Aspire Residential Care

Allegation investigated: Staff are not meeting residents needs

On 9-26-23 at 1:26pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver and discuss findings for the complaint allegations noted above. LPA met with lead caregiver Maria Hinautan and explained the purpose of the visit. Administrator Khanh Farkas was made aware by telephone of purpose and these findings. During this investigation, LPAs Bilger and Villanueva conducted interviews with four residents in care, four staff members, and two additional witnesses. Additionally, LPAs reviewed facility file documentation including needs and service plans, appraisals, medication logs, and physician’s reports for residents in care. LPAs also conducted facility observations on 8-23-23 and 9-21-23. Allegation: Staff are not meeting resident needs. LPAs conducted interviews with staff, residents, and witnesses as noted above. LPAs also conducted facility observations on the dates indicated above. Additionally, LPAs reviewed facility file documentation including physician’s reports, needs and service plans, and appraisals for residents in care. {Cont. on 9099C} Substantiated Based on records reviewed, it was revealed that 2 of 4 residents, resident1 (R1), and R3 were identified as requiring one on one (1:1) monitoring all or most of the time. It was further revealed that R2 requires 2-person assist with bathing and special observation at night due to confusion and forgetfulness. LPAs review of staffing schedule and interviews conducted revealed one staff member is on duty per shift consistently. LPAs observed 1 caregiver on duty during observations during both morning and afternoon shifts. Additionally, based on interviews, it was revealed that toileting and incontinence care for R2 is delayed due to one caregiver on duty per shift. As a result, there is a preponderance of evidence to conclude that staff are not effectively meeting resident needs as identified through record reviews, interviews, and observations, therefore, this allegation is SUBSTANTIATED. Citations are issued under Title 22, division 6 as a result of this investigation and indicated on LIC 9099D. An exit interview was conducted with Maria Hinautan and a copy of this report was provided to Maria including LIC 811. Appeal rights provided. Additionally, based on interviews, there were no substantial corroborated statements to reveal unqualified staff on duty. As a result of this investigation, there is not a preponderance of evidence to conclude unqualified staff are providing care for residents, therefore, this allegation is UNSUBSTANTIATED. Allegation: Staff not qualified to give medications. LPAs conducted interviews with staff, residents, and witnesses as noted above. LPAs also reviewed training records for staff members noted above and conducted facility observations on the dates indicated above. Based on record reviews, it was indicated that 5 of 5 staff members have received medication training per regulatory requirements. Based on interviews and observations it was further revealed that staff demonstrated appropriate knowledge towards general job requirements regarding medication handling. Additional interviews further revealed no substantial corroborated statements of staff unqualified to give medication. As a result of this investigation, there is not a preponderance of evidence to conclude staff are unqualified to give medications, therefore, this allegation is UNSUBSTANTIATED. An exit interview was conducted with Maria Hinautan and a copy of this report was provided to Maria including LIC 811. Appeal rights provided.the state’s words, verbatim · CDSS document, Sep 26, 2023 · control 27-AS-20230816132021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Sep 27, 2023

87411(a) Personnel Requirements. (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on record review, interviews, and observations, Licensee did not ensure appropriate numbers of staff available to meet the identified needs of residents in care. This poses an immediate health, safety, and resident rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 26, 2023

Plan of correction: Licensee will submit an appropriate staffing plan suitable to meeting the needs of residents in care. Plan to be submitted to LPA by POC due date. Licensee will read regulation 87411(a) and submit a signed declaration of understanding to LPA by POC due date.

Type of visit: Case Management - Other

On 9-26-23, LPA Michael Bilger arrived unannounced to conduct a case management visit regarding medication documentation and caregiving practices. LPA met with lead caregiver Maria Hinautan and explained the purpose of the visit. LPAs Bilger and Villanueva reviewed medication log sheets for August 2023 as part of a record review for complaint #27-AS-20230816132021 . LPAs also conducted interviews with four staff members and reviewed needs and service plans and appraisals for resident1 (R1), R2, R3, and R4. Based on interviews and record reviews, it was determined that a physician’s order for resident2 (R2) is written as Trazodone HCL 150 milligrams (mg) to be taken at 8:00pm daily. LPAs review of medication log sheets indicate this medication was not administered on 8-19-23 as staffing initials were not present to indicate such. Additionally, LPA Bilger conducted a facility observation on 9-21-23 related to complaint # 27-AS-20230816132021. LPA also conducted interview with caregiver on duty. Based on observations, interviews, and record reviews it was determined that R1 and R3 require one on one (1:1) monitoring all or most of the time. Additionally, it was determined through record review that R2 requires 2-person assist with bathing and toileting. Interviews and observations revealed only 1 caregiver is on duty per shift including 9-21-23 during LPA’s visit. Furthermore, it was revealed during interview, that R2 has been told to eliminate self in R2’s diaper due to 1 staff on duty and wait until the relief staff for the next shift comes on duty to assist. As a result of today’s case management, citations are issued under Title 22, Division 6 and indicated on LIC 809D. An exit interview was conducted with Maria Hinautan and a copy of this report was left with Maria. LIC 811 and appeal rights provided.the state’s words, verbatim · CDSS document, Sep 26, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Sep 27, 2023

