Saint Lorenz Assisted Living

Allegation investigated: Staff do not seek timely medical care for residents in care - UNSUBSTANTIATED Staff do not provide proper medication assistance to residents in care - UNSUBSTANTIATED Residents are left in urine for an extended amount of time - UNSUBSTANTIATED Residents are left on the floor for an extended amount of time - UNSUBSTANTIATED Staff do not provide proper food service to residents in care - UNSUBSTANTIATED

/27/2023 01:00 PM Licensing Program Analyst (LPA's) Rebecca Knight and Sarah Benson made an unannounced visit to the facility and met with facility manager Shirl Freeman. The purpose of this visit was to deliver the results of a complaint investigation. During the course of the investigation the licensee/administrator, and 5 staff were interviewed. LPA requested and reviewed the following documents: related incident reports, EMAR, Physician’s report, Admission Agreement, for 1 resident, staff list with telephone numbers, client list. Continued on LIC9099-C Unsubstantiated Page 1 Staff do not seek timely medical care for residents in care. - UNSUBSTANTIATED It was reported that residents aren't taken to the doctors as soon as is needed. 4 of 5 staff stated that residents are taken to see their doctor right away or as soon as possible if needed. 1 staff stated they had never been in that situation and did not know. 1 staff stated the only appointments that took time to get are denture and ophthalmic appointments due to a wait list. Administrator stated It depends on the nature of the care needed. If it is urgent we have a doctor that comes to the facility. If it is critical we take them ourselves or call for medical transport.. This allegation is unsubstantiated. Staff do not provide proper medication assistance to residents in care. - UNSUBSTANTIATED It was reported that staff are asked to pre-fill medication, and staff with no training are made to pass them sometimes resulting in wrong person getting meds. 3 of 5 staff stated they had not been instructed to pre-fill medications. 1 of 5 staff stated they had been asked to pre-fill medications 24 hours in advance. 1 of 5 staff stated they did not work with medications. Administrator stated We have been continuing to do the 24-hour med poor. The only exception are hospice residents with pre-drawn and pre marked medication by their RN. This allegation is unsubstantiated. Continued on LIC9099-C Page 2 Residents are left in urine for an extended amount of time. - UNSUBSTANTIATED It was reported that there is not enough staff to cover NOC shift leaving residents in urine. 4 of 5 staff stated they had not witnessed or heard about residents being left in urine for an extended amount of time. 1 of 5 staff stated they have come in and found the residents really wet. Administrator stated Typically, we have 2 staff until 8:00 or 9:00 pm and then until 6:00 am we have one awake on duty staff and a second staff person lives 15 minutes away if needed. The overnight staff take a break onsite and the expectation is that sometime between their start and end shift there would be 30 minutes they could take a break in the general dining area. This allegation in unsubstantiated. Residents are left on the floor for an extended amount of time. - UNSUBSTANTIATED It was reported that there is not enough staff to cover NOC shift leaving residents on the floor for long periods of time. 5 of 5 staff stated they had not witnessed or heard of any residents being left on the floor for an extended period. 3 of 5 staff stated that they have to call the fire department for lift assistance if a resident falls. Administrator stated Typically, we have 2 staff until 8:00 or 9:00 pm and then until 6:00 am we have one awake on duty staff and a second staff person lives 15 minutes away if needed. The overnight staff take a break onsite and the expectation is that sometime between their start and end shift there would be 30 minutes they could take a break in the general dining area. Continued on LIC9099-C Page 3 Staff do not provide proper food service to residents in care. - UNSUBSTANTIATED It was reported that staff are told not to feed residents that need help being feed resulting In them losing weight or going hungry. 5 of 5 staff stated if a resident requires help eating they will sit with the resident, assist them with guiding their hand to their mouth to feed themselves and make sure the resident chews and swallows. 5 of 5 staff stated no residents have gone hungry or lost weight due to not being able to feed themselves. Administrator stated Everything is dependent on the resident’s care plan, all staff are aware. If we have a resident that is having trouble chewing we have a staff member that sits with them while they are eating. They help the residents arm, if it is a problem chewing and swallowing they are trained to encourage the resident to take small bites and make sure they swallow before taking another bite. We had to cut back on snacks in order to keep the residents under a healthy weight. Snacks are available all throughout the day. We do have resident that lost weight because of other conditions or they are on hospice and pain meds suppress their appetite. This allegation is unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, and the findings are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report was provided to administrator James Bird.the state’s words, verbatim · CDSS document, Jul 27, 2023 · control 59-AS-20230424132145

