Brookdale Lodi

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ruth Wallace conducted an unannounced required annual inspection visit. LPA met with Administrator and explained purpose of visit. Administrator's Certification expires . LPA and administrator inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV areas, and outside yard of the facility to ensure compliance with Title 22 regulations. Food supply is adequate for two day perishable and seven day nonperishable. Fire extinguishers were last inspected May 17, 2023. Smoke alarms were tested and are operational. The facility has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 109.7 F degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA confirmed all staff present is background cleared. LPA reviewed four staff and five resident files. Resident emergency contact complete. LPA observed all staff and resident files complete. All staff have criminal record clearance and are associated to the facility. There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA received the following updated documents: LIC 308 Designation of Administrative Responsibility, and copy of current Administrator’s Certificate. Exit interview conducted with Administrator. A copy of report and LIC 811 (Confidential Names) left at facilitythe state’s words, verbatim · CDSS document, Oct 9, 2023

Type of visit: Case Management - Health Checks

On 04/28/2023, Licensing Program Analyst (LPA) Renee Campbell made an unannounced visit to the facility to conduct a Case Management due to multiple hospital visits for residents. R1 experienced a possible unwitnessed fall in Assisted Living on 04/18/2023. Because there were no witnesses, it is not clear if the resident fell. The injury was discovered when she was seen in the dining room eating, with blood running down her leg. R1 was then found to have a laceration. Per S1, when asked, the resident did not know how she had hurt herself. 911 was then called and R1 was taken to the hospital. R1 returned to the facility the same day with care instructions for her cut. On 04/19/2023 R2 reported vaginal bleeding and requested evaluation. Though she experienced no pain, 911 was called and R2 was taken to the hospital by ambulance. During examination, it was discovered that R2 had a UTI.. She was provided IV antibiotics and discharged the same night with no new orders. LPA reviewed both client's 602, the facility schedule, IR and the facility fall protocol. Per the documents provided, facility notified the necessary parties and provided medical care in a timely manner.the state’s words, verbatim · CDSS document, Apr 28, 2023

Type of visit: Case Management - Incident

On 3-1-23 at 10:25am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding incidents which occurred on 12-8-22 and 12-28-22. LPA met with associate executive director Nicole Bacon and explained the purpose of the visit. LPA reviewed incident reports, and reviewed facility file documentation for resident1 (R1), R2, and R3. LPA also reviewed facility staffing schedule and actual hours worked for 12-8-22 and 12-28-22. Additionally, LPA conducted interview with staff1 (S1). On 12-8-22, facility reported that resident1 (R1) was found in room on the floor next to bed. According to incident report, R1 tripped over chair causing the fall and landing next to R1’s bed. Incident report further stated R1 denied hitting head but did complain of right hip pain. Facility called 9-1-1 and R1 was taken to local hospital. Additionally, facility notified R1’s responsible party and Physician within regulatory time frames. After R1’s admission to hospital, it was determined R1 sustained a right hip fracture. R1 did not return to facility. Based on interviews conducted, R1 did not push call pendant for assistance.. Based on records reviewed, R1 has care plan in place which includes fall prevention and orientation to call button. Additionally. R1 was placed on alert charting and increased supervision per facility protocol due to history of falls noted with care plan updated. On 12-8-22, facility reported that R2 was found laying on R2’s back in kitchen area of R2’s room. According to incident report and based on interview, facility staff called 9-1-1 and R2 was transported to local hospital. Additionally, R2’s responsible party and Physician were notified of incident within regulatory time frames. Based on interview, R2 did not push call pendent for assistance. Based on record review, it was determined R2 suffered a stroke prior to fall. R2 was placed on hospice upon returning as well as facility’s alert charting protocol, and is no longer residing at facility. Alert charting also included increased supervision and fall precautions in place due to history of fall with updated care plan. On 12-28-22, facility reported that R3 was found on the ground in R3’s room with head injury. Based on interview, R3 was wearing call pendant, but did utilize it prior to fall. R3 was hospitalized with a rib fracture and pneumonia. Based on R3’s history of fall, R3 had been placed on facility’s alert charting resulting in increased supervision and fall precautions in place with updated care plan. Based on interview and record review, R3’s responsible party and physician were notified within regulatory time frames. Based on interview, R3 is no longer residing in facility. Based on record review, facility utilizes a fall precaution protocol for residents with history of falls. Additionally, LPA tested call pendant system which is functioning properly alerting facility staff to residents’ name and current location as necessary for needed assistance. LPA also reviewed facility staff schedule and actual hours worked with S1. Based on interview and record review, it was determined that actual hours worked were consistent with the established facility schedule in place during the dates of 12-8-22 and 12-28-22 As a result, of today’s case management, no deficiencies cited. An exit interview was conducted with Nicole Bacon and a copy of this report was left with Nicole.the state’s words, verbatim · CDSS document, Mar 1, 2023

