J & M Happy Guest Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted and allowed entry into the facility and conducted the visit with Administrator, Erolyn Delgado. LPA, accompanied by the administrator, toured the interior and exterior of the facility, and inspected each room. The facility was clean, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. Hot water temperature at taps accessible to residents measured at 150 F.. There were at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, and/or fireplaces accessible to clients. Some Medications were locked, however, the medications requiring refrigeration were not locked and accessible to residents. According to the administrator, Resident #1 (R1) refuses medications. Therefore, R1's medications are being crushed by the facility staff with no crushing order on file. Also, administrator stated the crushed medications are being camouflaged in the resident's food. LPA reviewed multiple staff and resident records/files. There were two residents, R1 and Resident #2 (R2) with half bed rails, and no bed rail orders on file. The facility does not have a plan for resident shelter accommodations in the event of an emergency. Also, disaster drills are not being conducted. R2 has a diagnosis of a Major Neurocognitive Disorder and does not have a current Physician's Report. Multiple residents do not have a current Resident Appraisals on file. The administrator was made aware Admission Agreements were not updated to reflect laws. No pools or bodies of water were observed on the premises. Per the administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was serviced within the last 12 months. Required licensing postings were observed in visible areas of the facility. Continued on an LIC 809C. LPA interviewed multiple staff and residents. The interviews did not raise any significant licensing concerns. The facility does not have current liability insurance. Based on interviews, observations, and record review, deficiencies were observed and cited on the attached LIC 809D. Technical Assistance and Technical Violations were also documented and issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Administrator, Erolyn Delgado whose signature below confirms receipt of these rights. [See LIC 811 Confidential Names List to identify Resident #1-#2]the state’s words, verbatim · CDSS document, Oct 25, 2023

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Norman Baloy. LPA also met with Licensee Maria Delgado, who arrived later during the visit. On 08/31/2022, the CCLD San Diego Regional Office met with the licensee for a Non-Compliance Conference (NCC). During today’s visit, LPA conducted a general tour of the facility and performed a welfare check on residents in care. LPA also interviewed residents and staff, reviewed personnel and training records, and evaluated licensee’s ongoing compliance with the actions/objectives that they agreed to during the NCC. No deficiencies were observed or issued during today's visit. An exit interview was conducted with Delgado, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Sep 28, 2023

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Maria Delgado. On 08/31/2022, the CCLD San Diego Regional Office met with the licensee for a Non-Compliance Conference (NCC). During today’s visit, LPA conducted a general tour of the facility, performed a welfare check and interviewed residents in care, interviewed relevant staff, reviewed care records, and evaluated licensee’s ongoing compliance with the actions/objectives that they agreed to during the NCC. During a prior visit: LPA provided the texts of selected regulations from Title 22 of the California Code of Regulations (i.e., 87465 Incidental Medical and Dental Care, 87625 Managed Incontinence, 87411 Personnel Requirements, 87219 Planned Activities, 87457 Pre-Admission Appraisal, and 87633 Hospice Care of Terminally Ill Residents) and from California Health and Safety Code (i.e., 1569.39 Assistance with accessing home health or hospice services; receipt of medical services). Also, LPA provided licensee with CCLD’s Pressure Injuries Guide publication (version 04/04/2019) and Hospice Care for Residential Facilities for the Elderly publication (version 08/30/2021). During today's visit: the Licensee affirmed that they read the above materials several times over, and have no additional questions. The facility was clean, safe, and in good repair. There were no immediate health or safety concerns. No deficiencies were observed or issued during today's compliance visit. An exit interview was conducted with Delgado, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Aug 3, 2023

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Maria Delgado. On 08/31/2022, the CCLD San Diego Regional Office met with the licensee for a Non-Compliance Conference (NCC). During today’s visit, LPA conducted a general tour of the facility, performed a welfare check on residents in care, interviewed relevant staff, reviewed resident records, and evaluated licensee’s ongoing compliance with the actions/objectives that they agreed to during the NCC. LPA also provided technical assistance/education about selected regulations from Title 22 of the California Code of Regulations (i.e., 87465 Incidental Medical and Dental Care, 87625 Managed Incontinence, 87411 Personnel Requirements, 87219 Planned Activities, 87457 Pre-Admission Appraisal, and 87633 Hospice Care of Terminally Ill Residents), and from the California Health and Safety Code (i.e., 1569.39 Assistance with accessing home health or hospice services; receipt of medical services). LPA also provided licensee with CCLD’s Pressure Injuries Guide publication (version 04/04/2019) and Hospice Care for Residential Facilities for the Elderly publication (version 08/30/2021). During today’s visit, the facility was clean, safe, sanitary, and in good repair. There were no immediate health or safety concerns. Licensee demonstrated compliance with the actions/objectives they agreed to during the NCC. No deficiencies were observed or issued as part of this compliance visit. An exit interview was conducted with Delgado, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Apr 26, 2023

