Mountain View Residential Care

Allegation investigated: Facility not providing adequate cleaning services to resident rooms. Staff yell at residents.

Licensing Program Analysts (LPA) Anna Bueno, Magda Malcore, and Bianca Wolcott conducted a subsequent unannounced visit to the facility to continue the investigation the above mentioned complaint allegations and deliver findings. LPAs identified themselves to staff who was informed of the reason for today’s visit and contacted licensee Nenita Carlos. The Department investigation included staff and resident interviews and facility inspections. Allegation 1: Facility not providing adequate cleaning services to resident rooms. Staff interviews reveal that resident rooms are cleaned as needed or requested by residents and are also cleaned on a weekly schedule. During unannounced LPA inspection of resident bedrooms, LPAs observed that rooms are kept tidy according to resident preference and LPAs observed facility staff cleaning rooms. Allegation 2: Staff yell at residents. Interviews with residents reveal that staff do not yell at residents and staff interviews deny that they yell at residents. The Department was not able to interview Resident 1 (R1). Based on the information obtained during the investigation, the allegations are therefore UNSUBSTANTIATED. A finding of unsubstantiated means that, although the allegations 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 where this report was reviewed with and a copy was provided to Joney Carlos. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 20, 2023 · control 18-AS-20210601154523

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.

Allegation investigated: Facility did not follow resident's care plan. Facility did not transport resident to medical appointments. Facility changed resident's choice of physician(s). Facility had pests.

Licensing Program Analysts (LPA) Anna Bueno, Magda Malcore, and Bianca Wolcott conducted a subsequent unannounced visit to the facility to continue the investigation the above mentioned complaint allegations and deliver findings. LPAs identified themselves to facility staff who was informed of the reason for today’s visit and contacted licensee Nenita Carlos. The Department investigation included staff and resident interviews and facility inspections. Allegation 1: Facility did not follow resident's care plan. Interviews with resident revealed that, while they go to their own medical appointments, residents will provide copies of the summary visit to staff. Staff interviews reveal that home health service providers communicate with staff on changes to their care. Allegation 2: Facility did not transport resident to medical appointments. Records reviewed show that some residents services that include transportation services. Interviews with residents revealed that they are able to use public transportation to get around the community or they contact transportation service provider. Allegation 3: Facility changed resident's choice of physician(s). Staff interviews reveal that the facility does not have their own physician however, residents who are receiving home health services are visited in the facility by medical provider. Interviews with residents confirm that they have their own physicians. Unsubstantiated Allegation 4: Facility had pests. Records revealed that the Department has been made aware that the facility has re-occurring issues with pests. Additional records reviewed confirmed the facility is receiving ongoing, scheduled pest control service. Based on the information obtained during the investigation, the allegations are therefore UNSUBSTANTIATED. A finding of unsubstantiated means that, although the allegations 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 where this report was reviewed with and a copy was provided to Joney Carlos.the state’s words, verbatim · CDSS document, Oct 20, 2023 · control 18-AS-20210505121329

Allegation investigated: Residents are using illegal drugs at the facility.

Licensing Program Analysts (LPA) Anna Bueno, Magda Malcore, and Bianca Wolcott conducted a subsequent unannounced visit to the facility to continue the investigation the above mentioned complaint allegations and deliver findings. LPAs identified themselves to facility staff who was informed of the reason for today’s visit and contacted licensee Nenita Carlos. The Department investigation included staff and resident interviews and facility inspections. The investigation revealed that Resident 1 (R1) is not a resident of this facility but lives in the Independent Room & Board located next door to the facility. LPAs were unable to speak with Witness 1 or R1. Staff and resident interview deny consuming illegal substances at the facility. Based on the information revealed during the investigation, this allegation is UNSUBSTANTIATED at this time. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 20, 2023 · control 18-AS-20210615162542

