Atria Del Rey

Type of visit: Case Management - Other

Licensing Program Analysts (LPA) Javier Prieto conducted an unannounced visit to the facility for to initiate Case Management visit Health & Safety check. LPA Prieto identified himself and discussed the purpose of the visit with Director Kumar. Clients in care were present during visit. No imminent health and/or safety concerns observed at the time of visit. LPA Prieto observed no health and/or safety hazards inside the facility. LPA Prieto inspected the outside perimeter of the facility and observed no health and/or safety hazards. It was observed to have sufficient staff present at the facility to provide care. LPA Prieto inspected the facility dining and kitchen area and found to be clean, sanitized and neat in order. The needs of the residents in care appear to be met during this inspection. An exit interview was conducted where this report (LIC809) was discussed and provided to Director Kumar.the state’s words, verbatim · CDSS document, May 3, 2023

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to this facility to request records for and deliver an amended allegation findings to complaint control number: 18-AS-20220126095612. LPA met with Executive Director (ED) Suby Kumar and Nicole Stinson, Resident Services Director. RSD Nicole Stinson will provide records electronically no later than the endo of this week due to system and access changes from April 2022. The allegation is Staff do not ensure resident takes medication and the amended finding is UNSUBSTANTIATED. ED Suby Kumar signed the amended LIC9099. The report was discussed with and copies were provided to ED at the conclusion of today’s visit.the state’s words, verbatim · CDSS document, Mar 21, 2023

Allegation investigated: The facility has rodent infestation. The facility is not maintained in a clean and sanitary manner. The facility is not providing assistance in meeting necessary medical needs of the resident. The facility is failing to dispense medications as ordered.

Licensing Program Analyst (LPA) Javier Prieto arrives the facility to conduct a complaint investigation regarding allegations that the facility has rodent infestation, the facility is not maintained in a clean and sanitary manner, the facility is not providing assistance in meeting necessary medical needs of the resident and that the facility is failing to dispense medications as ordered. LPA met with Executive Director Suby Kumar. LPA tour room of resident #1 (R1) where mouse droppings were observed. Incident was isolated to R1 room. Facility has an exterminator company that arrives monthly and bi-weekly to treat the facility as well as special instructions pertaining to rodent exclusions. R1's belongings were washed, room clean and treated with carpets professional cleaned. R1 was moved to another room were she will continue her residence. LPA toured the facility to find it clean, free from odors and free from clutter. Staff observed R1, in need of medical attention and addressed this matter appropriately by transporting to a medical facility and providing medical services before returning to the facility. This incident was documented by facility and copy provided to LPA Prieto. R1 is mobile and is witnessed by staff if any needs are required relating to care. Unsubstantiated Resident Services Director (S1) provided a copy of R1's Medication Administration Log (MAR) and upon reviews states that all medications are being dispensed as prescribed. Based on the information obtained there is not enough evidence that that the facility has rodent infestation, the facility is not maintained in a clean and sanitary manner, the facility is not providing assistance in meeting necessary medical needs of the resident and that the facility is failing to dispense medications as ordered.. Therefore, the allegations that are deemed UNSUBSTANTIATED at this time. A copy of this report was signed by LPA Prieto and Executive Director .the state’s words, verbatim · CDSS document, Sep 14, 2022 · control 56-AS-20220912103105

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javier Prieto made an unannounced visit to the facility to conduct an annual inspection with an emphasis on infection control. LPA met with Suby Kumar and explained the purpose of the visit. There are currently no cases of COVID-19 within the facility. During today's visit, LPA toured the facility and made observations pertaining to the facility's infection control measures. LPA observed proper signs throughout the facility, sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and proper use of 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 proper use and disposal of PPE and overall infection control. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and residents for COVID-19, when and how to isolate/quarantine residents, and when to schedule cleaning and disinfection times of high traffic and frequently touched areas. 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 to notify all emergency agencies in the event of any COVID-19 related and/or suspected illnesses. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview to review this report was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 8, 2022

Allegation investigated: Staff gave medication to a resident that was not prescribed for the resident Staff did not obtain timely medication refill for a resident

