Renaissance Living II

Allegation investigated: Staff financially abused resident Staff did not safeguard resident's personal property

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close a complaint investigation regarding the above-mentioned allegations. LPA identified herself and met with Leandra Smith, Caregiver, to discuss the purpose of the visit and elements of the complaint. It was alleged that staff financially abused resident. Interviews revealed Resident 1 (R1) had Dementia that was progressing and they would say things that were not true. Interviews with outside sources stated that the facility staff did not steal any money from the resident and they know because they were R1s responisble party. It was alleged that staff did not safeguard resident's personal property. Interviews with staff revealed they took care of R1 and that when R1 came they did not come with any furniture or extra clothes. Outside source interviews revealed the resident went to the facility with only the clothes on their back and nothing else. Interviews also revealed the facility staff took really good care of R1. Allegations of staff financially abused resident and staff did not safeguard resident's personal property are unsubstantiated. An exit interview was conducted with Leandra Smith, Caregiver. A copy of this report and Licensee Appeal rights (LIC 9058 3/22)were provided at the conclusion of the visit. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 21, 2023 · control 08-AS-20210423144948

Allegation investigated: Resident sustained unexplained injury while in care Staff hit residents in care Staff is under the influence of alcohol Staff threaten residents in care

On 9/18/2023 at about 10:40 AM, Licensing Program Analyst (LPA), Daniel Pena, conducted an unannounced complaint visit to the facility to deliver investigative findings. After introducing and identifying himself, LPA met with Caregiver, Leandra Smith to whom LPA discussed the elements of the complaint. On August 2, 2023, the Community Care Licensing Division (CCLD) received a complaint alleging staff caused a resident to sustain an unexplained injury requiring hospitalization; hit residents in care; worked under the influence of alcohol and threatened to call police on residents. The Department’s investigation consisted of physical plant inspection, review of facility and resident records and interviews with residents, staff and outside sources. The facility visit/inspection which occurred on 7/26/2023 depicted a quiet, well-lit and organized facility. Unsubstantiated LPA’s observations of staff and resident interactions revealed no obvious tensions between them. LPA did not observe any obvious injuries to residents. Interviews with residents consistently stated that staff treat them well. Interviews reported that residents have not been the focus of abuse nor witnessed abuse of other residents. None of the residents had knowledge about any resident being hospitalized. No resident said they had ever seen any staff report to work under the influence of alcohol. No resident stated staff threatened to call police on them or any other residents. Interviews with all staff produced consistent denials that they or any staff had physically abused or threatened residents in any way. Staff denied causing injury to any resident, resulting in hospitalization. The licensee was interviewed and stated that staff are lauded by residents for their manner of providing care. A review of facility records did not bring forth supporting evidence for the allegations. The Department has investigated the allegations that staff hit and threatened residents, caused a dislocated hip injury to a resident requiring hospitalization and worked under the influence of alcohol. Due to a lack of supporting information, the Preponderance of Evidence standard was not met. Therefore, the allegations are Unsubstantiated. An exit interview was conducted and a copy of the Licensee’s Rights (LIC 9058 3/22) along with a copy of this report was provided to Caregiver Smith.the state’s words, verbatim · CDSS document, Sep 18, 2023 · control 08-AS-20230719152301

Allegation investigated: -Resident received unexplained injuries in care -Staff yelled at residents -Staff did not follow food preparation requirements

Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegations. LPA met with Caregiver Silvia Moreno Camacho and we discussed the purpose of the visit and elements of the complaint. Community Care Licensing (CCL) has investigated the above allegations. The investigation consisted of LPA interviews with residents and facility staff and records review. It was reported to CCL that Resident (R1) received unexplained injuries while in care.[an LIC 811 Confidential Names List was provided to the facility representative to identify the resident.]. Complainant also reported that a staff member; Staff #1 (S1) yelled at R1 and other residents. S1 was also reported to be handling chemicals (insect spray near the area food is prepared for the residents.) Interview with Staff #2 (S2) revealed no knowledge of any staff members yelling or acting aggressively towards residents. S2 further stated that one ex-staff member (S1) was a foreigner and would speak louder due to an accent and cultural differences. Unsubstantiated S2 went onto say that this ex-staff member (S1) was loved by all of the residents and their responsible parties due to the staff's warm demeanor and family style meals they would regularly cook for the residents. S2 further stated that they have never used or seen another staff member spray insect chemicals inside the facility, primarily because a pest control company regularly visited the facility. Interview with R1 revealed no issues with staff members at the facility. R1 stated that they did not recall ever being yelled at or physically abused at the facility. Interview with Resident 2 (R2) revealed no issues with any staff members. R2 further stated that they have never been verbally or physically abused by any staff member at the facility. Interview with Outside Agency (OA) revealed that they worked closely with R1. OA stated R1 has a medical condition which causes R1 to fall down randomly, which often resulted in bruising on the knees and legs. OA stated that they never witnessed nor had any suspicion that S1 hit or injured R1. OA further stated that S1 often spoke in a loud and animated manner due to a cultural difference which could be confused for yelling. OA stated that they never witnessed staff using any insect chemicals inside the facility but they have witnessed a pest control company working at the facility. Interview with Administrator revealed no knowledge of any residents or family members upset with a staff member at the facility. Administrator stated that they and R1's responsible party would be in regular contact via text message. Administrator stated that they were never advised of any issues with the facility or a staff member. Administrator stated that it was in fact the opposite in that R1's responsible party would praise them (via text) for the work they did with R1. Administrator stated that R1 initially left the facility to live with the their Responsible Party on November 2022. Administrator stated that after a brief stay at the Responsible Party's residence they attempted to move R1 back to Renaissance Living II in the beginning of December 2022, but it was not possible since the room was already occupied. Administrator further stated that the facility had a contract with Aptive pest control company for several years and their would be no need for any insect chemicals to be used or stored inside of the facility. Based upon the foregoing, the above listed allegations are unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegations are not valid. An exit interview was conducted with Silvia Moreno Camacho and a copy of this report and Licensee/Appeal Rights (LIC9058, 3/22) were provided to Silvia Moreno Camacho whose signature below confirms receipt of documents.the state’s words, verbatim · CDSS document, Apr 27, 2023 · control 08-AS-20230130081739

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kennedy made an unannounced visit to the facility to conduct an annual required licensing inspection. LPA identified herself, and met with Unique Maye, Assistant Administrator, and discussed the purpose of today’s visit. A tour of the facility was conducted inside and out. LPA, accompanied by facility staff conducted a general overall inspection, with a specific focus on infection control. During today's inspection LPA observations include the following: Symptom screening procedures for staff, residents and visitors; posted signs including visitor policy, promoting hand washing, cough and sneeze etiquette and other infection control procedures; Hand hygiene practices; testing plan and procedures; plans for containing infections, PPE supplies procedures and training; and disinfection procedures. Based on today’s inspection, no deficiencies were observed at this time in the areas evaluated. This report was discussed with Unique Maye, Assistant Administrator. A copy along with Licensee Rights (01/2016) was emailed to Ms. Maye at the conclusion of the visit. An electronic response confirms the receipt of these documents. Please submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500 and Emergency Disaster Plan LIC 610-D to the licensing office within 10 business days. Forms available at www.ccld.ca.govthe state’s words, verbatim · CDSS document, Nov 10, 2021

Allegation investigated: Licensee did not provide resident records upon request

Licensing Program Manager (LPM), Alexandre Vo, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPM met with Licensee, Richard Edwards, identified himself, and stated the purpose of the visit. It was alleged that residents' documents were not provided upon request. Resident #1 (R1, see list of confidential names) relocated from the facility in May 2020 and sent a letter of request for documents, including Admission Agreement, financial papers, etc. A written letter of request was sent on July 8th, 2020, was received by the Administrator, Unique May, by certified mail on July 14th, 2020. Based on outside source records and interviews, Licensee did not comply within three business days for the record production response. Substantiated A deficiency is being issued in accordance with the Health and Safety Code and listed on the 9099D. The deficiency was also cleared because the licensee provided the required documents to the requesting entity. An exit interview was conducted, and a copy of this report, Letter of Deficiency Cleared, and Licensee's Appeal Rights (9058 01/16) were provided to the Licensee, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Aug 20, 2021 · control 08-AS-20200727113948