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: Case Management - Other

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to conduct additional interviews and gather documents pertinent to complaint control numbers listed below. LPA was met by staff and Licensee. Administrator Channe Carlos arrived shortly. 18-AS-20210615162542 18-AS-20210601154523 18-AS-20210505121329 LPA toured the facility, conducted resident interviews, and reviewed facility files. During this visit, LPA observed four of four staff files do not have current training within the last 12 rolling month. This poses a potential health and safety risk to residents in care. Refer to LIC-809D for deficiency cited. Administrator Carlos was advised that the investigation is still open. Additional time is needed to complete this investigation. An exit interview was conducted where this report, LIC-809D, and appeal rights were discussed and provided to Administrator..the state’s words, verbatim · CDSS document, Sep 18, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c) · Plan of correction due date: Sep 30, 2023

Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 This requirement was not met as evidenced by: LPA reviewed four of four staff files that did not have proof of training within the current year. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 18, 2023

Plan of correction: Licensee shall provide training as indicated in section 87411(c)(3) to all care staff. Proof of training and summary of training covered shall be submitted to CCL no later than end of POC date.

Allegation investigated: Staff is financially abusing resident.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Facility Caregiver Rosy Rivera and explained the purpose of the visit. The investigation consisted of interviews and a review of records. First allegation, Staff is financially abusing resident. LPA conducted a review of records and observed that on 5/23 facility had evicted Resident #1 (R1). On 6/5 LPA observed that facility cashed Resident # 1 (R1) rent along with PNI. LPA also observed that on 7/6 facility attempted to cash checks for the month of July however, checks were returned because of VOID. The facility was informed that $1,311.12 for rent and $52.00 for PNI is owed and must be paid back to ROG Services. Based on the evidence gathered during the investigation, the above allegation is Substantiated. Substantiated Substantiated A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, Admission Agreement 87507, from division 6, chapter, article 6, is being cited on the attached LIC 9099 D. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Caregiver Rosy Rivera at the end of the visit. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated. Unsubstantiated; meaning that 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 where this report (LIC 9099) was discussed, and a copy was provided to Facility Caregiver Rosy Rivera at the end of the visit. A find of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. An exit interview was conducted where this report was discussed, and a copy provided to Facility Caregiver Rosy Rivera.the state’s words, verbatim · CDSS document, Sep 1, 2023 · control 56-AS-20230816105227

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Sep 15, 2023

Admission Agreements... (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidence by: Based on observation, interviews and record review, the licensee did not ensure to follow Admission Agreement; by cashing rent/and PNI funds on a resident who was evicted, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 1, 2023

Plan of correction: Administrator has agreed to return total owed amount to Resident #1 (R1). Administrator will be contacting Resident #1 (R1) ROG payee and provide payment. Administrator will provide payment status to assigned LPA and provide proof of submitted payment. by POC date 9/15/2023.

Allegation investigated: Facility staff does not ensure hallways used by residents are clear from tripping hazards

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Facility Manager Joney Carlos and explained the purpose of the visit. The investigation consisted of interviews and review of records. First allegation, Facility staff does not ensure hallways used by residents are clear from tripping hazards. LPA, Fire Marshal, along with Assistant Building Official (ABO), conducted a walkthrough of the facility and observed extension cords running from the facility laundry room over to Building #2, LPA oserved commercial power outlet connected to several appliance outlets in Building #2 which can be a potential fire/and tripping hazard for residents in Building #2; Throughout the walkthrough LPA observed ten (10) power outlets being utilized all throughout building #2. LPA asked Staff #1 about the issue regarding the power outlets around the facility S#1 stated that facility is working on getting their electrical panels repaired. Substantiated Throughout the walk-through LPA observed that building #2 did not have operating smoke detectors in residents’ rooms which a 24-hour corrective action notice was given. Based on the evidence gathered during investigation, the above allegation is Substantiated. This complaint is also a cross referenced to CC# 56-AS-20230816105227; Facility electric panels are in disrepair. Substantiated A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations, Maintenance and Operation 87303 Maintenance and Operation, from division 6, chapter, article 6, is being cited on the attached LIC 9099 D. An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Manager Joney Carlos at the end of the visitthe state’s words, verbatim · CDSS document, Aug 24, 2023 · control 56-AS-20230711142641

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 29, 2023

Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: Based on observation, interviews and record review, the licensee did not ensure Maintance and Operation was maintained, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 24, 2023

Plan of correction: POC Administrator will review entire regulation and will provide invoices,permits, and provide all facility corrective documentation to assigned LPA by POC date 9/29/2023

Allegation investigated: Resident was inappropriately touched while in care. Staff did not properly safeguard the facility. Staff did not properly report incidents involving residents while in care.