Licensing Program Analysts (LPA) Rohit Lama conducted an unannounced visit to initiate a complaint investigation and deliver the findings for the allegations listed above. LPA met with Nicole Stinson, Resident Services Director. The first allegation indicates that staff was giving medication that was not prescribed to Resdent #1 (R1). The second allegation states that staff did not obtain a medication refill for R1 in a timely mannar. Interviews with Staff #1 (S1) confirmed that there was a mix-up with the the medication. S1 stated that the medication in question was suppsoed to run out (based on pill count) on 03/26/2022. It is unknown where additional pills of the same medication came from, however, it was noted on 04/07/2022 that the medication had run out. S1 further states that a refill was promptly ordered and the medications arrived in time to give R1's medications as prescribed on 04/08/2022 ***** CONTINUED ON LIC 9099-C ***** Substantiated Based on the evidence gathered during 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. Section 87464(f)(4) is being cited on the attached LIC 9099-D. Refer to LIC 9099-D dated 04/15/2022 for deficiencies cited. A civil penalty will be assessed for an amount of $100 per day retroactively for the first 15 days if the operator fails to correct the deficiency on the plan of correction (POC) date. Additional fees may be assessed thereafter. LPA conducted an exit interview where a copy of this report was discussed and provided to the Resident Services Director.the state’s words, verbatim · CDSS document, Apr 15, 2022 · control 56-AS-20220408152008

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Apr 29, 2022

Basic Services: (f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications. This regulation was not met as evidenced by: Staff #1 (S1)'s admission that medication was not administrered as prescribed and was not refilled in a timely mannar. This poses a potential heatlh and safety risk for residents in care.the state’s words, verbatim · CDSS document, Apr 15, 2022

Plan of correction: The Executuive Director has already ensured that appropriate medication has been refilled and an accurate pill count was taken of all medications. Executive Director will provide LPA with proof that an in-service trainning was given to the Med Techs covering the topic of Medication Administration and Management by Plan of Correction (POC) due date of 04/29/22.The proof will be in the form of a document stating what topic was discussed along with printed names and signatures of all staff that attended the training.

Allegation investigated: Resident fell while in care Rsident sustained injuries while in care

On 3/14/22 Licensing Program Analyst (LPA) Shaunte Henry conducted an unuannounced visit for the purpose of delivering the findings to the above allegations. LPA Henry met with Erick Romero, Director of Culinary Sevices. The investigation, which consisted of observation, file review and interviews revealed the following: During an interview family, it was reported that Resident 1 (R1) fell in September of 2021 and 11/24/21. R1 was not able to confirm the date of the September fall. During an interview with R1, during the September fall, they were able to get up off of the floor without assistance. R1 did not report the fall to the facility. R1 told a family member that they had fallen. R1's family called the facility on 9/30/21 and told the facility that R1 had a fall some time in September, but they did not have an exact date. ***Continued on 9099C*** Substantiated ***continued from 9099*** The LPA observed the ceiling repairs. Interviews with the director, Staff 1 (S1), R1 was being provided laundry services every Monday. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted where this report was provided to the director. ***Continued from 9099*** An interview with the facility director, Sam DeGuzman and R1 revealed R1 sustained a fall on 11/23/21, which resulted in a laceration to the left arm. R1's wounds were treated by the on-site nurse as well as urgent care. Based on LPAs observations and interviews, which were conducted, 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 ) is being cited on the attached LIC9099D. An exit interview was conducted where this report, LIC 9099D, LIC 81 and appeal rights were provided to Erick Romero, Director of Culinary Sevices.the state’s words, verbatim · CDSS document, Mar 14, 2022 · control 18-AS-20211201102705

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Mar 18, 2022

PERSONNEL REQUIREMENTS (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on file review and interviews, R1 sustaind a fall on 9/24/22 and 11/23/21. Both falls resulted in minor injuries. This is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: The licensee will review the cited regulation, sign/date and provide a copy to the department by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Mar 18, 2022

PERSONAL RIGHTS (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations... Based on file review and interviews, R1 sustained injuries after a fall in 9/24/21 and 11/23/21. This is a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: The licensee will review the cited regulation, discuss with staff the importance of safety regarding residents. Sign/date and provide a copy to the department by the POC date.

