Popo's Place

Allegation investigated: Residents are chemically restrained with medication Facility staff not fingerprint-cleared Staff are using drugs while on duty Facility staff are abusing residents

LIcensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to complete and deliver findings to a complaint received on 3/28/23. LPA met with Euretha Micheli, caregiver, and explained purpose of inspection. LPA spoke to Kim Rosa, House Manager, by phone, who arrived at 3:20 pm.. LPA completed required COVID-19 department protocols and was wearing a surgical mask. LPA observed (3) residents watching television in the common area and (2) residents in their rooms. LPA interviewed the Administrator, (2) caregivers and (2) residents and reviwed medication orders for (2) residents. LPA also toured the facility and observed all residents on 4/5/23 and on 4/19/23. The results of the investigation are as follows: Allegation: Residents are chemically restrained with medication. All staff and resident interviews indicated that residents are only administered medications that are ordered and generally sleep through the night. Caregiver interviews and medication review showed that (1) resident (R1) takes Trazadone, which can cause drowsinesss, as a scheduled medication and (2) residents (R2 and R3) take Trazadone as a PRN. LPA observed ordered medications to be given as ordered and no errors for residents (R1 and R4) . Facility to conduct refresher medication training on documentation and using the correct start date. Also, facility is correctly documenting the PRN medications but will train on this also. ***cont on 9099C(1).. Unfounded 9099C(1). Based on information obtained, LPA finds the allegation to be UNFOUNDED-means that the allegation is false, could not have happened, and/or is without a reasonable basis. Allegation: Facility staff not fingerprint- cleared. LPA reviewed staff files for (2) staff, including photo ID, and observed that both staff are fingerprinted cleared and associated. Additionally, Co-Administrator is fingerprint cleared and associated. Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis. Allegation: Staff are using drugs while on duty. Complaint alleges that staff are using drugs while on duty. Based on interviews with staff and residents and LPA's observations on 4/4/23 and on 4/19/23, and also in February and March 2023, staff were observed to be competently assisting residents and able to perform their jobs. Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis. Allegation: Facility staff are abusing residents. Based on interviews with staff and residents and LPA's observations on 4/4/23 and on 4/19/23, staff are not abusing or neglecting residents. Residents who were able to be interviewed stated staff provides excellent care and assists them well. LPA observed (3) residents watching television during all inspections and didn't observe any physical bruising on any residents. Based on information obtained, LPA finds the allegation to be UNFOUNDED- means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview. Copy of report provided to Co-Administrator.the state’s words, verbatim · CDSS document, Apr 19, 2023 · control 59-AS-20230328174026

Allegation investigated: Resident sustained an unexplained bruise while in care. Staff scratched resident while in care. Staff does not provide a comfortable temperature for resident in care. Staff does not provide resident clothing.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conclude the complaint investigation and deliver findings tp a complaint received 1/19/23 . LPA met with caregiver staff, Luz Jimenez, and explained purpose of inspection. Administrator was contacted but not able to be present. LPA observed (3) residents to be in the common areas and (2) residents to be in their room at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently, there are (0) residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols and was wearing a surgical mask. During the investigation, the Department interviewed House Manager, (2) care staff, (3) residents, including resident (R1), and R1’s representative. The Department took photos of R1’s clothing and socks and reviewed resident’s physician’s report, orders,charting notes and other documentation. Resident (R1) has a diagnosis of Unilateral Primary Osteoarthritis on the left knee and generalized muscle weakness. The physician’s report does not indicate resident has a diagnosis of Dementia but states that resident can be confused or disoriented, needs assistance with all activities of daily living and is not able to leave the facility unassisted. House manager indicated that R1 is in the early stages of Dementia. The results of the investigation are as follows: Unsubstantiated 9099C(1)..Allegation: Resident sustained an unexplained bruise while in care. Complaint alleges that staff mistreats her and was observed to have a bruise on her face. Staff (S1) stated on 1/27/23 that resident (R1) did not have a bruise when she moved to the facility in December 2022 and has been trying to get used to using a wheelchair, and has bruising on her arm because of this. A second staff (S2) stated that she has not observed R1 to have any bruises on the face but only on her wrist area, stating "her arms are sensitive" as with all of the residents. Two (2) residents stated they have not observed any bruising unless the resident did it to themselves, stating "some of us bump our hands or wrists". LPA Parks did not observe any bruise or marking's on resident's cheeks on 1/27/23. LPA Calzada did not observe any bruise or marking on resident’s face on 2/10/23 or on 3/2/23. Resident’s family member stated “there is no truth to any bruising" by staff and both S1 and S2 are "very professional every time" he has visited. Complaint indicated that R1 was observed to have a bruise on her face on/around 1/19/23. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- 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 scratched resident while in care. Complaint alleges that staff scratched resident's face. Resident stated to LPA on 1-27-23 that she was grabbed by her cheek by staff not that long ago; however, LPA did not observe any bruising on resident's face. cont on 9099C(2).. 9099C(2).. One resident interviewed stated she has not observed staff to ever hit or scratch a resident(s). Another resident stated she has never observed any bruising on any resident(s) due to staff hitting them. S1 stated on 1/27/23 that resident did not move in with any bruises but was frightened of her new living environment. S1 stated that resident can be verbally aggressive, does not like her (S1) and prefers to have staff (S2) provide care for her. S1 stated R1 will allow her to give her a shower. Charting notes for resident R1 document that on 12-10-22 staff (S1) wrote that while attempting to stop resident from sliding out of bed, she “grabbed her arms and accidentally tore her skin… and patched it”. Notes say the “nurse came in to fix the wound’ with instructions to not remove the bandages and to let the wound dry out… the bandages will fall off”. LPA Parks did not observe any bruise or marking's on resident's cheeks on 1/27/23. LPA Calzada did not observe any bruise or marking on resident’s face on 2/10/23 or on 3/2/23. Based on information obtained, including a prior incident when S1 accidentally scratched R1, LPA finds the allegation to be UNSUBSTANTIATED- 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 does not provide a comfortable temperature for resident in care. Resident complains of being cold. House Manager stated on that she removed the vent cover from R1's room, on 1/28/23, the day following when she spoke to LPA Parks. House Manager stated the vent cover had been placed there by a prior resident which "may have been preventing the heat" from heating the room”. R1’s representative stated "there was a vent that was closed in (R1's) room, from the previous tenant, but it has since been reopened” and “my grandma is always cold”. S2 stated on 3/2/23 that there was a plastic cover over the vent in R1's room, but the temperature has always been fine as the door is always open. S2 stated that the temperature is currently the same as it was before with the cover". LPA observed the temperature to appear to be the same as the rest of the facility on 3/2/23, even with the window slightly open. cont on 9099C(3).. 9099C(3).. LPA Parks observed the inside temperature to be 74 degrees on 1/27/23 in the early afternoon. LPA Calzada observed the inside temperature to be 75*F on 2/10/23 and 74*F on 3/2/23. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- 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 does not provide resident clothing. Complaint alleges that R1 doesn’t have enough clothing other than a hospital gown. All staff interviewed indicated that R1 moved to the facility with only a few items of clothing, including a robe and (2) tops. Resident Personal Property and Valuables (LIC621)was signed by resident’s POA on 12/14/22 with no items listed, including clothing. Staff interviews also revealed that the facility reached out to R1's responsible person on (2) to (3) occasions requesting R1 be provided with additional clothing for colder weather. S2 stated that in addition to R1's representative bringing some additional clothing to R1, another resident, who was cleaning out, gave some of her clothing to R1. (2) residents interviewed confirmed that R1 was given some winter clothing from another resident who was cleaning out. Resident's representative confirmed that the facility did reach out to him requesting additional clothing and he brought some clothing over, stating he felt R1 had adequate clothing when she moved in. LPA Calzada observed additional clothing on 3/2/23 than what was in resident’s room and dresser on 1/27/23, based on photos taken. Resident moved to the facility on/around the middle of December 2022. R1's charting notes indicate that R1's representative brought slippers, a blanket and a pair of pajamas over on 1/10/23 and S2 advised representative R1 needed more clothes. House manager stated that she brought some clothes to the facility for R1 on 1/28/23, after speaking with LPA on 1/27/23,. who stated it was the facility's responsibility to ensure that resident has sufficient clothing for the season and if the family is not responding, the facility can purchase the clothing and then issue a bill for the clothing. Based on information obtained and it not being clear how soon facility reached out to R1's representative, LPA finds the allegation to be UNSUBSTANTIATED- although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.the state’s words, verbatim · CDSS document, Mar 2, 2023 · control 25-AS-20230119110911

