Kokoro Assisted Living

Allegation investigated: - Resident sustained a fracture while in care - Staff do not provide activities for residents - Staff do not ensure residents are adequately fed

Based on observations made during initial complaint visit on 8/4/20, interviews with clients' responsible parties and staff, and review of documents provided by facility--including Incident Reports submitted to CCLD--these allegations are determined to be unsubstantiated. Unusual incidents--medical emergencies including falls--were reported to CCLD via submission of Incident Reports. In early 2020, due to absence of full-time activity director and COVID pandemic--which eliminated group activities--facility activities were greatly curtailed. Individualized social visits were facilitated by staff to engage residents and monitor them until group activities resumed in Fall of 2020. Food supplies were observed to be adequate during inspection in August 2020 and food service is overseen by food and beverage director, who is a certified registered dietician. In addition to meals, snacks were delivered to rooms by staff. Clients were assisted to eat by caregivers, who report to director of resident care when there are changes in appetite. Although the allegations may have occurred or are valid, there is not enough evidence to prove the alleged violations did or did not occur. Unsubstantiatedthe state’s words, verbatim · CDSS document, Apr 7, 2023 · control 14-AS-20200727150444

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 10/11/2022, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA observed COVID-19 signs posted by the entrance. LPA was greeted by the Administrator, Naoko Jones. LPA explained the purpose of the visit and LPA was screened at the front entrance. The Director of Marketing and Administration provided a toured of the facility and grounds. This is a 6 story facility with resident apartments on all floors with 2 apartments reserved on the 1st floor for isolation purpose. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, daily screening records for staff, residents and visitors and staff training and policies. During the tour, LPA observed resident apartments are equipped with emergency call system next to the bed and the bathroom which can be activated from bedroom and bathroom and residents also wear a call pendant. LPA observed bathrooms are equipped with soap and paper towels, and hand washing instruction is posted by the hand washing stations. COVID-19 signs are posted through-out the facility, in the elevators and hand sanitizer stations/dispensers installed by the elevator. PPE supply is adequate and stored on the 5th floor. Residents are observed wearing face masks and maintaining social distancing during activities. Kitchen and food supplies are inspected. LPA observed refrigerator temperature measured at 28 degrees Fahrenheit (F) and freezer measured at -1 degree F. First-aid kit is inspected and complete. Medications, toxins and sharps are stored appropriately and inaccessible to resident, a comfortable temperature is maintained, lighting is sufficient for comfort and safety. The following updated licensing forms or information are requested to be submitted to CCLD BY 10/13/22: LIC309 (Administrative Responsibility and LIC 308 (Designation of Administrative Responsibility). No deficiency cited today. This report is reviewed and discussed with the Administrator. A copy is provided.the state’s words, verbatim · CDSS document, Oct 11, 2022

Allegation investigated: Resident was not accorded the right for records and personal information to remain confidential and to approve their release. Resident’s representative was not regularly informed of activities related to care or services, including ongoing evaluations, as appropriate to resident’s needs. Communications from representatives were not answered promptly and appropriately.

On 10/12/2021, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the findings of complaint # 14-AS-20210819100818. LPA Han was properly screen at the front entrance. LPA Han met with the Administrator, Naoko Jones and explained the purpose of the visit. Regarding the allegation of: Resident was not accorded the right for records and personal information to remain confidential and to approve their release. The Reporting Party explained that the facility consulted and shared confidential health medical records of Resident #1 (R1) and Resident #2 (R2) with another organization without the consent and knowledge of the Responsible Party. The facility acknowledged the above allegation concerning R1 and R2, however, explained that this organization that the facility has consulted with is part of the facility's management group bound by a Management Agreement. LPA Han reviewed the Management Agreement and it did not revealed that there was an affiliation between the facility and this organization. After the investigation, this allegation is deemed to be substantiated. Substantiated Regarding the allegation of: representative was not regularly informed of activities related to care or services, including ongoing evaluations, as appropriate to resident's needs, the facility acknowledged of making arrangements with an outside Consulting Group to conduct an on-site assessment for R1 without notifying the Responsible Party. After the investigation, this allegation is deemed substantiated. Regarding the allegation of: communications from the representative were not answered promptly and appropriately, the Reporting Party stated that the Responsible Party emailed the facility some questions regarding to R1 and R2 and requested for medical records, and documents but the facility failed to respond to the emails and has yet provided the information. During the interviews, the facility acknowledged that they failed to provide the entire medical records and documents to the Responsible Party and they failed to respond to some of the email inquires that the Responsible Party has asked for. After investigation, this allegation is deemed substantiated. Based on interviews and record reviews 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 Administrator, and Appeal Rights provided.the state’s words, verbatim · CDSS document, Oct 12, 2021 · control 14-AS-20210819100818

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(c)(1) · Plan of correction due date: Oct 26, 2021

