Oceanside Rest Home

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by and identified himself to Caregiver Brandon Navasak. LPA then met and discussed the purpose of the visit with Licensee Siera Navasak, who arrived later during the visit. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office on 05/31/2023, involving Resident #1 (R1) and Staff #1 (S1). [See LIC 811 Confidential Names List for a description of person identifiers used in this report]. During today’s visit, LPA performed a facility tour and welfare check, interviewing R1 and verifying that they were safe and uninjured. LPA also collected pertinent records and interviewed relevant staff. Records and interviews showed: While S1 assisted R1 in the shower on 05/29/2023, S1 cut R1’s hair, against their will and protest. This caused R1 to be sad/upset. When licensee interviewed S1 about the incident, S1 admitted to doing this. Also, during one prior occasion in late 2022, Staff #2 (S2) had also cut R1’s hair, against their will. Personnel records showed that licensee had disciplined S1 and S2, following each respective incident. As of the date of LPA’s site visit, neither S1 nor S2 were still employed at the facility. A preponderance of evidence exists to show that licensee’s staff (S1 and S2) did not treat a resident (R1) with dignity. One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D). Since the deficiency is a repeat violation within a 12-month period of time, a civil penalty of $250.00 was also assessed (refer to the LIC 421-FC). A Plan of Correction was jointly developed with the licensee. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] An exit interview was conducted with Siera Navasak, to whom a copy of this report, the LIC 809-D, the LIC 421-FC, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Aug 16, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Sep 15, 2023

87468.1 Personal Rights of Residents in All Facilities: “(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff...” This requirement was not met, as evidenced by: Based on records and interviews, licensee’s staff (S1 and S2) did not treat 1 of 6 residents (R1) with dignity, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 16, 2023

Plan of correction: Records and interviews showed S1’s employment was terminated on 05/31/2023, and S2’s employment was terminated on 10/05/2022. Licensee agreed to utilize a third-party source to retrain their direct care staff on Resident’s Personal Rights (see Regulation 87468.1 and 87468.2). Licensee agreed to submit the training sign-in sheet to LPA, by the POC due date.

Allegation investigated: Staff restrained resident

Licensing Program Analyst (LPA) Nacole Patterson conducted an unannounced subsequent visit, to deliver findings regarding the above prior complaint allegation. LPA was welcomed by and identified herself to caregiver Victoria Phongpaphanh. LPA then met with and discussed the purpose of the visit with Administrator Siera Navasak. On 12/29/22 it was alleged that staff restrained a resident. The Department's investigation involved two unannounced facility visits/welfare check, review of facility records, interviews with relevant staff, residents, and outside sources. Regarding the first allegation, "Staff restrained resident", it was alleged that S1 (see LIC811 Confidential List of Names) physically restrained R1 from leaving the facility, causing injury. Staff interview revealed that the staff member in question was terminated in October 2022 for similar violations of residents' personal rights; this was confirmed by review of facility records. Continued on LIC9099-C (This is an amended report for signature only). Substantiated Continued from LIC9099 Staff interviewed observed the prior personal rights violations of S1, confirming R1 and R2 to be valid historians. 2 of 4 outside sources interviewed had knowledge of prior allegations against the staff in question, but did not have knowledge or observation of this incident. Resident interview revealed detailed information regarding the incident and R1 confirmed that there were no witnesses and they did not make anyone aware of the incident. Records review showed that previous personal rights allegations were made against the staff in question, which was investigated and substantiated by the Department. Based on interviews and records, the preponderance of evidence has been met, therefore the allegation is substantiated. Deficiencies are cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). A Plan of Correction was jointly developed with the Administrator. An exit interview was conducted with Siera Navasak, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Aug 7, 2023 · control 08-AS-20221229131315

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Aug 7, 2023

87468.1(a)(6) "Residents in all residential care facilities for the elderly shall have all of the following personal rights: …To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night." This requirement is not met, evidenced by Based on records and interviews, Licensee's employee (S1) physically restrained resident (R1), preventing them from leaving the facility. This posed a potential safety risk to 1 of 1 clients in care.the state’s words, verbatim · CDSS document, Aug 7, 2023