Type of visit: Required - 1 Year

06/23/2023 01:15 PM Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to conduct a Required-1 Year inspection. LPA met with Debbie Bird and explained the purpose of the visit. LPA Benson and the administrator toured the facility together to ensure the health and safety of residents in care. Areas toured include but are not limited to four (4) resident rooms, common areas, two (2) bathrooms, kitchen, storage areas and back yard. In the areas toured no immediate health, safety, or personal rights violations were observed. Staff and resident files were reviewed. Medications were also reviewed. Common area was clean and in good repair. All bedrooms had required furniture, bedding, and lighting. Bathrooms were clean and in good repair. Kitchen was clean and in good repair. Facility has required (7) seven-day non-perishable and (2) day perishable supply of food. Medication is locked in a locked closet. Administrator certificate is current James Bird (Cert.#6055654740 Exp. 02-26-24) . First aid kit fully stocked and ready for emergency use. Fire extinguisher fully charged. Smoke detectors are all operational. Hot water temperature measured within required Title 22 regulations of 105 degrees F and 120 degrees F. All employees requiring background checks are cleared. All required postings are displayed within facility. No pools/bodies of water are on premises. No firearms are on premises. Last disaster drill was conducted and documented on 04-19-2023, the facility has been conducting drills every month. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report was provided to Debbie Bird Administrator.the state’s words, verbatim · CDSS document, Jun 23, 2023

Allegation investigated: Licensee did not refund responsible party after resident's death

LPA Hiratsuka conducted this unannounced complaint visit. LPA wore a surgical mask and observed all staff wearing one. LPA investigated the allegation above. LPA interviewed Jenesy Edelman, Administrative Assistant, and Shirl Freeman, Facility Manager, and reviewed the admission agreement. The admission agreement does have the clause that a refund shall be issued when a resident dies and after all personal belongings are removed. California Health and Safety Code §1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds does state a refund shall be issued when a resident dies after all personal belongings have been moved out. LPA was also informed the room has been occupied by a new resident since. Substantiated Based on the above, the allegation is substantiated. A copy of the CA health and safety section was left with Administrative Assistant. Deficiencies cited from Title 22 Regulations and or the California Health and Safety Code. Failure to correct shall result in civil penalties. appeal rights leftthe state’s words, verbatim · CDSS document, Mar 8, 2023 · control 59-AS-20230307081924

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(a) · Plan of correction due date: Mar 29, 2023

A residential care facility for the elderly shall not require advance notice for terminating an admission agreement upon the death of a resident. No fees shall accrue once all personal property belonging to the deceased resident is removed from the living unit This requirement is not met as evidenced by: Based on interview with Complainant and Administrative Assistant a refund has not been issued. This does not pose an immediate risk to residents.the state’s words, verbatim · CDSS document, Mar 8, 2023

Plan of correction: By 03/29/2023, Licensee shall submit a written plan of correction on how he shall ensure refunds are issued correctly to the estate of deceased residents.

Type of visit: Required - 1 Year

08/31/2022 Licensing Program Analyst (LPA) Shannon Diegoruelas, arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Debbie Bird, Assistant Administrator and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA contacted facility and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical mask. Additionally, LPA was screened by Administrator assistant. LPA and Debbie toured facility to ensure health and safety of residents in care. Areas toured include but are not limited to: outdoor area, one common area, two (2) bathrooms, three (3) resident rooms, kitchen, dinning room, storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Debbie completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report was provided to Debbie.the state’s words, verbatim · CDSS document, Aug 31, 2022

Type of visit: Case Management - Other

Donna Gurriere, Licensing Program Analyst was in contact and met with Debbie Bird, RN. LPA Gurriere completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator/staff person was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask. Additionally, LPA Gurriere was screened by a staff person upon entering the facility. The purpose of the visit is to conduct a case management visit to follow up on an incident whereas a resident fell when he was exiting from the bus. Resident hit his head and had a laceration with a small cut. It was reported that the wound was kept clean and dry and that resident is doing well. Exit interview with no deficiencies cited.the state’s words, verbatim · CDSS document, Aug 22, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Konnor Leitzell arrived at the facility unannounced on 07/16/2021 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA met with James Bird (Admin) and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Masks. Additionally, LPA was screened by admin and answers were documented in their visitor screening log. LPA, admin, Debbie (Assisted Admin) toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, sixteen (16) of sixteen (16) resident bedrooms, eight (8) of eight (8) resident bathrooms and one (1) of one (1) common bathroom, kitchen, dinning area, laundry room, staff office, storage containers and yard area. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and admin completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Jul 16, 2021