Allegation investigated: Sufficient food service personnel shall be employed, trained and their working hours scheduled to meet the needs of residents.

Licensing Program Analyst (LPA) Ruth Wallace conducted unannounced initial ten (10) day complaint investigation visit. LPA explained purpose of visit and discussed with Administrator (AD). The initial 10-Day visit was conducted on today's date of 12/6/2022. LPA Wallace reviewed facility training records of kitchen and dining room staff. LPA reviewed staff working schedule at facility for approximately the last several months of 2022. LPA Wallace interviewed administrator, kitchen staff, and resident regarding the above allegation. It was alleged that there was not sufficient food service personnel, training, or working hours scheduled to meet the needs of residents. LPA reviewed all staff schedules, training, and new employees hired after approximately seven staff left employment within a month's time period. Continued on 9099-C Unsubstantiated Continued from 9099 - Page 2 LPA reviewed menus, food handler certificates, orientation training plan for kitchen staff, and observed lunch being served in dining hall. Based on the information provided through interviews and documentation provided to LPA, the allegation that there was not sufficient food service personnel employed, trained and working hours scheduled to meet the needs of residents is deemed UNSUBSTANTIATED. There was not a preponderance of evidence to prove or disprove that the allegation occurred as reported, therefore the allegation was deemed UNSUBSTANTIATED. An exit interview was conducted with AD. A copy of this report was provided along with a Confidential Names list, and Appeal Rights.the state’s words, verbatim · CDSS document, Dec 6, 2022 · control 27-AS-20221128155453

Allegation investigated: Facility is not following COVID-19 guidelines.

On 10-21-22 at 3:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate the complaint allegation listed above. Allegation states a staff member worked at facility on 10-11-22 while having symptoms of COVID-19. LPA conducted interviews with staff1 (S1) and reviewed COVID-19 line list. LPA also conducted facility tour. Based on interviews and record reviews it was determined that S2 tested positive for COVID-19 on 10/10/22 and S3 tested positive for COVID-19 on 10/7/22. Interviews and record reviews revealed S3 arrived at facility on 10-10-22, tested positive for COVID-19 and was sent home without working at facility. It was further determined that neither S2 or S3 worked on 10-11-22. Additionally, facility has not reported through weekly response testing any additional COVID-19 symptoms or positive results among staff since 10-10-22. A review of staffing records revealed S3 did not work on 10-11-22, and S2 was cleared to work by this date. Facility tour conducted revealed facility has adequate amounts of Personal Protective Equipment (PPE) available for staff use. {Cont. on 9099C} Unfounded Facility tour also revealed staff are practicing COVID-19 precautions including but not limited to wearing face masks, utilizing hand sanitizer, and COVID-19 screening at front entry. Based on interviews and record reviews, the preponderance of evidence standard is not met, and this allegation is UNFOUNDED. {Cont. 9099C} No citation issued today. An exit interview was conducted with Mary Margaret Chappell and a copy of this report was left with Mary.the state’s words, verbatim · CDSS document, Oct 21, 2022 · control 27-AS-20221013090747

Allegation investigated: Resident sustained falls while in care Staff did not administer resident's medication as prescribed