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.269(a)(21) · Plan of correction due date: Aug 20, 2021

1569.269 Enumerated rights; severability (a) Residents of residential care facilities for the elderly shall have all of the following rights: (21) To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days... This requirement was not met as evidenced by: Based on records and interviews, the Licensee did not provide prompt access to resident records. This posed a potential personal rights risk to one of the five residents in care.the state’s words, verbatim · CDSS document, Aug 20, 2021

Plan of correction: Licensee provided proof that the requested documents were delivered to the requestor. Deficiency cleared.

Allegation investigated: Facility staff financially exploited a resident Facility staff is not meeting basic food/water needs of residents

Licensing Program Analyst (LPA), Alexandre Vo, conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegations. LPA was allowed entry into the facility after identifying himself and stating the purpose of the visit. LPA met with Licensee, Richard Edwards. The Department’s investigation included review of facility and resident records, financial statements, and interviews with staff, residents, and outside sources. It was alleged that the Licensee financially exploited Resident #1 (R1, see List of Confidential Names) through the sale of R1’s properties below-market value price and pre-payment of rent in the amount of $50,000. The transfer of the value of R1’s home to the Licensee was in the amount of $325,000 and a vehicle sales transfer in the amount of $6,500. Based on review of admission agreements and interviews, R1 and Resident #2 (R2) were a married, elderly couple and they moved into the facility on August 7th, 2019 and September 2019, respectively. R2 was on hospice and passed away on May 5th, 2020 and R1 moved out the facility on May 29th, 2020. Per interviews, observations, and records, R1 is deemed alert and oriented and capable of making their own financial decisions. Unsubstantiated Regarding the sale of the residents’ property in El Cajon, according to R1’s and R2’s property loan terms, California Real Estate Listing Agreement and California Real Estate Purchase Agreement, the owners must reside within their own home to avoid a repayment clause. Because the residents were relocated to the residential care facility after their discharge from a skilled nursing environment, the repayment clause was triggered. In addition, to qualify for Veteran’s Administration (VA) Benefits Aid and Attendance, outside source documents corroborated that in order to allow for R2’s uninterrupted care, $84,500 from the sales proceeds was required to satisfy the VA benefits eligibility. This sale proceed is to be applied to the board and care agreement for assisted living services and room and board. The agreements also show that R1’s signature was on both forms. Thusly, R1 entered into the sale agreement and the contract for the uninterrupted care at the assisted living facility without coercion. Review of the financial ledgers indicate that the facility received $106,596 in total income from the residents for the board and care stay from August 2019 through May 2020, including the $84,500 advance payment. Facility’s board and care services for both residents during this time period were audited in the amount of $98,884.95 and includes rent payments in the amount of $5,000 for R1 and $6,000 R2--$1,000 for additional services for R2’s health conditions--and prorate adjustments in the amount of $4,451.61 for August 2019 and $1,333 May 2020. The resident, or their responsible party, is owed $7,711.05. According to San Diego County records, as of May 21st, 2020, the value of the resident’s property in El Cajon ranged from $329,406 - $471,984. Outside source observation in June of 2020 reported that the property’s external condition is very poor. A market difference of $4,406 for a house sold in August 2019 is not extreme as the house value has increased in recent market conditions. Financial documents show that the R1 also received a difference of $78,065.53 after the sale of the home, rent deductions, VA benefits adjustment, and repayment clause trigger. Kelly blue book records show that the market value of the vehicle was between $2,514 - $4,637 for a 1993 Toyota Pre-runner. Interviews also indicate that R1 was not under coercion at the time of the sales of the properties. (continued) Based on the available information through records and interviews, evidence could not corroborated that R1 was financially exploited through the sale of their properties to the licensee for payments of room and board. Even though the resident, or their representative, is owed a refund, the amount due is accounting for unsettled prorate funds. Therefore, this allegation is unsubstantiated which means that the preponderance of the evidence standard has not been met. It was also alleged that residents were not being provided food and water. Based on interviews and observations, the facility has an ample supply of food and that residents, including R1 and R2, were provided meals and liquids to meet their needs. Records review show that R1 did not require a special diet where licensee would have to meet a prescribed order. Therefore, this allegation is also unsubstantiated because the preponderance of the evidence standard has not been met. An exit interview was conducted and a copy of this report and Licensee’s Rights (9058 01/16) were provided to the licensee by electronic mail. An e-mail receipt confirms the acknowledgement of these documents.the state’s words, verbatim · CDSS document, Aug 20, 2021 · control 08-AS-20200518083518