87468.1(a)(3) 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: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions…such as…interfering with daily living functions such as…elimination. This requirement was not met as evidenced by: Based on interview, Licensee is not adhering to resident rights as stated above in that R2 has been told to eliminate self in diaper due to only 1 caregiver on duty to assist. This poses an immediate health, safety, and resident rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 26, 2023

Plan of correction: Licensee will ensure completed staff training on personal rights of residents. Training date to be submitted to LPA by POC due date. Proof of completed training to be submitted to LPA no later than 2 weeks from date of citation issuance. Licensee will ensure updated training on elder abuse to include but not be limited to: Appropriate care procedures necessary to avoid forms of neglect and humiliation as noted in personal rights Section 87468.1(a)(3). Training date to be submitted to LPA by POC due date. Proof of completed training to be submitted to LPA no later than 2 weeks from date of citation issuance.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87405(h)(5) · Plan of correction due date: Sep 27, 2023

87405(h)(5). Administrator Qualifications and Duties. (h) The administrator shall have the responsibility to: (5) Provide or ensure the provision of services to the residents with appropriate regard for the residents' physical and mental well-being and needs, including those services identified in the residents' Pre-Admission Appraisals, specified in Section 87457, Pre-admission Appraisal, and Reappraisal, as specified in Section 87463. This requirement was not met as evidenced by: Based on interview, record review, and observation, Administrator did not provide appropriate staffing solutions to meet the needs of residents as identified on appraisal and needs and service plans. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 26, 2023

Plan of correction: Licensee will read regulation 87405(h)(5) and submit a signed declaration of understanding to LPA by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Oct 6, 2023

87465(a)(4). Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility… (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on record review, Licensee did not ensure receive medication as ordered as indicated by lack of staff initials on medication log sheets. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 26, 2023

Plan of correction: Licensee will ensure completed staff training on assistance with self-administered medication and to include, but not be limited to: Medication documentation and following physician’s orders. Proof of completed training to be submitted to LPA by POC due date. Licensee to read regulation 87465(a)(4) and submit a signed declaration of understanding to LPA by POC due date.

Allegation investigated: Staff are not fingerprint cleared

On 8-23-23 at 10:10am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to open and investigate the complaint allegation noted above. LPAs met with lead caregiver Maria Marcos and explained the purpose of the visit. Administrator Khanh Farkas was notified of LPAs visit and purpose and arrived at 3:00pm. During the investigation for this complaint, LPAs reviewed Department records including Guardian Employee Roster to determine fingerprint clearance eligibility. LPA also reviewed LIC 500 staffing roster, and staffing records for Staff1 (S1), S2, S3, S4, and S5.. Based on record reviews, it was determined that S2 was officially hired as staff on 10-16-22 and a fingerprint clearance date of 7-31-22 and associated with facility. Upon further record review it was determined that S5 is associated with other licensed facilities, but not associated with Aspire Residential Care, LLC at this time, and working in facility since 7-12-23. All other staff reviewed have verified fingerprint clearances. As a result, the preponderance of evidence standard is met and this allegation is SUBSTANTIATED. A citation is issued under Title 22, Division 6. A civil penalty in the amount of $500 is issued in addition to the citation. An exit interview was conducted with Khanh Farkas and a copy of this report was provided to Khanh. Appeal rights provided. Substantiatedthe state’s words, verbatim · CDSS document, Aug 23, 2023 · control 27-AS-20230816132021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Aug 24, 2023

Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement was not met as evidenced by: Based on record reviews, S5 is not currently associated with facility and demonstrates employment in facility since 7-12-23. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 23, 2023

Plan of correction: Licensee to secure a transfer request and fingerprint clearance for S5 prior to S5 having further contact with residents in care. Proof of fingerprint clearance to by send to LPA by POC due date. Licensee to read regulation 87355(e) and submit a signed declaration of understanding to LPA by POC due date.

