Alphalife Homecare

Allegation investigated: Staff did not allow family member to visit resident.

Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to deliver the finding on the above allegation. LPA met with Licensee Bryant Saldivar and explained the purpose of the visit. The investigation consisted of file reviews, and interviews with relevant parties. The reporting party (RP) alleged that they were told by staff # 1 (S1) that a relative of resident #1 (R1) could not visit R1 because of their criminal record. The RP was unclear on how S1 found out about R1’s relative’s criminal record because it had nothing to do with them visiting R1. The RP also alleged on another occasion that as the Power of Attorney (POA) for R1, they attempted to make an appointment so R1’s relative could visit. That appointment was canceled by a facility staff member, who also threatened to call the police. LPA interview with the Licensee revealed that R1’s relative was rude and did not make an appointment. The Licensee also advised R1’s relative that the Licensee also needed to check with the POA before permitting the visit. LPA interview with the RP revealed that R1’s relative had been turned away several times because of their criminal record. Substantiated Based on the evidence gathered during the investigation, the above allegation is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conduct were a copy of this report (LIC 9099), LIC 9099D, and appeal rights were discussed and provide. Allegation #2 “Staff locked the resident in a room". The RP alleged that R1 informed them they were locked in a room and unable to come out. LPA interview with the RP revealed that when they questioned R1 about wearing the same clothing, R1 stated they were locked in another room. LPA interview with the Licensee revealed that the Licensee denied that R1 was locked in a room. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation #3 “illegal Eviction” LPA interview with the RP revealed that R1 was never served with an eviction notice. However, the Licensee stated they would evict R1 when the RP mentioned their intentions to remove R1 from the facility. LPA interview with the Licensee revealed that they did not serve R1’s Power of Attorney (POA) with an eviction notice. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation # 4: “Resident is missing personal items”. The RP alleged that the RP decided to look for another place for R1 to live and told the Licensee that they would be picking R1 up on 11/5/2021. The RP alleged that the Licensee advised them that R1’s personal belongings needed to be out by noon 11/4/2021 or they would be donated. The RP further alleged that they arrived on 11/4/21 and all R1’s belongings were at the front door, and they were not allowed to go inside to ensure all of R1’s belongings were collected. LPA interview with RP revealed that when they arrived at the facility to pick up R1 and R1’s belongings, they were not allowed inside. The RP stated that the facility staff brought R1 and R1’s items out. The RP further stated that another relative of R1 contacted the License, and the Licensee returned additional items to R1. However, the RP stated that we were never allowed to retrieve R1’s items inside the facility. LPA interview with the Licensee revealed that they coordinated with R1’s POA on a date to move R1 out. The Licensee stated that the original date agreed upon did not work, but the Licensee did work out with the POA to move R1 out a day ahead of schedule. The Licensee stated that after R1 was moved, they found additional items of R1 and returned them to a relative of R1. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 22, 2023 · control 18-AS-20211104131634

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(2)(A) · Plan of correction due date: Feb 27, 2023

87355 Criminal Record Clearance (2)(A) (2) The following persons are exempt from requirements applicable under paragraph (1): (A) A spouse, relative, significant other, or close friend ... This requirement was not met as evidenced by: Based on interviews, the licensee did not ensure that the facility staff was adhering to the Title 22 of the California Code and Regulation (CCR), Section 87355 (2)(A), which poses a potential heath, safety, and person rights violation to clients in care.the state’s words, verbatim · CDSS document, Feb 22, 2023