Type of visit: POC

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced POC visit. LPA was greeted, allowed entry into the facility and met with Licensee, Maria Erolyn Delgado. LPA stated purpose of today’s visit, to verify if a deficiency has been corrected. On 09/29/22, the licensee was issued a deficiency for Maintenance and Operation due bedroom #1 having a strong urine odor. During today's visit, LPA observed bedroom #1, the strong urine odor has been removed. The deficiency has been corrected. Licensee agreed to maintain bedroom #1 and keep free from urine odor. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Licensee, Maria Erolyn Delgado whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Oct 25, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Case Management - Other visit. LPA was greeted and allowed entry into the facility and met with Licensee, Maria Erolyn Delgado. LPA stated purpose of today’s visit, to deliver an amended report. No deficiencies were issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Licensee, Maria Erolyn Delgado whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Oct 4, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Case Management - Deficiencies visit. LPA was greeted and allowed entry into the facility and met with Licensee, Maria Erolyn Delgado. LPA stated purpose of today’s visit, to issue deficiencies observed on 08/30/22. On 08/30/22, LPA conducted a visit and observed the following deficiencies. Upon entry to the facility, Licensee and staff were not wearing masks. LPA asked staff to put on a surgical mask but was told by the staff member they don't have a supply. Not wearing masks was a repeat violation within a 12 month period and civil penalties are being assessed. An interview with residents revealed they stay in their bedrooms all day and no activities are offered by the facility. Not offering planned activities was also previously cited and this a repeat violation within a 12 month period, civil penalties are being assessed. LPA observed a newly built office attached to the facility. The licensee did not obtain a permit, update facility sketch to include the newly built office, or obtain a local building inspection to ensure no suspected hazard to health and safety of residents exists. LPA observed the licensee entering the residents bedrooms without knocking prior to entering. LPA made licensee aware of resident's privacy. As the visit continued, the licensee continued to enter resident's room without knocking, after being made aware. LPA opened bedroom # 1 and a strong urine odor was present. LPA inquired about linens but the linens were changed. The bedroom window was open but the urine odor filled the entire bedroom. Today, 09/29/22, again Licensee was not wearing a mask in the facility. Also, bedroom # 1 still has a strong urine odor, the window and front door were opened but the entire entry way has a strong urine smell coming from bedroom #1. Deficiencies were observed during the visit on 08/30/22 and 09/29/22 and were cited on the attached LIC 809D along with civil penalties for repeat violations. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Licensee, Maria Erolyn Delgado whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Sep 29, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Oct 20, 2022

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not ensure staff are wearing masks, putting 3 out of 3 residents at risk. This poses a potential health and safety code risk to residents in care.the state’s words, verbatim · CDSS document, Sep 29, 2022

Plan of correction: Licensee agreed to have staff wear masks while in the facility. In addition, Licensee will schedule another Personal Rights training from an outside vendor, along with proof of surgical masks supply. Licensee will provide proof of training and receipt of purchased masks by POC due date. Licensee and all staff will attend the training. A civil penalty is being assessed for a repeat violation within a 12 month period.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87219(a) · Plan of correction due date: Oct 20, 2022

Planned Activities. Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. This requirement is not met as evidenced by: Based on interviews, the licensee did not provide activities for 3 out of 3 residents. Residents remain in the bedroom with no activities offered by facility. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 29, 2022

Plan of correction: Licensee agreed to attend another Planned Activities training by an outside vendor and provide proof of training along with a calendar of planned activities offered by the facility. Licensee will submit proof by POC date. A civil penalty is being assessed for a repeat violation within a 12 month period.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 20, 2022

Personal Rights of Residents in All Facilities. To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not knock on 3 out of 3 residents door prior to entering, not allowing privacy. This poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 29, 2022

Plan of correction: Licensee will attend personal rights training regarding affording dignity to residents and provide proof of training.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Oct 20, 2022

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on observations, the licensee did not maintain a clean bedroom for 1 out of 3 residents. Resident’s bedroom had a strong urine smell. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 29, 2022

Plan of correction: Licensee will clean and sanitize bedroom #1 and ensure room is urine odor free by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(b) · Plan of correction due date: Oct 20, 2022