On 10-21-22 at 1:15pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to continue investigation and deliver findings for the allegations noted above. LPA met with Administrator Mary Margaret Chappell and explained the purpose of the visit. LPA also conducted interviews with Administrator and Staff1 (S1) during today's visit and reviewed needs and service plan for Resident1 (R1), staffing records, medication records, emergency pendant response log, and facility staff training records. Allegation #1: Resident sustained falls while in care. LPA conducted staff and resident interviews, and facility file documentation as stated above. Based on record reviews and interviews it was determined that R1 had multiple episodes of attempting to transfer with no evidence of falls as a result. Additionally, based on interviews and record reviews, it was determined that there have been no reported episodes of falls. A review of staffing records reveal staff is present consistently as per scheduled. Additional review of records and interviews reveal R1 has not sustained injuries while in care. {Cont .on 9099C} Unsubstantiated Based on interviews and record reviews, it is determined that there is not a preponderance of evidence to conclude resident definitively sustained falls while in care. Therefore, this allegation is UNSUBSTANTIATED. Allegation #2: Staff did not administer resident's medication as prescribed. LPA conducted staff interviews and reviewed medication log sheets and physician's orders for R1. The received allegation states R1 was given the wrong medication. Based on interviews and record reviews, it was determined that R1 had multiple medications changes for a pain medication which appeared on medication log sheets as ordered. It was further determined that facility was consistently following physician's orders as written and correctly transcribing medication to the log sheets on all medication in addition to pain medication. Based on record reviews and interviews, it is determined that there is not a preponderance of evidence to conclude that facility was not administering medication as prescribed or giving incorrect medication. As a result, this allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means even though the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Mary Margaret Chappell and a copy of this report was left with Mary.the state’s words, verbatim · CDSS document, Oct 21, 2022 · control 27-AS-20220803130753

Type of visit: Required - 1 Year

On 10-12-22 at 12:30pm, Licensing Program Analyst, (LPA) Michael Bilger arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Mary Margaret Chappell and 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 areas, and outside yard of the facility to ensure compliance with Title 22 regulations. Facility is an 82-bed assisted living facility with a current census of 68. 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 outside. 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. No obstructions to fire exits noted. LPA reviewed 5 staff charts and 5 resident charts. All first aid and CPR certifications are current. Fingerprint clearance in place. Medication log sheets were reviewed; 5 of 5 log sheets reviewed were accurate and up to date. Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 72*F throughout. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. No foul odors detected throughout facility. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 5/4/22. 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 and a report was given to Administrator Mary Margaret Chappell.the state’s words, verbatim · CDSS document, Oct 12, 2022

Allegation investigated: Staff billed resident in excess of the agreed upon rates provided in the Admission Agreement.

On 08/17/2022 at 9:45am, LPA R. Campbell and Michael Bilger arrived unannounced to facility to continue the complaint investigation for the allegation noted above. During this investigation, LPA Campbell interviewed Administrator and complainant, and reviewed admission agreement and billing statements for resident1 (R1). Based on interviews and record reviews, it was determined that there was no intention to overbill. It was found that there was a misunderstanding of the facility's billing process and funds were returned. There is no evidence of an actual physical bill received. Funds have been returned as requested. As a result, this allegation is UNSUBSTANTIATED. An exit interview was conducted with Mary Margaret Chappell and copy of this report was provided to Mary. Unsubstantiatedthe state’s words, verbatim · CDSS document, Aug 17, 2022 · control 27-AS-20220630115330

Type of visit: Case Management - Incident

On 8-17-22 at 2:15pm, Licensing Program Analysts (LPAs) Michael Bilger and Renee Campbell arrived unannounced to open a case management related to incident reports dated 7-8-22, 7-9-22, and 7-11-22. LPAs met with Administrator Mary Margaret Chappell and explained the purpose of the visit. LPAs also reviewed facility file documentation including progress notes for resident1 (R1), Physician's report for R1, Personalized service plan for R1, and staffing schedule for July 2022. LPAs also interviewed Administrator and Staff1 (S1). Based on records reviews and interviews, it was determined that R1 sustained falls on the three dates noted above and sustained a head injury as a result. Based on additional record reviews and interviews, it was determined that facility had implemented fall prevention precautions for R1 and increased staff monitoring of R1 on 7-11-22 due to recent falls. R1 was place on hospice on 7-12-22 and expired on approximately 7-22-22. Staffing schedule indicates adequate staffing levels on dates of reported falls. LPAs conducted check of facility's emergency pendant system and determined that system is functioning adequately. As a result of today's case management visit, no deficiencies are issued. An exit interview was conducted with Mary Margaret Chappell and a copy of this report was provided to Mary.the state’s words, verbatim · CDSS document, Aug 17, 2022

