College Manor

Allegation investigated: Resident sustained pressure sore while in care

Licensing Program Analyst (LPA) Christine Dolores conducted an unannounced complaint visit to deliver the investigation finding for the above allegation. LPA met with Licensee, Dominica Oliva. On 02/19/2020, the Department received a complaint regarding the above allegation. On 02/21/2020, Licensing Program Analyst (LPA) Karen Taku conducted an initial 10-day compliant visit and met with Administrator Cora Reyes. LPA Taku obtained copies of resident records including, but not limited to, admission agreement, emergency contact information, physician’s report, assessments, appraisal needs and services plan, and outside health agency reports. SEE LIC9099-C. Unsubstantiated Due to the COVID-19 pandemic, on-site facility visits were suspended to prevent the spread of the virus. On 5/05/2020, LPA Taku interviewed facility staff (S1-S3) via tele-visit. 3 out of 3 staff stated R1 was treated for a pressure injury while in care by a home health agency. S1 – S3 states R1 was bed-bound and required staff assistance with activities of daily living (ADLs). S1 – S2 states it would take about 2-3 caregivers to transport R1 to and from the wheelchair, assist with bathing, changing, and feeding. S2 stated R1’s routine which included getting R1 out of bed daily for meals and per R1’s request. On 06/06/2023, LPA Dolores interviewed a former staff (W1). W1 states R1 was being repositioned every 2 hours, and most especially when assisted with incontinence. Based on record review, R1 was admitted to the facility on 05/01/2019. R1’s Functional Capability Assessment dated 05/01/2019, indicates that R1 uses a wheelchair, is able to reposition from side to side, but needs help with bathing/showering, dressing, toileting, and personal hygiene. A Home Health note dated 01/07/2020, showed that R1 was evaluated and assessed by a Home Health medical professional for R1’s pressure ulcer. The review of records states the wound was healed on 02/04/2020. The Department has investigated the above allegation. Based on interview, record review, and observation the Department has investigated the above allegation is unsubstantiated. An unsubstantiated finding means although the allegations may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee, Dominica Oliva and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 21, 2023 · control 26-AS-20200219095259

Allegation investigated: Facility staff made false claims against resident. Facility is unable to meet resident's needs.

Licensing Program Analyst (LPA) Christine Dolores conducted an unannounced complaint visit to deliver the investigation finding for the above allegations. LPA met with Licensee, Dominica Oliva. On 06/22/2020, the Department received a complaint alleging resident (R1) was hurt by a staff who allegedly made false claims by stating R1 had bit themselves and attacked staff. It was also alleged that staff do not know how to handle residents with a neurocognitive condition and aggressive behaviors. On 06/30/2020, LPA Karen Taku conducted the initial 10-day complaint investigation virtually. Due to the COVID-19 Pandemic, the Department had suspended on-site visits for preventative measures. LPA Taku requested the followng documents to include a copy of staff and resident rosters, staff training logs, and resident (R1-R3) records. Emergency Contact Form, Physician's Report, Appraisal/Needs and Services Plan, and Functional Capabilities Assessment for R1-R3. SEE LIC9099-C. Unsubstantiated On 05/25/2023, LPA Dolores arrived at the facility unannounced to continue the complaint investigation. During visit LPA reviewed resident (R1)'s file to include only reports from 2014 - 2019. From 05/25/2023 - 06/02/2023, documents were obtained to include resident roster, R1's physician's report, skin / office visit sheet, and training records. Based on interview and record review, R1 had passed away in September 2020. The review of records indicates on 06/17/2020, R1 became agitated and combative and was transported by ambulance to the emergency room per physician’s instructions. Records show that upon EMS arrival, R1 was not combative or agitated with EMS crew but R1 stated facility staff was trying to hurt him/her. On 05/25/2023, 4 staff members were interviewed. Based on interview, R1 was diagnosed with a neurocognitive condition and was known to have aggressive behavior. Staff explained their process to first give R1 space and then to come back later to try again. 4 out of 4 staff stated R1 did not have self injurious behaviors to include biting of the skin. 4 out of 4 staff stated R1 was alert and verbal about his/her concerns and needs. 4 out of 4 staff denied a staff hurting and/or attacking R1. From 06/01/2023 – 06/06/2023, 2 witnesses (W1 – W2) was interviewed. Based on interview with W1, R1 never had behaviors of biting oneself. R1 was described to be verbally expressive. W1 states R1 displayed aggressive behavior towards individuals he/she may not be comfortable with. W1-W2 believe staff were trained to the meet the needs of the resident and trained to handle residents with aggressive behaviors. Based on review of the staff training records, the facility provided training from February 2020 – April 2020 in topics to include but not limited to understanding dementia and types of elder abuse. The Department has investigated the above allegations. Based on interview, record review, and observation the Department has investigated the above allegations are unsubstantiated. An unsubstantiated finding means although the allegations may have happened and/or is valid there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Licensee, Dominica Oliva and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 21, 2023 · control 26-AS-20200622143406