Alterations to Existing Building or New Facilities. The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement is not met as evidenced by: Based on interviews and observations, the licensee did not obtain a local building inspection where the agency determines that a suspected hazard to health and safety exists when she built an office attached to the facility. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 29, 2022

Plan of correction: Licensee stated she did not obtain a permit for the newly built office attached to the facility. Licensee will acquire a local building inspection to ensure there is not suspected hazard to health and safety exists. In addition, Licensee will submit an LIC 999 Facility Sketch to include the new office by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced annual required licensing inspection. LPA was greeted and allowed entry into the facility by Licensee, Maria Erolyn Delgado. LPA met with Licensee, Maria Erolyn Delgado and stated purpose of today’s visit, to verify compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices. LPA conducted a tour of the facility and observed residents in care. In accordance with the Department’s Infection Control, LPA provided consultation, observed, and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, testing, vaccination, screening protocols, and the use of personal protective equipment. During the tour, LPA observed Technical Assistance was needed and provided assistance in the areas observed. LPA observed the facility does not have Covid-19 signs posted. Licensee was made aware to post signs. Licensee has not notified residents about facility infection control policies. Licensee and staff have not been N95 fit tested. Licensee has not provided ongoing updates about infection control to residents and staff. Facility has not notified residents that CDSS PINs and CDSS PIN summaries for residents are available in an easily accessible location. Licensee does not have a 30 day supply of PPE or a list including items on hand or indicating where such items will be acquired and when. PPE is not stored in a location that is readily accessible to staff. Licensee is storing some PPE under her bed. Licensee does not have a contingency plan to address PPE supply shortages, including extended use and reuse in accordance with CDC guidelines. Advisory Notes regarding Technical Assistance were issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Licensee, Maria Erolyn Delgado whose signature below confirms receipt of these rights. Licensee does not have a 30 day supply of PPE or a list including items on hand or indicating where such items will be acquired and when. PPE is not stored in a location that is readily accessible to staff. Licensee is storing some PPE under her bed. Licensee does not have a contingency plan to address PPE supply shortages, including extended use and reuse in accordance with CDC guidelines. Advisory Notes regarding Technical Assistance were issued. An exit interview was conducted and a copy of this report along with Licensee Rights (LIC 9058 01/16) were provided to Licensee, Maria Erolyn Delgado whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Sep 29, 2022

Allegation investigated: -Neglect, resulting in delayed medical care -Licensee did not have sufficient staff to meet the needs of a resident -Unlawful Eviction

