Queja Residential Facility for the Elderly

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jenny Olson arrived at the facility unannounced to conduct a required annual visit at 9:45 a.m. When LPA arrived, there were five staff and five residents present. LPA was greeted by Administrator/Licensee and informed them of the reason for the visit. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Knives are stored in a locked drawer in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Common areas: Living and dining room furniture were observed to be in good condition. At 11:00 a.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. LPA observed required postings throughout the common space. The fire extinguisher was charged and serviced 7/13/2023. The backyard has a covered outdoor area equipped with furniture for client use. No bodies of water noted. The washer and dryer are in the laundry room. Restrooms: The three resident restrooms were clean and sanitary and in operating condition with non-skid mats. The bathrooms were sufficiently stocked with soap and paper towels. Bedrooms: There are six (6) resident rooms, which were furnished. A linen closet was located outside of the rooms, which stocked extra linens and towels. Records: LPA reviewed resident and staff records around 10 a.m. LPA reviewed five (5) resident files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, and current needs and services plan. 3/5 residents were missing a needs and services plan. Continued on 809-C LPA reviewed five (5) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification. 2/5 staff were missing health screening, personnel records, and criminal record statements. MEDICATIONS: Medications review began at 11:15 a.m. The medications are centrally stored and locked in a cabinet in the dining room. Medications are labeled and checked for expiration dates. LPA advised the Administrator to ensure that all the necessary information is properly documented on the CSMAR. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. The facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. At 1:00 p.m., LPA interviewed two (2) staff members and two (2) residents. During today’s visit, the LPA obtained copies of the following: current liability insurance. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 8, 2023

The state marks this report as 13 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Resident sustained injuries while in care.

Licensing Program Analyst (LPA) Olson conducted a subsequent complaint visit to deliver final findings for this investigation. LPA met with Dorothy Queja, Adminstrator/Licesee and explained the purpose of the visit. On the allegation: Resident sustained injuries while in care. It was alleged that R1 had “open wounds” that R1’s medical provider felt were “inconsistent” with R1’s medical history. R1’s medical documents indicate R1 has anemia, hypertension, hypothyroidism, hyperlipidemia, GERD, syncope/anemia, major depressive disorder, and dementia. Medical records indicate on 6/10/2021, home health’s plan of care for R1 includes physical therapy to help maintain and preserve R1’s skin integrity. Adult Protective Services originally started an investigation into this case before they determined it was a facility licensed by Community Care Licensing. Continued on 9099-C Unsubstantiated On 7/5/2021, a medical professional visited R1 and observed “open wounds” which were not documented on the previous nurse visitation report. The medical professional asked the staff about the bruises and the staff stated R1’s “clothes caused the wounds” but did not provide any further information. The medical professional felt the observations were not consistent with the staff’s statement. On 7/6/2021, Santa Barbara County Sheriff’s Office conducted a welfare check on R1. The staff at the facility stated R1 has very thin skin and it tears easily. The staff stated R1 gets combative when dressing which cases skin tears and bruising. The Deputy stated R1 was sleeping when they arrived but they were able to observe R1’s legs and did not observe any evidence of abuse. On 7/21/2021 and 8/10/2022, LPA interviewed staff for this investigation. Staff stated R1 was “hard to care for.” Staff stated when assisting with toileting needs, staff would assist with taking down and pulling up R1’s pants. Staff described that the injuries happened when pulling the resident’s pants up and down. Staff treated the skin tears with a wet towel, Neosporin, and bandages. Staff stated R1 would kick the staff when they helped change her. Staff stated they would pull up R1’s pants and R1 would kick, and when R1 kicked the pants left a mark and cut R1’s leg. Staff stated the resident was “difficult to change.” Staff stated they told a nurse R1’s pants scratched R1’s legs. Staff described R1 as bruising easily, marking easily, and having sensitive skin. Staff also stated R1 would bite them if they got too close. Staff were all consistent in their descriptions of R1 when interviewed. On 7/1/2021, a Home Health nurse indicated they observed blood on R1’s sock and shin, and bloody gauze taped to the skin with bandaids. The nurse noted 5 different wounds on R1’s legs. Staff stated the wound occurred when R1 was wearing clothes that were too tight, and staff had been treating the wound with first aid. The nurse’s notes indicates R1 was unable to answer questions about the injuries. On 9/12/2022, LPA interview R1’s physician. R1’s physician stated they did not observe the wounds first-hand, but knew of the concerns raised by other medical professionals. R1’s physician stated R1’s skin tears could have opened at some point but should close eventually. R1’s physician stated “elderly people can have skin tears from anything like even from rolling over in bed, its very possible.” R1’s physician stated they remembered the facility being attentive to R1. LPA interviewed a credible witness who stated they had never observed abuse in the facility and did not have any concerns about abuse. Administrator stated they spoke with R1’s family member when the incident occurred, and R1’s family member did not believe the injuries were intentional. LPA interviewed 4 residents and R'1s family member who also confirmed residents were well cared for. Based on the evidenced obtained, there is insufficient evidence to suggest staff abuse led to R1 sustaining injuries. Therefore the allegation is Unsubstantiated at this time.the state’s words, verbatim · CDSS document, Oct 5, 2022 · control 29-AS-20210715091930