Plan of correction: Immediate risk has been removed, LPA verified with the Licensee that S1 is no longer working at the facility as of 10/5/2022. Licensee will conduct an in-service training on personal rights, and abuse training for staff on and provide sign in sheets to the Department by POC due date.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by and identified himself to Caregiver Lucy Credito. LPA then met and discussed the purpose of the visit with Licensee Siera Navasak. Today's visit was in response to an LIC624 Unusual Incident/Injury Report, which licensee self-submitted to the CCLD San Diego Regional Office on 02/23/2023, involving Resident #1 (R1) and Staff #1 (S1). [See LIC 811 Confidential Names List for a description of person identifiers used in this report]. During today’s visit, LPA performed facility tour / welfare check, interviewed 6 of 6 residents in care, interviewed staff, and collected records. No deficiencies were observed or cited during today's visit. An exit interview was conducted with Navasak, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Mar 3, 2023

Allegation investigated: Staff grabbed resident's arm causing a bruise Staff did not treat resident with dignity

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint investigation visit to conduct follow-up and deliver findings regarding the above-mentioned allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Caregiver Lucita Credito. Licensee Siera Navasak arrived during the visit. During today's visit, LPA interviewed Licensee and observed residents in care. The Department’s investigation consisted of interviews with staff, residents, and outside sources, records review, and a tour of the facility. It was alleged that a staff grabbed resident’s arm causing a bruise and staff did not treat resident with dignity. Review of resident 1 (R1) medical records revealed that R1 did not have a memory impairment or diagnosis of dementia, was able to communicate needs, was able to follow directions, and was on a regular bathroom schedule. Continued on LIC9099-C page... Substantiated Review of R1’s facility records revealed that R1 had a history of agitation during incontinence care and refusing showers. Interviews revealed that in September 2022, R1 had an episode of incontinence and soiled their clothing. Staff 1 (S1) asked R1 to shower but R1 refused. S1 then took R1’s soiled pants and put them near R1’s face to show R1 that they needed to shower and R1 became upset and angry. Interviews revealed that S1 attempted get R1 to shower and R1 started yelling at S1 to “stop it” in response to being told to get in the shower. S1 was able to get R1 into the shower and began showering R1. Interviews revealed that while S1 showered R1, S1 grabbed R1’s left arm. R1 was observed with bruising in that area and reported pain after being grabbed. Interviews and record review revealed that on October 4, 2022, S1 indicated that R1 raised their arm to block S1 from spraying water on R1 and the shower-head cord wrapped around R1’s arm which caused R1’s bruising in that area. Interviews revealed that S1 was rude to residents and would yell and curse at residents when S1 was frustrated. Interviews revealed that the residents did not like the care provided by S1. The Department was unable to interview S1 due to S1 being unavailable. The Department has investigated the above-mentioned allegations and based on interviews and records review, the preponderance of the evidence has been met, therefore, these allegations are deemed substantiated. The following deficiencies are cited per CA Code of Regulations Title 22 and noted on the attached LIC9099-D page. An exit interview was conducted with Licensee Siera Navasak, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.the state’s words, verbatim · CDSS document, Dec 29, 2022 · control 08-AS-20221004103235

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Jan 20, 2023

87468.1 Personal Rights of Residents in All Facilities (a) residents... shall have all of the following personal rights (3) to be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... This requirement has not been met as evidenced by: Based on interviews and records review, the Licensee did not ensure R1 was free from abuse resulting in bruising. This poses an immediate personal rights risk to 6 of 6 residents in care.the state’s words, verbatim · CDSS document, Dec 29, 2022

Plan of correction: Immediate risk has been removed, LPA verified with the Licensee that S1 is no longer working at the facility as of 10/5/2022. Licensee will conduct an in-service training on reporting requirements, personal rights, and abuse training for staff and provide sign in sheets to the Department by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jan 20, 2023

87468.1 Personal Rights of Residents in All Facilities (a) residents... shall have all of the following personal rights (2) to be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement has not been met as evidenced by: Based on interviews and records review, the Licensee did not ensure that residents were accorded dignity in their relationship with S1. This poses a potential personal rights risk to 6 of 6 residents in care.the state’s words, verbatim · CDSS document, Dec 29, 2022

Plan of correction: Licensee will conduct an in-service training on reporting requirements, personal rights, and abuse training for staff and provide sign in sheets to the Department by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA identified herself to, was allowed entry by, and explained the purpose of the visit to Caregiver Lucita Credito . Administrator Siera Navasak arrived during the visit. During today's visit, LPA conducted a tour of the facility and observed the residents in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, 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. No deficiencies were cited or observed on this date. An exit interview was conducted with Administrator Siera Navasak, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.the state’s words, verbatim · CDSS document, Jul 14, 2022