Licensing Program Analyst, Natasha Persaud conducted an unannounced visit to conclude investigation. LPA was greeted and allowed entry into the facility and met with Licensee, Maria Erolyn Delgado. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff, residents, and outside sources. It was alleged Resident #1 (R1) was neglected, resulting in delayed medical care. On 08/15/22 and 08/20/22, R1 fell and was unable to get up independently and Licensee was unable to assist the resident up off the floor. R1’s Physician’s Report indicated R1 was ambulatory, does not wear a prosthesis, bladder impairment, unable to bathe, dress/groom, toilet or independently transfer to and from bed, and receiving hospice services. The Preplacement Appraisal indicated R1 wears a prosthesis for their right leg, requires assistance and has confusion with taking their own medications, can use the bathroom independently but requires assistance with baths/showers, is ambulatory and able to walk without physical assistance such as use of a walker; needs help with bathing and medications only. LPA observed R1 has a prosthesis and uses a walker. R1’s Physician’s Report and Preplacement Appraisal have conflicting information regarding R1’s care needs. Continued on an LIC 9099C Substantiated Outside source interviews revealed R1 was left on the floor after the fall due to the licensee being unable to assist R1 up off the floor due to R1’s weight. Additional outside source interviews confirmed R1 did not gain a large amount of weight, while residing at the facility. Therefore, the license was aware of R1’s weight and needs upon admittance to the facility. R1 confirmed being left on the floor after a fall due to the licensee not being able to assist R1 up off the floor. It was unknown at the time of the fall if R1 sustained any injuries and needed to be evaluated. Investigation revealed the licensee did not want to call 911 for assistance because she was instructed by hospice to contact hospice prior to 911, which resulted in delayed medical care for both incidents on 08/15/22 and 08/20/22. R1’s interview revealed they were on the floor for approximately 30 minutes yelling out for help, but no one came to assist. Staff interviews revealed when R1 fell on both occasions, the licensee, licensee's husband, licensee's son, licensee's grandson and staff all attempted to lift R1 up off the floor but were unsuccessful due to R1's weight. Staff stated 911 was called to assist R1 off the floor both occasions and R1 was transported to the hospital. Resident interviews revealed they were not aware of the incidents involving R1. Licensee’s interview revealed she was using the restroom on both occasions when she heard R1 call for assistance. The Licensee stated she went to R1's room and observed R1 on the floor after a fall. The licensee stated she called her husband to assist R1 up off the floor but they were unsuccessful and her husband has a bad back and unable to lift anything heavy. The licensee denied her son, grandson, and staff were present during the falls, only her and her husband assisted. The licensee stated R1 was transported to the hospital both times and did not have any injuries. Licensee was aware upon admission that R1 was an amputee and their size in weight. It was also alleged the licensee did not have sufficient staff to meet the needs of a resident. When R1 fell on 08/15/22 the licensee was unable to assist R1 up off the floor. R1’s interview revealed they were yelling out for help and no one came to assist. The licensee checked on R1 at approximately 6:00am-6:30am, during morning rounds. Once R1 was observed on the floor, the licensee was unable to assist R1 up due to R1’s weight and R1 being an amputee. R1’s interview revealed R1 asked the licensee to call her husband, the additional staff, to help. However, the staff/husband was unable to assist due to their own medical condition. The licensee was aware of R1’s care needs prior to admission to the facility. However, the licensee accepted R1 as a resident and was unable to meet R1’s care needs. There is only one staff per shift and staff do not check on the residents at night, as the licensee is the night staff and goes to bed at night. It was also reported that during the incident, R1 was lying on the floor and told the licensee they needed to use the bathroom to make a bowel movement. R1’s interview revealed the licensee told R1 to have their bowel movement in their diaper and the licensee will clean it up, since the licensee could not assist R1 up off the floor. Staff interviews revealed there is one staff at night, which is the licensee. Continued on an LIC 9099C. Staff also confirmed due to R1's weight they were unable to assist R1's with any falls. Resident interviews revealed there are no awake staff at night. Licensee stated she provides care during the night shift but goes to sleep at the facility and will check on the residents in the morning. Due to insufficient staffing, R1 had to lay on the floor until the paramedics arrived to assist. Lastly, it was alleged R1 was unlawfully Evicted. R1 fell at the facility on 08/15/22 and 08/20/22 and the licensee was unable to assist R1 up off the floor. Therefore, due to lack of staffing 911 was called to assist and evaluate R1 for injuries. R1 was transported to the hospital on both incidents for evaluation. Upon discharge from the hospital the licensee denied R1’s return to the facility. Outside source interviews revealed the licensee refused R1’s return to the facility. Outside source interviews confirmed on 08/20/20, the paramedics returned R1 to the facility and the licensee came running out of the facility to stop the return. Further outside interviews revealed the licensee told the paramedics to take R1 back to the hospital because R1 did not pay their monthly fees. R1 was returned to the hospital. On 08/19/22, the licensee issued a written 30 day eviction notice to R1. However, the eviction notice was not in compliance with Title 22 Regulations and was written unlawfully. The licensee abandoned R1 at the hospital. Staff interview revealed not being aware of the eviction. Licensee’s interview revealed she evicted R1 for safety reasons because R1 became a fall risk after moving into the facility. However, R1 was admitted as an amputee. The licensee stated she contacted a trainer she's used in the past and inquired how to evict a resident. The licensee did not review the eviction procedures outlined in Title 22 Regulations and therefore, did not comply with eviction laws when issuing the eviction notice. In addition, the licensee admitted she refused to take R1 back from the hospital when discharged due to R1 being a fall risk and not paying their monthly fees. R1 was unlawfully evicted when the licensee refused R1’s return to the facility and issuing an unlawful eviction notice. Based on interviews and record review, 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 & Chapter 8 are being cited on the attached LIC 9099D. A Civil Penalty was assessed for repeat violation within a 12 month period. This is an amended version of the original report created on 08/30/22.the state’s words, verbatim · CDSS document, Aug 30, 2022 · control 08-AS-20220822101936

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Aug 31, 2022

Incidental Medical and Dental Care. A plan for incidental medical...shall be developed by each facility.The plan shall...and provide for assistance in obtaining such care, by compliance with the following: The licensee shall arrange, or assist...for medical...care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not ensure an appropriate plan was in place to meet the needs for (R1) one out of five residents. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 30, 2022

Plan of correction: Licensee agreed to attend vendor training regarding Incidental Medical to include having an appropriate plan in place for each resident. The training will be scheduled by POC due date and proof of training provided within 2 weeks. Additional measures will be taken during the NCC scheduled for 08/31/22.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Aug 31, 2022

