A Loving Living Home Care

Allegation investigated: Personal Rights

On 9/20/2023, Licensing Program Analyst, Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Lead Staff, Suzette Hojilla. LPA toured the facility, interviewed residents, non-resident individuals, outside parties, conducted facility file review and made observations. Complaint alleges facility had violated the personal rights of resident (R1). Based on a review of resident medical records, admissions agreements and facility client registry; LPA confirmed that R1 is not an admitted resident residing in the facility. Based on interviews with resident (R2), LPA was informed that the facility staff treat R2 and other residents with dignity and respect. R2 also stated that they have not observed staff or any other individuals in the facility speaking in appropriately while in presence of R2 or any other residents' in care. LPA conducted an interview with non-resident individual (I1) residing in the facility. I1 stated that they were the partner of staff (S1) and not admitted to the facility as a resident. Interview with I1 did not indicate any observation of mistreatment from staff towards the residents. Continued onto LIC9099-C Unsubstantiated Interviews with staff (S1 & S2) also explained to LPA that they have positive relationship with residents and other staff with no observations of residents being mistreated by staff. Allegation, personal rights violation is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Appeal Rights given. Report was reviewed with Lead Staff and copy of the report was provided for Licensee. No deficiencies cited during visit.the state’s words, verbatim · CDSS document, Sep 20, 2023 · control 21-AS-20230828135544

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Karina Canela arrived for the purpose of conducting a Required -1 Year inspection and was granted access into the facility by Suzette Hojilla, Caregiver. Administrator Lovelyn Hojilla arrived later. LPA toured the facility, all exits were unobstructed. The facility was found to be at a comfortable temperature. LPA observed a supply of linens (bedding, towels, etc.), and cleaning solutions (observed locked & inaccessible). Resident bedrooms were furnished per regulation. Facility food supply was within regulation and accessible to clients. Medication was centrally stored. Water temperature was tested and observed between 105 to 120 degrees F. Disaster Drills are conducted quarterly as required. Fire extinguisher was charged and serviced 04/07/2023. There are 8 smoke detectors & 1 carbon monoxide detector, which were tested & observed operational. LPA reviewed staff and resident records. Staff have current training certifications in First Aid & Cardiopulmonary Resuscitation (CPR) in file. LPA addressed fire clearance and postural supports deficiencies on continued page (LIC809-C). LPA discussed regulations 87465(h)(5), 87463(c), 87463(a); and discussed Health & Safety Code 1569.696(a)(1) & 1569.625(b)(2) LPA requested the following updated forms to be submitted to Community Care Licensing by 07/06/2023: · LIC 308 Designation of Facility Responsibility (1 person per form) · LIC 500 Personnel Report · LIC 400 Affidavit Regarding Client/Resident Cash Resources (indicate if not handling cash for residents) · Copy of Liability Insurance · LIC 9020 Facility Register of Client/Residents · LIC 610E Emergency Disaster Plan · Copy of current Administrator's Certificate Report continued on LIC809-C Deficiencies observed: Fire Clearance Violation: During inspection, LPA observed 1 shed in the backyard on the facility property with a bed, television, dresser, air conditioner, food, and personal belongings (photos taken). Staff (S1) stated they live in the shed with their partner non-client adult resident (NCAR). Administrator stated the shed is a relief room for staff staying over night; S1 and NCAR stay in the staff room inside the facility adjacent to the kitchen. LPA discussed with Administrator that the shed is required to be inspected and approved by the Vacaville Fire Department to ensure it is safe for staff to occupy. Administrator understood. Additionally Administrator disclosed Resident (R1) occupying bedroom #1 is bedridden, as they can't turn in their bed and can't ambulate without the use of a wheelchair. LPA discussed with Administrator that the Vacaville Fire Department approved bedroom #5 for bedridden (per facility sketch received 05/20/2020) and bedroom #1 is approved for only non-ambulatory. Postural Supports Violation: During inspection, LPA observed 5 of 5 residents with half-rails (photos taken). LPA discussed with Administrator that half-rails are only allowed if the resident's medical physician provides an order for half-rail to be used for mobility and support per regulation. Administrator stated they understood. **An immediate civil penalty in the amount of $500 was assessed today for the fire clearance violation. Deficiencies cited (see LIC809-D page) from the California Code of Regulations, Title 22, Division 6. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Appeal Rights Provided. Exit interview conducted with Administrator, whose signature on this document confirms receipt. Due to printer issues, this report was emailed to Administratorthe state’s words, verbatim · CDSS document, Jun 5, 2023

The state marks this report as 9 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: POC

