Treehouse Senior Living

Allegation investigated: Facility threatened to discharge/evict resident

Licensing Program Analyst Bertozzi arrived unannounced to conduct a Complaint Investigation regarding the above complaint allegation and met with Administrator, Dharmisthaben (Dharmi) Patel. LPA conducted interviews and made observations. Facility threatened to discharge/evict resident - Complaint alleges that facility threatened to evict a resident. Additional interview revealed that Licensee communicated that facility may need to issue a 30 day eviction due to a resident potentially needing a higher level of care and it was not meant to be a threat. This agency has investigated the complaint alleging that facility threatened to discharge/evict resident. 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. Nothe state’s words, verbatim · CDSS document, Apr 27, 2023 · control 21-AS-20230421075815

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required – 1 yr. Infection Control Inspection of the facility. LPA was welcome by staff Meliki. Facility has 6 residents with 1 under hospice care at this time and 2 with dementia. LPA conducted inspection with Kathlyn Ligalevu after speaking on the phone with Administrator, Dharmisthaben Patel who was unavailable. LPA arrived at the facility and observed hand sanitizer at the entrance and a log in binder for temperature of visitors and answering questionnaire. During tour the facility on 2/24/2023 with staff Kathlyn Ligalevu, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Sample tour of resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 03/02/22. Facility Smoke and Carbon Monoxide detectors were found to be operational. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day. Hot water temperature measured between 109.2 degrees F to 119.1 degrees F in 5 out of 7 resident’s bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. Toxins are stored in a locked laundry room. Dangerous items were stored inaccessible to residents in care. There was a supply of cleaners, hygiene products and paper products available for residents. The bathrooms designated for residents at the facility were supplied with individual paper towels; hand soap dispenser was available. Sample resident’s bedrooms have lighting & appropriate furnishings. Resident’s files have been updated under new facility as well as staff files. All required facility postings are in place. Resident’s medications are centrally stored and locked on kitchen draws. Disaster Drills have been conducted by monthly and last dated 12/16/22. Infection Control: Facility has submitted a mitigation program plan and infection control plan. Posters have been placed at facility by entrance. Facility has PPE supply stored in the facility garage/storage room. Facility has a 30-day supply of medication for residents. Continued LIC 809-C Residents aren’t wearing masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit. Facility is allowing visitors and residents have available virtual and telephone calls when contacting with family members and others. Facility has acquired N-95 fit testing and received PPE training. LPA reviewed Licensing Information System (LIS) with designee who stated that is corrected and updated at this time; no need to change any of the information. In addition, LPA advised facility to contact County Public Health and Community Care Licensing immediately if symptoms or COVID-19 + in the facility. LPA was presented with proof of current CPR & 1st Aid certification for staff. Administrator Certificate is for Dharmisthaben Patel # 6033357740 Exp. 01/08/2023 resubmitted 11/2022 will send updated Admin Certificate when receive. All staff have received COVID booster vaccinations and inclusively work at this facility. There were no deficiencies cited at this time. LPA Hansen is requesting Licensee to update and submit the following documents by 3/7/2023 to SRRO: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Proof of Liability Insurancethe state’s words, verbatim · CDSS document, Feb 24, 2023

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Hansen arrived unannounced to conduct a Case Management inspection and met with Licensee Darmi Patel & staff Pamela Lopez. LPA is following up regarding a self-reported Incident Report received on October 10, 2022 regarding an incident that occurred on 10/9/22 at 3:40 am where resident, R1 slipped and fell while getting out of bed. According to caregiver R1 then got up and used the bathroom, stated is fine and caregiver helped R1 back to bed. Later that morning R1 was observed with bruising on right side of head. The following day R1 was feeling weak and dizzy and refused breakfast. Appropriate parties contacted and R1 went to the hospital. No other details were provided. LPA was unable to contact facility and has since obtained other contact information. During today's inspection LPA obtained discharge documents and was informed R1 was brought back to the facility same day as incident with no concussion or restrictions and no change in care or hospice recommendation. No deficiencies cited during today's inspection.the state’s words, verbatim · CDSS document, Oct 14, 2022