Personnel Requirements – General - Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Additional staff shall be employed as necessary...and house cleaning, laundering maintenance of buildings, equipment and grounds. This requirement is not met as evidenced by: Based on interviews and observations, the licensee did not ensure the facility was adequately staffed to meet the needs for (R1) one out of five residents. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 30, 2022

Plan of correction: The Licensee will provide an LIC 500 Personnel Report to reflect she has augmented staffing by POC due date. A civil penalty is being assessed for repeat violation within 12 month period. The licensee was previously cited on 06/10/22. Additional measures will be taken during the NCC scheduled for 08/31/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(d) · Plan of correction due date: Sep 13, 2022

Eviction Procedures. The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not issue a lawful eviction notice in accordance with the law for (R1) one out of five residents. This posed a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 30, 2022

Plan of correction: Licensee agreed to attend vendor training regarding Eviction Procedures and provide proof of training by POC due date. Additional measures will be taken during the scheduled NCC on 08/31/22.

Allegation investigated: -Residents developed pressure injuries, due to neglect -Licensee did not have sufficient staff to meet the needs of residents

Licensing Program Analyst, Natasha Persaud conducted an unannounced visit to conclude investigation. LPA was greeted and allowed entry into the facility by Staff,Dolores Goldhammer. LPA spoke with Licensee, Erolyn Delgado via telephone while at the facility. During the investigation, the Department briefly toured the facility, requested records, and conducted interviews with staff, residents, and outside sources. It was alleged residents developed pressure injuries, due to neglect. Resident #1’s (R1) Physician’s Report indicated R1 was Non-ambulatory with a major neurocognitive disorder, bowel and bladder incontinent, unable to independently bathe, dress/groom, toilet, or handle their own medications, and was receiving hospice services. The Resident Appraisal indicated R1 used a wheelchair, required assistance with activities of daily living (ADL) and assistance with transferring from their bed to their wheelchair. Resident #2’s (R2) Resident Appraisal indicated R2 used a wheelchair, was unable to independently transfer from the bed to their wheelchair, and was unable to bathe, dress/groom, toilet, or handle their own medications and was receiving hospice services. Resident #3’s (R3) Physician’s Report indicated they require assistance with bathing, dressing/grooming, and toileting. Continued on an LIC 9099C Substantiated R3’s Resident Appraisal indicated R3 can no longer perform activities of daily living and required assistance with going to the bathroom. It also contained contradictory information stating R3 does not require assistance with toileting. Resident #4’s (R4) Physician’s Report indicated they require assistance with bathing, dressing/grooming, and toileting. R4’s Resident Appraisal confirmed R4 required assistance with ADL’s. The investigation revealed R1 developed four (4) pressure injuries, while in the care of the facility, due to neglect. On 03/27/20, R1 had a Stage IV pressure injury on their sacrum, which progressed to unstageable. On 04/30/20, R1 developed a deep tissue injury on their left shoulder, by 07/10/20 that wound progressed to a Stage IV. It was also noted R1 had a Stage IV pressure injury to their left posterior leg, and on 09/15/20, R1 had a stage III pressure wound on their left ankle. Further investigation revealed on 09/18/20, R2 sustained two (2) Stage IV pressure injuries on their sacrum. On 09/02/20, R3 sustained a Stage II pressure injury on their left hip. Outside source interviews confirmed staff left residents in soiled clothing. Soiled diapers allow for the residents skin to stay moist, which contributed to progression of the wounds, along with not repositioning. The Mayo Clinic classifies pressure injuries into four (4) stages of increasing depth and severity, known as Stages one (1) thru four (4). However, they also have an additional stage known as unstageable. Unstageable injuries are described as covered by dead tissue or eschar that obscures the ulcer base. A Stage IV is also described as exposed bone. There were two (2) outside agencies providing care, a hospice agency and wound care specialists, who strictly provided wound care. Outside source interviews revealed R2 declined very rapidly, because they weren’t receiving the proper care at the facility, even though hospice and wound care specialists were providing care. The hospice agency provided orders for the facility to follow to include turning and repositioning R1 and R2 every hour while sitting and every two hours while in their beds. Interviews conducted with outside sources revealed the orders were not being followed, as there was only one caregiver during the day, and the night caregiver was not complying with hospice orders of repositioning and changing the residents incontinence briefs every two (2) hours. Outside source interviews revealed the one (1) staff assigned during the day was unable to lift R2 out of bed, as R2 needed maximum assistance with transfers. Therefore, R2 stayed in bed all day. Staff admitted not being able to lift R2 out of bed. Hospice records for R2 reflected R2 was verbally unable to communicate their needs and used face grimaces to communicate. Hospice records reflected the hospice staff would come to the facility in the morning and find the residents soaked in urine, their pressure injury patches were soiled, and their orders not being followed by the night shift, which was assigned to the licensee to provide care. Continued on an LIC 