Abundant Care

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Darlene Chavez and Kristin Kontilis conducted an unannounced required Annual Inspection at the facility. The facility is a one-story home which is licensed as a Residential Care Facility for the Elderly (RCFE) with a dementia diagnosis. The facility has been approved for a hospice waiver for 4 residents and has a fire clearance for 6 non-ambulatory residents, one of which can be a bedridden resident. Upon arrival, there were six residents in care and two staff on duty. Currently there are six residents residing in the facility with 1 resident on hospice. Administrator Timothy Pryko arrived at approximately 9:59 am. LPAs explained the purpose of the visit. Entrance interview conducted. A tour of the physical environment and accommodations were assessed. The following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the facility for fire safety, personal accommodations, and food service. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors, and floor coverings were checked. The facility was seen to be in good repair inside and outside. There is one fire extinguisher located in the common area, last serviced on 1/15/2023. The carbon monoxide alarm and smoke alarms are in good working order. Medications are kept in a locked centrally stored cabinet. The kitchen, living room and dining area are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors and walls are in good repair. The kitchen has a refrigerator, dishwasher, toaster, hot water teapot, and a stove-top oven. LPAs observed the kitchen stove has knobs in place and is accessible to residents in care. Between 10:15 am and 11:09 am, the refrigerator located in the kitchen was measured at 43.1 degrees Fahrenheit (F) and the freezer was measured at 5.8 degrees F. The refrigerator located in the hallway closet was measured at 35 degrees (F) and the freezer was measured at 17.3 degrees (F). Please continue to 809-C, Pg 2. The facility has 5 private bedrooms with private baths. Bedroom #1 is a private bedroom with access to the bathroom across the hallway. Each resident’s room is furnished with overhead lights to provide sufficient lighting, a nightstand, and a bed. The laundry area and storage area are located off the hallway. Cleaning agents and detergents are kept locked and inaccessible to residents in care. The backyard consists of a covered and fenced patio area with chairs and tables. The patio has planters, walkways, and built-in garden areas. The trash, recycling, and green waste cans are standardized cans located outside the facility. There is a hard-wired dual carbon monoxide detector and smoke alarm system in every room and each hallway. LPAs observed a comfortable room temperature throughout the facility. Residents participate in activities based on their individual interests and preferences, including musical entertainment, painting, drawing, social activities, and puzzles. Outdoor activities include socializing, leisure walks, visitors from community organizations, and seasonal celebrations. Residents records were reviewed and were found to be current and in good order. Staff records were reviewed. Staff training and required documents are in good order. All staff have received a criminal background check and have been properly associated to the facility. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted. Deficiencies noted. A copy of this report and appeal rights issued at the time of the visit..the state’s words, verbatim · CDSS document, Sep 1, 2023

