Primrose Alzheimer's Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Alviso, is conducting a Required 1-Year visit, and met with Administrator John Wotring on 4/27/23 at approximately 9:35am. There are thirty-three residents in care at this time. Facility specializes in dementia care. Hospice care waiver approved for eight (8) residents. Facility has submitted the required Infection Control Plan, this is now part of the plan of operation. Fire clearance approval is for fifty (50) non-ambulatory, which includes approval for twelve(12) bedridden. LPA toured the facility with the Administrator. The facility is sprinkled, and has a hard wired smoke alarm system. The facility has four(4) carbon monoxide detectors. All exits with delayed egress were on and working properly during the inspection. Fire extinguishers, seven(7) were serviced and tagged as required- expires 6/8/23. Facility has the fire extinguishers scheduled annually to be serviced and tagged before they expire. The facility exits were all free and clear of obstruction. Hot water was checked at 109.F which is within regulation. All bathrooms inspected were clean, had grab bars, and non-slip mats/flooring in the showers. Resident and visitor bathrooms were clean and orderly. Resident rooms inspected were clean and orderly. LPA observed staff using a rug cleaner machine to clean the rug in resident rooms due to incontinence clean-up and maintenance. The facility has a sufficient supply of cleaners and disinfectants for use as needed. LPA observed other staff assisting residents with care services as needed. Facility has a sufficient supply of hygiene products, paper products, and a sufficient supply of personal protective equipment(PPE) for use as needed. Continued on LIC809C..... LPA observed activities going on with residents in care; LPA observed a guest guitarist come in, play music, and sing. LPA observed residents that were participating in the music activity. There was sufficient lighting in hallways, bathrooms, common areas, and resident rooms. LPA observed kitchen staff prepping for the lunch meal, and staff in the dining area setting up the tables. LPA observed a sufficient supply of food, perishable and non-perishable. Medications were observed to be in a locked and secured medication room; Only staff that are trained to handle medications have access to this room. Toxins/cleaners were locked up and inaccessible to residents in care. Facility was observed to be clean and orderly. LPA reviewed twelve(12) out of twelve(12) resident files. Resident files were complete. LPA reviewed twelve(12) out of twelve (12) staff files. Staff files were complete. All staff have required criminal record clearance. All staff that are required to have first aid certification were current. There are staff that also have CPR certification as required. Staff have required training. LPA is requesting the following documents be updated and submitted by 5/27/23: LIC308 - Designation of Administrator Responsibility LIC500 - Personnel Report LIC610E-Emergency Disaster Plan (ensure to provide all information in all boxes as required) Copy of LIC400 Handling of Client Cash Resources, include copy of surety bond. Copy of Current Liability Insurance Copy of current Administrator Certificate No deficiencies cited today. Exit interview conducted with Licensee/Administrator John Wotring.the state’s words, verbatim · CDSS document, Apr 27, 2023

Allegation investigated: Facility failed to meet the needs of the resident

Licensing Program Analyst (LPA) Alviso conducted a subsequent complaint inspection, on 9/1/22 at approximately 12pm, and met with the Administrator John Wotring. LPA also met with the Health Services Director, Dan O'Brien. LPA reviewed resident's file, and obtained copies from records. The LPA also reviewed medical records of the resident that were provided to the LPA The LPA had toured the facility with the Administrator. The LPA conducted interviews with staff, and other interested parties regarding the complaint allegations. The investigation revealed that resident(R1) had started having bowel movement changes which were observed as loose stools/diarrhea; Per interview(s) R1's room had to be cleaned by staff, including the resident's rug in their room from loose stool incident, and every other day after the incident occurred. The staff also cleaned resident's bathroom and disinfected it after the incident, and as needed after incident. Continued on LIC9099C... Substantiated The LPA toured the facility and found the resident's vacated room clean and free from urine and/or feces, including urine and feces odor .It is unknown how the resident's room and bathroom were cleaned and maintained prior to the LPA's inspection. There was differing information obtained from reporting party(s) and others interviewed regarding the allegations. Based on LPAs observations, record reviews, interviews with staff, interviews with other party(s), there is insufficient information to prove or disprove the allegation of "resident hygiene needs not being met" and "facility is not being kept clean." Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No citations/deficiencies. Exit interview conducted with the Administrator. Per record reviews, there were no progress notes of resident's observed changes and/or any written documentation of resident observed change in condition. There was no documentation that was written and able to be provided and updated as needed in order to ensure the needs of the resident could be addressed by required parties, such as the Physician of the resident. Per record reviews the resident had a prescription for "stool softener" to be given daily, and was still receiving the medication, though the resident was experiencing loose stools; Per record review, Physician had not been notified and/or no written documentation for staff to ensure monitoring of the resident in regards to loose stools, in order to ensure needs of the resident are being met. Resident per interviews had started having loose stools approximately around 3/16 and/or 3/17, 2022. Resident had continued to have issues with bowel movements and was seen by the Physician on 3/22/22. Resident was treated for dehydration and also noted in medical documentation was "resident bowel function was liquid." Resident was prescribed an over the counter medication, Imodium for loose stools. The Physician had the stool softener stopped while resident was having loose stools. Resident was moved out of the facility 3/30/22. Per the investigation, there was no follow-up documentation on resident's observed changes, no documentation to staff on monitoring the resident for loose stools and hydration due to loose stools, no documentation notifying the Physician. Based on LPA interviews, and review of information obtained, the investigation has revealed that the allegation of "facility failed to meet the needs of the resident' has been substantiated. Due to the substantiation of the allegation, deficiency citations will be issued, 7468.2 Additional Personal Rights of Residents in Privately Operated Facilities and 87466 Observation of the Resident -see LIC9099D. The preponderance of evidence standard has been met, therefore the allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Appeal Rights Given. Exit interview conducted with the Administrator.the state’s words, verbatim · CDSS document, Sep 1, 2022 · control 21-AS-20220404141240