9099C. Outside source interviews revealed R3 sustained a Stage II pressure injury from not being repositioned or having their incontinence briefs changed at night. Further outside source interviews revealed the licensee was instructed to rotate the residents and assumed the licensee would follow the instructions but the licensee failed to comply. Hospice records for R2 indicated the licensee was instructed to check briefs; turn every two (2) hours; and change dressing if soiled. It also indicated the licensee voiced back all understanding of the instructions provided by hospice. The licensee’s interview confirmed she was instructed by the hospice agency to check the residents for soiled briefs and reposition them every 2-3 hours. The licensee admitted she did not check on the residents during the night to change their briefs or reposition them. The licensee failed to maintain managed incontinence for residents, which allowed the wounds to progress. Staff interviews confirmed R1 and R2 were being left in soiled diapers and clothing during the night. Further interviews confirmed the caregiver would double up on residents diapers and the following morning the residents would be soaked in urine or laying in their own feces while still having the same diaper on them from the prior night. Staff interviews also confirmed due to staff not being unable to lift R2, R2 was placed in diapers. The licensee failed to meet the care and supervision of R1 and R2, by leaving them both to lay in their soiled diapers. Investigation confirmed staff left residents in soiled clothing, which contributed to progression of the wounds. Due to the facility staff not complying with the orders, the residents were neglected. It was also alleged that the licensee did not have sufficient staff to meet the needs of residents. The facility only had one caregiver during the day from 7:30 a.m. to 8:30 p.m. That one caregiver was responsible for all the cooking, cleaning, changing of clothes, sometimes showering and feeding the residents. Four (4) out of six (6) residents were bedbound and unable to feed themselves. Due to only having one caregiver, it was not possible for the caregiver to give the residents the individual time and attention needed to properly take care of each resident. Also, R2 was a maximum assist with transfers per the hospice records and outside source interviews confirmed R2 required two (2) people to assist. Which would reflect there was not enough staff per shift to assist R2. Four (4) of the resident’s records reflected residents needs and service plans all needed constant supervision, some were to be taken to the toilet and others would be outfitted with a diaper instead. Interviews with outside sources revealed none of the residents were ever placed into a wheelchair, instead they were left in their beds, no social interaction given to them other than the hospice agency coming out to shower or attend to their pressure injuries. Outside source interviews also revealed witnessing R1 and R2 with dried fecal matter in the morning hours, as an indication the briefs were not being changed at night. Continued on an LIC 9099C. Further outside source interviews revealed due to only having one staff per shift and R2 needing two (2) people to assist with transfers resulted in R2 being in bed all day, leading to a rapid decline. Investigation revealed the licensee was advised by the hospice agency to hire additional staff, but the licensee could not afford additional staff. Outside source interviews indicated R1’s pressure injuries were so bad it was down to their bone, which was a result from not being rotated and having to sit in soiled diapers. Outside source interviews corroborated residents being left in soiled briefs and not being repositioned resulted in decline of residents health. Hospice records reflected the licensee was instructed to reposition and check briefs every two (2) hours for the residents, the licensee voiced her understanding. However, she did not comply and none of the four (4) residents needs were being met. Outside source interviews revealed R2 had a fall at the facility during the night and due to lack of staffing, R2 was not assisted up. Outside source and resident interviews confirmed R2 did not have a fall at the facility, the fall was prior to being admitted to the facility. Licensee’s interview confirmed she worked the night shift. Licensee stated she was aware R2 was a two (2) person assist. Licensee indicated she would go to bed at approximately 12:00am and had to wake up by 6:00am to tend to the residents. Therefore, she did not check on the residents after going to bed. The licensee admitted she was instructed by the hospice agency to check the residents for soiled briefs and reposition them every 2-3 hours. However, the licensee did not feel it was necessary to get up during the night once she already went to bed, since she checked on them so late, prior to 12:00am. Licensee failed to adequately staff facility to meet the needs of the residents. Based on record review and interviews 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 & Chapter 8 are being cited on the attached LIC 9099D. A civil penalty in the amount of $500 was assessed per Health and Safety Code 1569.49(c)(1), for a violation that the Department determined resulted in an injury of R1-R3. Determination of Civil Penalties under Health and Safety Code Section 1569.49 are pending and under review by the Program Administrator of the Community Care Licensing Division. An exit interview was conducted with Administrator and a copy of this report, LIC 421IM – Civil Penalty Assessment Form, and Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Licensee, whose signature below confirms receipt of these rights.[See LIC 811 Confidential Names List to identify Resident #1, Resident #2, Resident #3, and Resident #4].the state’s words, verbatim · CDSS document, Jun 10, 2022 · control 08-AS-20200909134240