On July 22, 2022 at approximately 09:15 AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at A Loving Living Home Care for the purpose of conducting a Plan of Correction (POC) inspection. LPA was greeted at the door by Administrator, Lovelyn Hojilla and was granted access into the facility. During the POC inspection, LPA observed the sliding door alarm leading out to the backyard was tested and operational during the POC inspection. LPA requested Administrator to send a summary of how future compliance as it relates to this regulation will be met moving forward. In addition, LPA toured the facility with the Administrator. During the tour, LPA observed the facility to be clean and at a comfortable temperature with all exits free from obstruction during the inspection. LPA toured the kitchen and found the food to be properly stocked and stored with perishable and non-perishable foods. No deficiencies were observed or cited during today's Required 1 year inspection. Exit interview was conducted and a copy of this report was emailed to the facility Administrator due to printer issues.the state’s words, verbatim · CDSS document, Jul 22, 2022

Allegation investigated: Staff did not provide a safe and comfortable environment for residents in care Staff did not provide adequate food service

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at A Loving Living Home Care for the purpose of conducting an additional tour of the facility, interviewing a staff member, a resident and delivering complaint findings. LPA was greeted at the door by Staff Member, Imelda Good and was granted access into the facility. During the course of the investigation, LPA toured the facility on June 30, 2022 and July 6, 2022 and observed the facility to be clean and at a comfortable temperature with all exits free from obstruction. Hot water temperature measured at 111 degrees in residents bathrooms on both tours of the facility conducted on said dates. LPA observed the kitchen counter to be clean and free of clutter on both dates. LPA observed inside the kitchen fridge and freezer during both tours and found on both dates that the food was properly stocked and stored with perishable and non-perishable foods. LPA conducted staff and resident interviews on said dates that yielded no concerns with the facility. (Report continued on LIC 9099C) Unsubstantiated A finding that the complaint allegations of, Staff not providing a safe and comfortable environment for residents in care and Staff not providing adequate food service are unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted and a copy of this was report was signed and given to the Staff Member, Sylvia Cabnila.the state’s words, verbatim · CDSS document, Jul 6, 2022 · control 21-AS-20220627104121

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at A loving Living Home Care for the purpose of conducting a Case Management-Deficiencies inspection. LPA was met at the door by Staff Member #1, Terecita Abaya and was granted access into the facility. During the tour of the facility at 08:01 AM, LPA observed the auditory device by the rear sliding door leading out to the backyard not operational at the time of the inspection. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6, Chapter 8 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and a copy of this report along with appeal rights were emailed to the Administrator due to printer issues.the state’s words, verbatim · CDSS document, Jun 30, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(j) · Plan of correction due date: Jul 7, 2022

87705(j) Care of Persons with Dementia .The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement was not met as evidenced During todays opening of the complaint and facility tour, the sliding door alarm leading out to the backyard not operational. This is a potential risk to residents in care.the state’s words, verbatim · CDSS document, Jun 30, 2022

Plan of correction: Licensee shall ensure that ALL auditory devices are in operational order. In addition, licensee shall give a summary on how future compliance will be met.

Type of visit: Required - 1 Year

At approximately 10:45AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct an Annual Inspection visit and was greeted by Administrator, Lovelyn Hojilla. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival at the facility, LPA had their temperature checked and logged. LPA answered a standard COVID-symptom questionnaire. LPA conducted a walk-through of the facility and observed the following: COVID-19 signs were observed at the entry way and throughout the facility. Hand-washing signs were observed in the bathrooms and at sinks. All staff present were observed to be wearing a mask. The facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Facility has a cleaning and disinfecting schedule that occurs twice per day. Facility has at least a 30-day supply of Personal Protective Equipment (PPE) and medication for clients. Staff and Residents are screened daily for COVID-19 symptoms and it is logged into facility binders. Facility has a plan in place if a staffing shortage were to occur. Fire extinguishers were last serviced May 2022. Fire alarm system and carbon monoxide detector were tested and operational. Continued on LIC-809C Continued from LIC-809 LPA and Administrator discussed PIN 21-43-ASC regarding Mitigation Plans and PIN-22-13-ASC regarding Infection Control Plans. LPA requested the following documents to be submitted to CCL by Close of Business, Wednesday, 5/18/2022: Updated LIC 500 (Personnel Report) No Deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, May 13, 2022

Allegation investigated: Questionable Death. Staff did not obtain medical care for resident in a timely manner. Food service is inadequate. Resident medication was not locked.

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with Emelda Good and discussed findings. Complainant alleges that R1's death is questionable due to facility staff's failure to obtain timely medical care; facility's failure to provide sufficient nourishment for R1; and that the refrigerated medications were not kept secure. This Department's investigation has included site visits to facility; review of documents; and statements from staff and witnesses. The following determinations are made: R1 left the facility on 10/20/2021 for emergency care and did not return; R1 died on 11/05/2021 while in skilled nursing; Cause of death was determined to be from an incurable illness from which R1 suffered for many years and Alzheimer's Dementia; Staff report that R1's condition was stable on the days preceding her hospitalization although R1 was sleeping more and eating less but was alert; No refrigerated medications were stored at time of site visits; all staff report the medications were kept secure; Facility notes and records suggest that R1 was monitored by staff and that medical care was obtained when staff noted change in condition of R1. Although the allegations may be true, or valid, based upon observations, statements, and records, there is not a preponderance of evidence to prove the allegations are, or are not, true. Therefore, allegations are UNSUBSTANTIATED. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jan 27, 2022 · control 21-AS-20211129134113