Licensing Program Analyst (LPA) Rayshaun Nickolas met with Administrator Channe Carlos in the Riverside/San Bernardino Regional Office to deliver findings on the above allegations. Department staff investigated these allegations, and LPA Nickolas’ requested additional information and a facility file review pertinent to this investigation. Allegation #1 “Resident was inappropriately touched while in care”. The allegation alleged that resident #1 (R1) was fondled during a break-in. Department staff interview with R1 revealed that R1 was sleeping at the time, and the unknown perpetrator touched their leg. R1 stated that this incident was reported to staff, and staff reported this incident to the police. Department staff interview with resident #3 (R3) revealed that R3 shares a room with R1. R3 stated that they were sleeping and did not witness the incident. Department staff interview with staff #2 (S2) revealed that on February 1, 2021, an unidentified perpetrator touched R1’s leg. S2 stated that the police were notified, and the police arrived right away. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Unsubstantiated Allegation #2 “Staff did not properly safeguard the facility”. The allegation alleged that a few weeks ago, the facility suffered a break-in, and items were stolen from residents. The allegation alleged that the facility’s administrator assured the reporting party (RP) that a security system and the appropriate door locks would be installed immediately. The allegation alleged that the facility was broken into again, additional items were stolen from residents, and the residents still do not have locks on their doors. Department staff interview with R1 revealed that the intruder entered R1’s room on two (2) separate occasions. R1 stated they could not lock their door because the door latch was broken, preventing them from locking the door. However, R1 acknowledges that the door lock was fixed on February 9, 2021, and Department staff also confirmed that the lock and latch were fixed. Department staff interview with resident #2 revealed that R2 confirmed an intruder in the facility, and their items were stolen. R2 confirmed that they have a lock on their door and that the facility has installed additional locks. Department staff interviews with several facility staff members revealed that all staff interviewed confirmed the break-in and that resident’s items were stolen. However, all staff denied the allegation that the facility did not safeguard the residents' property. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation #3 “Staff did not properly report incidents involving residents while in care”. The allegation alleged that the facility intimidates staff and residents from reporting issues. Department staff interview with the RP revealed that the facility failed to notify them about the break-ins. The RP stated they learned about the break-ins through a family member at the facility. Department staff interview with the administrator revealed that facility staff contacted the police and filed a report. The administrator stated that an incident was faxed to Community Care Licensing Division (CCLD). LPA Nickolas’ cannot attest whether the facility faxed an incident report to CCLD when this allegation was made.The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. A finding of Unsubstantiated means that 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. LPA Nickolas completed an exit interview, where this report was discussed. LPA Nickolas' also provided Carlos with a copy of this report.the state’s words, verbatim · CDSS document, Jun 28, 2023 · control 18-AS-20210201140614

Allegation investigated: Illegal eviction

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation. listed above. LPA met with Facility Administrator Channe Carlos and explained the purpose of the visit. The investigation consisted of interviews and review of records. First allegation: Illegal eviction Regarding the first allegation, Illegal eviction. Based on the phone interview LPA Gardner had with facility Manager Joney Carlos. Joney stated to LPA that she was aware that Resident #1 (R1) was still at the hospital, and the reason why the facility refused to pick up Resident #1 (R1), was because a 30-day eviction notice was issued to R1; because Resident #1 is in need of a higher level of care. During phone interview Joney agreed to pickup R1 from the hospital, because the facility did not want a deficiency. The facility was not allowed to refuse the resident based on title 22 regulation 87224 “(a) (2). Based on the evidence gathered during the investigation, the above allegation is SUBSTANTIATED. Substantiated Substantiated; A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations 87224 “(a) (2) from division 6, chapter, article 6, is being cited on the attached LIC 9099 D. An exit interview was conducted where this report was discussed, and appeal rights were provided to Facility Administrator Channe Carlos.the state’s words, verbatim · CDSS document, Jun 1, 2023 · control 56-AS-20230524090711

