Buena Vista Manor House

Type of visit: Case Management - Legal/Non-compliance

On 6/20/2023, Licensing Program Analysts (LPA) Murial Han conducted an unannounced Case Management - Legal/Non-compliance visit. LPA completed the passive COVID-19 screening at the front desk. LPA met with Administrators, Hazel Castro, Angelina Guzman and, co-administrator David Wall. LPA explained the purpose of the visit. During today's visit, LPA review staff training records in the areas of Observation and Assessment of Residents, Residents' Personal Rights, Reporting Requirements, Types and Symptoms of Infectious Diseases, and Prevention/Mitigation and Care of Residents with Infectious Diseases and LPA observed records to be sufficient. During the facility tour, LPA observed COVID-19 signs are posted by the main entrance and around the facility. Facility appeared to be cleaned and tidy. Residents in the living room mingling with each other. Activity room was set up for an activity. Multiple hand sanitizing stations are observed. Kitchen storage room appeared to be cleaned, and tidy. The walking refrigerator temperature was observed to be at 39 degrees Fahrenheit (F) and freezer was at -0 degrees Fahrenheit(F). Fire extinguisher was last serviced on Nov 21, 2022. PPE supply is adequate. A comfortable temperature is maintained, lighting is sufficient for comfort and safety. No deficiency cited today. This report is reviewed and discussed with Administrator. A copy is provided.the state’s words, verbatim · CDSS document, Jun 20, 2023

Type of visit: Case Management - Legal/Non-compliance

On 2/15/2023 Licensing Program Analysts (LPA) Murial Han conducted an unannounced Case Management - Legal/Non-compliance visit. LPA was properly screened by the receptionist. LPA met with Administrators, Angelina Guzman, co-administrator David Wall and Infection Control Preventionist Diana Wall.. During the facility tour, LPA observed COVID-19 signs are posted by the main entrance and round the facility. LPA observed residents in the activity room were wearing face mask and practicing social distancing. Multiple hand sanitizing stations are observed as in place. The tables and chairs in the dining room and activity room remain 6" apart. Kitchen appeared to be cleaned, and tidy. The refrigerator temperature observed to be at 38 degrees Fahrenheit and freezer was at -4 degrees Fahrenheit. Hand-washing instruction is posted by the kitchen sink. The public bathrooms are equipped with liquid soaps, paper towel, trash cans with lids and hand washing instruction posters. The water fountains are taped off with a sign stating "Do Not Use". LPA observed individual infection control stations were set-up in the hallway through-out the facility. LPA reviewed infection control training records, and daily COVID-19 screening records for visitors, staff and residents. No deficiency cited today. This report is reviewed and discussed with the Administrator. A copy is provided.the state’s words, verbatim · CDSS document, Feb 15, 2023

Type of visit: Required - 1 Year

On 12/21/22, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA was properly screened by the receptionist at front entrance with the COVID-19 questionnaire and the temperature taken. After the screening, LPA was greeted by the Administrator, Angelina Guzman, Infection Control Preventionist, Diana Wall and Co-Administrator, David Wall. LPA explained the purpose of the visit. LPA reviewed the following documents: daily monitoring and screening for residents and staff (residents are screened daily unless they tested positive for COVID-19 then they will be monitored every 4 hours; staff are being screened at the beginning and the end of their shifts). LPA observed PPE/ COVID-19 training is completed on a monthly basis. Staff provided a tour of the facility. LPA observed COVID-19 signs are posted by the main entrance, there are hand sanitizer stations through-out the facility. The public bathrooms for the staff and residents are equipped with liquid soaps, paper towels and hand-washing signs indicating the 20 second rule. In the activity and living rooms, LPAs observed residents were wearing masks, and tables were 6" apart. The water fountains are continued to be taped off with a sign stating "Do Not Use". The dining room observed to be cleaned and the tables were at least 6" apart. The elevator has COVID-19 signs posted both inside and outside and hand sanitizer station is installed next to the elevator. Individual infection control stations were set-up in the hallway through-out the facility. The facility has 2 PPE supply stock rooms- one on the 2nd floor and one on the 3rd floor. The facility is well equipped with supplies. Donning and doffing signs are posted by each room. Medications are stored appropriately and inaccessible to residents, a comfortable temperature is maintained, lighting is sufficient for comfort. First-aid kit is inspected and complete. No deficiency cited today. This report is reviewed and discussed with the Administrator, Co- Administrator and the Infection Control Preventionist. A copy is provided.the state’s words, verbatim · CDSS document, Dec 21, 2022

