Mountain View Cottages-VI

Type of visit: POC

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced Proof of Correction (POC) visit for deficiency cited on form LIC9099-D issued on 07/28/2023. During this visit, LPA inspected the physical plant and observed that Staff 1 (S1) is separated from this facility. LPA conducted staff and resident interviewed that acknowledged S1 was disassociated to the facility. Letter of Cleared POC was issued during today's visit. This report was reviewed with, and a copy was provided to Agnes Edithe state’s words, verbatim · CDSS document, Aug 14, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Facility Administrator MODY TRUPTI and was granted entry to the facility. At the time of the visit there was two (2) staff present, one resident (1) present and three (3) residents were attending Day Program. The facility is a six (6) bedroom, two (2), bathroom home, with a kitchen/dining area, living room, and attached garage. The facility is a Residential Care Facility for Elderly (RCFE) designated home. Licensed capacity is (6) current census (4). LPA was accompanied by Facility Administrator MODY TRUPTI, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms to be at 105.5 degrees F The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated storage space for client/staff files. Medications are kept inside kitchen cabinet inaccessible to clients. Overall, the facility is clean, in good repair, and operating in safe conditions for clients in care. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed four (4) client files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator MODY TRUPTI.the state’s words, verbatim · CDSS document, Aug 4, 2023

Allegation investigated: Staff yells at residents in care.

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to commence the complaint investigation of and deliver findings on the above allegations. LPA met with direct support provider (DSP) Octavia Mcvea who was informed of the purpose of today’s visit. The investigation consisted of witness, staff, and resident interviews and records review. The allegation is Staff yells at residents in care. It is alleges that staff verbally abuse residents on a regular basis. Interviews with witness and staff deny that staff yell at residents and these interactions are between facility staff, not towards residents. Resident interviews deny that staff yell at them. This allegation is therefore UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. This report was reviewed with administrator Trupti Mody. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 28, 2023 · control 56-AS-20230721164908

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 11, 2023

87468.1 Personal Rights of Residents in All Facilities -- (a) Residents in all RCFE shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews with staff, wtiness, and residents, S1 was observed to speak loudly at residents and claim that they are the authority in this home to be followed.the state’s words, verbatim · CDSS document, Jul 28, 2023

Plan of correction: Licensee provide S1 with training or information on resident personal rights and corrective action. Licensee shall submit POC to the Department no later than the end of the POC date.

Type of visit: POC

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced plan of correction (POC) visit to the facility. This POC was conducted to verify compliance from deficiency citations that were issued on 4/19/2022. LPA met with care provider Norma Garcia. Health & Safety Code 1569.38 requires the licensee to provide written notification to a resident, the residents' responsible party, if any, and the local long-term care ombudsman within 10 days from the date indicated on the accusation. The licensee is also required to post the accusation in a conspicuous place in the facility. The date the Accusation was delivered was on 4/8/2022. The licensee had 10 days from this date to notify, in writing, the residents, their responsible parties, and the ombudsman. The 10th day was 4/18/2022. During today's visit, LPA did not observe Accusations posted by the front door. Two of three resident and/or responsible parties deny receiving a written notice regarding the Accusations. On 4/19/2022, LPA issued a deficiency under Health & Safety Code 1569.38. POC was that Licensee shall post accusations: 8219211401, 8219211401B, 8219211401C and 8219211401D in a conspicuous place and provide written notification to the residents and/or resident's responsible party and local long-term care ombudsman. The following deficiency was not corrected by the POC due date nor at the time of this visit. Civil penalties are being assessed and will continue to accrue until proof of corrections has been submitted. Civil penalties assessed today at the rate of $100 per day and the assessment of $2100 is for the period of 4/26/22 through 5/16/22. Civil penalties will continue to accrue at rate of $100 until the violation is corrected. This assessment will not exceed $100 per day regardless of the number of notices the licensee fails to send. The total civil penalty for a continuous violation shall not exceed $5,000. ********CONTINUED ON LIC809-C******** The civil penalty assessment started on 04/19/2022 and continues until Licensing has received proof that all required parties have received written notification of the revocation action. Refer to LIC 809D issued on 4/19/2022 for deficiency cited. Civil Penalties assessed today total $2100. An exit interview was conducted where this report, LIC 421A (civil penalty assessment forms) and appeal rights were discussed. A copy of all reports and forms were provided to care provider, Norma Garcia.the state’s words, verbatim · CDSS document, May 16, 2022