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224"(a)(2) · Plan of correction due date: Jun 1, 2023

Eviction Procedures A licensee of a licensed residential care facility for the elderly shall, prior to transferring a resident of the facility to another facility or to an independent living arrangement as a result of the forfeiture of a license.... (2) Provide each resident or the resident’s responsible person with a written notice no later than 60 days before the intended eviction. The notice shall include all of the following.... Based on observation, interviews and record review, the licensee did not ensure to follow evicion procedures which poses an immediate Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 1, 2023

Plan of correction: Administrator will read over regulation and provide a same day written statement that indicates the acknowledgement and review of the regulation. Regulation shall be reviewed and signed by all facility Management associated to the facility. Administrator will send the acknowledgement to LPA via email on 6/1/23.

Allegation investigated: Facility is without hot water. Facility is without heat.

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to initiate and deliver the findings for the above complaint’s allegations. LPA met with Facility Administrator Channe Carlos who was informed of the purpose of my visit and the allegations listed above. The investigation consists of direct observations, records review, regarding the above allegations. Allegation One: Facility is without hot water. Licensing Program Analyst (LPA) Paola Guerrero conducted a check sampling of the facility restrooms (#1, #2, #3, #4, and #5), LPA tested the water in all restrooms which tested at temperature 113.6 F in compliance with Residential Care Facility for Elderly (RCE), state regulation 87303. Based on the evidence gathered during investigation, is Unsubstantiated; meaning that 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. Unsubstantiated A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations 87303(a) from division 6, chapter, article 6, is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report along with the appeal rights were discussed and provided to Facility Administrator Channe Carlos Allegation two: Facility is without heat. Licensing Program Analyst (LPA) Paola Guerrero conducted a check sampling of the facility heating system and observed that heating system was in despair. S#1 stated that quotes to repair heating system have been initiated for heating system repair. LPA observed portable heaters in building one (B1), rooms (#1, #2, #3, #4). LPA also observed portable heaters in building two (B2) (#5, #6, #7, #8, #9, #10, and #11). As temporary usage while heating system gets repaired. Based on the evidence gathered during investigation, is Unsubstantiated; meaning that 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 where this report (LIC 9099) was discussed, and a copy was provided to the administrator Channe Carlos at the end of the visitthe state’s words, verbatim · CDSS document, Mar 14, 2023 · control 56-AS-20230308142036

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Apr 7, 2023

Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: Based on observations, the licensee failed to esnsure that the facilty is keept clean and sanitary all all times for residents, which can poses a Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 14, 2023

Plan of correction: Licensee will have a professional exterminator come to the facility and address the infestation of bed bugs. Proof of exterminator visit and plan to be sent to LPA Guerrero by 4/7/23.