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Olson conducted an on-site 1 year infection control annual visit to the facility above on 10/05/2022 around 2:15 PM. LPA met with Dorothy Queja, Licensee/Administrator around and explained the purpose of the visit. LPA took a physical plant tour of the facility with Administrator. The facility has an entry point at the front door where everyone entering completes sign-in, symptom questionnaire and temperature screening on all staff and visitors wanting to come into the facility. The entry station has hand sanitizer along with a thermometer. The staff will screen residents for symptoms and temperature at least once a day and documentation is kept on file. Increased monitoring is conducted if any change of condition are noted or any residents are showing any signs, symptoms or a temperature. Staff makes sure residents have a mask when leaving the facility on outings into the community. All staff willwear face coverings in the facility and when on outings with residents. Facility have areas for visiting inside and outside. The facility also offers virtual and telephone communications to all residents in care. Staff, Residents and visitors are informed of the facilities infection control policies. New residents and staff will be tested and negative results received before working or residing in the facility. The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed. The Administrator is in charge of infection control and provides training and education to staff, residents and visitors. Continued on 9099-C Staff will use full PPE with N95 masks and face shields when around with any pending or confirmed cases of Covid-19. The facility has single rooms that are disinfected and wiped down daily. Precautionary Droplet signs will be posted on any room with quarantine or isolated individuals. PPE supplies will be located right outside those rooms when required. Facility has a 30 day supply of PPE on hand. Facility has plans for delivering medications and meals to any quarantined/isolation resident rooms. Facility Administrator has a plan in place for when and whom to notify in an outbreak or other emergencies. Administrator will keep a line list of all vaccinated and tested staff/residents in care with dates/results. Facility will conduct training on infection prevention, symptoms, transmission and PPE use. Facility has non-punitive sick leave polices for staff. Sick staff are requested to stay home and not report to work if ill. Residents medication is delivered in 30 day supplies to the facility. The facility ensures proper cleaning is done on frequently touched surfaces and between any individuals sharing of space or items. Sinks were well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in locked office. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. Administrator Certificate is valid. Fire extinguishers were charged and inspected annually, Smoke and carbon monoxide detectors were present and working. At approximately 4:00 pm, LPA reviewed Department of Social Services, Community Care Licensing Division, Licensing Information System (LIS), Facility Personnel and facility staff roster and determined that all staff are fingerprint cleared and associated to the facility At approximately 2:15 PM LPA Olson observed Licensee and 2 staff in the facility with no masks LPA also observed Facility did not submit multiple Incident reports (LIC 624 and LIC 624A) for at least one resident. Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 809-D). Exit interview completed and copy of report, Deficiencies, and appeal rights emailed to Administrator /Licensee.the state’s words, verbatim · CDSS document, Oct 5, 2022

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility did not follow COVID-19 precautions.