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Jan 31, 2022

87465(a)(1) Incidental Medical and Dental Care. The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. ***This requirement has not been met as evidenced by: Based upon statements and records, R1 was not tested for blood sugar as frequently as order by R1’s physician. This posed an immediate risk to the health of R1.the state’s words, verbatim · CDSS document, Jan 27, 2022

Plan of correction: Administrator shall secure additional training for all staff that addresses the issue of caring for residents who require blood sugar monitoring and the administration of insulin. The plan will comply with the requirements of 87628 and will be submitted to CCL by POC date and follow -up confirmation of the training in order to clear the deficiency.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) A. Canela conducted an unannounced Case Management- inspection and met with staff Suzette Hojilla, Imelda Good and Jon Cafuir; Administrator, Lovelyn Hojilla was not available and was said to be at work, during this visit. The purpose of this case management visit was to follow up on self reported incident report that was submitted to Community Care Licensing (CCL) regarding resident R1. LPA went over incident details and requested copies of resident R1's file. On September 27, 2021 at about 10:00pm R1 sustained a fall in their room. It was reported staff were assisting other residents when they heard a noise and found R1 on the floor in their room. LPA is gathering additional information regarding the procedures facility took regarding this incident. The resident was sent to the hospital the next day, 9/28/2921 and diagnosed with a Femur Fracture and Lesser Trochanter medially displaced; R1 had surgery on 9/29/2021. The facility submitted a request for a Hospice exception for resident and later withdrew the request, when R1 passed away on 10/20/2021. During today's visit LPA received information R1 returned to this facility on Hospice services on 10/18/2021, aspirated and passed away on 10/20/2021. A hospice exception was never approved or granted to the facility. LPA will review information and will follow up with facility, once additional information is gathered and reviewed. During today's visit LPA found that tenant/staff S4, has fingerprint clearance, S4 is not associated to this facility as required. LPA reminded facility, that staff must wear a mouth covering while at the facility, staff S1 and S2 were not wearing a mask upon LPAs arrival. LPA also observed the facility auditory devices on the two sliding doors were not working properly and not completely turned/plugged on; review of records indicate there are at least 4 residents with Dementia. Continue report see LIC809-C and LIC809-D for deficiencies observed and cited. Physician report for resident R2 is dated 9/22/2020 and not done yearly as required. LPA informed facility, the administrator must be present at least 20% of the time during business hours. LPA consulted regarding requirements for a facility if a Hospice resident becomes bedridden. Facility does not have bedridden approval, facility will need to immediately call CCL and a Fire Clearance will need to be approved by the fire department for bedridden room. Facility to get additional records and forms needed to be submitted if there is ever a need. LPA also consulted regarding facility not able to admit a resident who requires Hospice services, if they do not have approval or number of Hospice residents exceed. LPA will follow up with facility regarding this matter. Facility not to accept any residents who are bedridden unless written approval has been granted from Fire department and CCL. LPA also reminded facility of having complete staff records and facility scheduled activities. The following deficiencies were observed (see LIC 809-C) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. A civil penalty in the amount of $100.00 was assessed today for staff S4 not being properly associated to this facility. Exit interview conducted and appeal of rights and this report will be emailed to facility due to computer problems. LPA informed administrator, due to computer issues, LPA will email report that LPA was unable to obtain signature.the state’s words, verbatim · CDSS document, Oct 27, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Oct 28, 2021

87355(e)(2) 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:(2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by: During today's visit tenant/staff S4 had fingerprint clearance but was not associated to this facility. This is an immediate risk to the residents in care.the state’s words, verbatim · CDSS document, Oct 27, 2021

Plan of correction: Facility to send in written statement they understand regulation and requirements. Facility stated they processed paperwork to associate S4 but do not know what happened. Facility went into Guardian and processed the paperwork for S4. POC due date 10/28/2021 $100.00 civil penalty assessed for S4 not associated.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87705(j) · Plan of correction due date: Oct 28, 2021

87705(j) Care of Persons with Dementia .The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement was not met as evidenced by: during todays visit and facility tour, the sliding door alarm in resident R3 and R4 was not operational. The dining slide door alarm was also not operational. This is a potential risk to residents in care.the state’s words, verbatim · CDSS document, Oct 27, 2021

Plan of correction: Facility to send in written plan on how they will ensure alarms are always turned on and operational. Proof of staff training POC due date 10/28/2021 to LPA Araceli Canela.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5) · Plan of correction due date: Nov 26, 2021

87705(c)(5) Care Persons with Dementia - Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by: during record review, resident R2 did not have a current Physician report- last report in file was dated 9/17/20220 and not within regulation. This is a potential risk to the health and safety of residents in carethe state’s words, verbatim · CDSS document, Oct 27, 2021

Plan of correction: Facility agrees to send in proof of current medical assessment for resident R2 and statement they understand regulation. POC due date 11/26/2021 to LPA Araceli Canela