC 308 and current Liability Insurance to be emailed to LPA Yang by Friday, December 9, 2022. As a result of today's inspection, no deficiencies were observed. Exit interview was conducted. A copy of report was left at facility.the state’s words, verbatim · CDSS document, Nov 29, 2022

Allegation investigated: Resident denied visitation

Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 8/ /22 to deliver complaint findings. LPA met with Diane Oltean and explained the purpose of the visit. Prior to initiating the complaint visit, LPA completed the department's required COVID-19 testing and screening protocols. LPA ensured they 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. The department reviewed client/resident records and conducted extensive interviews. On 6/24/2022, a family member ( FM1) of R1 attempted to visit R1 at the facility. FM1 alleged staff S1 would not allow the FM1 into the facility based on POA instruction and when S1 showed R1 FM1 photo id, S1 reportedly told FM1 that R1 does not recognize her. S1 stated that R1 seemed to recognize FM1 and stated "no" to wanting to have FM1 visit. The staff then called R1’s POA and informed him that FM1 was at the facility requesting to visit R1. POA arrived at the facility and blocked the facility door, so that Substantiated FM1 could not enter into the facility. Latter on 6/24/22 at temporary restraining order was issued for FM1 to not visit R1. On 8/11/22, LPA interviewed R1 in her room. R1 has advanced dementia and very limited verbal interaction skills. LPA looked at a family photo of R1 and her family with R1. R1 was not able to verbally state the name or relationship of her to anyone in the photo except “my husband” when staff pointed at him. Facility records provided found R1 had granted POA financial powers in 1999. Powers to restrict visitation was not found in the document at the facility. POA provided the following documents to LPA on 8/17/22: 1995 temporary restraining order from R1 for POA (financial) 1999, Do not visit letter from R1 to family member attempting to visit 2007; Typed letter from R1 to her prior facility asking facility to restrict FM1 visits 2017; a hand written note from R1 to the same facility to restrict FM1 visits 2019. LPA is unable to verify the authenticity of the documents. The department’s guidance, as presented in Provider Information Notice PIN 21-48-ASC Authority of Conservators and Agents Under Powers of Attorney Related to Residents' Rights, for such circumstances is that while both a POA and a conservatorship give one person the authority to make decisions for another person, the extent of that authority varies. POA agents are limited to the powers granted in the POA document. POAs typically do not address issues concerning visitation, telephone calls, or personal mail and therefore, agents are not authorized to restrict these rights. However, a POA agent can regulate visitation, telephone calls or personal mail only if: 1) the resident explicitly gave the agent the authority to regulate these issues in the POA and 2) the principal does not disagree with the choices the agent is making. Principals, even those with a cognitive impairment, retain the legal authority to control their health care and other personal decisions unless a court has taken that authority away. [Probate Code section 4689] The law specifically prohibits conservators from restricting visitors, telephone calls and personal mail unless there is express court approval. [Probate code section 2351] If licensees have concerns about a resident's visitors, telephone calls, and personal mail being disruptive, abusive, or threatening in nature, the department advises the licensee to seek assistance from local law enforcement. Therefore, on 6/24/22, FM1 was restricted from visitation to R1. R1 was not provided an opportunity in a manner within her current abilities to accept or decline the visit. 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 summarized by phone with Diane Oltean. Signature received by caregiver . Copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Aug 24, 2022 · control 25-AS-20220803094857

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Sep 7, 2022

Personal Rights of Residents in All Facilities (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement was not met based on records and interviews finding POA did not have standing to restrict visits and R1 was not allowed a visit. This violated R1’s personal rights.the state’s words, verbatim · CDSS document, Aug 24, 2022

Plan of correction: Licensee will submit a statement of understanding of resident rights vs POA powers limitations when determining resident visitation, by the POC date of 9/7/22.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with Tracey, caregiver, and explained purpose of inspection. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA confirmed there are no residents or staff with a confirmed case or signs/symptoms or Covid. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA observed all (6) in their private resident rooms. LPA was advised there is (1) resident is on hospice. LPA met with Administrator, Dianne, who arrived shortly to the facility. LPA and caregiver toured the interior of the facility. LPA observed it to be clean and in good repair. LPA observed various Covid posters throughout.. Rooms toured include (6) private bedrooms and (2) caregiver rooms, (3) bathrooms, kitchen, laundry, garage and common areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and caregiver completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 72* F. LPA observed sufficient 2+day perishable and 7+day non-perishable food. LPA observed paper towels, soap and sanitizer, trash can with lid and hand-washing poster in the bathrooms. Discussed vaccination status of residents and staff. Current copies of Administrator certificates posted. Fire extinguisher serviced 10/27/2021. There were no deficiencies observed during today's inspection. LPA requested updated copy of liability insurance and LIC308. Exit interview. Copy of report to be e-mailed to facility.the state’s words, verbatim · CDSS document, Nov 8, 2021