Silver Star

Allegation investigated: Staff prevented resident from having visitors Facility staff did not adequately dress resident

Licensing Program Analyst(LPA) Dina Alviso conducted a complaint inspection, on 9/25/23 at approximately 9:25am, and met with Janine Sorrenson, Administrator. Ami Kumar, Licensee/Administrator arrived to the facility shortly after the LPA. LPA reviewed resident records, and obtsined copies. LPA conducted interviews with staff, and other interested parties.The investigation revealed that resident R1 was admitted to hospice care on 8/1/23. LPA observed a facility care plan, and a hospice care plan. LPA reviewed medical documentation, including medication orders/records. Per interviews and socumentation reviews,hospice agency was reviewing R1's medications as needed, and instructed facility staff on Physician medication orders. Hospice was visiting the resident once a week in the beginning of services but as resident was transitioning/declining hospice staff was visiting R1 daily. Continued on LIC9099C.. Unsubstantiated Per interviews with staff, and review of records, facility does have visiting hours, which are adjusted as needed for residents on hospice care. R1 was admitted into care, and responsible party asked that there be no visitors right away so the resident could get settled in. Per staff interviews, R1 had visitor(s)/visitation come in to see them; Staff deny that they didn't allow any visitors to R1. Per interviews and record reviews, staff had a resident care plan in place, and all staff were trained in resident's care needs. Staff stated the resident was well cared for, and appropriately dressed as needed. Facility staff stated they cared for the resident's needs till they passed. Hospice agency care plan was in place, and staff were working with hospice agency ensuring resident's needs were being met. There is differing information from parties interviewed, records reviewed, and information provided by reporting party to the Department. The investigation didn't obtain any information and/or documentation that supported violations having occurred. Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegations, "staff prevented resident from having visitors and facility staff did not adequately dress the resident" are Unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. No deficiencies cited. Exit interview was conducted with the Administrator.the state’s words, verbatim · CDSS document, Sep 25, 2023 · control 21-AS-20230915150346

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Alviso, arrived unannounced to conduct a Required -1 Year visit, on 5/18/23 at approximately 9:30am, and met with Licensee/Administrator Ami Kumar, and Janine Sorenson, facility Administrator. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. The facility has an infection control plan, and submitted required plan to the Department. LPA discussed with the Licensee and Administrator to review the newest PIN 23-12, and ensure to update infection control plan as/if needed. Submit a copy when the plan has been updated. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden. The LPA toured the facility with the Licensee and the Administrator. The hot water was checked at 110.F which is within regulation Fire extinguishers(3 of 3) were serviced and tagged as required, expires 2/6/24. All exits were free and clear of obstructions. Facility was found to be clean, orderly, and at a comfortable temperature. Toxins/cleaners are stored in locked cabinets. All exit alarms were on exit doors and working properly. All bathrooms had grab bars, and non-slip mat/flooring for bathing as needed. Required postings were up and visible. LPA observed a sufficient supply of perishable and non-perishable food, emergency food & water supplies, hygiene supplies, cleaners, and paper products. LPA observed a sufficient supply of personal protective equipment(PPE). The LPA reviewed four(4) staff files. All staff have required criminal record clearance. All staff have required current First Aid certification, including CPR certification. LPA reviewed required staff training. Continued on LIC809C... The LPA reviewed five(5) of five(5) resident files. All resident files were complete. Licensee/Administrator to submit updates of the following documents by 6/18/2023: LIC 500 Personnel Summary Copy of Liability Insurance LIC 610 Emergency Disaster Plan (If changes) Infection Control Plan (If changes) During the tour of the facility, the LPA observed a prescription medication bottle in a resident's(R2) room on a tray table, the resident can't handle their own medications, per file review. The medications are required to be crntrally stored, the facility also has dementia residents in care. This deficiency will be cited,87465 Incidental Medical and Dental Care (h)(2) The following requirements shall apply to medications which are centrally stored: Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. see LIC809D. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal rights were provided.the state’s words, verbatim · CDSS document, May 18, 2023