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.39(d) · Plan of correction due date: Jun 11, 2022

Assistance with accessing home health or hospice services; receipt of medical services- Failure to meet or arrange to meet the needs of those residents who require health-related services...is a licensing violation and subject to civil penalty pursuant to Section 1569.49 (c)(1). This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not ensure the written record of care identified by the hospice agency for four (4) out of six (6) residents were not being followed. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 10, 2022

Plan of correction: Licensee agreed to schedule outside vendor training regarding hospice care and following hospice care plans by POC due date and provide proof of training within 2 weeks. Licensee and all staff will attend the training. On today’s date, the Department is issuing a $500.00 civil penalty under HSC 1569.49(c)(1), for a violation that the Department determined resulted in an injury of R1-R3.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jun 11, 2022

Personnel Requirements – General - Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Additional staff shall be employed as necessary...and house cleaning, laundering maintenance of buildings, equipment and grounds. This requirement is not met as evidenced by: Based on interviews and observations, the licensee did not ensure the facility was adequately staffed to meet the needs of four (4) out of six (6) residents. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 10, 2022

Plan of correction: Licensee agreed to schedule outside vendor training regarding Personnel Requirements and duties by POC due date and provide proof of training within 2 weeks. Licensee and all staff will attend the training.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Natasha Persaud conducted an unannounced Case Management - Deficiencies visit. LPA identified herself and discussed the purpose of the visit with Staff, Dolores Goldhammer. LPA spoke with Licensee, Erolyn Delgado via telephone while at the facility. During today’s visit, LPA toured the facility and briefly observed residents in care. The reason for the visit was to issue deficiencies that were identified during a complaint investigation. Four (4) out of six (6) residents required managed incontinence. All four residents were receiving hospice services. Hospice records indicated all four (4) residents required assistance with their activities of daily living. Interviews conducted with outside sources revealed the facility was not following the hospice orders. The facility had only one caregiver during the day, and one caregiver at night. The night caregiver was not complying with hospice orders of repositioning and changing the residents incontinence briefs every two (2) hours. Hospice records reflected the hospice staff would come to the facility in the morning and find the residents soaked in urine, their pressure injury patches were soiled, and their orders not being followed by the night shift, which was assigned to the licensee to provide care. Outside source interviews revealed Resident #3 (R3) sustained a Stage II pressure injury from not being repositioned or having their incontinence briefs changed at night. Hospice records for Resident #2 (R2) indicated the licensee was instructed to check briefs; turn every two (2) hours; and change dressing if soiled. The licensee’s interview confirmed she was instructed by the hospice agency to check the residents for soiled briefs and reposition them every 2-3 hours. The licensee admitted she did not check on the residents during the night to change their briefs or reposition them. The licensee failed to maintain managed incontinence for residents, which allowed the resident's wounds to progress. Staff interviews confirmed Resident #1 (R1) and R2 were being left in soiled diapers and clothing during the night. Further interviews confirmed the caregiver would double up on residents diapers and the following morning the residents would be soaked in urine or laying in their own feces while still having the same diaper on them from the prior night. Staff interviews also confirmed due to staff not being unable to lift R2, R2 was placed in diapers. Continued on LIC 809D. The licensee failed to meet the care and supervision of R1 and R2, by leaving them both to lay in their soiled diapers. Due to the facility staff not complying with the orders, the residents were neglected. The licensee did not have sufficient staff to meet the needs of residents. The facility only had one caregiver during the day from 7:30 a.m. to 8:30 p.m. That one caregiver was responsible for all the cooking, cleaning, changing of clothes, sometimes showering and feeding the residents. Four (4) out of six (6) residents were bed bound and unable to feed themselves. Due to only having one caregiver, it was not possible for the caregiver to give the residents the individual time and attention needed to properly take care of each resident. Four (4) of the resident’s records reflected residents needs and service plans all needed constant supervision, some were to be taken to the toilet and others would be outfitted with a diaper instead. Interviews with outside sources revealed none of the residents were ever placed into a wheelchair, instead they were left in their beds, no social interaction given to them other than the hospice agency coming out to shower or attend to their pressure injuries. Outside source interviews also revealed witnessing R1 and R2 with dried fecal matter in the morning hours, as an indication the briefs were not being changed at night. Further outside source interviews revealed due to only having one staff per shift and R2 needing two (2) people to assist with transfers resulted in R2 being in bed all day, leading to a rapid decline. Planned activities were not provided to the residents. Investigation revealed the licensee was advised by the hospice agency to hire additional staff, but the licensee could not afford additional staff. Outside source interviews indicated R1’s pressure injuries were so bad it was down to their bone, which was a result from not being rotated and having to sit in soiled diapers. Outside source interviews corroborated residents being left in soiled briefs and not being repositioned resulted in decline of residents health. Upon review of documents it was noted R2's Physician's Report was not included. R2's services were terminated in 2020. The licensee was contacted and asked to provide a copy. The license stated she was unable to locate the document and possibly threw it out. Title 22 Regulations requires records be kept for three years. During today's visit, LPA observed a prescribed medication sitting on a table in Resident #5's (R5) bedroom. The prescribed medication was for a resident that is no longer residing at the facility. An additional medication was sitting on the dresser in R5's bedroom, that medication belonged to R5. Neither medication was centrally stored. In addition, facility staff are not wearing masks, while in the facility. The staff stated the masks were unavailable due to being locked in licensee's room. Another staff member arrived during the visit and was not wearing mask, LPA reminded staff masks are required. Continued on an LIC 809C. Based on record review and interviews, the licensee failed to maintain resident's managed incontinence, provide planed activities, maintain record keeping, centrally store medications and failure to follow infection control procedures. 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 & Chapter 8 are being cited on the attached LIC 809D. [See LIC 811 Confidential Names List to identify Resident #1, Resident #2, and Resident #3 and Resident #5 An exit interview was conducted with Staff, Dolores Goldhammer and a copy of this report, LIC 421IM – Civil Penalty Assessment Form, and Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Staff, Dolores Goldhammer, whose signature below confirms receipt of these rights.[See LIC 811 Confidential Names List to identify Resident #1, Resident #2, Resident #3, and Resident #4].the state’s words, verbatim · CDSS document, Jun 10, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87625(b)(2) · Plan of correction due date: Jun 11, 2022