Type of visit: POC

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced plan of correction (POC) visit to the facility. This POC was conducted to verify compliance from deficiency citations that were issued on 4/19/2022. LPA was met by staff as administrator was not available. Staff stated they sent a text message to Administrator. Health & Safety Code 1569.38 requires the licensee to provide written notification to a resident, the residents' responsible party, if any, and the local long-term care ombudsman within 10 days from the date indicated on the accusation. The licensee is also required to post the accusation in a conspicuous place in the facility. The date the Accusation was delivered was on 4/8/2022. The licensee had 10 days from this date to notify, in writing, the residents, their responsible parties, and the ombudsman. The 10th day was 4/18/2022. During today's visit, LPA observed that the Accusation is not posted in the facilty at all. LPA confirmed with two of three resident responsible parties that they have not received a written notice regarding the accusation. The following deficiency was not corrected by the POC due date nor at the time of this visit. Civil penalties are being assessed and will continue to accrue until correction has been submitted: On 4/19/2022, LPA issued a deficiency under Health & Safety Code 1569.38. POC was that Licensee shall post accusations: 8219211401, 8219211401B, 8219211401C and 8219211401D in a conspicuous place and ***CONTINUED ON LIC 809C*** provide written notification to the residents and/or resident's responsible party and local long-term care ombudsman. Civil penalties assessed today at the rate of $100 per day. Today's civil penalty assessment of $700 is for the period of 4/19/2022 through 4/25/2022. Civil penalties will continue to accrue at rate of $100 until the violation is corrected. This assessment will not exceed $100 per day regardless of the number of notices the licensee fails to send. The total civil penalty for a continuous violation shall not exceed $5,000. The civil penalty assessment starts on 04/19/2022 and continues until Licensing has received proof that all required parties have received written notification of the revocation action. Refer to LIC 809D issued on 4/19/2022 for deficiency cited. Civil Penalties assessed today total $700. An exit interview was conducted where this report, LIC 421A (civil penalty assessment forms) and appeal rights were discussed. A copy of all reports and forms were provided to staff Norma Garcia.the state’s words, verbatim · CDSS document, Apr 25, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Anna Bueno conducted a case management visit on this day. LPA was met by staff as administrator was not available. Staff stated they sent a text message to Administrator. During today's visit, LPA and staff toured the outdoor area of the facility. LPA and staff made observations to the access to and the exterior of the facility structure. Plan of Correction (POC) was discussed telephonically with Administrator during today's visit. LPA made observations and found issues listed below: Wooden pallets and/or fencing, a side table withe two drawers, and stacked plastic containers with black bags on the exterior of the right perimeter fence. A mattress frame was observed next to the perimeter gate, next to the trash bins. The dining/common area screen door to the backyard the is off the track. LPA and staff were unable to close and/or open the screen door with ease as the door drags on the ground. There is an outdoor seating area but it is not shaded. Refer to LIC 809D for deficiencies cited. An exit interview was conducted where this report, LIC 809D, and appeal rights were discussed and provided to Norma Garcia.the state’s words, verbatim · CDSS document, Apr 25, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80087(a) · Plan of correction due date: May 7, 2022

BUILDINGS AND GROUNDS: The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by: LPA and staff observed debris (wooden pallets, side/end table, plastic containers and bags, mattress) were observed on the facility.the state’s words, verbatim · CDSS document, Apr 25, 2022

Plan of correction: Licensee shall arrange for the debris to be picked up by a sanitation crew no later than the end of day of 5/7/22. Proof shall be provided to the Department no later than 5/7/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: May 26, 2022

MAINTENANCE/OPERATION: The facility shall be clean, safe, sanitary, in good repair at all times. Maintenance shall include provision of maintenance services, procedures for the safety and well-being of residents, employees, visitors. This requirement was not met as evidenced by: LPA and staff observed the dining/common arear screen door off track. LPA snd staff were not able to close and/or open the screen door without the door going off track.the state’s words, verbatim · CDSS document, Apr 25, 2022

Plan of correction: Licensee shall arrange for a properly aligned and adjusted dining/common area screen door no later than the end of day of 5/26/22. Proof shall be provided to the Department no later than 5/26/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(h)(2) · Plan of correction due date: May 7, 2022

PLANNED ACTIVITIES: Facilities shall provide sufficient space to accommodate both indoor and outdoor activities...(2) Outdoor activity areas...easily accessible to residents...Gardens or yards shall be sufficient in size, comfortable, appropriately equipped for outdoor use. This requirement was not met as evidenced by: LPA and staff observed outdoor seating that does not have shade.the state’s words, verbatim · CDSS document, Apr 25, 2022

