Windsor Golden Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and was greeted by staff. Licensee/Administrator, Arthur Alcones was available by phone. Backup Administrator, Lily Alcones arrived later. LPA initiated a tour of the facility around 9:40am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in bathroom used by residents measured at 116.8 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Laundry room containing cleaning supplies was locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Facility has some emergency food and water supplies but not three days worth to be self-sufficient for 72 hours, per Health and Safety Code 1569.695, Emergency Plans. LPA directed Administrator to add additional supplies. Fire extinguishers were last serviced September 2023. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational during inspection. Most recent fire/disaster drill was conducted September 2023. Staff and Resident files are stored electronically and the facility laptop was not working during inspection. Additionally, Administrator was unable to come to the facility to provide LPA access to files. LPA will return to conduct file review. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Nov 7, 2023

Allegation investigated: Staff handled resident in a rough manner Staff do not administer medications to residents as prescribed Staff isolated residents to their rooms for an extended period of time Staff do not provide residents with clean towels Staff pressured resident for funds

Licensing Program Analyst Bertozzi arrived unannounced to deliver findings regarding the above complaint allegations and met with Licensee, Arthur Alcones. During investigation LPA conducted interviews, reviewed documents and made observations. Staff handled resident in a rough manner – Complaint alleges that staff tried to force resident to undress by tying them down. Per interviews, resident R1 refused assistance with showering and getting dressed. Staff denied forcing a resident to undress as the resident chose to do those tasks independently without assistance from staff. An incident was described by staff where resident requested a bandaid but would not allow staff to see their wound. Per interview, staff asked multiple times to assess resident due to concern for their health and safety but resident refused. Continued on LIC9099C Unsubstantiated Continued from LIC9099C Staff do not administer medications to residents as prescribed – Complaint alleges that the facility over medicates the resident by doubling their medication and that all residents are prescribed sedatives. Per staff interviews, R1’s medication dosage was doubled by their primary physician. Per LPA review of medication documents, R1 did have a medication doubled by their physician. LPA did not find evidence that all residents are prescribed a sedative. Staff isolated residents to their rooms for an extended period of time – Complaint alleges that residents are made to go to bed and that there is a resident who staff will not allow to leave their room. Per staff interviews, residents are encouraged to come out of their room and there is not a requirement that they go to bed at a certain time. Per interview with identified resident, they choose to stay in their room and denied that staff force them to stay in their room. Staff do not provide residents with clean towels – Complaint alleges that staff only provide residents with one towel and if another towel is requested, staff will pick up a dirty towel from the floor and hang it up again for the resident. Per staff interviews, residents are given a clean towel each day and residents are not denied additional towels. Staff pressured resident for funds – Complaint alleges that staff took another resident to the bank to pressure them for money. Per interview with Licensee, they drove the identified resident to the bank as a courtesy and they did not pressure the resident for money. A finding that the complaint allegations that Staff handled resident in a rough manner, Staff do not administer medications to residents as prescribed, Staff isolated residents to their rooms for an extended period of time, Staff do not provide residents with clean towels and Staff pressured resident for funds were unsubstantiated meaning that although the allegations may have happened there is not a preponderance of evidence to prove that the allegations occurred. No deficiencies cited.the state’s words, verbatim · CDSS document, Feb 9, 2023 · control 21-AS-20221213085128

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Victoria Bertozzi arrived unannounced to conduct an Annual Required inspection and was greeted by a caregiver. Licensee, Arthur Alcones arrived later. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival, LPA was screened by staff for Covid-19. LPA initiated a walk-through of the facility around 11:00am and observed the following: Facility has COVID-19 posters throughout that included hand washing signs in bathrooms. Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Observed staff had masks on during this visit. Commonly touched surfaces are disinfected after meals, in the morning and in the evening. Facility maintains documentation of staff and resident daily temperatures. Facility has a designated visitation area outside and is allowing for visitation in resident rooms per CCL guidance. Staff continue to receive training on infection control and donning and doffing of PPE and have been N95 fit tested. LPA and Licensee discussed visitation and activities. Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has a 30 day supply of Personal Protective Equipment (PPE) including but not limited to masks, gowns, and hand sanitizer. Facility maintains a 30 day supply of medication. Fire extinguishers were last serviced September 2022. Smoke and carbon monoxide detectors throughout facility were tested and operational. Continued on LIC809C Continued from LIC809C Licensee and LPA discussed their Emergency Disaster Plan and their Infection Control Plan. Licensee provided LPA with their Liability Insurance inspection. Licensee/Administrator to submit updates of the following documents by 11/19/2022: LIC 308 Designated Administrator - If applicable LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (review and update) LIC 9020 Register of Facility Client’s/Resident’s No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Oct 19, 2022

