Mountain View Cottages-VIII

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Chitgian made an unannounced visit to conduct a Required Annual inspection. LPA met with House Manager Jasbindar Singh. This Residential care facility for the elderly is licensed for six (6) non-ambulatory and has a hospice waiver for two (2). LPA observed that there are currently five (5) residents admitted to the facility. There are no pools, bodies or water, firearms or ammunition. LPA observed the facility is kept at a comfortable temperature of 74 degrees F. Hot water was measured in resident’s bathrooms at 111 degrees Fahrenheit. LPA observed grab bars where appropriate and non-skid mats or strips in showers and tubs. LPA observed a sufficient supply of towels, linens and personal hygiene items. Cleaning supplies were observed to be locked and inaccessible to the residents. The facility’s smoke detectors and carbon monoxide detectors were tested and are in working condition. LPA observed the fire extinguisher to be recently serviced and completely charged. LPA observed the kitchen to be clean and free of odor and all food is stored and prepared in a healthful manner. All frozen and refrigerated food is sealed correctly and protected against contamination. LPA observed an appropriate food supply of 7-day non-perishable. The back yard is completely enclosed and revealed no immediate hazards. LPA observed where resident’s medications would be centrally located and secured and inaccessible to residents. Appropriate number of staff are present in the facility during operating hours and during the evening/sleeping hours. LPA reviewed facility files and resident files for admission agreements, physician reports and written records of care. All files were organized and complete. LPA reviewed the posted signs and policies, including the Emergency and Disaster plan (LIC 610E). LPA observed the completed date to be from 2021. Technical violation issued. LPA reviewed Administrators file and observed a lack of training hours in Laws and Regulations. Technical violation issued. Per record review, last emergency drill was conducted on 5/31/2023. No deficiencies cited per Title 22, Division 6 of the California Code of Regulations at this time. Two(2) technical violations issued. An exit interview was conducted where this report was discussed and provided to House Manager Jasbindar Singh at the end of the visit.the state’s words, verbatim · CDSS document, Jun 16, 2023

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff do not have the ability to communicate with residents.

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Mountain View Cottages VIII Facility, unannounced to initiate a complaint investigation into the allegations above. LPA introduced self to staff upon arrived, introduced self and stated purpose of the visit. LPA was greeted and granted entry by staff member Harijinder Kaur, who took LPA's temperature and requested LPA sign in. Ms. Kaur contacted, the Administrator and gave LPA the phone. LPA introduced self and stated purpose of the visit. Today's visit consisted of collection of pertinent documents, staff and resident file reviews and interviews of staff and residents. Staff reported the current census is five (5). Two, (2) residents were out walking the neighborhood for exercise. It is alleged that staff do not have the ability to communicate with resident in care. During staff interviews, LPA had no difficulty communicating to staff during interviews. Interviews with staff indicated that there are 2 staff members who live on facility grounds. The two of them work 5 days on and 2 days off. A third staff member works 7am to 3pm, 4 days a week. Unsubstantiated All staff deny having any problems communicating with one another or with residents in care. The Administrator makes a visit to the facility everyday. In the event she is needed, staff contact her and within the hour she makes herself available for the needs of the facility. LPA did not experience any problem communicating with the Administrator. Interviews with residents revealed that no resident had any challenges communicating with staff. No resident indicated that staff have challenges communicating with them. Residents report when staff's assistance is needed they call out for assistance and experience no problem getting staff's attention and receiving assistance in a timely manner. LPA observed interaction between residents and staff. LPA made no observation of staff and residents experiencing difficulty communicating with one another. LPA reviewed three, (3) staff files. Three (3) out of 3 staff files contained all completed documents per regulation. Based on information above, these allegations are UNSUBSTANTIATED. 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, this report was reviewed, discussed, then provided to facility representative.the state’s words, verbatim · CDSS document, May 12, 2023 · control 56-AS-20230508165247

Type of visit: Case Management - Deficiencies

Licensing Program Analyst, Amber Coleman, (LPA) arrived to the Mountain View Cottages - VIII Facility to conduct a Case Management visit to address observed deficiencies not related to the complaint allegations. LPA met with Caregiver, Helen Nova, introduced self and stated purpose of the visit. LPA was invited inside and provided space to work. On 4/5/2023, it was observed that the Administrator did not report the incident resulting in the disrepair of the facility's window. Based on observations and interviews, a deficiency is being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted where this report was discussed and provided to Facility Representative.the state’s words, verbatim · CDSS document, Apr 14, 2023

