Golden Oaks Senior Living

Type of visit: Case Management - Other

On 09/21/2023 Licensing Program Analyst (LPA) Ivan Avila arrived at the facility unannounced to deliver an amended complaint, COMPLAINT CONTROL NUMBER: 59-AS-20230728163040, that was previously recorded on 09/07/2023. LPA Avila met with Amber Greene and explained the purpose of the visit. LPA Avila delivered an amended 9099 to reflect the appropriate deficiencies LPA observed during the complaint investigation that was previously recorded on 09/07/2023. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the amended 9099D. Exit interview conducted with Amber Greene and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 21, 2023

Type of visit: Case Management - Deficiencies

On 09/21/2023 Licensing Program Analyst (LPA) Ivan Avila arrived at the facility unannounced to conduct a case management visit. LPA Avila met with Amber Greene and explained the purpose of the visit. On 04/26/2023 R1 exited the facility alone and unassisted in the late evening and R1 was found later by staff. LPA interviewed staff and they stated R1 had walked out of the facility and was found some time after. On 04/28/2023 R1 exited the facility again alone and unassisted and was found down the street at the corner of the block. LPA interviewed Facility Manager (S1) and S1 stated that it took staff 10 minutes to realize R1 had left the facility and an additional 10 minutes to locate R1 down the street. R1 was missing for approximately 20 to 30 minutes. The facility did not report the two incidents to the Department within the required time frame. The Department was notified of the two incidents three months later in July of 2023 and both incidents occurred in April of 2023. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the 809-D. Exit interview conducted with Amber Greene and a copy of the report along with appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 21, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(D) · Plan of correction due date: Sep 28, 2023

87211(a)(D) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to…Any incident which threatens the welfare, safety or health of any resident or unexplained absence of any resident. This requirement is not met as evidence by: Based on interviews and record review, the licensee did not submit incident reports to the Department regarding a resident’s unexplained absence at the facility when resident left the facility alone and unassisted in two seperate incidents.the state’s words, verbatim · CDSS document, Sep 21, 2023

Plan of correction: Licensee had a training with all staff that was held by the local Ombudsman and went over the eloping procedures and how to report all incidents in the facility and send them to the Department.

Allegation investigated: Staff do not properly supervise resident, resulting in resident awoling from the facility. Staff did not monitor resident for change in condition.

This document has been amended on 09/21/2023 to reflect the appropriate deficiencies LPA Avila observed during the investigation that was previously recorded on 09/07/2023. LPA made an unannounced complaint investigation visit at this facility and met with Amber Greene. On 04/26/2023 R1 exited the facility alone and was found later by staff. LPA interviewed staff and they stated R1 had walked out of the facility and was found some time after. On 04/28/2023 R1 exited the facility alone again and was found at the corner of the block. LPA interviewed Facility Manager (S1) and S1 stated that R1 was missing for approximately 20 to 30 minutes. LPA interviewed staff and reviewed documents indicating that the Needs and Service plan for R1 was not updated to reflect R1s change of condition in leaving the facility alone and unassisted on 04/26/2023 and 04/28/2023.Based on LPAs interviews which were conducted and record reviews, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations Title 22 and or the California Health and Safety Code are being cited on the attached LIC 9099D and copy of report and appeal rights were provided to Amber Greene. Substantiatedthe state’s words, verbatim · CDSS document, Sep 7, 2023 · control 59-AS-20230728163040

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Sep 8, 2023

87411 (a) Facility personnel shall at all times be sufficient in numbers...or the physical arrangements of the facility require such additional staff for the provision of adequate services. The requirement is not met as evidence by: Based on interviews and record review, the licensee did not provide adequate care and supervision by letting a dementia resident walk outside without supervision, which poses an immediate Health, Safety, Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 7, 2023

Plan of correction: Licensee had a training with all staff that was held by the local Ombudsman and went over the eloping procedures and reporting all incidents. Licensee placed call alarm matts in all the main exit doors in the facility to alert staff.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Sep 28, 2023

87463 (a)The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate...shall document changes in the resident's physical, medical, mental, and social condition. The requirement is not met as evidence by:. Bases on interviews and record review, the licensee did not update the residents appraisal after resident had a change in condition when leaving the facility alone and unassisted in two seperate incidents.the state’s words, verbatim · CDSS document, Sep 7, 2023

Plan of correction: Licensee will start to implement an updated appraisal to a residents care plan once an incident occurs or a change of condition happens. Licensee will write up a plan to have a managers training to update a residents care plan and will email the plan to LPA.