Allegation investigated: Staff assaulted resident

On 6-22-22 at 2:20pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver complaint findings for the allegation listed above. LPA met with Administrator Mary Margaret Chappell and explained the purpose of the visit. During this investigation, On 6-8-22, LPA interviewed staff1 (S1), S2, and S3. LPA also interviewed Resident2 (R2), R3, and R4. On 6-8-22, LPA also interviewed Administrator on duty at time of alleged incident. Additionally, LPA reviewed facility file documentation including pre-admission appraisal for R1, physician’s report for R1, physician communication note for R1, staffing schedule, and police report dated 4-27-22. Based on interviews and record reviews conducted, it was determined that Resident1 (R1) stated an allegation of being slapped in the face and punched in the back on 4-27-22 by a caregiver. Interviews conducted and records reviewed revealed no witnesses to said allegation or outstanding visible injuries noted. A police report dated 4-28-22 revealed no visible injuries and no witnesses to alleged incident noted. As a result, it is determined that there is not a preponderance of evidence to prove this allegation occurred, therefore, this allegation is UNSUBSTANTIATED. An exit interview was conducted with Mary Margaret Chappell and a copy of this report was left with Mary. Appeal rights provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 22, 2022 · control 27-AS-20220428133810

Type of visit: Case Management - Incident

On 6-8-22 at 2:45pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit for an incident occurring on 3-13-22. LPA met with Patricia Olvera, Business Office Manager, and explained the purpose of the visit. Administrator Mary Margaret Chappell was made aware of LPA’s visit and purpose. LPA reviewed physician’s report and service plan for resident1 (R1). LPA also reviewed incident report dated 3-16-22 regarding R1. Additionally, LPA interviewed R1. LPA also tested emergency response testing system during visit. Based on record review and interview it was determined that on 3-13-22 at approximately 1:00am, R1 sustained a fall and was sent to the emergency room and returned with a femur fracture. Interview with R1 revealed R1 pushed emergency pendent after she attempted to get out of bed to use restroom, and staff responded to pendent within 5-10 minutes. Resident was then found on floor and was sent to emergency room by facility staff via 9-1-1 call. Interview with R1 also revealed appropriate staff are available to meet R1’s needs and response time to emergency pendant is adequate. An additional interview with R2 revealed appropriate staffing levels are consistent to meet needs. LPA tested emergency pendent response time in the presence of Patricia Olvera and response was within 10 minutes. Review of physician’s report and service plan for R1 determine that both documents are updated to reflect R1’s current needs. No deficiencies cited during today’s visit. An exit interview was held with Patricia Olvera and a copy of this report was left with Patricia.the state’s words, verbatim · CDSS document, Jun 8, 2022

Type of visit: Case Management - Incident

On 03/17/2022, Licensing Program Analyst (LPA) T. White conducted a case management visit regarding incident report that was submitted to CCLD on 02/23/2022. LPA spoke with Assistant Executive Director, Brittany Andrews and explained the purpose of the visit. Based on incident report (SOC341), Staff #1 (S1) received an anonymous email regarding staff members verbally and physically abusing residents. S1 stated the facility interviewed 3 residents regarding incident and 3 of 3 residents stated they were not abused. S1 stated no further action was taken after interviews were completed. LPA interviewed 3 staff members and 5 residents. Based on staff interviews, 3 of 3 staff members stated staff do not physically or verbally abuse residents. Based on resident interviews, 5 of 5 residents stated staff has not physically or verbally abused any residents. No deficiencies cited during inspection. Exit interview conducted with Assistant Executive Director and a copy of report given.the state’s words, verbatim · CDSS document, Mar 17, 2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) T. White arrived at the facility on 02/14/2022 unannounced to conduct a case management visit. LPA met with Associate Executive Director, Brittany Andrews and explained the purpose for todays' visit. LPA amended complaint # 27-AS-20211214154259 dated 12/14/2021 and Associate Executive Director Brittany Andrews signed the amended report. LPA left the amended report at the facility with Associate Executive Director, Brittany Andrews. Per title 22 no deficiencies being cited during this visit. An exit interview was conducted with Associate Executive Director, Brittany Andrews and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Feb 14, 2022

Allegation investigated: Resident was injured while in care. Staff did not respond to resident's calls for assistance. Facility staff did not ensure that diabetic resident was fed timely.