Type of visit: POC

Licensing Program Analyst (LPA) Melody Brown arrived unannounced at the facility 06/23/2022 at 09:30 AM for the purpose of a Plan of Correction (POC) visit. LPA Brown met with staff Nancy Keller and LPA Brown explained the purpose of the visit. Administrator Channe Carlos was contacted and informed of the visit. On 03/24/2022 the facility was issued a deficiency with a plan of correction date on 04/21/2022. On 04/21/2022, Administrator Channe Carlos had submitted a request for a POC extension to reflect as 06/21/2022 due to the amount of work that needs to be done and its cost. LPA Brown approved the requested POC date to now reflect as 06/21/22. Per Plan of Correction issued, the licensee stated to repair and level the concrete pavement/walkway located between building 1 and building 2. During the visit, LPA Brown conducted a physical plant assessment of the plan of correction. LPA Brown toured the facility and observed new concrete pavement between building 1 and building 2 and LPA Brown noticed that the pavement floor was leveled. LPA Brown has determined that the plan of correction has been met. Facility will receive a Letter of Deficiency Citation Cleared for the deficiency cleared during inspection. An exit interview was conducted where this report (LIC809) was discussed and provided to staff Nancy Keller.the state’s words, verbatim · CDSS document, Jun 23, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Melody Brown arrived at the facility 03/24/2022 at 09:30 AM unannounced in order to complete the facility's Annual Inspection. LPA Brown met with Staff 2 and LPA Brown advised Staff 2 of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. Administrator Channe Carlos was contacted and arrived at the facility during the visit. Below is a summary of what was observed: Infection Control: LPA Brown went over COVID-19 best practices for infection control and prevention with Administrator Channe Carlos and per file review, Mitigation Plan was submitted 04/2021. LPA Brown observed the facility having Covid-19 signages throughout the facility for proper hand washing procedure and social distancing. LPA Brown toured the facility and observed that resident bathrooms have hand soap and Administrator Carlos reported that each resident was provided with clean hand towel everyday. LPA Brown requested to inspect the facility's Personal Protective Equipment (PPE) supply. LPA Brown observed the facility to have a sufficient supply of sanitizer, gloves, masks, isolation gowns, face shields/goggles. LPA Brown went over the various recommended training for facility staff with Administrator Channe Carlos in relation to COVID-19 and Administrator Channe Carlos reported that all staff were trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing of PPE. During the visit, LPA Brown observed no routine symptom screening/temperature check has been initiated at entry for all staff, residents and visitors. LPA Brown will be issuing a deficiency as this practice has a health and safety impact that includes, but is not limited to personal rights, health related services and personnel requirements. *** Continuation in LIC809C ***** LPA Brown inquired as to if staff have been fit tested for N95 masks, and Administrator Channe Carlos informed LPA Brown that at this time staff have not been fit tested. LPA Brown will be issuing a deficiency for this item due to the facility recently have a COVID-19 positive resident last 02/07/2022, and N95 masks needs to be worn when a resident is COVID-19 positive or under observation while awaiting test result. Also, LPA Brown observed that most residents and staff have been vaccinated and are practicing other COVID-19 precautions. LPA Brown informed Administrator Channe Carlos the information for Provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks. 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. The facility has a plan in place which follows Community Care Licensing guidelines for when and how long to test staff and their residents for COVID-19, when and how to isolate/quarantine resident, 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 their 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. Throughout today's inspection, LPA Brown observed Administrator Channe Carlos, Staff 2 (S2) and Staff 3 (S3) to not wearing mask. As of today's date, Community Care Licensing is still recommending for all staff to continue to wear a mask when inside the facility. LPA Brown requested Administrator Carlos, S2 and S3 to wear a mask during the visit. LPA Brown will be issuing a Technical Assistance Advisory Note for staff not wearing masks while inside the facility. LPA Brown additionally observed a resident to not be wearing a mask either, and LPA Brown advised Administrator Carlos to encourage the residents to wear masks when in common areas indoors, though they cannot be forced. LPA Brown reviewed facility roster and observed that Staff 4 (S4) is not associated at the facility. Administrator Carlos reported that she’s having problem accessing her account to associate S4 at the facility and contacted customer service during the visit. LPA Brown will be issuing a technical violation for failure to associate employee at the facility. **** Contiuation in LIC809C *** During the visit, LPA Brown observed no carbon monoxide detector in the second (2nd) building. Administrator Carlos reported that they will purchase carbon monoxide detectors today. LPA Brown will be issuing a deficiency. In addition, LPA Brown noticed that most windows do not have screen and some window blinds are in disrepair. Administrator Carlos reported that they will install the missing windows screens and blinds. Moreover, LPA Brown observed the facility concrete floor located along the walkway from the 1st building to the 2nd building walkway of the facility were not leveled and a fall hazard for residents in care. There are holes and and cracks on concrete floors. LPA Brown will be issuing a deficiency as it poses a potential risk to residents in care. In addition, LPA Brown noticed a construction at the facility and Administrator Carlos reported that she was told it was an office space or a storage space. LPA Brown inquired if there's a building permit obtained and House Manager Nenita Carlos reported that there's no building permit now but she will obtain a building permit this week. LPA Brown will be issuing a deficiency for not obtaining a building permit prior to construction. An exit interview was conducted with Administrator Channe Carlos and a copy of this report (LIC809), LIC809D, LIC9102 AN Technical Violation, LIC9102 AN Advisory Notes and Appeal Rights were discussed and provided.the state’s words, verbatim · CDSS document, Mar 24, 2022