Type of visit: Required - 1 Year

On 9/30/2021 Licensing Program Analyst (LPA) Shaunte Henry arrived at the facility to conduct an unannounced annual inspection with an emphasis on infection control. The LPA met with Executive Director (ED) Samuel Deguzman, explained the nature of the inspection and was granted entry into the facility. LPA’s temperature was taken with contactless thermometer and the LPA was screened for COVID-19 symptoms. There are currently 85 residents at the facility. As of this date, there are no positive COVID-19 cases or individuals with COVID-19 like symptoms present in the facility. The LPA toured the facility with the Executive Director. The ED was advised to post additional signs regarding proper hand washing, cough/sneeze etiquette, and social distancing practices. Facility also documents daily temperature and COVID-19 symptom checks, and any change in condition for staff and residents via an application that is accessible to residents families. The LPA observed hand sanitizer throughout the facility. The LPA observed a sufficient supply of hand hygiene, cleaning and disinfecting items. The LPA observed a sufficient supply of Personal Protective Equipment (PPE) that included surgical masks, N-95 masks, face shields, gloves, gowns, glasses, etc. The facility has a designated infection control person who is responsible for ensuring that the facility is compliance with infection control practices. The facility has a COVID-19 mitigation plan in place, which outlines testing requirements, isolating/quarantining positive COVID-19 cases, proper cleaning/sanitizing/disinfecting and monitoring of individuals for COVID-19 symptoms. The facility is aware that it is mandatory that Community Care Licensing (CCL) is contacted if anyone tests positive for COVID-19. According to California Code of Regulations, Title 22, Division 6, there were no deficiencies observed or cited during this visit. An exit interview was conducted where this report was discussed with and provided to the ED.the state’s words, verbatim · CDSS document, Sep 30, 2021

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Pauline Beschorner conducted a case management visit to deliver an amended complaint investigation report regarding complaint number 18-AS-20210525135840. The report was reviewed with and provided to Executive Director Samuel DeGuzman. Nothing further is needed at this time. An exit interview was conducted and a copy of this report was provided to Executive DIrector Samuel DeGuzman.the state’s words, verbatim · CDSS document, Jul 8, 2021

Allegation investigated: Facility does not meet resident's dietary needs Facility not maintained clean and sanitary at all times Facility did not ensure that needles and syringes are disposed of properly

Licensing Program Analyst (LPA) Pauline Beschorner conducted an unannounced complaint visit in order to deliver findings for the above complaint allegations. LPA met with Executive Director Samuel DeGuzman. The investigation included interviews with executive director, staff, resident (R1) and record review. The first allegation alleges facility does not meet resident's dietary needs. On October 30, 2020 R1 signed a special diet clarification form that indicated R1 was able to self-manage a special diet and R1's diet should not include any concentrated sweets. A review of R1's physician report reveals R1 is to have a diabetic diet. A review of R1's admission's agreement does not indicate R1 has a special diet. Interviews with executive director and staff revealed a diabetic diet is not offered at the facility but rather limited concentrated sweets are offered. Based on the information provided it is unclear what type of diet R1 is to be on and whether R1 was able to self-manage R1's own diet. The second allegation alleges facility is not clean and sanitary at all times. LPA observed the facility to be Unsubstantiated executive director and staff revealed R1 is R1's own responsible party. A review of R1's Admission's Agreement, and R1's Identification and Emergency Information form corroborates R1 is R1's own responsible party. R1 has signed all documents and there is no information showing R1 has any other responsible party to report change of condition to. This agency has investigated the above-mentioned allegations and we have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted, and a copy of this report is being reviewed with and provided to the facility Executive Director Samuel DeGuzman whose signature on this form confirms the above-mentioned documents. clean, safe, sanitary and in good repair. LPA observed the housekeeping schedule for R1's room. The resident’s rooms are cleaned based off of the residents Admission's Agreement. R1's admission's agreement states housekeeping will go into R1's room 1 time per week to dust, vacuum, clean the bathroom and provide towels if needed. Due to R1's health diagnosis LPA is unable to corroborate whether R1's room has health hazards that would affect the health and safety of R1. The third allegation alleges facility did not ensure that needles and syringes are disposed of properly. Interviews with executive director and staff revealed R1 is able to administer R1's insulin shots. Executive Director stated R1 has always taken used syringes to the fire station and recently stopped. The facility provided R1 with a disposable bin to place used syringes in. During interview with R1 LPA observed approximately 5 used insulin needles in a coffee mug. LPA is unable to corroborate when staff started providing the disposable bin and what further steps staff took when R1 would not put used syringes in bin as needed. Although the above-mentioned allegations may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are deemed UNSUBSTANTIATED at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Executive Director Samuel DeGuzman, whose signature on this form confirm receipt of the above-mentioned documents.the state’s words, verbatim · CDSS document, Jul 1, 2021 · control 18-AS-20210525135840