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On 9/26/22 at 10:17am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver complaint findings for the allegations noted above. LPA met with administrator Adetayo Kokumo and explained the purpose of the visit. During this investigation, LPA interviewed Administrator and Resident1 (R1). LPA also reviewed hospital and home health records pertaining to R1 as well as facility file documentation including R1’s admission agreement, needs and service plan, physician’s report, care notes, eviction notice, and a hospital agreement with facility. Allegation #1: Resident sustained pressure injuries while in care. LPA reviewed home health and hospital notes pertaining to wound care for R1. LPA also interviewed administrator and R1. LPA also reviewed care notes, needs and service plan, and physician’s report for R1. Based on record review and interviews, it was determined that R1 was admitted to facility from hospital with pressure injury on buttocks described as stage 4 inRead the full finding— CDSS inspection report, September 26, 2022 · control 27-AS-20220719142225

On 3-2-22, 10:41pm Licensing Program Analyst (LPA) Michael Bilger opened and investigated a complaint for the allegations noted above. LPA met with Administrator Adetayo Kokumo and explained the purpose of the visit. LPA requested the following documents: Medication log sheets for Resident1 (R1), for February and March of 2022, Central storage medication list for R1 for February and March of 2022, and staff medication training records. LPA also interviewed R1, Administrator, and Staff1 (S1), and R1's physician. LPA also conducted medication audit of stored medication and reviewed current physician orders for R1. Additionally, LPA conducted facility observation. Based on interviews, record reviews and observations it was determined that resident has been receiving medications as ordered and on time for February and March of 2022. Additionally, LPA observed medications stored at facility to match physician orders and medication log sheets. An interview with R1's physician on 3-2-22 verifRead the full finding— CDSS inspection report, March 2, 2022 · control 27-AS-20220224105810

On 2-17-22, at 10:29am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation for the complaint allegations noted above. LPA met with Administrator Adetayo Kokumo and explained the purpose of the visit. LPA interviewed Administrator, Staff1 (S1) Resident1 (R1), and R2. LPA also reviewed facility care notes and previous incident reports dated 12-13-21, 12-14-21, and 12-26-21. LPA interviewed S2 on 2-15-22. LPA also reviewed physician’s report for R1 and needs and service plan for R1. LPA also reviewed police report dated 12-26-21. Additionally, LPA reviewed medication log sheets and conducted observation of medication storage for R1, R2, and R3. Allegation #1: Resident sustained injury while in care. LPA interviewed R1, R2, S1, and Administrator. LPA also reviewed incident reports, physician report for R1, and needs and service plan for R1. Based on interviews and record reviews, it was determined that emergency services and police came to the faciRead the full finding— CDSS inspection report, February 17, 2022 · control 27-AS-20220120131855

On 1-27-22 at 1:56pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate complaint allegation noted above. LPA met with Administrator Adetayo Kokumo and explained the purpose of the visit. LPA interviewed Administrator and reviewed facility admission agreement for resident1 (R1), physician report for R1, and requested copy of pre-admission appraisal for R1. LPA also interviewed hospital case manager. Based on interview and record review it was determined that R1 was discharged to the hospital on 1-24-22 and was not intended to be accepted back when ready for return. Upon further interview, it was determined that a 30-day notice was not issued in accordance with Title 22 regulations and per admission agreement. Based on interview and record review, it is determined that the preponderance of evidence standard is met. Therefore, this allegation is SUBSTANTIATED. Deficiencies are cited under Title 22 regulations, Division 6, Chapter 8. An exit intervRead the full finding— CDSS inspection report, January 27, 2022 · control 27-AS-20220126113038