The state marks this report as 10 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: Sexual Abuse

Licensing Program Analyst (LPA) Melody Brown arrived at the facility to conclude a complaint investigation regarding allegation of sexual abuse. LPA Brown met with Community Liason Nenita Carlos and Caregiver Nancy Keller. Administrator Channe Carlos was contacted and unable to come to the facility. The investigation included residents and staff interviews and file reviews. Based on interviews and records review conducted, LPA Brown cannot find evidence to corroborate the allegation. LPA Brown interviewed R1, and the information and details obtained were inconsistent. R1 reported the incident never occurred. There are no witnesses or medical documentation to corroborate the allegation of sexual abuse. Based on the information obtained there is not enough evidence of allegation of sexual abuse. therefore, the allegation is deemed UNSUBSTANTIATED at this time. Unsubstantiated 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, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with caregiver Nancy Keller, where this report, LIC 9099 were discussed and provided.the state’s words, verbatim · CDSS document, Nov 3, 2021 · control 18-AS-20210913135608

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility for the purpose of completing a Health and Safety check. LPA Brown was greeted and granted entrance by Administrator Channe Carlos and explained the purpose of today's visit. Administrator Carlos accompanied LPA Brown on a tour of the inside and outside of the facility. Residents in care were present during visit. Residents in care appeared to be safe with no imminent health/safety concerns observed. LPA Brown observed no health/safety hazards inside the facility. LPA Brown inspected the outside perimeter of the facility and observed no health/safety hazards. There was sufficient number of staff present at the facility to provide care for residents. LPA Brown inspected facility food supplies and observed an adequate supply of perishable and non-perishable food. LPA Brown observed proper signage throughout the facility, sufficient hand hygiene supplies, cleaning supplies, and a sufficient supply of Personal Protective Equipment (PPE). Sharps, cleaning supplies and medications were locked and inaccessible to residents. The needs of the residents in care appeared to be met during the inspection. An exit interview was conducted where this report (LIC 809) was discussed and provided to Administrator Channe Carlos.the state’s words, verbatim · CDSS document, Sep 16, 2021

Allegation investigated: Staff are not maintaining a comfortable room temperature for resident Resident does not have access to a sink

Licensing Program Analyst (LPA) Christine Le conducted an unannounced visit to the facility to investigate the above allegations. LPA met with caregiver Rosie Rivera. LPA spoke with the administrator over the phone. LPA toured the facility, conducted interviews, and reviewed facility files. The first allegation indicates that staff did not maintain a comfortable room temperature for Resident 1 (R1). LPA was informed that in December 2020 - January 2021 R1 had to isolate due to COVID-19. R1 was placed in a isolation room away from the other residents. Interviews with the resident and staff reported that the room temperature was comfortable and the staff brought a heater/fan upon request. The facility staff also opened R1's windows to increase ventilation in the room. The second allegation indicates that during isolation R1 did not have access to a sink. Interviews with the resident and staff reported that R1 used a bathroom down the hall and had access to a sink. R1 also had a portable commode and sanitizing wipes in the isolation room to use as an additional option. Unsubstantiated 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. No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the caregiver.the state’s words, verbatim · CDSS document, Aug 26, 2021 · control 18-AS-20210119110834