RESIDENT RECORDS- (c) All information and records obtained from or regarding residents shall be confidential. (1)The licensee shall be responsible..for safeguarding the confidentiality of their contents.The licensee...shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement was not met as evidenced by: the facility failed to obtain prior authorization from the Responisble Party for providinng resident's confidential information to an outside organization which posed potential health and safety risks to resident in care.the state’s words, verbatim · CDSS document, Oct 12, 2021

Plan of correction: The Administrator will review Title 22 , Division 6 Resident Records and submit a statement of acknowledgment after the review. The Administrator will provide in-service to the staff on this regulation. The Administrator will submit a copy of the sign-in sheet of the in-service to licensing by the POC due date, 10/26/2021.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Oct 26, 2021

PERSONAL RIGHTS OF RESIDENTS....(a)Residents in all residential care facilities....(8)To have their representatives regularly informed...activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by: the facility arranged for an outside consultant group to conduct an on-site assessment for R1 without informing the Responsible party which posed potential health and safety risks to resident in care.the state’s words, verbatim · CDSS document, Oct 12, 2021

Plan of correction: The Administrator will review Title 22 , Division 6 Personal Rights of Residents in All Facilities and submit a statement of acknowledgment after the review. The Administrator will provide in-service to the staff on this regulation and The Administrator will submit a copy of the sign-in sheet of the in-service to licensing by the POC due date, 10/26/2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(9) · Plan of correction due date: Oct 26, 2021

PERSONAL RIGHTS OF RESIDENTS....(a)Residents in all residential care facilities....(9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement was not met as evidenced by: the facility failed to provide R1 and R2's complete medical records and documents to the Reporting Party promptly as requested which posed potential health and safety risks to resident in care.the state’s words, verbatim · CDSS document, Oct 12, 2021

Plan of correction: If the facility has yet provided the medical records and the documents that the RP has requested for from the beginning of July, the facility shall do so by 10/15/2021. The Administrator will review Title 22 , Division 6 Personal Rights of Residents in All Facilities and submit a statement of acknowledgment after the review. The Administrator will provide in-service to the staff on this regulation and The Administrator will submit a copy of the sign-in sheet of the in-service to licensing by the POC due date, 10/26/2021.

Type of visit: Required - 1 Year

On 10/12/2021, Licensing Program Analyst(LPA) Murial Han conducted an unannounced annual inspection. LPA observed COVID-19 signs posted by the entrance. LPA was greeted by the Administrator, Naoko Jones. LPA explained the purpose of the visit and LPA was screened at the front entrance. The Administrator and the Resident Service Director provided a toured of the facility and grounds. No accessible bodies of water or fire safety hazards observed. Infection control practices are reviewed: entry procedures, staff training and policies, staff randomly testing records, resident and staff daily monitoring records, containment strategies (facility has reserved 2 private apartments with their own bathrooms and shower rooms on the first floor for isolation. quarantine purposes), PPE supply (the staff conducts weekly inventory count and the Resident Service Director orders the supplies accordingly on a weekly basis) and the environmental cleaning supply are adequate, bathrooms are equipped with soap and paper towels, and hand washing instruction is posted by the hand washing stations. Signs are posted through-out the facility. Residents are observed to be wearing face masks and maintaining social distancing during activities and meals. There are COVID-19 signs posted inside and outside of the elevator and hand sanitizer station outside. Medications, toxins and sharps are stored appropriately and inaccessible to resident, a comfortable temperature is maintained, lighting is sufficient for comfort and safety No deficiency cited today. This report is reviewed and discussed with the Administrator and the Resident Service Director. A copy is provided.the state’s words, verbatim · CDSS document, Oct 12, 2021

Allegation investigated: -- Staff failed to address residents change in medical condition. -- Staff failed to follow proper reporting requirements.

On 7/22/2021, on behave of Licensing Program Analyst (LPA) Michael Garcia, Licensing Program Analyst (LPA) Murial Han conducted an unannounced complaint visit to deliver the finding on the above allegations. LPA met the Executive Director, Naoko Jones. Regarding to staff failed to address residents change in medical condition. According to staff interviews, Staff 1 (S1) stated that resident weights are monitored monthly. Families are informed if a resident has a 5% weight loss within a month. According to the Mayo Clinic's website, a medical evaluation is called for if a person loses more than 5% of weight in six months to a year, especially for an older adult. CONTINUE ON NEXT PAGE... Substantiated According to facility records, Resident 4 (R4) had a weight of 145lbs on January 2019, 135lbs by October 2019, and was at 129.6lbs by December 2019. R4 had a 15.4lbs or 10.62% weight loss from January 2019 - December 2019. R4's physician was not informed of the weight loss until January 16, 2020 and was not seen by R4's physician until October 26, 2020. According to administrator, R4 didn't have any hospital visits for 2019. Regarding to staff failed to follow proper reporting requirements. According to facility records, Resident 1 (R1) had an unwitnessed mechanical fall on May 31, 2018 inside the apartment. According to staff interviews, S1 stated that incidents, such as resident falls, are reported in writing to Community Care Licensing and to the resident's physician. However, no written report is provided to the person responsible for the resident, only verbal report is given according to S1. The allegations were SUBSTANTIATED, meaning that the allegation was valid because the preponderance of evidence standard has been met. This report was reviewed and discussed with the Executive Director and a copy is provided.the state’s words, verbatim · CDSS document, Jul 22, 2021 · control 14-AS-20200305140351

