Daniel Residential Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced on 5/10/23 to conduct an annual inspection at this facility. LPA Moleski met with administrator Emmanuel Diala and explained the purpose of the visit. Diala's administrator certificate number is 6035710740, and it expires on 8/2/2023. LPA Moleski reviewed two staff files (S1 and S2) and two resident files (R1 and R2). LPA Moleski toured the facility with Diala and inspected common areas, the kitchen, bedrooms, bathroom areas and backyard areas. Furniture and furnishings were sufficient to meet the needs of residents. The facility temperature was 73 degrees Fahrenheit, which is within the required range. LPA Moleski and Diala observed a bathroom faucet's water temperature measure 135 degrees Fahrenheit, which is outside of the required range of 105 and 120 degrees Fahrenheit. LPA Moleski photographed the reading. LPA Moleski observed a first aid kit, an up-to-date fire extinguisher and working carbon/smoke detectors. LPA Moleski observed a minimum 2-day perishable supply of food and a minimum 7-day supply of nonperishable food. LPA Moleski observed a locked cabinet for the storage of medication. LPA Moleski observed a locked closet for the storage of cleaning solutions. LPA Moleski interviewed S2 and R2. This facility is being cited per 22 CCR Section 87303(e)(2). An exit interview was conducted with Diala. Appeal rights and a copy of this report was left with Diala.the state’s words, verbatim · CDSS document, May 10, 2023

Allegation investigated: Staff did not assist resident with medication refills in a timely manner.

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund was met by Care Staff Helen Agbiriogu who called administrator Emmanuel Diala. LPA Lund spoke administrator Emmanuel Diala and explained the reason for the visit. Administrator Emmanuel Diala could not make the visit today and gave permission for care staff Helen Agbiriogu to sign required paperwork. Staff did not assist resident with medication refills in a timely manner- Based on records reviewed and interviews conducted with staff, and residents. It was reported to LPA Lund that resident (R1) was admitted to the facility on 8/3/2022 with many different medications that were no longer prescribed for R1. R1 wanted to take the medications that were no longer prescribed to R1. R1 complained to staff and Administrators Emmanuel & Joyce Diala that R1 wanted to take unprescribed medications. . Unsubstantiated R1 was admitted to the facility on August 3, 2022. R1 stayed at the facility from August 3, 2022 through August 9, 2022. August 10, 2022 through August 19, 2022, R1 was admitted to the hospital and came back to the facility from August 20, 2022 through August 22, 2022. R1 went back to the hospital on August 22, 2022 and didn’t return back to the facility. Administrators and staff only gave R1 prescribed medications according to the Medication Administration Record (MAR) dated August 3 through August 31, 2022. LPA Lund interviewed staff and resident in care. Staff stated, “That they only give medications according to the MAR and give the medication to residents in care in a timely manner. Residents stated, “That they get the medications when they ask for them and when staff give it to them.” Based on facility records, interviews with staff and residents on the information provided, it was unclear if staff did not assist resident with medication refills in a timely manner therefore the allegation was deemed UNSUBSTANTIATED. The Department (CCLD) has found the allegations. Unsubstantiated. A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. An exit interview was conducted with care staff Helen Agbirioguthe state’s words, verbatim · CDSS document, Dec 13, 2022 · control 27-AS-20220810094936

Allegation investigated: Untrained staff Staff did not administer resident's medication as prescribed Staff mismanaged resident's medication