From the deficiency page — Deficiency type: Type A · Section cited: CCR 7468.2 · Plan of correction due date: Sep 2, 2022

7468.2 Additional Personal Rights of Residents in Privately Operated Facilities. a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met based on: LPA's investigation, record reviews, and interviews; Facility did not ensure observed changes of the resident were documented and resident changes were being shared to all staff caregiving to resident 1, ensuring current needs were met. This is an immediate personal rights risk to resident(s) in care.the state’s words, verbatim · CDSS document, Sep 1, 2022

Plan of correction: Licensee/Administrator to ensure that all resident rigths are not violated; Ensure all staff are trained in resident rights by an outside agency. Submit plan of training for staff providing care services, including Administrator, Health DServices Director. Submit proof of training by 9/16/22. Submit plan of correction by 9/2/22.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Sep 2, 2022

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met based on LPA's investigation, interviews, and reviewof records. acility did not ensure observed changes of the resident were documented and resident changes were being shared to all staff caregiving in order to meet resident's current needs-ensuring observed changes are addressed by the Physician and any other required parties. This is an immediate personal rights and health and safety risk to resident(s) in care.the state’s words, verbatim · CDSS document, Sep 1, 2022

Plan of correction: Licensee/Administrator to ensure that all resident observed changes are documented and brought to the attention of all those required , including faciity staff and resident's Physician. Ensure records are kept updated as needed and shared with staff on all shifts as needed to ensure resident's health and sfety. Submit proof of inservice regarding "Resident Observed Changes" to all staff providing care services, including Administrator and Health Services Director. Submit Proof of correction due 9/16/22. Submit plan of correction by 9/2/22.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Dina Alviso, is conducting a Required 1-Year inspection, and met with Administrator John Wotring. The inspection is focused on the Infection Control procedures and practices of this facility. Currently thirty-five (35) residents in care. Facility specializes in dementia care. Hospice care waiver approved for eight (8) residents. Mitigation plan submitted and reviewed by the Department. Fire clearance approval is for fifty (50) non-ambulatory, which includes twelve (12) bedridden approval. Facility offers activities during the day for those wanting to participate; LPA observed a group activity exercising class during the inspection. All visitors and staff are screened upon entering the building; All visitors have their temperatures taken and answer all screening questions, 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. Fire extinguishers were serviced and tagged as required, dated 6/2/21. Toxins are stored inaccessible and in locked cabinets. Medications were stored locked making them inaccessible to residents in care. The facility has a large sufficient supply of personal protective equipment (PPE). All exit alarms were on exit doors and working properly. Bathrooms observed had grab bars, and non-slip mat/flooring for bathing as needed. All postings were up and visible to all as required. Administrator stated that staff wear masks in the facility, and also when providing care services to the residents in and out of the facility. Administrator had a mask on, and LPA observed all staff had masks on during the LPA's inspection. Administrator stated that the facility is following and operating in compliance with the facility mitigation plan, and in compliance with Department PINs, and title 22 regulations/H&S Code as required. No deficiencies cited today. Exit interview conducted with Administrator John Wotring.the state’s words, verbatim · CDSS document, Mar 29, 2022