On 01/10/2022, Licensing Program Analyst (LPA) T. White conducted an unannounced complaint investigation regarding the above allegations. LPA White discussed the purpose of the visit and the elements of the allegations with Executive Director, Mary Margaret Chappell. During the course of investigation, LPA White interviewed 4 staff members and 4 residents. LPA collected the following documents for Resident #1 (R1): Physician Report (LIC602), Identification and Emergency Information, Needs and Service Plan, Progress Notes, Room Service Slips and Pendant tracker within the last 30 days. Report Continues at 9099C. Unsubstantiated Resident was injured while in care. On 12/16/2021, LPA spoke with Resident #1 (R1) regarding injuries while in care. Based on interview, R1 attempted to lower bed and the table tilted over. R1 stated, she almost fell out of the bed. R1 stated she twisted her arm and back. Based on interview, Staff #3 (S3) and Staff #4 (S4) stated R1's table had fallen and S3 picked it back up. S3 stated she did not observe any injuries. Based on Staff #1 (S1), R1 moved out of the facility on 12/20/2021. LPA is unable to prove or disapprove if allegation occurred. Staff did not respond to resident's calls for assistance. On 01/10/2022, 3 of 4 residents stated they use there pendants. 3 of 4 residents stated when their pendants are pressed, staff respond in a timely manner. 4 of 4 staff stated residents pendants are always answered. LPA collected and reviewed pendant history for R1. Based on documentation, R1 had a history of pressing the pendant throughout the day. On 01/10/2022, LPA observed the pendant was cleared when R1 pressed the pendant on 12/18/2021 through 12/20/2021. However, 1 of 4 residents stated staff did not respond to resident's call. LPA is unable to review all pendant history for the month of December due to the system saving information for only 30 days. Based on interview, R1 moved out on 12/20/2021. Facility staff did not ensure that diabetic resident was fed timely. On 01/10/2022, LPA collected and reviewed R1's room service slips dated 12/01/2021 to 12/11/2021. Based on documentation, R1 was fed for breakfast, lunch, and dinner daily. Based on resident interviews, 3 of 4 residents stated facility staff ensures residents are fed timely. Based on staff interviews, 4 of 4 staff stated all residents are fed in a timely manner. However, 1 of 4 residents stated staff does not feed resident in a timely manner. Based on S1's interview, the room service slips are not used everyday. The room service slips are used for charging purposes, not tracking. LPA was unable to verify the remaining times R1 received her food. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. No deficiencies cited during visit. Exit interview conducted with Executive Director and a copy of report given.the state’s words, verbatim · CDSS document, Jan 10, 2022 · control 27-AS-20211214154259

Type of visit: Required - 1 Year

On 09/30/2021 at 11:30 am, Licensing Program Analyst (LPA) T. White spoke with Executive Director, regarding facility risk assessment questions. Executive Director confirmed no staff or clients have experienced symptoms within the last 10 days. At 11:45 am, LPA T. White arrived unannounced to conduct a required 1-year annual inspection. LPA met with Executive Director, Mary Margaret Chappell and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 82 non-ambulatory residents which 10 may be on hospice. LPA toured the facility including but not limited to apartments, bathrooms, kitchen, common area, backyard and courtyard. All outdoor and indoor passageways are kept free of obstruction. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in 6 residents' apartment bathroom sinks was measured above 120 degrees Fahrenheit. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. LPA observed smoke detector is interconnected with the fire department. LPA observed carbon monoxide was in operating condition during inspection. Fire extinguisher was last serviced on 05/21/2021. First aid kit was observed to be complete. Fire drill was last conducted on 09/28/2021. LPA observed mitigation plan completed - LPA observed 6 apartment bathroom sinks' hot water temperature measured above 120 degrees F. Report Continues on 809C. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 10/09/2021: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency may result in civil penalties. Exit interview conducted with Executive Director. A copy of report given and Appeal rights giventhe state’s words, verbatim · CDSS document, Sep 30, 2021