Plan of correction: Licensee shall provide appropriate shaded outdoor area for resident use no later than the end of day of 5/7/22. Proof shall be provided to the Department no later than 5/7/22.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Anna Bueno conducted a case management visit to verify compliance with Health & Safety Code Section 1569.38. LPA met with two (2) care providers and explained the nature of today's visit. Administrator Trupti Mody was phoned who stated that they will not be able to be present during today's visit. Health & Safety Code 1569.38 requires the licensee to provide written notification to a resident, the residents' responsible party, if any, and the local long-term care ombudsman within 10 days from the date indicated on the accusation. The licensee is also required to post the accusation in a conspicuous place in the facility. The date the Accusation was delivered was on 4/8/2022. The licensee had 10 days from this date to notify, in writing, the residents, their responsible parties, and the ombudsman. The 10th day was 4/18/2022. During today's tour of the facility, LPA observed that the facility did not post, as required by law, the accusations: #8219211401, #8219211401B, #8219211401C and #8219211401D at the front entrance of the facility. During a previous visit at Mountain View Cottage VII, Licensee telephonically stated she has not informed residents, or their responsible parties, or the local ombudsman in writing of the legal proceedings against the facility. During the call with Administrator, she stated that Licensee gave instruction to the facilities for not posting the Accusation. During today’s visit, LPA observed and/or the Administrator verbally confirmed that: The facility failed to post accusations: #8219211401, #8219211401B, #8219211401C and #8219211401D, as required by law. The facility failed to provide written notification as required by H&S Code 1569.38(b) to the residents/resident's responsible party within the required 10 days. A civil penalty is being assessed for a violation of Health & Safety Code 1569.38. Civil penalties shall be assessed until violation is corrected. Per California Health & Safety Code section 1569.38, you are hereby notified that a $100 civil penalty per day will be assessed until the violation is corrected. This assessment will not exceed $100/day regardless of the number of notices the licensee fails to send. The total civil penalty for a continuous violation shall not exceed $5,000. The civil penalty assessment starts on 04/19/2022 and continues until Licensing has received proof that all required parties have received written notification of the revocation action. Refer to LIC809D for deficiency cited. A civil penalty of $100.000 was assessed on 4/19/2022. An exit interview was conducted where this report was provided to Norma Garcia, care provider.the state’s words, verbatim · CDSS document, Apr 19, 2022

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38 · Plan of correction due date: Apr 19, 2022

POSTING OF LICENSING REPORTS; DISCLOSURE TO NEW RESIDENTS: Requires the licensee of a residential care facility for the elderly to provide written notification to the residents, resident's responsible party (if any) and to the local Long-Term Care Ombudsman within 10 days..: The Department of Social Services commences proceedings to suspend or revoke the license of the facility. This occurs when the accusation is served to the respondent. This requirement was not met as evidenced by: LPA observed that the facility failed to posta ccusations. Licensee verified that they have not provided written notification as required by H&S Code 1569.38(b) to the residents/resident's responsible party and Ombudsman.the state’s words, verbatim · CDSS document, Apr 19, 2022

Plan of correction: Licensee shall post accusations: 8219211401, 8219211401B, 8219211401C and 8219211401D in a conspicuous place and provide written notification to the residents/resident's responsible party and Ombudsman. The facility was issued a civil penalty of $100 a day which is imposed until the facility complies with a maximum of $5000.

Type of visit: Required - 1 Year

On 2/25/22 Licensing Program Analyst (LPA) Shaunte Henry arrived at the facility to conduct an unannounced annual inspection with an emphasis on infection control. LPA met with caregiver, Candida Gumban, explained the nature of the inspection and was granted entry into the facility. As of this date, there are no positive COVID-19 cases or individuals with COVID-like symptoms present in the facility. LPA toured the facility with caregiver. There is one point of entry for routine COVID-19 symptoms screening is initiated for all residents, staff and visitors. Signs have been posted throughout the facility which indicates the visitor policy and 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. LPA observed hand sanitizer throughout the facility. LPA observed a sufficient supply of hand hygiene, cleaning and disinfecting items. 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 mitigation plan in place, which outlines testing requirements, isolating/quarantining positive COVID-19 cases, proper cleaning/sanitizing/disinfecting and monitoring of individuals for COVID-like 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 Candida Gumban.the state’s words, verbatim · CDSS document, Feb 25, 2022