Plan of correction: The Licensee shall read Title 22, Division 6, of the California Code and Regulation (CCR), Section 87355 (2) (A), and submit a letter of understanding. The Licensee shall provide training to all staff at the facility and submit proof of training with all facility staff signatures acknowledging proof of training to LPA by the POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Rayshaun Nickolas conducted a case management deficiency visit. The case management visit is in response to a deficiencies cited at the facility. LPA met with Licensee Bryant Saldivar and explained the purpose of the visit. LPA read a notification of fee increase to resident #1’s (R1’s) Power of Attorney (POA) dated 10/07/2021, notifying the POA that their “new payment is $3,000 starting November 1, 2021,” signed by the Licensee. LPA review of R1’s “Admission Agreement and Contract” revealed that R1’s total monthly fees were 2500; therefore, R1’s monthly fees would increase by $500.00 according to the notification to R1’s POA dated 10/07/2021. Page 15 of R1’s Admission Agreement and Contract states, “The facility reserves the right to increase the basic monthly fee and fees for its levels of care by providing a 60-day notice”. LPA interview with R1’s POA revealed that they were notified by the Licensee of the $500.00 fee increase effective November 1, 2021. LPA also discovered during a facility file audit that R1 was accepted as a resident without a medical assessment, signed by a physician. Based on observations made during today’s inspection, two ( 2) deficiencies was cited per Title 22, Division 6, of the California Code of Regulations (CCR) and the Health and Safety Code. An exit interview was conducted and a copy of this report, LIC 809D, and Appeal Rights were given to the Licensee.the state’s words, verbatim · CDSS document, Feb 22, 2023

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.655(a) · Plan of correction due date: Feb 27, 2023

Health and Safety Code section 1569.655(a) a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services... This requirement was net met as evidenced by: Based on file review & interview, the Licensee did not ensure to provide resident # 1 (R1) representative(s) at least 60-day notification of fee increase., which poses a health, safety, and personal rights violations of clients in care.the state’s words, verbatim · CDSS document, Feb 22, 2023

Plan of correction: Licensee shall read the Health and Safety Code section 1569.655 (a) and submit a letter of understanding to LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Feb 27, 2023

87458 Medical Assessment (a) (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment.. This requirement was net met as evidenced by: Based on file review & interview, the Licensee did not ensure that R1 had a medical assessment prior to admission to the facility, which poses a health, safety, and personal rights violation of clients in care.the state’s words, verbatim · CDSS document, Feb 22, 2023

Plan of correction: Licensee shall read 87458 Medical Assessment (a) and submit a letter of understanding to LPA by the POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rayshaun Nickolas conducted an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA arrived and met with Licensee Bryant Saldivar and explained the purpose of the visit. LPA was screened for COVID-19 symptoms and asked to sign-in upon arrival. Saldivar confirmed that there are currently no cases/exposures of COVID-19 within the facility. During the inspection, LPA conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures and other health and safety concerns. LPA observed appropriate postings throughout the facility, including, face coverings, and COVID-19 symptoms postings. The facility was also equipped with sufficient cleaning/disinfecting provisions. LPA observed facility staff wearing face coverings. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division (CCLD) guidelines for COVID-19 testing, isolating/quarantining clients. The facility also has a plan in place to monitor clients regularly for any changes in condition and to subsequently notify the client's physician and emergency personnel in the event the clients presents any COVID-19 symptoms. LPA reviewed clients records during today's inspection. LPA observed and interview a individual volunteering at the facility without criminal record clearance. LPA observed this individual moping in a bedroom and working in the kitchen. The individual states that he/she does not work at the facility but has been visiting for a month. LPA also observed during the client's records review that all clients in care do not have a documented medical assessment, signed by a physician, made within the last year. Based on observations made during today’s inspection, two (2) deficiency was cited per Title 22, Division 6, of the California Code of Regulations (CCR). A $500.00 civil penalty has been assessed for the individual volunteering at the facility without a criminal record clearance. An exit interview was conducted and a copy of this report, LIC 809D, LIC421BG, and Appeal Rights were given to the Licensee.the state’s words, verbatim · CDSS document, Oct 27, 2022

Allegation investigated: Facility staff placing resident in restraints

Licensing Program Analyst (LPA) Rohit Lama made an unannounced visit to initiate an investigation and deliver findings for the allegation listed above. LPA met with the Administrator, Bryant Saldivar. The investigation consisted of interviews and a tour of the facility. The allegation indicates that the facility is using restraints on Resident #1 (R1)'s hands. During the tour of the facility, it was noted that R1 did in fact have hand mitten restraints in place. When the Administrator was asked about the hand restraints, it was explained to the LPA that this was being done because R1's family and Attorney-In-Fact had requested the use of the hand restraints. The Administrator stated that the use of hand restraints was requested to maximize R1's safety. No mention of the restraints is seen in R1's Care Plan. Based on the evidence gathered and observations made during the investigation, the above allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Health and Safety Code 87608(a)(5) is being cited on the attached LIC 9099-D. *****CONTINUED ON LIC 9099-C***** Substantiated LPA conducted an exit interview where a copy of this report (LIC 9099, LIC 9099C, and LIC 9099D) was discussed and provided to the Administrator.the state’s words, verbatim · CDSS document, Apr 11, 2022 · control 56-AS-20220405151228