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced post-licensing infection control inspection to this facility and was welcome by staff Pamela Lopez. Facility has 6 residents with 2 under hospice care at this time. LPA arrived at the facility and observed hand sanitizer at the entrance and a log in binder for temperature of visitors and answering questionnaire. During tour the facility on 7/15/2022 with staff Pamela Lopez, facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Sample tour of resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 03/22. Hot water temperature measured between 114.2 degrees F and 120 degrees F in 3 out of 3 resident’s bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. Toxins are stored in a locked laundry room. Dangerous items were stored inaccessible to develop disabled residents. There was a supply of cleaners, hygiene products and paper products available for residents. The bathroom designated for residents at the facility were supplied with individual paper towels; hand soap dispenser was available. Sample resident’s bedrooms have lighting & appropriate furnishings. Facility understands that unvaccinated and/or not fully vaccinated staff must have an exception on file and be tested once a week. Resident’s files have been updated under new facility as well as staff files. All required facility postings are in place. Resident’s medications are stored and locked on kitchen draws. Disaster Drills have been conducted monthly and last dated 07/01/22. Continued LIC 809-C Infection Control: Facility has submitted a mitigation program plan that has been approved at this time and infection facility program plan has been submitted. Posters have been placed at facility by entrance. Facility has PPE supply stored in the facility garage/storage room. Facility has a 30-day supply of medication for residents. Residents aren’t wearing masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit. Facility is allowing visitors and clients have available virtual and telephone calls when contacting with family members and others. Facility has acquired N-95 fit testing. There were no deficiencies cited at this time Department is requesting the following to be submitted to CCLD by 7/22/2022: LIC 500 LIC 9020 Copy of liability insurancethe state’s words, verbatim · CDSS document, Jul 15, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Fernandes-Goes conducted a pre-licensing inspection and met with Licensee/Administrator Dharmi Patel. Fire clearance has been approved for 10 non-ambulatory residents by the County Fire Department. LPA will conduct a component III orientation with Dharmi Patel Administrator/Licensee. There is a total of 6 residents with 3 under Hospice care. Facility is a one-floor facility. LPA toured the facility on 3/30/2022 with Licensee/Administrator Dharmi P.; facility was found to be at a comfortable temperature with all exits free from obstruction. Exits were free from obstructions at the time of the visit. Fire Extinguisher was found to be last charged on 03/2022. Sample test of facility smoke detectors and carbon monoxide detectors were found to be operational. Sample hot water temperature measured 114.8 degrees F falling out Title 22 acceptable regulation of 105 to 120 degrees F in 2 of 2 resident’s bathroom faucets. The facility has special care plan of operation and programming for residents with dementia. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations. LPA observed that provisions are made for individuals with special dietary needs; facility shares information between staff regarding residents' dietary needs. Food is available for residents any time of the day. There is a daily activity schedule for residents that will be posted after becoming licensed. Toxins are stored in a locked supply room in the hallway. There was a supply of cleaners, hygiene products and paper products available for residents. Bathrooms inspected designated for residents at the facility were supplied with paper towels and hand soap dispensers. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. Mattress pads are available for residents. Continued LIC 809-C Facility floor includes kitchen, laundry room, living room area, bathrooms, dining room, and resident's bedrooms, and bathrooms, and supply room. Facility plans on having several different activities available for residents as desired and an activity calendar posted by the dining room as well as a menu posted in the kitchen. There is outdoor space for activities. Resident's & Personnel records, medication, first aid supplies, and toxins will be locked in medication closet. Postings noted to be current and in compliance with guidelines. Locked cabinets for sharps and daily used toxins located in office room. PPE is being stored in a supply room. Disaster Drills have been conducted often and in different shifts with the last one being conducted on 3/1/2022. Community Care Licensing has requested the following item be corrected prior to licensure: - Facility to provide pictures of Emergency Preparedness LIC 610, facility sketch approved by Fire Marshall, Non-discrimination and Theft & Loss Facility Program Plan posted as required. - Facility to provide a copy of Resident R1 complete medical assessment LIC 602. - Facility to provide a copy of staff S1 fit testing. - Facility to provide proof of booster shot for staff S1. - Facility to provide proof of First Aid Kit purchase – facility purchased during visit and showed proof of purchase. There were no deficiencies cited at this time.the state’s words, verbatim · CDSS document, Mar 30, 2022

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Office

COMP II by CAB successfully completed Facility Type: RCFE Application Type: INC Capacity: 10 Census (if any clients in care): 6 Method: Telephone at CAB COMP II Participants: Dharmisthaben Patel (Applicant/Administrator) Applicant/Administrator participated in COMP II at CAB via telephone with analyst at CAB. Identification of the Applicant and Administrator was verified by providing California Driver License number. During COMP II, Applicant and Administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and Administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Mar 29, 2022