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA), Alexandre Vo, conducted a case management deficiency found during a complaint investigation. LPA met with Licensee, Richard Edwards, and explained the purpose the case management. The Department’s findings were derived from records and interviews surrounding charges against a former resident’s account that were not agreed upon. During the complaint investigation, financial ledgers show that Resident #1 and Resident #2 were charged a household moving fee of $1,800, as well as, a $475 outside auditor fee. Based on interviews and review documents, neither charges were agreed upon by the residents. Therefore, the Department concludes that the licensee did not adhere to the payment provisions in the residents’ admission agreements. Therefore, the resident, or their representative, is owed $2275.00. In addition, the conflicting language of the facility’s admission agreement indicates that “pre-admission fees are not charged. If in the future a preadmission fee is charged, the admission agreement will be revised…” Records review indicate that residents, R1 through R6, were charged the pre-admission fee of $500.00 each and their admission agreements were not revised to reflect the appropriate charge and refund conditions. Based on evidence gathered during the complaint investigation, the accounting for unsettled funds resulted in an owed amount of $7,711.05. The total refund due to residents R1 and R2, or their representative, is $10,986.05 -- preadmission and unsettled funds. The amount owed to each resident R3, R4, R5, and R6 is $500.00 each. Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6, Chapter 8 and are listed on the LIC809D. A Plan of Correction was developed with the Licensee. An exit interview was conducted, and a copy of this report, List of Confidential Names, and Licensee’s Rights (9058 01/16) were provided to the Licensee, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Aug 20, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(3)(B)(2) · Plan of correction due date: Sep 10, 2021

87507 Admission Agreements (g) Admission agreements shall specify the following (3)...(B) Rate for additional items and services, including: 2. A separate charge for an item or service may be assessed only if that charge is included in and authorized by the admission agreement. This requirement was not met as evidenced by: Based on records and interviews, the licensee charged resident #1 for a service that was not included and authorized by the admission agreement. This posed a potential financial risk to the resident in care.the state’s words, verbatim · CDSS document, Aug 20, 2021

Plan of correction: The licensee agreed to refund R1 and R2, or their responsible party, in the amount of $2275.00 and $7,711.05. Licensee agreed to provide proof payment by cancelled check or similar to LPA by the POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87507(a)(1)(B) · Plan of correction due date: Sep 10, 2021

87507 Admission Agreements (a) … (1) The text of the admission agreement, including any attachments and modifications, shall be: (B) Written in clear, understandable, coherent, and unambiguous language, using words with common and everyday meanings, and shall be appropriately divided with each section appropriately titled. This requirement was not met as evidenced by: Based on records review and interviews, the admission agreements for six out of seven residents contain ambiguous language regarding pre-admission fees. This posed a potential financial risk to all residents in care.the state’s words, verbatim · CDSS document, Aug 20, 2021

Plan of correction: The licensee agreed to refund the resident, or their responsible party, in the amount of $500.00 for R1, R2, R3, R4, R5, and R6. Licensee agreed to provide proof of payment or similar to LPA by POC date. In addition, the licensee agreed to update their admission agreement for all current residents, and provide an admission agreement addendum to LPA by POC date.