Allegation investigated: Resident incontinence care needs are not being met Facility is not providing activities Personal Rights

Licensing Program Analyst Willis arrived unannounced to deliver findings regarding the above complaint allegations and met with Licensee, Arthur Alcones. Resident incontinence care needs are not being met – Complaint alleges that resident, R1 is left in wet incontinence briefs and on at least one occasion, there was enough liquid to drip onto the floor. Complaint goes on to allege that staff used disinfecting wipes instead of incontinence wipes causing resident to complain of burning and that facility refuses to allow for a bidet to aid the resident in providing for some of their own toileting needs. LPA was provided a photo of a person identified as R1 sitting on a chair with an incontinence brief on and a pad underneath them and a puddle below them. Per interviews, staff did mistakenly use a disinfectant wipe but when resident complained of burning, the mistake was realized, and the wipes were not used again. Continued on LIC9099C Substantiated Continued from LIC9099 Personal Rights – Complaint alleges that R1 does not feel comfortable coming into common areas of the facility because of another resident’s behavior. During a visit, LPA heard a resident, R2 yelling. Interviews also supported that R2 yells and interview confirmed that at least one resident has been frightened by R2’s behavior. Staff interview indicated that R2 curses at staff but not other residents. Facility recently reported that R2 was “verbally and physically aggressive” resulting in 911 being called. Facility is not providing activities – Complaint alleges that facility does not provide activities. Per staff interview, they attempt to engage residents in activities like walking around the facility, but residents refuse. Other interviews indicate that staff do not regularly offer walks or other activities and walks are sporadic because two staff are required to ensure supervision and the facility does not always have two staff on shift. Per interview, residents engage in individual activities, like watching tv, but not group activities, like having a musician come in. The allegation, that Resident incontinence care needs are not being met, Facility is not providing activities and Personal Rights is Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. 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. Continued from LIC9099 Preplacement appraisal indicates that resident needs standby assistance when using the walker and needs help moving about the facility. Resident also needs assistance with incontinence care, needs staff to hand them their clothes and that resident sleeps through the night. The reappraisal dated 7/1/2022 indicates that noted resident is wheelchair bound and rarely uses a walker due to increased weakness and needs moderate to maximum assistance with bathing, toileting and dressing. Level 2 of the facility’s level of care rates indicates a resident who needs moderate to maximum assistance with Activities of Daily Living such as bathing, toileting, dressing, is a fall risk or needs 1-2 person transferring and/or needs assistance with incontinence care. Evidence indicates that resident’s needs changed after move-in. Licensee is not providing personal accommodations per regulation – Complaint alleges that facility did not provide a chair in the resident’s room. Additional interview and a picture revealed that facility did provide a chair. This agency has investigated the complaint alleging Level Of Care - Resident not assessed for proper level of care and Licensee is not providing personal accommodations per regulation. 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.the state’s words, verbatim · CDSS document, Aug 30, 2022 · control 21-AS-20220706100129

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Aug 31, 2022

87411 Personnel Requirements – General- (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure resident’s incontinence was managed appropriately. This is an immediate risk to personal rights.the state’s words, verbatim · CDSS document, Aug 30, 2022

Plan of correction: Licensee agrees to conduct an in-service with staff to ensure the proper incontinence products are used and that residents are checked as often as needed to manage their incontinence. Proof of inservice training to be submitted to LPA no later that 8/31/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Aug 31, 2022

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure resident’s personal rights. This is an immediate risk to personal rights.the state’s words, verbatim · CDSS document, Aug 30, 2022

Plan of correction: Licensee agrees to conduct an in-service with staff regarding regulation 87468.1 to ensure resident's personal rights. Proof of inservice training to be submitted to LPA no later that 8/31/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87219(a) · Plan of correction due date: Sep 5, 2022

87219 Planned Activities (a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure residents are provided adequate activities. This is a potential risk to health and safety of residents in care.the state’s words, verbatim · CDSS document, Aug 30, 2022

Plan of correction: Licensee agrees to provide a written plan on how they will ensure that they have enough staff to engage residents in activities by POC due date, 9/5/2022.