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 2-10-23 at 12:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with lead caregiver Teresa Marcos and explained the purpose of the visit Administrator Knanh Farkas was made aware of LPA's visit and gave permission for Teresa to accommodate LPA and sign in her absence. LPA conducted COVID-19 screening questions prior to entry to ensure no active COVID within facility. LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed residential care facility for the elderly with a current census of 4. Facility has 4 bedrooms and 2 bathrooms for client use. There is a dining area off the kitchen and a formal living room. LPA also conducted the infection control domain tool. The facility has an approved COVID Mitigation plan LIC 808 form in place. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and backyard. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. LPA reviewed 4 resident charts and 5 staff charts. All contents in place and current. Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 71*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 9-29-22 . Facility has an emergency food and water kit. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Teresa Marcos a copy of this report was given to Teresathe state’s words, verbatim · CDSS document, Feb 10, 2023

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: Case Management - Other

On 10/27/22 at 3:30pm Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to assist a resident with obtaining documents from her previous facility. LPA Jensen met with licensee Khanh Farkas and explained the purpose of today's visit. Resident 1 (R1) requested LPA Jensen's assistance in obtaining her medical records from the facility she previously resided at. LPA Jensen requested a copy of R1's resident file from Sunny Place of Stockton. Sunny Place of Stockton emailed the records to LPA. LPA Jensen handed R1 all the records that were provided to the LPA by email.. An exit interview was conducted and a copy of this report was given to Licensee.the state’s words, verbatim · CDSS document, Oct 27, 2022

Type of visit: Required - 1 Year

On 2-16-22 at 2:54pm, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Khanh Farkas and explained the purpose of the visit. LPA conducted COVID-19 screening questions prior to entry to ensure no active COVID within facility. LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed residential care facility for the elderly with a current census of 4. Facility has 4 bedrooms and 2 bathrooms for client use. There is a dining area off the kitchen and a formal living room. LPA also conducted the infection control domain tool. The facility has an approved COVID Mitigation plan LIC 808 form in place.The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and backyard. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Four resident charts and four staffing charts were reviewed. All staff first aid and COVID-19 vaccinations status current. Water temperature reads 105.4*F in the bathroom and room temperature reads 73*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 8-16-21. Facility has an emergency food and water kit. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held with Khanh Farkas and a copy of this report was given to Khanhthe state’s words, verbatim · CDSS document, Feb 16, 2022

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff are not trained

{This document is an amendment from the original document recorded 1-5-22 and created on 1-18-22 at 9:29am referring to complaint control #27-AS-20211228151714. Licensing Program Analyst (LPA) Michael Bilger arrived at facility on 1-18-22 at 9:29am and met with Herbiberto Dela Pena, facility manager to explain purpose of LPA's visit. Administrator Khanh Farkas was notified by phone of the purpose of the visit and gave permission for Herbiberto to sign in her absence. An exit interview was conducted an a copy of this report was left with Herbiberto}. On 1-5-22 at 9:30am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a complaint visit for the allegation noted above. LPA met with caregiver who notified Administrator Khanh Farkas of LPA’s arrival. LPA spoke with Administrator via phone and explained the purpose of the visit. Administrator arrived at facility at 12:10pm. LPA reviewed records for Staff1 (S1), S2, S3, and S4. LPA also interviewed S1, S2, and S3. LPA conducted interviews for Resident1 (R1), R2, R3, and R4. LPA requested facility file documentation including staffing roster, staffing schedule, resident roster, and training records. {Cont. on 9099C}. Unsubstantiated Based on additional interviews, it was noted that S4 arrives at facility with Administrator as a volunteer, supervised, and without interacting with residents in care. Additionally, a vaccination card for S4 was observed and reviewed by LPA. Based on the interviews and records reviewed, the preponderance of evidence standard is not met, therefore, this allegation is UNFOUNDED. An exit interview was conducted with Khanh Farkas on 1-5-22 and a copy of this report was left with Khanh. . Based on interviews conducted and records reviewed, it was determined that all staff have received up to date training as indicated by Administrator signature on training records, however, staff signature was not present on training records. Based on additional interviews, it was noted that S4 arrives at facility with Administrator as a volunteer, supervised, and without interacting with residents in care. Based on the interviews and records reviewed, the preponderance of evidence standard is not met, therefore, this allegation is UNSUBSTANTIATED. An exit interview was conducted with Khanh Farkas on 1-5-22 and a copy of this report was left with Khanh.the state’s words, verbatim · CDSS document, Jan 18, 2022 · control 27-AS-20211228151714

Type of visit: Required - 1 Year

On 8/16/21 at 9:31am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA was greeted by lead caregiver Theresa Marcos. The administrator Knanh Farkas was not present but gave permission for lead caregiver to sign necessary paperwork and accommodate LPA. LPA explained the purpose of the visit. LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is a 6 bed facility with a current census of 3. Facility has 4 bedrooms and 2 bathrooms . There is a dining room off the kitchen area. LPA also conducted the infection control domain tool. The facility submitted a LIC 808 mitigation plan. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and outside. 30-day supply of PPE observed. Bathrooms contained adequate soap, paper towels (in dispenser), and foot pedal garbage can. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Water temperature reads 110.6*F in the bathroom and room temperature reads 75*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 2/20/21. Facility has an emergency food and water kit. Per California Code of Regulations, Title 22, deficiencies were observed during this visit has noted on LIC 809D. Exit interview was held and a report was given to lead caregiver Theresa Marcos.the state’s words, verbatim · CDSS document, Aug 16, 2021