Right Choice Senior Living LLC - La Mesa

Allegation investigated: Staff impaired with alcohol while caring for residents Staff not dispensing medication appropriately to residents Staff yell at residents

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced complaint investigation visit to the facility to deliver findings on the above allegations. LPA were granted entry to the facility by Marilena Villa, House Manager, after identifying herself and explaining the purpose of the visit. The investigation consisted of interviews of residents, staff, and outside sources in addition to records review, and inspection of the facility. It was alleged that facility staff were impaired with alcohol while caring for residents. Interviews with outside sources and residents revealed that staff have not been observed drinking or intoxicated while working or providing care. Staff denied consuming alcohol on facility grounds or being intoxicated while providing care to residents. Interviews with staff and residents confirmed that a couple of residents drink alcohol in the facility, specifically during BBQs or other social events. Staff indicated they monitor residents that drink alcohol socially to ensure they don’t have contraindications. Interview with staff in question (S3) revealed that S3 admits that some resident’s do have a few drinks at the facility during a holiday BBQ but the staff Unsubstantiated does not drink at the facility especially if thery are on the clock as all employees are invited to attend holiday BBQs. It was alleged that staff did not dispense medication appropriately to residents, specifically that medication was found on the facility floor. Interviews with staff revealed that the facility has a buddy system to ensure medications are dispensed as prescribed. In addition, they conduct medication audits (reconciliations) in which they compare residents’ medication orders to the medications on hand to avoid medication errors. Multiple staff confirmed they observe residents take their medications and if a resident refuses, staff take the medication back, bag it and log it accordingly. Furthermore, staff notify the resident’s Primary Care Physician of the refusal. Staff deny finding medication on the floor or having residents that “cheek” (temporarily storing pills inside of the cheek of the mouth) their meds. Interviews with residents revealed they have not seen pills on the floor or heard of medication being assessable. Interviews with outside sources did not support the allegation and did not have concerns. During a tour of the facility on December 27, 2022, LPA and IAPA observed medications stored in a locked medication cart. Record review, to include review of medication logs, did not reveal inconsistencies with the administration of medications. It was alleged that staff yell at residents. According to interviews, staff denied yelling at residents and denied observing other staff yell at residents. Staff described residents as calm and indicated they get along which results in little re-direction. Interviews with residents and outside sources corroborated staff statements and indicated they have not observed or witnessed staff yell at residents. Interview with staff in question (S3) revealed that S3 denies yelling at residents and denies observing any staff yell at residents. Based on the evidence obtained during the complaint investigation, the allegations were found to be UNSUBSTANTIATED, as there is not a preponderance of evidence to prove the alleged violations occurred. An exit interview was conducted; a copy of this report along with licensee rights LIC 9058 (REV 3/22) were provided to House Manager and their signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, Jan 6, 2023 · control 08-AS-20220914140919

