North La Costa Assisted Living

Allegation investigated: -Resident developed pressure injuries while in care -Facility staff did not ensure that resident had an adequate intake of liquids -Facility staff did not seek medical attention in a timely manner

Licensing Program Analyst (LPA) Daniel Pena conducted an unannounced facility visit to follow up on a complaint investigation regarding the above-mentioned allegations. LPA identified himself, explained the purpose of the visit and nature of the complaint to Administrator, Dejan Boskoski. On 12/17/2020, the Department received this complaint which alleged, Resident 1 (See LIC811 Confidential Names to identify R1) developed pressure injuries while in care, facility staff did not ensure R1 had an adequate intake of liquids and did not seek medical attention for R1 in a timely manner. The Department’s investigation included, virtual and on site physical plant inspections, record reviews and interviews with residents, staff and outside sources. A review of facility records included a self-reported unusual incident, involving R1. On 12/14/2020. R1 informed facility staff they were not feeling good and experiencing pain. Staff called R1’s hospice provider and reported the concern but was told R1 had an appointment with a nurse later in the week and would Unsubstantiated be seen then. Staff asked the hospice agency to send a nurse to immediately evaluate R1, but the agency said they could not. Facility staff then called R1’s conservator to advise them of the situation and informed them that that 911 would be called for R1. Facility staff called 911 and remained on the phone until paramedics arrived. R1 was admitted to the hospital and received treatment. R1 returned to the facility and still currently resides there. During R1’s hospital admission, a health care professional observed R1 was in decline and non-verbal. The source indicated R1 was admitted with elevated sodium levels, wounds and dehydration. The source stated R1 was on hospice and receiving bathing services twice a week. The source said they spoke with the hospice provider about R1’s wounds but the agency said they were unaware of any skin conditions. The source expressed concerns for the care provided by the hospice agency, not R1’s licensed residential care facility. Hospice record reviews revealed that R1 began receiving hospice services on 9/26/2020 with a terminal diagnosis of Senile Degeneration of Brain. At the time of hospice admission, R1 resided at another licensed care facility. R1’s hospice admission contract showed that a hospice aide was supposed to visit facility twice per week and as needed to assist R1 with personal care, home making and to promote comfort per nurse assignment. Additionally, hospice records showed the provider was to perform Peri-area skin maintenance which was to include cleanse with warm water and soap, pat dry and apply skin protectant daily and as needed for skin maintenance. The record did not show the presence of an existing skin condition or wound. R1 was admitted to North La Costa Assisted Living on 12/02/2020 and appraised by the administrator. R1's appraisal report showed no evidence of skin condition or dehydration. R1’s Physician Report showed they required assistance with all Activities of Daily Living (ADL) but the documentation did not show evidence of skin conditions or wounds. R1’s conservator was interviewed and stated, North La Costa Assisted Living staff identified the change in R1's condition and took action to get R1 medical treatment. The conservator stated R1’s dehydration was identified at R1's previous facility and due to sepsis. R1’s conservator said, the hospice agency provided decent care, but they were not totally impressed with them. After R1 returned from the hospital, the facility administrator and R1's conservator met with the hospice agency. Following this meeting, hospice aides visited R1 three times a week until R1 was cleared from hospice in 2022. R1 still resides at North La Costa Assisted Living and is seen regularly by home health nurses and a physician. When asked, the conservator said North La Costa Assisted Living staff did a "fantastic" job providing care to R1. The conservator said it was facility staff who identified R1's medical issues and immediately sought medical treatment. The source also said the facility followed up with the hospice provider once R1 returned from the hospital. The Department has investigated the allegations that R1 developed pressure injuries while in care, facility staff did not ensure R1 had an adequate intake of liquids and staff did not seek medical attention for R1 in a timely manner. Based upon the information obtained during this investigation; it is determined that although the incidents may have happened and are valid, there is not a preponderance of evidence to prove they occurred and are therefore UNSUBSTANTIATED. An exit interview was conducted with Administrator Boskoski, to whom a copy of this report and the Licensee's Rights (LIC9058 01/16) were provided via hard copy.the state’s words, verbatim · CDSS document, Jan 6, 2023 · control 08-AS-20201217121625

Allegation investigated: Facility did not inform emergency contacts that the resident passed away.

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Administrator Dejan Boskoski and we discussed the purpose of the visit and elements of the complaint. Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA direct observation, records review, and interviews. In response to the allegation, it was alleged that Facilty did not inform emergency contacts that the resident passed away (R1) [an LIC 811 Confidential Names List was provided to the facility representative to identify the resident.] Records review revealed that on February 8, 2022 emergency services were called to pick up R1 from the facility due to R1 not responding as usual. R1 was admitted to the hospital that same day. On February 9, 2022 the hospital notified R1's responsible party that the resident passed away. R1's responsible party then notified the facility of the death. Unsubstantiated Records review further revealed only one contact name was listed for R1 which was their responsible party on file. Interview with responsible party (RP) on file revealed immediately after R1's death they notified the only family member they had documented on their contact list and advised them of the death. Interview with Administrator revealed R1 was admitted to the facility over seven years ago by R1's responsible party. R1's responsible party advised the Administrator that R1 had one next of kin. During R1's stay at the facility, R1 did not have any visits from any friends or family. Administrator stated they attempted to notify R1's next of kin immediately after R1's death, but they could not reach them. Administrator further stated that R1's responsible party stated they would handle all of R1's affairs after R1 passed away. Based on LPA interviews and review of facility records, we have found that the preponderance of the evidence standard has not been met, therefore, the allegation is found to be unsubstantiated. An exit interview was conducted with Dejan Boskoski and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to Dejan Boskoski whose signature below confirms receipt of documents.the state’s words, verbatim · CDSS document, Nov 29, 2022 · control 08-AS-20220218120802

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an annual required licensing inspection. This annual inspection was focused on infection control due to the COVID-19 pandemic. LPA was greeted at the front entrance by Caregiver, Nareyda Ledesma and granted entry after identifying herself. LPA discussed the purpose of the visit. Administrator, Dejan Boskoski arrived during the visit. This facility serves six (6) elderly residents ages 60 and above; all of whom are non-ambulatory. Facility has a hospice waiver for four. During today's visit, LPA toured the facility with Caregiver, Dianna Cisneros, and verified compliance with infection control practices. LPA and Administrator, Dejan Boskoski reviewed the facility’s COVID-19 Mitigation and Infection Control Plan. LPA observed one central entry point; routine symptom screening initiated at entry for staff, residents and visitors; a sign-in policy enacted for all visitors; signs throughout the facility to promote hand hygiene, cough/sneeze etiquette; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; and an adequate supply of PPE and disinfectants. Based on today's visit, no deficiencies were observed in the areas evaluated above. An exit interview was conducted with Administrator, Boskoski and a copy of this report along with the Licensee/Appeal Rights (LIC 9058) was provided at the facility.the state’s words, verbatim · CDSS document, Aug 11, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Marisela Garcia-Centeno conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA met with Administrator, Dejan Boskoski, and we discussed the purpose of the visit. All staff present have a current criminal record clearance. LPA conducted a tour of the facility, both inside and outside and observed the clients in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. No deficiencies were cited or observed on this date. The Licensee was provided a copy of her appeal rights (LIC9058 01/16). An exit interview was conducted, and a copy of this report was emailed to the Administrator, Dejan Boskoski with an electronic read receipt as confirmation of documents.the state’s words, verbatim · CDSS document, Aug 30, 2021