Carlsbad Elder Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Administrator Marko Kolomijcev. The facility's license shows a maximum capacity of six (6) residents, ages 60 and over all of whom may be non-ambulatory. The facility has an approved hospice waiver for six (6). During today’s inspection there were 6 (six) residents in care. LPA and Administrator toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, 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 Resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and clients, and reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 2, 2025

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced case management visit to cite for a deficiency observed during a different visit. LPA introduced themselves to and discussed the purpose of the visit with Administrator David Swagerty. During today's visit LPA conducted a brief tour of the facility, reviewed and collected facility records, and interviewed staff and residents. At 10:53 AM, LPA observed three (3) weekly medication containers that were filled with a resident's medication for the week in a locked cabinet located in the kitchen. The medications in the weekly containers were not in its originally received container and had been transferred from their originally received container. Based on the foregoing, one (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D pages). Plans of Correction were jointly developed with Administrator Swagerty. An exit interview was conducted with Administrator Swagerty, to whom a copy of this report, the LIC 809-D page and the Licensee/Appeal Rights (LIC9058 03/22) were provided for today’s visit.the state’s words, verbatim · CDSS document, Apr 15, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(5) · Plan of correction due date: May 6, 2025

Incidental Medical and Dental Care (h)The following requirements shall apply to medications ...:(5) Each...medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was been met as evidenced by: Based on obsevations and interview the licensee did not comply with the section above in that one (1) out of two (2) resident's medications were transferred to a different a container for days in advance, which posed a potential health and safety risk.the state’s words, verbatim · CDSS document, Apr 15, 2025

Plan of correction: Licensee agreed to conduct an in-house training on centrally stored medications and provide the Department proof of this training with a sign-in sheet and training agenda by POC date of 05/06/2025.

Allegation investigated: Licensee did not communicate with resident’s representative of change in medication.

Licensing Program Analyst (LPA) Ryan Fulton conducted an unannounced subsequent visit to deliver findings regarding the above allegation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Marko Kolomijcev. The Department's investigation consisted of LPA observations, interviews with facility staff, residents, and outside sources, as well as records reviews. It was alleged that Licensee did not communicate with resident’s representative of change in medication. Specifically, it was reported that the Reporting Party had no knowledge of a medication change to R1’s medications list that now included Morphine. Records revealed that R1 was placed on hospice on 02/05/2024. This was confirmed by signatures on the Admissions Consent Agreement by R1’s responsible party. In this agreement, there is documentation describing what care the hospice agency provides, which includes a list of medication prescriptions that will be ordered on behalf of R1. One of the medications listed is Morphine, which comes in two different forms: one is a tab, and the other is liquid. Unsubstantiated The hospice notes revealed that on 03/01/2024, the hospice agency arrived at the facility to discuss comfort medications with staff and the responsible party. On 03/02/2024, the responsible party requested that the hospice agency begin comfort medications for R1, which included Morphine. On 03/03/2024, it was reported that the responsible party acknowledged that R1 looked comfortable after Morphine had been administered. Interviews with hospice employees revealed that when an individual is admitted into hospice, they are aware that comfort medications include Morphine. Staff also explained that when an individual is placed on hospice services, the company will order the comfort medication in advance for the client so they will not have to wait for the medication when they begin to decline in health. This agency has investigated the complaint allegation, Licensee did not communicate with resident's representative of change in medication. The Department has found that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations occurred. Therefore, the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted, and the report was along with licensee appeal rights (LIC 9058 03/22) were reviewed with Administrator Marko Kolomijcev.the state’s words, verbatim · CDSS document, Dec 20, 2024 · control 08-AS-20210312110409

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Hannah Rodgers and LPA Rebecca Ruiz conducted an unannounced case management visit to cite for a deficiency observed during a previous visit. LPAs introduced themselves, and met with Administrator Marco Kolomijcev. LPA spoke with Administrator David Swagerty via telephone during the visit. During today’s visit, LPAs observed residents in care. LPAs' observations and information provided by licensee and staff today and during previous visit on 12/5/2024 revealed that Resident 1 (R1) is bedridden and unable to reposition independently. Administrator Kolomijcev was provided with an LIC811 Confidential Names List to identify R1. Review of facility's license and fire clearance revealed that the facility is cleared and licensed for 6 non-ambulatory residents. The facility does not have an approved fire clearance to house a bedridden resident. Based on this information, a deficiency is being cited Per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on an LIC 809-D. Additionally, an immediate civil penalty in the amount of $500 is being assessed on an LIC421IM. An exit interview was conducted with Administrator Kolomijcev, to whom a copy of this report, LIC809-D, LIC811, LIC421IM, and Licensee/Appeal Right (LIC9058), were provided.the state’s words, verbatim · CDSS document, Dec 9, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Dec 10, 2024

Fire Clearance... Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall...obtain an appropriate fire clearance approved by the city, county... fire department... or the State Fire Marshal. (2) Bedridden persons. This requirement was not met as evidenced by: Based on record review and observations, the licensee did not obtain an approved fire clearance prior to accepting or retaining R1, who is bedridden. This poses an immediate safety risk to 1 of 5 persons in care.the state’s words, verbatim · CDSS document, Dec 9, 2024

Plan of correction: Administrator David Swagerty agreed to work with R1's responsible party to relocate R1 to a sister facility with a bedridden clearance. Administrator agreed to provide the Department with a copy of R1's responsible party written agreement for R1's relocation to the sister facility and admission paperwork by POC due date of 12/10/2024.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was greeted by, identified themselves to and discussed the purpose of the visit with Caregiver Edwin Mungcal. The facility's license shows a maximum capacity of six (6) non-ambulatory residents. Hospice waiver for two (2). During today’s inspection there were four (4) residents in care. Administrators David Swagerty & Marco Kolomijcev arrived later during the visit. LPA with Administrator Kolomijcev toured the interior and exterior of the facility, and inspected each room. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to residents. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Administrator Kolomijcev, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA reviewed facility records.The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Administrator Swagerty to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Dec 5, 2024

Type of visit: Required - 1 Year

On 1/12/2024, at about 09:17 AM, Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced Required Annual Inspection. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Marko Kolomijcev, Administrator and David Swagerty, Co-Administrator. According to the facility’s license, the facility serves six (6) elderly residents, age 60 and above, all of whom may be non-ambulatory. Hospice waiver for two (2) residents granted. On the day of the visit, LPA observed six residents, all non-ambulatory. During the inspection, LPA toured the interior and exterior of the facility and observed each resident’s room. The facility was organized, kempt and in good repair. The facility had no offensive odors. Pathways inside the property were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, 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 resident activities. There was at least two days of perishable food, and at least seven days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water were observed on the premises. Per Administrator, Kolomijcev, no firearms or ammunition are kept at the facility. Emergency lighting, and facility telephone were all working. LPA observed carbon monoxide, smoke detectors, and fire extinguishers and all were serviceable and operational. First aid kit(s) were observed. Required licensing postings were observed in visible areas of the facility. Hot water temperatures measured at 107.2 and 107.7 in sinks accessible to residents. Bathroom toilets, sinks and showers were observed to be in good service and operational. LPA interviewed residents and reviewed staff and resident records/files. Staff records were reviewed and contained CPR/First Aid certifications, health screenings and fingerprint clearances. LPA interviews did not raise any licensing concerns. The resident files which LPA reviewed contained the required documents. Confidential records were stored in locked areas. No deficiencies were cited during today's annual inspection. An exit interview was conducted with Administrator, Kolomijcev 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, Jan 12, 2024