Allegation investigated: -Facility staff touched resident in a sexual manner. -Licensee used a device that inhibited a resident’s mobility.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver findings regarding the above prior complaint allegation(s). LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Marilyn Ancho. LPA also spoke briefly with the licensee via phone. It was first alleged that facility Staff #1 (S1) touched Resident #1’s (R1) breasts because R1 said their breasts hurt and because R1’s physician said the elevated level of hormones present in R1’s breasts could mean they were “self-stimulating.” It was secondly alleged that Licensee’s use of an alarmed floor mat beside R1’s bed caused R1 to feel “restrained” and unable to leave their room. CCLD’s investigation involved an unannounced facility tour/welfare check, review of pertinent care and medical records, and interviews of R1 and relevant facility staff and outside sources. [CONTINUED ON LIC 9099-C,1 of 2] Unfounded [CONTINUED FROM LIC 9099] Per outside interviews, their LIC602 Physician’s Report, and their Care and Service Plan, R1 was in an early stage of cognitive impairment but still “able to follow instructions” and “able to communicate [their] needs.” CCLD interviewed R1 and verified they were a credible witness. R1 was alert and oriented to self, others, place, and time. R1 was articulate and self-aware, able to describe their current physical and cognitive condition, their likes and dislikes, and their life story. R1 affirmed knowing and remembering who S1 was. R1 said S1 never touched their breasts or any other part of their body in a sexual manner, nor did they tell anyone such. R1 said their breasts still hurt, six months after they moved out of the facility, concluding, “I think I have breast cancer.” S1 also denied the allegation. S1 said they were administrative staff and thus not hands-on with any aspect of R1’s personal care. Interviews of multiple facility caregivers and review of the facility’s care task logs corroborate S1 did not personally bathe, dress, or toilet R1; caregivers instead completed these tasks. The complainant admitted there were no witnesses to the alleged incident with R1. All staff interviewed said they never saw S1 inappropriately touch R1 or any other resident. The San Diego County Long Term Care Ombudsman’s Office (LTCOP) reviewed the alleged incident, advising CCLD that they found no evidence of wrongdoing. CCLD observed the bedside device described by the complainant, determining it was a pressure-activated bedside alarm/alert mat, a tool not expressly prohibited by California Code of Regulations or California Health and Safety Code. According to a March 2019 study titled “Alarming and/or Alert Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review,” published by the National Institutes of Health (www.nih.gov), alert devices “can assist in the care and safety of nursing facility residents…when used as one piece of a comprehensive care plan…” and “can be quite effective devices in ensuring resident safety.” [CONTINUED ON LIC 9099-C, 2 of 2] [CONTINUED FROM LIC 9099-C, 1 of 2] Per their LIC602 Physician’s Report and their Care and Service Plan, R1 was “recovering from a left hip fracture” and was a “fall risk.” R1 had impaired eyesight, required staff assistance with transferring in/out of bed, and needed a combination of walker and/or wheelchair for mobility. Interviews of facility staff, outside sources, and R1 themselves showed that R1 had a history of falls. Per LIC624 Incident Reports licensee previously submitted to the CCLD San Diego Regional Office (RO), R1 had three falls from April 2021 through August 2021. In their interview, R1 said they liked having a bedside alarm/alert mat because “it makes me feel safer.” When R1 was asked if the mat was too large, R1 said, “No.” When asked if the mat caused them to feel their restrained or unable to leave their room, they said “No.” Multiple caregivers corroborated that while R1 lived at the facility, they never complained about the mat or of feeling restrained. The LTCOP also reviewed the alarm/alert mat allegation, concluding that it did not infringe R1’s personal rights. Based on records and interviews, the allegations that S1 touched R1’s breasts or that Licensee’s use of a fall mat restrained R1’s movement are unfounded, meaning they were false and/or without a reasonable basis. We have therefore dismissed both allegations. An exit interview was conducted with the Ancho, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided. [CONTINUED FROM LIC 9099] Per the LIC624 Incident Report (which licensee submitted to the CCLD San Diego Regional Office on the day after the incident): during the early morning of 08-01-2021, R1 fell in their bathroom. R1 described pain and “soreness in [their] back,” leading facility staff to send them to the hospital ED. The licensee then sent a text message via cell phone to R1’s responsible party (RP) around 6:15 AM. RP phoned S1 back around 8:20 AM, relaying updates on R1’s condition from the hospital staff. According to hospital records, R1 sustained a thoracic vertebral compression fracture and a lumbar vertebral compression fracture, but no surgery was required. In their interview, the licensee reiterated the above timeline, and provided CCLD a date and time-stamped screenshot of the text message they sent to the RP. In this 6:15 AM text message, the licensee wrote that R1 fell in the bathroom, their back was sore, and that paramedics had been called. (The text message did not indicate if R1 had been transported to the hospital.) In their interview, Caregiver Staff #2 (S2) corroborated that the licensee indeed notified RP about the incident. During an unannounced site visit on 02-24-2022, LPA inspected and photographed the contents of the facility’s refrigerator and a nearby countertop. LPA observed red grapes, cut watermelon, Roma tomatoes, romaine hearts, celery hearts, zucchini, bell peppers, carrots, tangerines, orange juice, and yogurt with cut strawberries. All fruit and vegetables were reasonably fresh and stored in safe packaging. CCLD also reviewed the facility’s written food menus for the two weeks preceding the filing of the complaint. The menus show residents were served three meals per day, and no same dish was repeated from one day to the next. The dishes showed balance between carbohydrates, proteins, fruit, and vegetables. This two-week menu excerpt included these specific side dishes: fresh mixed fruit, peas, carrots, green beans, cauliflower, zucchini, oranges, corn, sweet potatoes, and different kinds of salad. The licensee and multiple caregivers consistently affirmed that fruits and vegetables are served as part of the menus. The San Diego County Long Term Care Ombudsman’s Office reviewed their prior visits to the facility, advising CCLD they had no concerns, and received no prior complaints, regarding the nutritive value of the food served at the facility. Based on interviews and records, the preponderance of evidence shows facility staff notified R1’s responsible party of R1’s 08-01-2021 fall, and fruit and vegetables are served to residents in care. Both allegations are therefore unsubstantiated. An exit interview was conducted with Ancho, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.the state’s words, verbatim · CDSS document, Nov 28, 2022 · control 08-AS-20220216141756

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregivers Marilena Villa, Marilyn Ancho, Gabriela Macias, and Deodata Silva. LPA conducted a brief tour of the facility and observed the staff and residents in care. In accordance with the Department’s Infection Control program, LPA 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 Villa. A a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail to the licensee.the state’s words, verbatim · CDSS document, Feb 24, 2022

Type of visit: Case Management - COVID-19

Licensing Program Analyst (LPA) Dang Nguyen conducted an announced Case Management visit, accompanied by nurse contractors Elizar Perez and Sandra Brackman from the Healthcare Acquired Infection (HAI) team of San Diego County Health and Human Services Agency. LPA and HAI nurses were welcomed by, identified themselves to, and discussed the purpose of the visit with Caregiver Marlena Villa. Facility administrator Todd Brooks arrived during the visit. The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's COVID-19 screening, testing, and disinfection processes and the staff’s use of personal protective equipment. During the visit, LPA and HAI nurses briefly toured the facility, interacted with staff, and interviewed the administrator. No deficiencies were cited on this date. An exit interview was conducted with Brooks, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail. LPA requested a reply E-mail or read receipt confirmation upon receipt of documents.the state’s words, verbatim · CDSS document, Jul 30, 2021