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met with caregiver staff, Retha Micheli, and explained purpose of inspection. LPA spoke to Administrator, Rachel Miles, by phone at the start of the inspection. Rachel stated her manager would meet LPA at the facility. Manager, Kim Rosa, arrived at 2:30 pm.LPA observed (4) residents to be in the common areas and (1) resident to be in her room at the start of the inspection. The facility is licensed for (6) non-ambulatory residents and has a hospice waiver for (2). Currently, there are (0) residents on hospice. 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. LPA and manager toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms (1) shared resident bedroom, (2) resident bathrooms, (1) staff room, kitchen and laundry area, and garage 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, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps, medications and toxins in the kitchen and locked toxins in the laundry area. LPA observed the inside temperature to be 75*F. All staff are cleared and associated to the facility. Discussed vaccination status of residents/staff. Booster flyer was provided. LPA observed multiple Covid posters throughout as well as other required postings. LPA observed (2) unlocked gates from the outside patio and also covered seating. LPA observed sufficient incontinent and PPE products on hand. Discussed PIN 23-02 issued 2/9/23. LPA observed RCFE Administrator certificate #6001225740-exp 6/1/23. LPA reviewed (2) resident files and (2) staff file and found them to be complete with current documentation, including training, completed through out approved outside vendor. LPA requested an updated copy of the LIC308, LIC500 and current liability insurance be provided by 2/17. There are no citations issued during today's inspection. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Feb 10, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with Assistant Administrator Kim Rosa during today's 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical masks. LPA toured facility with administrator to ensure health and safety of residents in care. LPA toured 4 resident rooms, 1 staff room, bathrooms, kitchen, common living spaces, backyard and the garage area. In the areas toured no immediate health, safety, or personal rights violations were observed. Administrator stated there has been no positive COVID cases at the facility, and have sufficient amount of PPE. LPA and admin completed the infection control domain and facility was found to be in substantial compliance at this time. Administrator to send into CCL LIC500 and copy of liability insurance. No deficiencies are being cited as a result of todays inspection. Exit interview conducted.the state’s words, verbatim · CDSS document, Apr 11, 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: Annual/Random

On 12/10/2021 LPA Tryon visited the facility to perform an Annual Inspection using the Infection Control Domain of the Annual Tool. Prior to visiting, LPA had contacted the facility and did a quick screen to learn that there are no COVID positive residents or staff at this time. LPA screened prior to entering including taking temperature and using hand sanitizer. LPA requested a copy of most recent Administrator Certificate, copy of liability insurance, and current staff schedule. A Technical Advisory was issued regarding N-95 Fit Testing. The facility is in the process of finding a resource. The facility appears to be in substantial compliance at this time. Exit interview conducted.the state’s words, verbatim · CDSS document, Dec 10, 2021