Type of visit: Case Management - Legal/Non-compliance

On 5/24/2022, Licensing Program Analysts (LPA) Murial Han conducted an unannounced Case Management - Legal/Non-compliance. LPA was properly screened by the receptionist. LPA met with Administrators, Angelina Guzman, and Hazel Castro. During the facility tour, LPA observed COVID-19 signs are posted by the main entrance, the lobby, the dining room, the hallways on each floor, the staff break room, etc. Multiple hand sanitizing stations are observed as in place. Residents in the dining room are 6" apart from each other with face covering. The tables and chairs in the dining room and activity room are at least 6" apart. The public bathrooms are equipped with liquid soaps, paper towel, trash cans with lids and hand washing instruction posters. The water fountains were taped off with a sign stating "Do Not Use". LPA observed individual infection control stations were set-up in the hallway through-out the facility. The 3rd floor is the designated Red Zone. LPA observed isolation PPE stations set-up both inside and outside of each room equipped with PPE supplies, hand sanitizers, alcohol wipes, thermometers, daily COVID-19 screening logs, donning and doffing signs are posted by each room, the bathrooms are equipped with supplies, and hand-washing signs are posted by the sinks. In addition, there is a designated PPE supply room and a designated staff break room with a bathroom inside on that floor. LPA reviewed infection control training records, and daily COVID-19 screening records for visitors, staff and residents. No deficiency cited today. This report is reviewed and discussed with the Administrator. A copy is provided.the state’s words, verbatim · CDSS document, May 24, 2022

Allegation investigated: Medication logs are not adequately documented.

On 4/28/2022, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings of complaint # 14-AS-20220112101835. LPA Han was properly screen at the front entrance. LPA Han met with administrators, Angelina Guzman, and Hazel Castro and explained the purpose of the visit. Regarding medication logs are not adequately documented, according to the Medication Technicians (Med Techs), they prepare the medication in a plastic bag with resident's information on it for the caregivers to give it to the residents. After the medications are given, the caregivers return the plastic bags and the Med Techs retrieve the plastic bags, and document it in the resident's Electronic Medication Administration Record accordingly. In regards to documentation of the PRN (as needed) medication, when a resident requests for their PRN medication, if Med Techs are at the facility, they will prepare it, give it to resident and document it in the resident's Electronic Medication Record. However, if they are not at the facility, the assigned caregiver will get it from the medication cabinet that is located at the receptionist desk, logs it on the PRN medication log, signs it and gives it to the resident. Based on the documentation provided, LPA observed the PRN Medication logs and the Electronic Medication Administration Records indicated numerous PRN entries that had not been entered and initialed by the staff who gave the medication. Substantiated Based on interviews and record review during the investigation, the preponderance of evidence standard has been met. Therefore, this allegations were determined to be substantiated. Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC9099-D. Failure to correct the deficiencies may result in civil penalties. Report was discussed with Administrators, and Appeal Rights provided. A copy is provided.the state’s words, verbatim · CDSS document, Apr 28, 2022 · control 14-AS-20220112101835

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: May 12, 2022

Resident Records..(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility....This requirement was not met as evidenced by: Based on the documentation provided by the facility, it indicated that numerous PRN and routine medications were not initialed and entered by staff who gave the medication which posed potential health and safety risks to resident in care.the state’s words, verbatim · CDSS document, Apr 28, 2022

Plan of correction: The administrator and/or the designee will provide in-service to staff who gave medication to residents regarding proper documentation and provide a copy of the lesson plan and a copy of the sign-in sheet to CCL by the plan of correction due date 5/12/2022.

Allegation investigated: Staff are not adequately trained. Medications are not being administered to residents according to physician's instructions.