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Diego Cortez and Kristin Kontilis conducted an unannounced Annual Required visit and inspection of the facility. LPAs arrived at 1:46 pm and were greeted by Staff 1 (S1) on duty. Upon arrival, there was one staff on duty and five residents in care. Timothy Pryko arrived at approximately 1:47 pm. LPA explained the purpose of the visit. Entrance interview conducted. There are currently 5 residents residing in the facility. The facility is home to residents with a dementia diagnosis. There are currently no residents on hospice. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked. The facility was seen to be in good repair inside and outside. Fire inspection was conducted on 9/1/2022. The carbon monoxide alarm and smoke alarms are in good working order. Medications are kept in a locked centrally stored cabinet. The backyard has a covered patio with outdoor furniture. There are no bodies of water. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. A locked private staff room is located in the main part of the house near the front entrance. The living room and dining area are neat and clean. The facility maintains a comfortable temperature at 74.0 degrees Fahrenheit (F). Hallways, bedroom doors and walls are in good repair. The facility has 5 private bedrooms with private baths. Bedroom #1 is a private bedroom with access to the bathroom across the hallway. Each resident’s room is furnished with overhead lights to provide sufficient lighting, a night stand, and a bed. Please continue to 809-C, Pg 2. The bathrooms have secure grab bars and no skid flooring. LPAs advised Administrator that COVID-19 screenings should be done with all visitors, staff, and residents who return from outings upon entry into the facility. LPAs advised Administrator that CDSS PINs and CDSS PIN summaries should be readily available to residents, staff, and visitors. LPAs advised Administrator that visitation policies and COVID-19 awareness posters should be made available prior to entering the facility. The facility has multiple areas spaced to accommodate as much space as possible for social distancing. The staff 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. Signs are posted on the front door, entry area regarding Covid-19. Staff ensure residents have a mask when leaving the facility on outings into the community. All staff wear face coverings in the facility and when on outings with residents. Facility has 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. Administrator is in charge of infection control and provides training and education to staff, residents and visitors. Staff will use full PPE with N95 masks and face shields when dealing with any pending or confirmed cases of Covid-19. 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. Sinks were well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in locked offices. Facility recognizes that 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. The most stringent orders should be followed by any of these agencies. Administrator’s Certificate is valid. Fire extinguishers were charged and inspected annually. The facility has hardwired smoke detectors thorough the facility. At approximately 2:07 pm, LPAs reviewed Department of Social Services, Community Care Licensing Division, Licensing Information System (LIS), Facility Personnel and facility staff roster and determined all staff have completed a criminal background clearance and are properly associated to the facility. Exit interview conducted. No deficiencies cited. A copy of this report is issued via email.the state’s words, verbatim · CDSS document, Sep 23, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kristin Kontilis conducted an onsite one-year infection control annual visit to the above-named facility. LPA met with Timothy Pryko, Administrator and explained the purpose of the visit. LPA conducted a physical tour of the facility. The facility has submitted a Mitigation Plan to the Department. The facility has an entry station at the front of the building. Upon entry, staff, visitors, and residents returning from an outing are required to sign-in, complete a symptom questionnaire, and have a temperature screening. All documentation is kept in a a binder on a daily basis. The entry station has PPE gear, hand sanitizer, and disinfecting wipes along with a thermometer. Entrance interview conducted. There are currently 6 residents residing in the facility. The facility is home to residents with a dementia diagnosis. There are currently three (3) residents on hospice. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. First aid kit was observed to be complete. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked. The facility was seen to be in good repair inside and outside. Fire inspection was conducted on 9/01/2021. The backyard has a covered patio with outdoor furniture and sitting areas. There are no bodies of water. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. A locked private staff room is located in the main part of the house near the front entrance. The living room and dining area are neat and clean. The facility maintains a comfortable temperature at 75 degrees Fahrenheit (F). Hallways, bedroom doors and walls are in good repair. Please continue to 809-C, Pg 2.. The facility has 6 private bedrooms. Bedroom #1 has a shared bathroom off the hallway. Bedrooms 2-6 each have a private bathroom. Each resident’s room is furnished with overhead lights to provide sufficient lighting, a nightstand, and a bed. The bathrooms have secure grab bars and no skid flooring. Exit interview conducted. Copy of report emailed. No deficiencies noted.the state’s words, verbatim · CDSS document, Sep 21, 2021

Allegation investigated: Staff inappropriately handled Resident. Staff did not report incident.

Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced complaint visit to the facility regarding the above allegations. During the investigation, LPA interviewed resident on 12/31/2019 at 9:45 am; interviewed staff on 12/31/2019 at 11:35 am and 8/5/2021 at 6:58 pm; and interviewed witnesses on 12/20/2019 at 10:08am, 12/26/2019 at 9:00am, 12/30/2019 at 11:29 am, and 8/5/2021 at 2:59 pm. LPA also collected and reviewed relevant documents on 12/31/2019. Allegation #1: Staff inappropriately handled resident. Resident 1 (R1) reported that Staff 1 (S1) punched R1 three times in the ribs on or about November 25, 2019. R1 recounted the incident consistently to five separate individuals on different dates. R1 reported the incident to Staff 3 (S3) on 11/26/2019. R1 recounted the incident to Credible Witness 1 in the presence of R1’s responsible party on 12/11/2019. On 12/18/2019, R1 recounted the incident to Credible Witness 2 and R1’s friend. R1 recounted the incident to LPA on 12/31/2019. On 12/11/2019, R1 visited R1’s physician for a routine appointment. While at the appointment, R1 disclosed S1 punched R1 in the ribs. X-rays were taken and R1’s physician noted no rib fractures and observed no visible Please continue to 9099-C, Pg 2. Substantiated contusions but observed R1’s rib area was painful when touched and noted that R1 “winced” upon touch. R1’s responsible party was present at the appointment and noted this was the first time they were hearing about the incident. R1 reported S1 punched R1 three times in the ribs. R1 screamed out S1’s name after the third punch. S1 took a step back and seemed to be “dazed” at what happened. R1 stated S1 suddenly left the facility. According to R1, when Staff 2 (S2) came on shift, S2 was not happy that S1 left a mess in the kitchen. R1 reported what occurred to S2 and that S1 had suddenly left the facility. LPA obtained an incident report that includes an attached, unsigned declaration from S3. The declaration states on 11/26/2019, R1 reported to S3 that on 11/25/2019, S1 hit R1 in the ribs. S3 states R1 was checked and S3 observed no bruises or skin tears, and R1 reported no pain. S3 asked S1 about the incident and S1 denied touching R1. Credible Witness 2 and R1’s friend stated they believe R1 is credible and does not have a history of false statements. R1’s physician’s report dated 12/13/2018 and signed 1/1/2019 does not indicate R1 has any cognitive issues. Based on the information obtained, the allegation is Substantiated. Allegation #2: Staff did not report incident. Prior to conducting the initial visit on 12/31/2019, LPA reviewed CCL’s incident report log and observed no incident report(s) for R1 in November 2019, and no incident report(s) indicating S1 hit R1. LPA also observed no incident reports indicating R1 embellished other incidents. During the visit on 12/31/2019, LPA obtained a written incident report for the incident on 11/25/2019, when S1 inappropriately handled R1. Administrator could not provide any verification that the incident report was sent in to CCL. In addition, the incident report does not indicate the alleged abuse was reported to the Long Term Care Ombudsman or law enforcement. The incident report also includes an attached, unsigned declaration from Staff 3 (S3). The declaration indicates R1’s responsible party was notified of the incident. However, R1’s responsible party indicated they first became aware of the incident from R1 at R1’s physician’s appointment on 12/11/2019. Over the course of the investigation, R1 passed away. Community Care Licensing did not receive a required death report from the facility for R1’s death. Based on the information obtained, the allegation “staff did not report incident” is Substantiated at this time. At 2:41 pm, Administrator Lidia Kravchuk refused to sign Complaint Investigation Report (LIC9099, Pages 1-3. Exit interview conducted, report given, deficiencies cited on 9099-D, appeal rights provided. contusions. However, the physician observed R1’s rib area was painful when touched and noted that R1 “winced.” There was no evidence to indicate that S3 offered to have R1 evaluated by a medical professional. Although it may have been prudent for the administrator to ensure R1 was assessed by a medical professional, R1 did not report pain and S3 stated there was no visible bruising or skin tears when a body check was conducted on 11/26/2019. Based on interviews conducted, there is insufficient evidence to prove facility failed to provide timely medical attention. Therefore, the allegation is Unsubstantiated at this time. Exit interview, report giventhe state’s words, verbatim · CDSS document, Aug 6, 2021 · control 29-AS-20191226094333

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 9, 2021

Personal Rights. Residents in all residential olcare facilities for the elderly shall have all of the flowing personal rights: To be accorded d ignity in their personal relationships with staff, residents, and other persons.. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not ensure S1 accorded R1 with dignity when S1 inappropriately handled R1, which posed an immediate health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2021

Plan of correction: Administrator agrees to conduct personal rights training with all facility staff. Administrator agrees to submit the date of scheduled training by 8/9/2021 and will submit proof of training by 8/13/2021. At 2:41 PM, Administrator refused to sign report

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 13, 2021

Reporting Requirements. A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days… (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not by as evidenced by: Based on record review and interviews, the licensee did not submit required written incident report/death report to CCL within seven days, which posed a potential health, safety, and personal risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2021

Plan of correction: Administrator agreed to submit a written statement of understanding of Regulation 87211 Reporting Requirements in its entirety to CCL by 8/13/2021. At 2:41 pm, Administrator refused to sign report.