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation. LPA Lund was met by care staff Helen Agbiriogu who called administrator Emmanuel Diala. LPA Lund spoke administrator Emmanuel Diala and explained the reason for the visit. Administrator Emmanuel Diala could not make the visit today and gave permission for care staff Helen Agbiriogu to sign required paperwork. Untrained staff- Based on records reviewed and interviews conducted with staff, and residents. It was reported that medications were not give timely. LPA Lund reviewed resident (R1) facility records R1 was admitted to the facility on 8/3/2022 with many different medications that were no longer prescribed for R1. R1 wanted to take the medications that were no longer prescribed to R1. R1 complained to staff and Administrators Emmanuel & Joyce Diala that R1 wanted to take unprescribed medications. Unsubstantiated LPA Lund reviewed facility training records for staff. On 1/26/2021 and 6/7/2022. On 1/26/2021 staff were trained on how to assist residents with medications intake, how to store and destroy medications, report/document medication errors and etc. On 6/7/2022 staff were trained on the process of handling medications, administration of medication logging, in destruction of medication, process of reading labels, recording, reporting, storage and other information of medication. LPA Lund interviewed staff and residents in care. Staff stated, “That they only give medications according to the MAR and give medications in a timely manner”. Residents stated, “That they get medications when ask for and when staff give it to them when it is time to be given.” Based on facility records, interviews with staff and residents on the information provided, it was unclear if the facility has untrained staff therefore the allegation was deemed UNSUBSTANTIATED. Staff did not administer resident's medication as prescribed- It was reported that staff didn’t read the proper Medication Administration Record (MAR) for Resident (R1). Based on records reviewed and interviews conducted with staff, and residents. It was reported to LPA Lund that R1 was admitted to the facility on 8/3/2022 with many different medications that were no longer prescribed for R1. R1 wanted to take the medications that were no longer prescribed to R1. LPA Lund reviewed Medication Administration Record (MAR) from the facility Medication Administration Record (MAR) dated August 3, 2022 through August 31, 2022. R1 was admitted to the facility on August 3, 2022. R1 stayed at the facility from August 3, 2022 through August 9, 2022. August 10, 2022 through August 19, 2022 R1 was admitted to the hospital. R1 came back to the facility from the hospital August 19, 2022 through August 22, 2022. R1 went back to the hospital on August 22, 2022 and didn’t return to the facility. LPA Lund observed that MAR for R1 for August 2022 and it was properly filled out.. LPA Lund reviewed facility training records for staff. On 1/26/2021 and 6/7/2022. On 1/26/2021 staff were trained on how to assist residents with medications intake, how to store and destroy medications, report/document medication errors and etc. On 6/7/2022 staff were trained on the process of handling medications, administration of medication logging, in destruction of medication, process of reading labels, recording, reporting, storage and other information of medication. Based on facility records, interviews with staff and residents on the information provided, it was unclear if the staff did not administer resident's medication as prescribed therefore the allegation was deemed UNSUBSTANTIATED. Staff mismanaged resident's medication- It was reported that staff didn’t give out the proper medications to R1. Based on records reviewed and interviews conducted with staff, and residents. It was reported to LPA Lund that resident (R1) was admitted to the facility on 8/3/2022 with many different medications that were no longer prescribed for R1. R1 wanted to take the medications that were no longer prescribed to R1. LPA Lund reviewed Medication Administration Record (MAR) from the facility Medication Administration Record (MAR) dated August 3, 2022 through August 31, 2022. R1 was admitted to the facility on August 3, 2022. R1 stayed at the facility from August 3, 2022 through August 9, 2022. August 10, 2022 through August 19, 2022 R1 was admitted to the hospital. R1 came back to the facility from the hospital on August 20, 2022 through August 22, 2022. R1 went back to the hospital on August 22, 2022 and didn’t return to the facility. LPA Lund observed that MAR for R1 for August 2022 and it was properly filled out.. Based on facility records, interviews with staff and residents on the information provided, it was unclear if the staff mismanaged resident's medication therefore the allegation was deemed UNSUBSTANTIATED. The Department (CCLD) has found the allegations. Unsubstantiated. A finding that the complaint allegation(s) are UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. An exit interview was conducted with care staff Helen Agbirioguthe state’s words, verbatim · CDSS document, Dec 13, 2022 · control 27-AS-20220817154450