Allegation investigated: Facility failed to keep hazardous area inaccessible

Licensing Program Analyst Willis arrived unannounced to deliver findings regarding the above complaint allegation and met with Licensee, Arthur Alcones. Facility failed to keep hazardous area inaccessible – Complaint alleges that facility failed to keep the door to the laundry room closed despite there being a significant drop in the entryway that is hazardous to residents in care. LPA was provided a picture of the open door. LPA has observed the entryway and has spoken with the Licensee multiple times regarding keeping the door closed and locked to ensure resident safety. The allegation that Facility failed to keep hazardous area inaccessible is Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Substantiatedthe state’s words, verbatim · CDSS document, Aug 30, 2022 · control 21-AS-20220720150827

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 5, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: Based on interviews and review of picture, the Licensee did not ensure residents are safe by ensuring that the door to the laundry room is closed. This is a potential risk to health and safety of residents in care.the state’s words, verbatim · CDSS document, Aug 30, 2022

Plan of correction: Licensee has changed the lock on the door and spoken with staff regarding closing and locking the door. Deficiency is cleared.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst Willis arrived unannounced to conduct a Case Management inspection and met with Licensee, Arthur Alcones. During investigation LPA discovered deficiencies that were not part of the complaint. Interviews revealed that the Licensee verbally communicated care changes to the responsible party of a resident in June 2022 but there is a discrepancy of whether a rate change was discussed. A letter dated 6/22/2022 from the Licensee notified the responsible party of the rate change but per interview, the letter was not provided to the responsible party until 7/1/2022. Per interview, the appraisal dated 7/1/2022 was included with the letter. The responsible party had previously paid the lower care rate for July 2022 so the difference was due. A second and third notice followed on 7/7/2022 and 7/8/2022. The responsible party was then given a 30-day notice of eviction dated 7/10/2022 due to non-payment of fees and indicating that the facility was no longer able to meet the care needs. An updated appraisal was not provided supporting that the facility was no longer able to meet the care needs. Per Licensee, they provided the letter to the responsible party on 7/11/2022. Per interviews, on 7/10/2022, the responsible party attempted to give payment to facility staff who refused the payment and instructed the responsible party to mail the check to the address on the Admission Agreement despite the facility accepting payment in this way previously. Per Admission Agreement, payment can be made by sending a check to the listed mailing address however, it also allows for individuals to submit payment at the facility. The responsible party provided payment to the address indicated on the Admission Agreement but was not notified until July 27, 2022 that the eviction had been rescinded despite being notified of their obligation to notify the resident and their responsible party by this LPA multiple times. Continued on LIC809C Continued from LIC809 During investigation LPA conducted a review of facility’s current Admission Agreement which was part of the facility’s approved program design and was being used by the facility. Review revealed that certain language does not meet Title 22 regulations. Because this language was not previously identified by the Department, Licensee will not be cited but will be required to submit a revised Admission Agreement for further review and approval to the CCL SRRO by 9/16/2022. 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.the state’s words, verbatim · CDSS document, Aug 30, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(9) · Plan of correction due date: Sep 2, 2022

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure responsible party was adequately communicated with regarding the level of care change and status of the eviction. This is an immediate risk to personal rights of residents in care.the state’s words, verbatim · CDSS document, Aug 30, 2022