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87608(a)(5) · Plan of correction due date: Apr 12, 2022

Postural Supports: Based on the individual's preadmission appraisal... the facility shall provide assistance and care for the resident... Postural supports may be used under the following conditions: (5) Under no circumstances shall postural supports include tying, depriving, or limiting use of a resident's hands or feet. This regualtion was not met as evidenced by: Observations made by LPA and Interview with Administrator. This poses as a immediate health and safety risk to resident's in care.the state’s words, verbatim · CDSS document, Apr 11, 2022

Plan of correction: Administrator had removed restraints prior to LPA leaving. Administrator needs to read and understand the Regulation Section 87608 - Postural Support. Administrator needs to train all staff on this regulation as well. Administrator will provide LPA, by POC Due Date (4/12/2022), with a scanned self-certification document showing understanding of the material, which needs to be signed by all staff.

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Stephanie Williams conducted an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Williams identified herself to Administrator, Bryant Saldivar and discussed the purpose of the visit. LPA Williams was asked to sign-in and provide temperature reading upon arrival. Saldivar confirmed that there are currently no cases/exposures of COVID-19 within the facility. During the inspection, LPA Williams conducted a tour of the facility and made observations pertaining to the facility's infection control measures and other health and safety concerns. LPA Williams observed appropriate postings throughout the facility, including COVID-19 symptoms postings and face coverings postings. The facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). LPA Williams observed that one facility staff member was not wearing a face covering. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms. Based on observations made during today’s inspection, two deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. LPA Williams observed that two portable gates were obstructing the facility's hallway passageway where resident bedrooms are located. LPA Williams also observed that two exterior gates where equipped with a padlock without proper fire clearance. LPA Williams also issued two technical violations for Reporting Requirements & Maintenance and Operation. The Administrator confirmed that the facility did not provide the Department with COVID-19 Mitigation Plan (LIC 808) LPA Williams also observed that one staff member was not wearing a face covering upon arrival to the facility. An exit interview was conducted where this report was discussed and a copy was provided to Saldivar at the conclusion of the inspection.the state’s words, verbatim · CDSS document, Nov 2, 2021

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Applicant was not refunded preadmission fee.

Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation and to deliver findings for the allegation listed above. LPA was greeted and granted entry by caregiver Yanira Saldivar. Administrator was unavailable to come to the facility, but was available by telephone. LPA explained the purpose of the visit and discussed the elements of the allegation with the administrator. The investigation consisted of observation, interviews, and a review of pertinent documents. Allegation: Applicant was not refunded preadmission fee. Administrator stated during the interview that there was a signed agreement that anything above $500 was to be refunded, however due to having to go out to the home to conduct the preadmission appraisal assessment took 4 different trips from Apple Valley to Rialto. Having to pick up the applicant to take them to tour the facility, take the applicant back home, and for the Administrator to then drive back home. Administrator stated that they have a signed agreement outlining the conditions in which the preadmission fee would be refunded. Unfounded The applicant did confirm that they were in fact picked up and went to a fast food place to sign a bunch of paperwork, and provided copies of the completed pre appraisal assessment, as well as a signed and dated copy of the Application Fee/preadmission procedure. LPA reviewed the application/processing fee for the applicant as well as resident # 2 and # and it states the reasons for the $500 fee, which includes the resident appraisal. Under conditions for Preadmission refund: 1. If the applicant decides to not to enter the facility prior to the facility's completion of the preadmission appraisal or if the facility fails to provide full written disclosure of the preadmission fee changes and refund conditions..." Based on observation, interview and record review the allegation of Applicant was not refunded preadmission fee is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted and a copy of this report, and appeal rights were provided to Caregiver Yanira Saldivar.the state’s words, verbatim · CDSS document, Aug 12, 2021 · control 18-AS-20210810084426