Type of visit: Office

An announced office meeting was conducted on October 3, 2022 in the Sacramento South Regional Office via Microsoft Teams. The purpose of this office meeting was to discuss professional forward progress and licensee conduct. Present in the meeting representing Community Care Licensing Sacramento South, was Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analyst (LPA) Christina Valerio, Licensing Program Analyst (LPA) Jamie Ivey Canady, and Daniel Residential Care Home LLC representatives Emmanuel Diala and Joyce Diala. Topics discussed during the meeting: Establish a timeline for Scabies Outbreak Health and Safety of Residents Licensee Conduct Licensing Program Analyst (LPA) Standards of Responsibility Business practices regarding licensee interaction with Community Care Licensing (CCL) Emmanuel Diala: The only thing I can say is that everybody did not get the rash at the same time. Stephen and them probably in March. As soon as we noticed it all of them have been taking to the hospital. Emmanuel Diala: Resident 1 (R1) is the biggest problem everyone is focusing on. He did test on allergy. R1 was referred to dermatology. We did everything for each of the resident. All the residents have been to the hospital in March until about July at least 4 to 5 times. Cont 809-C. Emmanuel Diala: Prior to that we were sending them to the doctor and diagnosis of scabies was only to R1. To make sure I am understanding… R1 had a rash was taken to the PCP and PCP determined an allergy test needed to be done and then eventually determined to be seen by dermatology. In July they determined that he had scabies. LPA Jamie Ivey Canady noted the 1/27/22 After Visit Summary for R2 with a diagnosis of Scabies and Emmanuel said that they do not remember sending that document. LPA Jamie Ivey Canady agreed to send the document back to Emannuel Diala after the meeting. LPM Stephen Richardson then continued to talk and Joyce tried to interrupt at 10:44 AM. Stephen told her to hold on he needs to finish. LPM provided feedback regarding on what the facility needed to do after receiving the documents in 01/27/2022. Administrator Joyce Diala: We did not ignore our clients. Even if we got it in January 2022, we did not ignore her. We still took her. LPM Stephen Richardson explained: We are not saying you did not take them to the doctor. We are talking about the follow up care that occurred or did not occur. We are talking about how it was not 100% there to make sure the health and safety of the resident. In January after you received that document, you are required to report to public health. Administrator Joyce Diala at 10:58 AM told Jamie not to nod her head and to say yes or no. Emmanuel Diala: When she came, we did the treatment for bed bugs. We got that treatment. They did not say he had scabies in July. Final Discussion: LPA Christina Valerio tried to deliver the findings. Joyce and Emmanuel Diala refused to sign findings and establish a POC. LPM explained the purpose of delivering findings and the role and what had transpired. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit. An exit interview was conducted with Administrator Emmanuel Diala. A copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. Administrator Emmanuel Diala will sign the document and send signed copy to LPA Ivey Canady at at jamie.ivey-canady@dss.ca.gov.the state’s words, verbatim · CDSS document, Oct 3, 2022

Allegation investigated: Resident sustained rashes while in care Staff failed to meet resident's needs

Licensing Program Analyst (LPA) Christina Valerio contacted Administrator Joyce Diala via Teams Virtual Meeting and explained the reason for the meeting. LPA Valerio explained current complaint is being closed virtually due to the current Scabies outbreak at the facility. The department has determined the following as it relates to the above-mentioned allegations. According to RP and S1, 2 out of 3 residents have had an undiagnosed rash since March of 2022. In accordance with those interviews, residents have been passing the rash back and forth between residents. R1’s rash was finally diagnosed on 8/17/2022, while in the hospital. According to interviews, continued requests made by CCL and RP, residents were not physically provided medical care regarding rash outbreaks. Continues on LIC 9099 - C... Substantiated S1 stated the Scabies outbreak started with a resident that is no longer at the facility. S1 stated the resident was at the facility for less than one month’s time. S1 stated there was no knowledge as to why the rash was being passed back and forth between residents. Based on statements by staff, R2 has ongoing refused treatment, which has proposed a potential continued health and safety risk to the other residents in the facility. According to interview with S2, the length of time R2 has refused medical treatment for the outbreak has been approximately 5 months. According to LPA Ivey Canady observations, staff did not ensure residents medical needs were properly addressed. According to interviews, licensee did not produce requested documentation to verify residents’ medical needs are addressed in a timely manner. Licensee stated residents had been taken to doctor’s appointments. Upon further investigation of those appointments, LPA Ivey Canady discovered those appointments were only phone consultations which required the licensee to follow-up with a dermatologist. According to records produced by the licensee, the residents had not been seen for this medical issue for over a month since the televisit. According to record review, a specialized dermatologist directed the care providers to take the residents in to see a specialist immediately. According to interviews, S1 and S2 did not follow doctors’ orders. Based on interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 6) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An exit interview was conducted with Administrator Joyce. Administrator Joyce said the entire report is false and not true. Administrator Joyce said she is not going to sign anything or create any plan of correction. Administrator Joyce did not want to continue conversation with LPA unless a manager is present. LPA to set up an office meeting with licensee and Licensing Program Managers to discuss this matter.the state’s words, verbatim · CDSS document, Sep 12, 2022 · control 27-AS-20220518093355

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(16) · Plan of correction due date: Sep 13, 2022

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services. This requirement was not met as evidenced by: Based on observations, interview, and record review, residents sustained unidentified rash while in care. Diagnosis of rash was not confirmed until 5 months after onset of rash. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 12, 2022

Plan of correction: Licensee refused to create a plan of correction with LPA Valerio. LPA Valerio will verify if deficiency is cleared on POC due date. Licensee refused to sign. On 09/13/22, Licensee signed hard copy. This report was amended to show plan of correction created with licensee on 09/13/22. Licensee stated the facility will ensure all residents will receive medical care or other services. Licensee stated the facility will follow doctors orders and keep records for each resident in care. Licensee to send statement acknowledging review of 8746.1(a)(16).