Allegation investigated: . Cleaning toxin accessible to residents. 2. Medications accessible to residents

LPA HIratsuka, conducted this unannounced complaint visit. LPA conducted the investigation into the allegations above. 1. LPA interviewed the staff. All staff state they keep cleaning toxins locked up. Complainant stated during the visit that staff left cleaning toxins unlocked. LPA toured the facility and did not see any cleaning toxins out or unlocked today and on 03/28/2023. LPA cannot prove or disprove allegation because each side has their own version of events. 2. Complainant stated an ointment and a body soap was found on one of the toilets during a visit. LPA toured the facility today and on 03/28/2023, and did not see any. Staff interviewed stated they have not left anything out. LPA cannot prove or disprove allegation because each side has their own version of events. Unsubstantiated 3. There are two fuse boxes that had tape over them. Title 22 regulations does not state the fuse boxes need to be locked. The fuse box doors are not broken. When the tape was taken off the doors snapped shut, stayed shut, and had to be pulled open by the latch. LPA was informed during the visit on 03/28/2023, that the tape was placed over the doors to prevent former residents from opening the doors, but they have long moved out and no one has tried to open them since. The tape did not appear to be tampered with during the visits. Allegation unfounded. 4. LPA reviewed the staff training. All staff have the training required by Title 22 regulations. Allegation unfounded. “This agency has investigated the complaint alleging;1. Facility does not have a variety of food; 2. Residents not given enough food to eat; 3. Facility is in disrepair; and 4. Staff is not trained properly. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis." Due to the information gathered, LPA cannot determine the 1. Cleaning toxin accessible to residents; and 2. Medications accessible to residents. LPA finds allegation to be 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.the state’s words, verbatim · CDSS document, May 17, 2023 · control 59-AS-20230323083532

Allegation investigated: Door knobs covered to prevent residents from going out.

LPAs Hiratsuka and Avila, conducted this complaint visit. LPAs wore a surgical mask and observed all staff wearing masks. LPAs toured the facility and observed one doorknob that was covered. The cover for the doorknob is one that covers it and to open the doorknob there were a couple of places for the fingers to press that created pressure between the cover and the doorknob and the doorknob could open. The doorknob that was covered is a desigated exit. Because it is a designated exit an immediate $500.00 civil penalty was issued. It was removed during visit. Based on the above, the allegation is substantiated.the state’s words, verbatim · CDSS document, Mar 28, 2023 · control 59-AS-20230323083532

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Mar 29, 2023

Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on LPAs' observation of the doorknob being covered with a cover to prevent people from getting out and it is a designated exit. This poses an immediate risk to residents.the state’s words, verbatim · CDSS document, Mar 28, 2023

Plan of correction: By 03/29/2023, the licensee shall submit a written statement how they are going to ensure no doorknobs for designated exits. ***$500.00 Immediate Civil Penalties issued today. *** Doorknob covered was removed during visit***

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Faciity did not admit resident properly

LPAs Hiratsuka and Avila, conducted this unannounced complaint visit. LPAs wore a surgical mask and observed alls staff wearing masks. LPAs reviewed the resident in question's file. The file is missing the following: admission agreement, completed pre-appraisal, personal rights, client personal belongings inventory list, medical release, and consent forms. The resident moved in the beginning of this month and the file is not complete. Based on the above, the allegation is substantiated.the state’s words, verbatim · CDSS document, Mar 28, 2023 · control 59-AS-20230324141842

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Apr 28, 2023

Resident Records. The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff This requirement is not met as evidenced by: Based on LPAs review of the resident's file, it is missing a lot of documentation. This does not pose an immediate risk to residents.the state’s words, verbatim · CDSS document, Mar 28, 2023

Plan of correction: By 04/28/2023, the licensee shall submit in writing a plan of correction on how they shall ensure resident's files are complete upon move in.

Type of visit: Case Management - Other

LPA Hiratsuka, conducted this visit to deliver the results of the complaint against the previous Licensee. LPA did not have the contact information for the previous Licensee. LPA obtained it today. There are no deficiencies against this license nor do the allegations pertain to this license. No deficiencies cited.the state’s words, verbatim · CDSS document, Mar 8, 2023

Type of visit: Prelicensing

LPA Hiratsuka conducted this unannounced pre-licensing visit. This visit is unannounced because it's a change-of-ownership. LPA wore a surgical mask and observed all staff wearing surgical masks. This facility has two buildings. The perimeter of this facility has a fence surrounding the property. The main gate is locked from the outside to prevent people from getting in but unlocked to allow people out. The facility does not require visitors to schedule visits unless there is an emergency situation. The building on the left has eight resident rooms: six rooms are shared and two private for a total of 14 residents. There are two resident rooms that share a doorway between them because one room has a designated exit to the outside. The door between the two rooms cannot be blocked due to the one room having the fire exit. Some of the other rooms have exits to the outside. It also has a dining room, the kitchen for both buildings, sitting area, staff break room, and three full bathrooms. The building on the right has eight resident rooms: two shared and six private for a total of ten residents. Some of the resident rooms have exits to the outside. This building also has three full common bathrooms, and kitchenette area that does not have an oven/stove, two sitting areas, and an office. The courtyard has several locked storage units. Component III orientation was waived due to Applicant owning multiple facilities. Multiple topics were discussed. This facility meets regulations. LPA is going to submit this report to the application specialist.the state’s words, verbatim · CDSS document, Jan 10, 2023

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 26 Census (if any clients in care): 14 COMP II Participants: Kenneth Williams, Licensee/Administrator Evelyn Lander-Williams Interview Method: Telephone interview On January 6, 2023 at 10:00 AM, Applicant and Administrator participated in COMP II. Identification of the Applicant and Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. During COMP II, CAB Analyst confirmed Applicant and Administrator’s understanding of following areas: 1. Facility Operation: License type, Client/resident Populations, and Program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicant and Administrator. Report sent via pdf email and informed to return signed copy back to CAB by end of business day today.the state’s words, verbatim · CDSS document, Jan 6, 2023