/28/22- This report has been amended on this date after superviosor's review. On 3/29/2022, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings of complaint # 14-AS-20220112101835. LPA Han was properly screen at the front entrance. LPA Han met with administrators, Angelina Guzman, Hazel Castro, Co-administrator, David Wall and explained the purpose of the visit. Regarding to allegation of- staff are not adequately trained, LPA Han interviewed the administrator who denied the allegation and stated that the facility provided in-services to staff on assisting residents with their medications. After the in-services, each staff was given an exam and if they passed the exam, they were presented with a certificate of completion and if they failed, they have to retake the exam. LPA interviewed 8 facility staff on different shifts and all of them validated that they were trained, they passed the exam and they were presented with a certificate of completion. LPA also reveiwed the staff training sign-in records from February, 2021 and a copy of the certificates that were issued to the staff upon their completion of the training. Base on record review and interviews during the course of investigation, this allegation is unsubstantiated. Unsubstantiated Regarding allegation of- Medications are not being administered to residents according to physician's instructions. There is no additional information forthcoming from the Reporting Party and the investigation was based on the information that was provided during the initial reporting that the Reporting Party alleged the facility prepared medications more than 24 hours ahead, the person who gives the medication does not know the medication orders, there was no follow-up when residents refused their medications, staff were not aware of the PRN (as needed) medication orders and facility does not keep up with updating the new medication order. During the investigation, LPA interviewed two Medication Technicians (Med Techs) and caregivers regarding to the above allegation. The Med Techs denied that the medications were prepared 24 hours ahead. LPA toured the medication storage cabinet and did not observe any medications were prepared 24 hours in advance. The Med Techs also reported that prior to preparing the medications, they always reviewed the physician's orders, then they would prepare the medication for the facility staff who would give it to the residents whom they are assigned to. Furthermore, to ensure the accuracy of the medication orders, the facility conducts a monthly medication reconciliation with the pharmacy, or the attending physician to review the resident's routine and PRN (as needed) medication orders. LPA reviewed the medication reconciliation records for December 2021 and it revealed that the process was completed by one of the Med Techs. Concerning to the facility does not follow-up if there is a refusal of medications, the Med Techs stated that there are very few incidences where the residents refused their medication(s) but if that happens, the facility staff would report it to one of them right away and they would follow-up with the resident and the physician accordingly. However, if they are not at the facility, the staff would contact them by phone and/or write an endorsement note for them to follow-up. LPA interviewed 8 facility staff and all of them validated this process. Concerning to PRN medication orders that staff is not aware of, the Medication Technicians stated that when there is a change to the existing PRN medication order or a new PRN medication order from the attending physician, one of them would be notified and they would verify the order, input the order into the resident's electronic Medication Administration Records and follow-up with the new medication order accordingly. Furthermore, LPA interviewed 4 residents regarding to their experience with staff assisting them with their medication and all of them reported that they did not have any problems with receiving their medications from the facility staff and they have not experienced getting the wrong medication from the facility staff. Base on record review, observation, and interviews during the course of investigation, this allegation is unsubstantiated. Although the above investigations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. This report is reviewed and discussed with administrators. A copy is provided.the state’s words, verbatim · CDSS document, Mar 29, 2022 · control 14-AS-20220112101835

Type of visit: Case Management - Legal/Non-compliance

On 12/30/2021, Licensing Program Analysts (LPA) Murial Han conducted an unannounced Case Management - Legal/Non-compliance virtual inspection due to COVID-19. LPA met with Administrator, Angelina Guzman, Administrator, Hazel Castro, Co-Administrator, David Wall and Infection Control Preventionist, Diana Wall LPA was provided a virtual tour by the Infection Control Preventionist, Diana Wall and LPA observed COVID-19 signs were posted by the main entrance, there were several hand sanitizer stands installed and screening logs for the visitors and the facility staff. The public bathrooms were equipped with liquid soaps, paper towel, trash cans with lids and hand washing instruction posters. There were hand wipes and hand sanitizer bottles placed on many of the tables, all the trash cans were observed to have foot operated lids, and the water fountains were taped off with a sign stating "Do Not Use". and individual infection control stations were set-up in the hallway through-out the facility. During the tour on the 3rd floor designated isolation unit, LPA observed isolation PPE stations, and two trash cans with foot operated lids (one for soiled PPE supplies and the other one for soiled incontinent changes and garbage) were set-up before the entrance. After the entrance, LPA observed isolation PPE stations set-up both inside and outside of each isolation room equipped with PPE supplies, hand sanitizers, alcohol wipes, thermometers and daily COVID-19 screening logs, donning and doffing signs were posted both inside and outside of each room, and the bathrooms were equipped with supplies, and hand-washing signs were posted. During today's inspection, LPA also reviewed the facility's Medication Management process and the facility explained the documentation procedure for the resident's files. No deficiency cited today. This report is reviewed and discussed with the Administrators, Co- Administrator and the Infection Control Preventionist. A copy is provided.the state’s words, verbatim · CDSS document, Dec 30, 2021

Type of visit: Case Management - Legal/Non-compliance

On 10/06/2021 at 1045 Licensing Program Analysts (LPA) Jaime Vado and Murial Han conducted an unannounced case management - Legal/Non-compliance inspection. LPAs met with David Wall and Diana Wall During today's inspection visit LPAs made observations within the facility with both David and Diana. This is a five floor facility. Residents reside through out all floors. Upon entrance to the facility that is considered the second floor. PPE storage room is located on this floor adjacent to front desk area. PPE is in place. COVID check in procedures are in place. LPAs observed seating areas and specific seats are marked to show which are allowed to sit in adhering to the six foot distancing policy. Exterior balcony also observed with similar seating arrangements. Dining room is observed as well with six foot rule in place. Cleaning schedule and procedure was observed as in place. Group activity room is observed on this floor as well as taking place with social distancing being practiced and residents are masked. Multiple hand sanitizing stations are observed as in place. Third floor is observed and COVID isolation area is located on this floor. Seven rooms are designated for COVID positive. Room 3106 is observed as equipped with required CDSS furniture, a private bath, individual PPE, trash cans for doffing and trash cans with tight fitting lids are present. COVID signs encouraging social distancing, hand washing, and masking observed through out entire facility and bathrooms. Continued on next page. /// Page 2 Case Management - Legal/Non-compliance Records are reviewed for staff and residents. Records reviewed indicate that facility is training staff, new and current, in the the items outlined in the Stipulation Waiver and Order issued in Section 2 part A. Training records show that staff are trained annually in the topics outlined in Section 2 part B. In accordance to Section 2 part C there are co-administrators in place. In accordance to Section 2 part D, LPAs discussed the regular assessment of residents to ensure that facility is appropriate setting for those residents assessed and when necessary to evict the facility understands it will follow proper eviction procedures under Title 22, Code of Regulations, section 87224. Under section 3 part B David Wall agreed to begin the required training outlined in this section during the second year of probation. Report is reviewed with David Wall. No citations issued.the state’s words, verbatim · CDSS document, Oct 6, 2021