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Sep 13, 2022

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed...:(1)The licensee shall arrange, or assist in arranging, for medical... care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on observations, interviews, and record review, the licensee did not obtain a plan for medical care regarding the rashes for 2 out of 3 residents. This poses an immediate health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Sep 12, 2022

Plan of correction: Licensee refused to create a plan of correction with LPA Valerio. LPA Valerio will verify if deficiency is cleared on POC due date. Licensee refused to sign. On 09/13/22, Licensee signed hard copy. This report was amended to show plan of correction created with licensee on 09/13/22. Licensee stated they will document resident appointments, including follow up appointments. Licensee will send documentation via fax regarding scabies treatment and show when facility is cleared by public health.

Type of visit: Office

An announced office meeting was conducted on June 1, 2022 in the Sacramento South Regional Office via Microsoft Teams. The purpose of this office meeting was to discuss the deficiencies observed on visit 05/20/2022 and to discuss the Administrator's plan to mitigate the spread of a current rash observed on 2 residents. Present in the meeting representing Community Care Licensing Sacramento South, was Licensing Program Manager (LPM) Stephen Richardson, Licensing Program Analyst (LPA) Christina Valerio, Licensing Program Analyst (LPA) Jamie Ivey Canady, and Daniel Residential Care Home LLC representatives Emmanuel Diala and Joyce Diala. Topics discussed during the meeting: Unannounced Visit on 05/20/2022 Health and Safety of Residents Follow-up Appointments Universal Precautions Administrator Responsibility Reporting Requirements Bi-Weekly Progress Reports Cont on 809-C The facility has stated they will do the following to achieve continued and improved compliance: Remove "Death Report" from verbiage on outgoing fax cover sheet to Community Care Licensing (CCL), unless facility is in fact reporting a resident death. Professional cleaning monthly. Licensee will submit professional cleaning invoice to LPA Ivey Canady monthly until further notice from CCL. Provide progress reports, regarding all resident rashes, every 2 weeks beginning 6/13/2022. Documentation to be sent to attention LPA Ivey Canady via fax. Maintain documentation in residents' file to show all medications received. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, no deficiencies were cited during this visit. An exit interview was conducted with Administrator Emmanuel Diala. A copy of this report was provided via email and an electronic email read receipt confirms receiving these documents. Administrator Emmanuel Diala will sign the document and send signed copy to LPA Ivey Canady at jamie.ivey-canady@dss.ca.gov.the state’s words, verbatim · CDSS document, Jun 1, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christina Valerio and LPA Jamie Ivey Canady arrived to the facility unannounced to conduct the required annual inspection. LPAs were met by Staff 2 (S2), whom was not wearing a mask once LPAs entered the home. LPAs requested Administrator Joyce Diala to be present during the visit. Administrator arrived 20 minutes later. Upon entering the facility, LPAs observed the home to be malodorous, a smell resembling feces, fish, and dust. LPAs observed a resident in the home at the dinning table. She appeared to be eating breakfast. There were food pieces on the floor, food all over the table, and crumbs from other residents from previous meals. LPAs started to wipe down the kitchen countertop to set up equipment. LPAs observed tiny unidentified bugs, old food scraps, dried sticky residue, and dust after wiping the counters. The counter tops were filled with old plates, used plastic containers, foil wrapped plates with food residue, and used hand towels. Fire extinguishers was up to date with last check on 03/12/2022. No emergency exits were obstructed. Facility temperature in the home was 74* degrees, which is within the required range. The facility was observed to have an adequate supply of non-perishable and perishable foods. Bedrooms had necessary furniture: bed, chair, night stand, light, and a dresser. Bathrooms had a trash can with a close lid, paper towels, and soap. 2 bedrooms and 1 bathroom were observed to have holes in the wall caused by the door knob. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, deficiencies were found and can be found on LIC 809-D. Failure to correct the deficiency may result in civil penalties. An exit interview was conducted. Administrator Joyce Diala refused to sign. Signature will be obtained on the hard printed copy and put in the facility file. Administrator to send signed copy via fax to the department by COB 05/20/22.the state’s words, verbatim · CDSS document, May 20, 2022