Licensing Program Analyst (LPA) Diaz conducted a complaint visit to deliver final findings of the complaint investigation conducted by LPA Diaz. LPA Diaz reviewed facility documents and conducted interviews with staff residents and family member. LPA interviewed staff on 09/01/21 at 12:50pm, 1:33pm, 1:38pm, 2:00pm. LPA interviewed residents on 09/01/21 at 1:51pm. LPA interviewed family members on 09/04/21 at and 1:09pm and on 09/23/21 at 3:41pm. On the allegation: Facility did not follow COVID-19 precautions. LPA arrived at the facility on 09/01/21 at 12:15pm. LPA was greeted to enter the facility by staff 1 (S1). LPA informed S1 that visitors must be screened before entering the facility. According to the administrator, all staff wear masks inside the facility and the staff screen visitors before entering the facility. LPA observed the administrator instruct 3 staff members to screen visitors before entering the facility during the LPAs visit. LPA toured the facility and conducted interviews with the staff. 3 out of 3 staff stated that all visitors are screened before entering the facility and all staff members wear face masks inside the facility. Substantiated Resident 2 (R2) stated they do not remember or notice if staff members wear facemasks inside the facility. According to the resident family member, the staff allowed the family member inside the facility without taking their temperature or ask screening questions. LPA toured the facility and observed a hairstylist cutting a resident’s hair at 1:10pm. According to the hairstylist, they were greeted inside the facility by S1 without being screened. At 2:10pm LPA observed a nurse enter the facility. The nurse stated that the facility staff screen visitors and log the information. LPA reviewed the 2021 visitor log for September July and August and verified that the facility did not document 19 visitor’s temperatures. LPA also verified that the nurse’s temperature and screening questions were not documented in the visitor log on 09/01/21. The facility did not implement a sign-in policy for all visitors to ensure compliance with one central entry point for COVID-19 symptom screening and to record contact information in case needed for reporting requirements or contact tracing. Based on the evidence gathered through interviews and records reviewed, the allegation is deemed substantiated at this time. Exit interview, dfeiciency cited, report given, appeal rights given.the state’s words, verbatim · CDSS document, Nov 18, 2021 · control 29-AS-20210827102315

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Nov 18, 2021

87468.1(a)(2) Personal Rights of Residents in all Facilities: ..To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interview and observation, the licensee did not ensure all persons entering the facility were screened before entering the facility, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 18, 2021

Plan of correction: Administrator will ensure sign in check sheet is being used going forward and will retrain staff regarding covid precautions.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Diaz conducted an unannounced visit to the facility and was met at the facility by Dorothy Queja, the owner/licensee. LPA explained the reason for the visit. A tour of the interior and exterior premises of the facility was conducted. The facility's premises are found to be very clean, well-organized, sanitary, free of undesirable odors, and very well maintained. LPA observed alarms on the front door, and two alarms on the outside fences. 6 emergency alarm exists for the resident’s bedroom. On 8/22/21, around 12:00am The Police arrived at the facility stating the resident was found wandering the streets. The Licensee stated that they neglected to lock the laundry room door and the resident left the facility through the side door/laundry room. The laundry room door did not have an alarm installed. There are two exists that lead outside from the laundry room door and both exist contained alarms with dead batteries. The resident was found not injured and stayed the rest of the night with family but returned to the facility the next morning at 1130am. LPA observed 2 newly installed alarms on the laundry room door and on the door entrance of the resident’s room. LPA also observed new batteries for the two exit doors that lead outside from the laundry room. The licensee failed to protect the personal rights of residents in care to be able to receive safe and healthful accommodations. Pursuant to Title 22, California Code of Regulations, the deficiency will be cited on an LIC 809-D. An Exit interview conducted, deficiency cited, and a copy of this report and appeal rights were emailed to Licensee for signature and return.the state’s words, verbatim · CDSS document, Aug 25, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(A)(4) · Plan of correction due date: Aug 25, 2021

87468.1 (A)(4) Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have the following personal rights: (4) To care, supervision, and services that meet their individual needs and delivered by staff that are sufficient, qualifications, and competent to meet needs. Based on the Licensee’s statement, the licensee did not lock the laundry room door and R1 was AWOLthe state’s words, verbatim · CDSS document, Aug 25, 2021

Plan of correction: Administer agreed to immediately install additional alarms to the laundry room door and replace door exit alarms with new batteries by 8/25/21. LPA observed additional laundry room door alarm and new batteries for the door exits.