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87211(a)(1)(D) · Plan of correction due date: Apr 14, 2023

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports ...Any incident which threatens the welfare, safety or health of any resident... This requirement is not met as evidenced by Based on observations and interviews the Administrator did not report the incident resulting in the facility's disrepaired window, which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 14, 2023

Plan of correction: Licensee will submit a statement of undertsnding of the reporting requirements by way of completing an LIC9098 form self certifying that the reporting requirement is understood and will be followed.

Allegation investigated: Facility is in disrepair.

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Mountain View Cottages VIII Facility to initiate a complaint investigation regarding the allegation listed above. LPA knocked on the door and was met by Caregiver, Marjinda Kaur, (MK) who granted LPA entry to facility. LPA was asked to sign in and have temperature taken. MK called and informed Administrator of LPA's visit. Administrator arrived later during LPA visit. Today's visit consisted of a walk through of the facility, record review and staff and resident interviews. During the walk through of the facility, LPA did not observe any window of the facility to be broken or compromised. During interviews, LPA learned that approximately 2 weeks ago, a resident experienced a behavioral episode. During the episode, the resident, (R1) picked up a chair in the living room and through it through the window, causing the window to shatter. On 3/16/23 a window technician was scheduled for a consult. Substantiated On 3/22/23 the window technician returned to the facility to replace the window. The window could not be fixed immediately due to the inclement weather. Staff denies that any resident was injured in the process. LPA did not observe any resident to have injuries due to the broken window. LPA checked the office's log of reported incidents for the last 2 weeks and was unable to locate an incident report of the incident. Based on observations and interviews, we have substantiated the complaint allegation(s) as valid and that a violation has occurred based on the preponderance of available evidence. A copy of this report along with appeal rights are being reviewed with, and furnished to the facility representative. Please see LIC 9099D. A copy of this report along with appeal rights are being reviewed with and furnished to the facility representative.the state’s words, verbatim · CDSS document, Apr 5, 2023 · control 56-AS-20230404142242

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Apr 13, 2023

87303 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.the state’s words, verbatim · CDSS document, Apr 5, 2023

Plan of correction: Administrator agrees to review regulations regarding reporting requirements and what incidents warrant an incident report. Administrator will complete a statement of understanding of this regulation by way of completing a LIC9098 within 7 business days.

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 Bartoleme De Leon, care provider. 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 Accusations posted by the front door. Two of four 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, Bartoleme De Leon.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. 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 Accusations posted by the front door. However three of four resident and/or responsible parties deny receiving a written notice related to the Accusations. 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 provide written notification to the residents and/or resident's responsible party and local long-term care ombudsman. ***LIC809-C*** 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 care provider De Leon.the state’s words, verbatim · CDSS document, Apr 25, 2022

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 phoned administrator Jasbinder Singh, who arrived at the facility shortly. 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 the 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 the 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 today's visit, Administrator Jasbinder Singh arrived and the accusations: #8219211401, #8219211401B, #8219211401C, #8219211401D were posted on the During today’s visit, LPA observed and/or the Administrator confirmed that: The facility posted 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 (b). 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 Jasbinder Singh, administrator.the state’s words, verbatim · CDSS document, Apr 19, 2022

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.38(b) · 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: Licensee verified that they have not provided written notification as required...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

Licensing Program Analysts (LPAs) Anna Bueno and Rayshaun Nickolas made 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. LPAs were met at the door by caregivers and granted entry into the home. LPAs observed all staff are wearing masks. Staff confirmed there are no active and/or suspected COVID positive individuals in the home. Precautionary Covid-19 postings are present at the front door and at the entry point. There is one entry point designated where sign in procedures and screening will occur. The staff temperature screen visitors upon entry into the facility. LPAs observed four (4) residents in the home. LPAs conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures. The facility was equipped with sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions, and has a limited supply of Personal Protective Equipment (PPE). Based on observations made during today’s inspection, there are no deficiencies being cited per Title 22, Division 6, of the California Code of Regulations. LPAs reviewed this report with and a copy was provided to the facility representative.the state’s words, verbatim · CDSS document, Mar 21, 2022