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection. LPA met with Licensee, Dominica Oliva. During visit, LPA toured the facility with staff to include the kitchen, dining room, resident bedrooms, staff bedrooms, bathrooms, and backyard. Fire exits are free and clear of obstruction. Facility temperature maintained between 69 - 76 degrees Fahrenheit. Facility's kitchen observed in a sanitary condition. Facility maintains at least 2 days worth of perishable foods and 7 days worth of non-perishable foods. Refrigerator temperature maintained at 43 degrees Fahrenheit. Food stored in containers with lids and are labeled. Freezer temperature maintained at 0 degrees Fahrenheit. Chemical and sharp objects observed locked. Hand washing sign observed above the kitchen sink along with soap and paper towels. Facility's backyard observed free and clear of obstruction. LPA observed at least 10 pieces of long wooden planks with exposed nails on the wood. During visit, the wooden planks of wood was removed from the premises. LPA observed 6 out of 6 resident bedrooms equipped with proper furniture and supplies such as bedding, linens, adequate lighting, dressers, clothing, night stands, and a chair. Facility has an adequate amount of extra linens and towels to supply the residents. 1 out of 6 residents observed with a PRN of oxygen. Oxygen in use sign and facility emergency exit sketch observed posted on the door. LPA observed the physician's order for oxygen that was emailed to the Licensee. LPA advised to ensure the physician's order is maintained in the resident's file. Staff were provided training by a skilled professional on the oxygen equipment. SEE LIC812-C. 2 out of 2 bathrooms supplied with hand soap, paper towels and hand washing signs. Showers equipped with grab bars, non-slid mats, and shower chairs. Bathroom #1 hot water temperature maintained at 140 degrees F. During visit, staff lowered the hot water temperature. LPA observed the hot water temperature maintained at 130 degrees F. Licensee was advised. Facility has an emergency disaster plan. During visit, Licensee placed the emergency disaster plan in a visible area. It was observed 1 out of 2 facility emergency lighting in the hallway was non-operable. Facility was only equipped with 1 flash light that did not contain batteries. During visit, a staff member arrived with 6 flashlights and placed them in every residents bedroom. Facility has a complete first aid kit. Facility last conducted an emergency drill in January 2023. Licensee was advised to conduct a drill at least quarterly. Fire extinguisher last serviced on 05/03/2023. Facility is equipped with an operable carbon monoxide detector. LPA reviewed 4 out of 6 residents files contained an up-to-date physician's report, TB information, admission agreement, emergency contact form, personal rights form, consent forms, safeguard of personal properties, pre-admission, and appraisal needs and services plan. 4 out of 6 residents appraisal needs and services plan was more than 1 year old. Licensee was advised. During visit, Licensee began updating residents appraisal needs and services plan. LPA inspected 3 out of 6 residents centrally stored medications. Licensee was verbally advised to ensure the centrally stored medication records are filled out completely and accurately. LPA reviewed 3 staff files contained an up-to-date 1st Aid Certification, health screening form with TB information, and training in January - March 2022. Staff members present are fingerprint cleared and associated to the facility. LPA did not observe facility staff were provided training in 2023. Licensee was advised. 5 residents and 3 staff members were interviewed. Posters observed to include Ombudsman, if you see something say something, facility sketch, and COVID-19 poster. Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. Advisory notes provided. This report was reviewed with Licensee, Dominica Oliva and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 2, 2023

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to continue a complaint investigation and during visit a case management – deficiencies visit was conducted due to a violation observed. LPA met with Licensee, Dominica Oliva. During visit, LPA toured the facility to include the living room, kitchen, resident rooms, bedrooms, staff bedrooms, and exterior. During tour, it was found staff (S1) is residing and working in the facility without obtaining a fingerprint clearance. S1 began work in February 2023. Licensee was unable to produce S1’s clearance letter from the Department. LPA observed S1's letter from the Department of Justice. S1 was asked to leave the facility. Licensee was informed S1 cannot return to work and reside in the facility without obtaining a fingerprint clearance. Licensee stated understanding. A deficiency was cited per California Code of Regulations, Title 22. See LIC809-D. A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500), for staff (S1) working and residing at the facility without fingerprint clearance. Please see LIC 421BG. This report was reviewed with Licensee, Dominica Oliva and a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, May 24, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: May 25, 2023

(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: (1) Obtain a California clearance or a criminal record exemption as required by the Department or ... This requirement was not met as evidenced by: Based on record review, interview, and observation the Licensee did not comply with the section cited above for staff (S1) working and residing in the facility without fingerprint clearance which poses an immediate health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 24, 2023

Plan of correction: Staff (S1) was asked to leave the facility. Licensee was informed S1 cannot reside or work in the facility until a fingerprint clearance has been obtained. Licensee will submit a written plan to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct the facility's annual inspection focusing on infection control. LPA met with Licensee Dominica Oliva. During visit, LPA toured the facility to include the resident rooms, bathrooms, living rooms, kitchen, and backyard. Toxins and sharp objects were observed secured. Facility has a designated entry point for all visitors to include sign-in, symptom screening and temperature check. Hand sanitizer made available upon entry and throughout the facility. Bathrooms observed supplies with hygiene products, paper products, and hand washing sign. Trash can observed covered with lid. LPA observed Personal Protective Equipment (PPE). LPA advised to keep an adequate amount of PPE supplies in the facility at all times. Facility staff clean and disinfects multiple times daily and as needed. Staff are trained on infection control. Staff are scheduled for N95 fit testing on July 11, 2022. Facility has a procedure for visitation, LPA advised to refer to PIN 22-07-ASC. The following posters observed to include cough etiquette, symptoms and warning signs of COVID, and visitor guidelines. LPA observed the sliding door in the living room which is used for emergency exit in disrepair, making it difficult to slide open. During visit, staff repaired the sliding door. Updated documents were obtained to include the LIC610 and LIC308. Licensee will send LPA the updated Administrator certificate and LIC500. No deficiencies were cited per California Code of Regulations, Title 22. Advisory notes provided. This report was reviewed with the Licensee and a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 28, 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.