Plan of correction: Licensee agrees to submit a policy regarding how they will effectively communicate with residents and their responsible parties per regulation by POC due date, 9/2/2022.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Victoria Willis arrived unannounced to conduct a Post Licensing inspection and met with caregiver, Cheryl Alcones. Licensee, Arthur Alcones was available by phone and gave permission for caregiver to sign report. The inspection is focused on the Infection Control procedures and practices of this facility. Upon arrival, caregiver took LPA's temperature and asking standard Covid screening questions. LPA noted that the temperature on the thermometer was very low compared to LPA's normal temperature. Review of visitor log revealed that all visitors appeared to have low temperatures. LPA suggested to caregiver that the battery may need to be changed or the thermometer may need to be replaced. Per conversation with caregiver, they verbally confirm with visitors that they are vaccinated but have not requested the actual vaccination card. LPA instructed caregiver that visitors must provide proof of vaccination per Provider Information Notice (PIN) 21-40-ASC. LPA initiated a walk-through of the facility and observed the following: Facility has some COVID-19 posters in the hallway and hand washing signs in bathrooms but there are no postings on the front door or in the entryway. LPA suggests adding posters to more central areas of the facility Facility was a comfortable temperature and exits were free from obstructions. Hand sanitizer is located throughout common areas of the facility. Observed staff had a mask on during this visit. Commonly touched surfaces are disinfected once per day . Facility maintains documentation of resident daily temperatures but per caregiver, they take staff's temperatures at the beginning of their shift but it is not being documented. LPA instructed staff to start documenting staff temperatures as well. Facility has a designated visitation area outside and is allowing for visitation in resident rooms. Staff have completed PPE training and have been N95 fit tested. Continued on LIC809C Continued from LIC809C Facility has submitted and CCL has reviewed their Covid Mitigation Plan. Facility has at least a 30 day supply of Personal Protective Equipment (PPE) including masks, gloves, face shields and hand sanitizer. Additional PPE should be stored at the facility. Facility maintains a 30 day supply of medication. Licensee has put in a fence to enclose the entire yard to decrease the risk to a resident who may have wandering behavior. Licensee will submit an update to their Dementia Care Plan. Licensee and LPA discussed their Emergency Disaster Plan. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Mar 18, 2022

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Victoria Willis and Caitlynn Felias arrived announced to conduct a Pre-Licensing Inspection and met with Applicant, Arthur Alcones. Upon arrival, LPAs were screened for Covid-19 symptoms and had their temperatures checked. Facility is a one story residence with four client bedrooms, two single rooms and two shared rooms, three bathrooms and common areas. Facility plans to eventually have a capacity of 14 and will submit a change of capacity at that time. Resident rooms are furnished with a bed, chair and bedside table. Two bedrooms do not have a lamp and three bedrooms do not have dressers. Bathroom showers have bath mats and grab bars. Water temperature in bathroom read at 122 degrees F which is over the regulation of 105 & 120 degrees F. Facility has sufficient items used for cooking and eating. Facility has a locked pantry in the kitchen that may be used for centrally stored medications and files. Cleaning supplies and other items, like knives, will also be locked in pantry. Perishable and non-perishable foods observed per regulation. Facility backyard has an area for visiting and activities. Facility does not currently have a fence around the entire perimeter of the yard. At this time, facility is choosing to not admit residents with wandering behavior. Applicant has agreed to update their Plan of Operation to remove language regarding advertising for dementia and add policy regarding not admitting or retaining residents with wandering behavior. Facility received an approved fire clearance dated October 26, 2021 that allows for 4 non-ambulatory clients and 2 bedridden. Hardwired smoke alarms and Carbon Monoxide detector were tested and operational. Facility has emergency lighting in hallways. LPAs confirmed that contents of the facility First Aid Kit were sufficient. Continued on LIC809C Continued from LIC809 LPAs confirmed that Applicant is familiar with Guardian and has read the most recent Provider Information Notices (PINs) that the department sent out regarding Covid-19 vaccinations and visitation. Component III is waived due to Applicant being a current Licensee. The following items are needed in order to move forward with licensure: Noted updates to Plan of Operation Applicant to turn down water heater and submit three days of temperatures within regulation to LPAs Receipt showing that Applicant has obtained copies of Rights to Resident Councils and Family Councils for posting Once above items are received, LPAs will notify Application Unit so application process may proceed.the state’s words, verbatim · CDSS document, Dec 22, 2021

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care):0 COMP II Participants: Alcones, Arthur Interview Method: Telephone interview On 10/26/2021, applicant/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 the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/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 readinessthe state’s words, verbatim · CDSS document, Oct 26, 2021