Managed Incontinence- In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by:Based on interviews and record review, the licensee did not ensure four (4) out of six (6) residents briefs were changed, which allowed exposure to urine and stool to cause skin breakdown. This posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 10, 2022

Plan of correction: Licensee agreed to schedule Managed Incontinence training from an outside vendor by POC due date and provide proof of training within 2 weeks. Licensee and all staff will attend the training.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87219(a) · Plan of correction due date: Jul 1, 2022

Planned Activities. Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. This requirement is not met as evidenced by: Based on interviews, the licensee did not provide activities for 4 out of 6 residents. Residents were left in bed all day. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 10, 2022

Plan of correction: Licensee agreed to attend along with all staff, Planned Activities training by an outside vendor and provide proof of training by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(e) · Plan of correction due date: Jul 1, 2022

Resident Records. Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This requirement is not met as evidenced by: Based on record review and interviews, the licensee did not maintain records for 1 out of 6 residents. Licensee does not have a physician’s Report on file for R2, whose services were terminated in 2020. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 10, 2022

Plan of correction: Licensee agreed to attend outside vendor training regarding Residents Records and provide proof of training by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jun 11, 2022

Incidental Medical and Dental Care. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not centrally store medications for 1 out of 6 residents. This poses an immediate health and safety risk to residents on care.the state’s words, verbatim · CDSS document, Jun 10, 2022

Plan of correction: Licensee agreed to schedule medication training by an outside vendor by POC due date and submit proof of training within 2 weeks. Licensee and all staff will attend the training.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468.1(a)(2) · Plan of correction due date: Jul 1, 2022

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on observations and interviews, the licensee did not ensure staff are wearing masks, putting 6 out of 6 residents at risk. This poses a potential health and safety code risk to residents in care.the state’s words, verbatim · CDSS document, Jun 10, 2022

Plan of correction: Licensee agreed to have staff wear masks while in the facility. In addition, Licensee will schedule Personal Rights training from an outside vendor and provide proof of training by POC due date. Licensee and all staff will attend the training.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Dang Nguyen and Sabel Martinez conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPAs were welcomed by Licensee Maria Delgado. LPAs identified themselves and discussed the purpose of the visit. LPAs conducted a brief tour of the facility and observed the staff and residents in care. In accordance with the Department’s Infection Control program, LPAs provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, screening protocols, and the use of personal protective equipment. No deficiencies were cited on this date. An exit interview was conducted with Licensee Maria Delgado, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mailthe state’s words, verbatim · CDSS document, Oct 28, 2021