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Aug 5, 2021

87465 Incidental Medical and Dental Care... (1) The licensee shall arrange, or assist in arranging, for medical... care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on staff interviews and record reviews, the licensee failed to arrange for medical care appropriate to R4's conditions and needs which poses potential health risks to residents in care.the state’s words, verbatim · CDSS document, Jul 22, 2021

Plan of correction: Administrator shall ensure to provide an in-service training to facility staff that will suffice the requirements of Section 87465 Incidental Medical and Dental Care. And provide proof of training, with staff signatures, to the San Bruno licensing by the POC due date, 8/5/2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 5, 2021

87211 Reporting Requirement... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of... (D) Any incident which threatens the welfare, safety or health of any resident. This requirement was not met as evidenced by: Based on staff interviews, the licensee failed to ensure that written reports are submitted to the person responsible for the resident within seven days of the occurrence which poses potential health and safety risks to residents in care.the state’s words, verbatim · CDSS document, Jul 22, 2021

Plan of correction: Administrator shall ensure to provide an in-service training to facility staff that will suffice the requirements of Section 87211 Reporting Requirement. And provide proof of training, with staff signatures, to the San Bruno licensing by the POC due date, 8/5/2021..

Allegation investigated: -- Facility failed to conduct emergency preparedness drills.

On 7/22/2021, on behave of Licensing Program Analyst Michael Garcia, Licensing Program Analyst (LPA) Han conducted an unannounced complaint visit to deliver the finding on the above allegations. LPA met the Executive Director, Naoko Jones. According to records review conducted, on January 16, 2020, the facility was cited for failure to conduct a fire and earthquake drill at least once every three months. The facility’s Plan of Correction was received by CCL on January 19, 2020, and the deficiency was cleared. CCL received the complaint on March 5, 2020. The facility was in compliance when the complaint allegation was received. CONTINUE ON NEXT PAGE... Unfounded This agency has investigated the complaint alleging facility failed to conduct emergency preparedness drills. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.the state’s words, verbatim · CDSS document, Jul 22, 2021 · control 14-AS-20200305140351

Allegation investigated: -- Residents sustained injuries from falls while in care. -- Staff leaving residents in soiled diapers for extended periods of time. -- Staff was unable to locate a resident while in care -- Staff failed to notify authorized representative of residents incidents. -- Staff administered discontinued medication to a resident

On 7/22/2021, on behave of Licensing Program Analyst Michael Garcia, Licensing Program Analyst (LPA) Han conducted an unannounced complaint visit to deliver the finding on the above allegations. LPA met the Executive Director, Naoko Jones. -- Residents sustained injuries from falls while in care: According to facility records, Resident 1 (R1) had an unwitnessed mechanical fall while trying to get out of bed inside the apartment on May 31, 2018. Injuries were noted in R1’s knees and forehead. According to staff interviews, Staff 1 stated that R1 has no fall prevention plan due to R1 is independent and is low risk for falls. CONTINUE ON NEXT PAGE... Unsubstantiated According to R1’s physician’s report, R1 is ambulatory and has no motor impairment. There was no special instruction in R1’s physician’s report for the facility to follow to prevent falls prior to incident. -- Staff leaving residents in soiled diapers for extended periods of time: According to administrator, continence care is provided to residents every 2 hours; hourly if a resident has a condition. Facility staff logs continence care provided in a chart inside the resident's apartment per administrator. According to facility records, continence care was provided to Resident 5 (R5) regularly for June 2019, as documented by facility staff. -- Staff was unable to locate a resident while in care: According to records review conducted, on August 23, 2019, CCL unsubstantiated a complaint allegation that Resident 4 (R4) left the facility unauthorized. According to R4’s physician’s report, R4 was able to leave the facility unattended, can communicate needs and follow instructions. According to facility records, R4 signed out prior to leaving the facility and signed in upon return. -- Staff failed to notify authorized representative of residents incidents: According to staff interviews, S1 stated that the person responsible for the resident is notified of incidents verbally. According to facility records, the May 31, 2018 fall incident was reported to the person responsible for the resident as documented by facility staff. -- Staff administered discontinued medication to a resident: According to Physicians Orders dated March 13, 2019, the medication FUROSEMIDE (aka LASIX) 40 mg is to be discontinued for R2. According to facility records, this medication was last administered to R2 around noon of March 2, 2019, as documented by facility staff. The allegations were deemed UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.the state’s words, verbatim · CDSS document, Jul 22, 2021 · control 14-AS-20200305140351