Allegation investigated: Illegal Eviction

Licensing Program Analyst(LPA) Dina Alviso conducted a complaint inspection and met with Ami Kumar, Licensee/Administrator, and Janine Sorrenson, Administrator. LPA reviewed resident records, and obtsined copies. LPA conducted interviews with staff, and other interested parties. The investigation revealed that the Licensee/Administrator didn't provide written 30-day notice of eviction to the resident/responsible party as required by regulation. Due to the substantiation of the allegation, "Illegal Eviction", deficiency citation will be issued, Eviction Procedures 87224(a)(4), see LIC9099D. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies may result in civil penalties being assessed. Appeal Rights Given. Exit interview conducted with the Administrator Substantiatedthe state’s words, verbatim · CDSS document, Dec 1, 2022 · control 21-AS-20221122162249

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(4) · Plan of correction due date: Dec 7, 2022

87224 Eviction Procedures (a)The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5) (4)If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident. This requirement was not met as evidenced by LPA's review of of resident records and interviews with staff. The Licensee/Administrator didn't provide a written 30-day notice of eviction tothe resident/responsible party. Thhis is a personal rights risk to resident(s).the state’s words, verbatim · CDSS document, Dec 1, 2022

Plan of correction: Licensee/Administrator to ensure that if evicting a resident that a written 30 day notice of eviction, in compliance with regulation, is provided to resident/responsile party as required. Licensee to submit written self confirmation of understanding of the regulation 87224. Submit plan of ensuring that the facility will be in compliance with the above reguation as required. POC due 12/7/22.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dina Alviso, arrived unannounced to conduct a Required 1 -Year inspection and met with Licensee/Administrator Ami Kumar. The inspection is focused on the Infection Control procedures and practices of this facility. Facility has an approved dementia plan of operation. There is an approved hospice waiver for three (3) residents. Mitigation plan was reviewed by the Department. Fire clearance is approved for six (6) non-ambulatory, which includes one(1) bedridden. Fire extinguishers were serviced and tagged as required- dated 2/18/2022. There were 5 residents in care at the facility during this inspection. All visitors, essential visitors, and staff are screened upon entry from tje backyard cement patio area; Temperatures are taken, and screening questions are to be answered before being allowed into the facility, all information is logged. Residents are screened daily, and observed for any changes, all information is logged. Facility was found to be clean, orderly, and at a comfortable temperature with all exits free from obstruction. Toxins are stored in locked cabinets. Medications were stored locked making them inaccessible to residents and care. All exit alarms were on exit doors and working properly. All bathrooms had grab bars, and non-slip mat/flooring for bathing as needed. All postings were up and visible to all as required. Facility has a sufficient supply of personal protective equipment(PPE). Residents have masks available to them for their use if needed and/or wanted. LPA observed all staff, including the Administrator to have masks on as required. There was a sufficient supply of food, cleaners, hygiene products, and paper products for use as required. No deficiencies found in the areas inspected. No citations issued. Exit interview conducted with the Administrator.the state’s words, verbatim · CDSS document, Mar 28, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) conducted a case management and met with Administrator /Licensee Ami Kumar, and Administrator Janine Sorrenson. LPA is conducting the case management to review a recently submitted resident incident report. LPA reviewed facility resident file, and obtained information regarding the incident. Licensee/Administrator Ami K and Administrator Janine are addressing the incident as required. All parties have been contacted as required. All reports were completed and submitted as required. Licensee/Administrator has agreed to submit requested documentation no later than 12/31/21. No deficiencies cited today.the state’s words, verbatim · CDSS document, Dec 29, 2021

Allegation investigated: Staff failing to meet residents care needs

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on the above captioned complaint allegation. LPA met with Ami Kumar and discussed the findings. It has been alleged that facility staff have not met the care needs of R1 in that R1 declined while in placement due to staff neglect. During the course of this investigation statements were taken from staff and witnesses; documents and medical records were obtained and reviewed; three site visits were made to the facility and one collateral visit to another facility. Based upon this investigation, the following determinations have been made: R1 is 95 with a history of recurrent illness; R1 did deteriorate while in placement at the facility; Records show that staff responded to R1's symptoms and did seek medical attention when necessary as well as making the required reports; Family reports R1's skin appeared well care for despite being bedridden; R1's condition worsened on April 24, 2021 but was not sent out until April 26, 2021; The available evidence suggests that the delay resulted from advice from hospital nurse who recommended allowing time to see if R1 would respond to a new course of medication. While the allegation may be true, based upon statements and records, there is not a preponderance of evidence to prove allegation did or, did not occur. Therefore, it is UNSUBSTANTIATED. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 26, 2021 · control 21-AS-20210521165957