Type of visit: Case Management - Incident

Licensing Program Analysts (LPA), Dina Alviso is conducting a case management inspection, on 3/23/22, at approximately 10:00am, and met with Administrator John Wotring. The case management is to obtain more information on a resident incident reported by the facility Administrator. The LPA spoke with the Administrator and reviewed the incident and how the incident has been addressed. The Administrator will submit the additional information requested by the LPA during the discussion regarding the resident incident. The Administrator stated he will be conducting an Elder Abuse Training with all staff, and will submit proof of training to the Licensing office. Per LPA's review, Administrator has reported the incident to all agencies as required, and completed and submitted all required report forms. There are no deficiencies cited today.the state’s words, verbatim · CDSS document, Mar 23, 2022

Allegation investigated: Lack of supervision resulting in resident injury and possible death

Licensing Program Analyst (LPA) Dina Alviso conducted a complaint inspection, on 3/18/22, and met with Administrator John Wotring. LPA interviewed five (5) staff, and reviewed resident files. The LPA interviewed other parties in relation to the complaint investigation. The investigation revealed that R1 was a fall risk, and was on a fall risk care plan. R1 was a resident who loved to walk, move around the facility, and was a resident who loved talking a lot. R1 used a walker to ambulate but would at times forget to use it, and staff stated they would bring the walker to R1 when needed, and remind R1 that they needed to use it for walking. R1 also used a wheelchair on days they felt more tired than usual. Per staff, R1 was said to use the walker most days, and at times when R1 didn't have the walker, staff reminded R1 to use it, and R1 would get mad at staff when they did this. Staff stated that one time R1 was upset and didn't want staff assistance, R1 was put in a wheelchair, and R1 pushed theirself out the door by using their feet mostly; Staff watched R1 from the doorway, after a short while the staff was able to assist R1 and redirect R1 back inside. Continued on LIC9099C... Unsubstantiated Per review of R1's care plan, and per interviews with staff, R1 was a fall risk, and was on a fall risk care plan but R1 was not on a one to one care staff need. R1 was assessed by facility staff to be a fall risk due to medical documentation and personal history obtained from the Power of Attorney (POA). R1 was supervised, and care needs met, per staff interviews, and LPA's interview with other party(s) related to the investigation. Per LPA's file review, upon R1's admittance into the facility, there is documentation identifying R1 as a fall risk, and information provided regarding falls/falling stating that there is no way to ensure a fall never happens but to ensure a general level of supervision to residents, and that staff will strive to keep a resident from falling, and that even with total supervision of a resident, this may not prevent a resident from falling, This document is signed by the POA of the resident. Per interview with (S1 and S2) R1 had a fall on 2/12/22 as R1 had left the dining room , and walked into the center hallway. Staff (2)RN who was doing paperwork in the dining area heard R1 fall, and rushed out to assess R1, other staff assisted as needed. Staff assessed R1 as having hit their head which resulted in an injury, and contacted 911 immediately; 911 was contacted due to the resident's sustained head injury, and medication the resident was on. Per interview with staff, the 911 emergency medical services (EMS) arrived quickly, and medical attention for R1 was obtained about 10 minutes after the incident occurred. There was differing information obtained from reporting party regarding the allegation. There was no obtained information by the LPA to support the allegation, Lack of supervision resulting in resident injury and possible death. Based on LPAs observations, record reviews, interviews with staff, interviews with other party(s), and conflicting information obtained from other related party(s), there is insufficient information to prove or disprove the allegation of Lack of supervision resulting in resident injury and possible death. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No citations/deficiencies. Exit interview conducted with John Wotring, Administrator. Per interview with staff, the 911 emergency medical services (EMS) arrived quickly, and medical attention for R1 was obtained about 10 minutes after the incident occurred. Per interviews, and file reviews, the resident went out 911, on 2/12/22, after having a fall that resulted in a head injury. There was differing information obtained from reporting party regarding the allegation. There was no obtained information by the LPA to support the allegation per the investigation by the LPA. Based on the interviews, record/document reviews, and related information obtained during the investigation, the allegation, Facility failed to seek timely medical attention, is Unfounded. We have found that the complaint allegation was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. No citations/deficiencies. Exit interview conducted with John Wotring, Administrator.the state’s words, verbatim · CDSS document, Mar 18, 2022 · control 21-AS-20220215152441