Type of visit: Required - 1 Year

On 10/6//2021, Licensing Program Analyst(LPA) Murial Han and LPA Jaime Vado conducted an unannounced annual inspection. LPAs were properly screened by the receptionist at front entrance with the COVID-19 questionnaire and the temperature. After the screening, LPAs were greeted by the Administrator, Angelina Guzman and Co-Administrator, David Wall. LPAs explained the purpose of the visit. LPAs reviewed the following documents: daily monitoring and screening documents for residents and staff (residents are being screened twice a day- AM and PM and staff are being screened as they arrive and when they leave), training records, and COVID-19 testing records and schedule. After reviewing the records, LPAs started with a tour of the facility that was led by the Infection Control Preventionist/Public Health Nurse, Diana Wall along with the Administrators, Angelina Guzman and Hazel Castro and Co- Administrators, David Wall, LPAs observed COVID-19 signs were posted by the main entrance, there were several hand sanitizer stands installed. The public bathrooms for the staff and residents were equipped with liquid soaps, paper towels and hand-washing signs indicating the 20 second rule. LPAs observed residents were wearing masks and maintaining social distancing in the Activity room, the couches and the benches are marked off appropriately to ensure social distancing is maintained. There were hand wipes and hand sanitizer bottles placed on many of the tables, all the trash cans were observed to have foot operated lids, the water fountains were taped off with a sign stating "Do Not Use", the dining room observed to be cleaned and the tables were at least 6" apart. The dining room staff demonstrated the equipment and high touched areas such as the food carts, the tables, the door knobs, etc. that are being sanitized every 4 hrs along with a log showing who and when those cleaning tasks were performed. The elevator has COVID-19 signs posted both inside and outside and hand sanitizer stand was installed next to the elevator. Individual infection control stations were set-up in the hallway through-out the facility. After the tour on the 2nd floor, we continued onto the 3rd floor that the facility has designated it as to be the COVID-19 unit. LPAs observed closed lid trash cans were placed in front of each room, donning and doffing and other COVID-19 signs were posted on both inside and outside of the doors, the bathrooms were equipped with liquid soaps, and hand-washing 20 second signs. LPA recommended to remove the cloth towels in the bathrooms. The facility has 2 PPE supply stock rooms- one on the 2nd floor and one on the 3rd floor. The facility is well equipped with supplies. The staff members who are designated to work in the COVID-19 unit, has their own assigned PPE supplies stocked in a container with their names on it. No deficiency cited today. This report is reviewed and discussed with the the Administrators, Co- Administrator and the Infection Control Preventionist. A copy is provided.the state’s words, verbatim · CDSS document, Oct 6, 2021

Type of visit: Office

Licensing Program Analyst (LPA) Michael Garcia, Licensing Program Manager (LPM) Julio Montes, and Regional Manager (RM) Vivien Helbling conducted a collaborative tele-visit meeting with facility co-administrator David Wall, along with facility infection prevention nurse Diana Wall, RN, BSN. During the meeting, RM Helbling went over and elaborated each item of the Stipulation and Waiver; And Order (“Stipulation”) that was effective on June 18, 2021. Prior to this meeting, the vendor/trainer submitted by facility for evaluation was approved by RM Helbling. Questions from meeting participants, including questions regarding training, were answered by RM Helbling and LPM Montes. All meeting participants stated that they understood the Stipulation at the end of the meeting. RM Helbling confirmed that the Department’s transparency website has been updated to reflect the probationary status of the facility. David Wall agreed to submit a copy of the facility’s most updated Personnel Report (LIC500) to the licensing office, attention LPM Montes, by end of business day tomorrow, July 8, 2021. No deficiency cited during this visit. This report was reviewed with David Wall, co-administrator, and a copy of this report was provided electronically for signature.the state’s words, verbatim · CDSS document, Jul 7, 2021