Alta Care Home

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Hansen conducted an unannounced Case Management inspection to this facility and met with Laarni Lockerbie, Licensee who arrived at 8:45 AM. The purpose of today’s inspection is to amend LIC 9099/9099C from delivering Complaint findings on 7/18/2023. LPA arrived at facility to obtain signatures for amended complaint findings from 7/18/2023 due to Technical Violation not being related to complaint. On 7/18/2023 LPA was at facility delivering complaint findings and observed Licensee putting 24 hour container of entire day's medication pre-poured for each resident away in locked medication cabinet. LPA discussed regulation to not pre-poured or transferred from original container into any other container. Technical Violation given CCR 87465(h)(5)(see LIC9102). See Amended 9099/9099-C from Complaint investigation 7/18/2023 No deficiencies cited during today’s inspection.the state’s words, verbatim · CDSS document, Aug 3, 2023

Allegation investigated: Staff handled resident in a rough manner Staff withheld water from resident

*** Amended Licensing Program Analysts (LPA) Hansen arrived unannounced at the facility to deliver findings regarding the above allegations. LPA met with Aira Melanie V. Monte, Administrator & Laarni Lockerbie, Licensee. Staff handled resident in a rough manner & Staff withheld water from resident– Complaint alleges resident got up out of bed after staff directed not to get out of bed and staff allegedly grabbed resident by the back of the neck and forced back into bed. LPA obtained police report, conducted interviews with residents, staff, and other individuals. Reporting party and resident were unable to identify alleged staff. Resident moved from facility within a weeks’ time period, LPA conducted collateral visit to conduct interviews regarding visible bruising. Based on LPA’s interview with reporting party and collateral visit, no bruising was viewed or reported. It was also alleged staff withheld water from residents – LPA made observations on 6/6/2023 and observed residents with water in glasses in their rooms. LPA conducted interviews with 2 residents who confirmed water is offered when desired. LPA is unable to prove water is being withheld from residents. See LIC 9099-C Unsubstantiated Based on LPAs observations, record reviews, interviews with staff, residents and conflicting information obtained from parties, there is insufficient information to prove or disprove the allegations listed above. 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.the state’s words, verbatim · CDSS document, Jul 18, 2023 · control 21-AS-20230601144419

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an Annual Required inspection and met with Administrator, Aira Monte. There is a total of 6 residents, 2 under hospice care. Upon arrival, LPA observed that staff continue to wear masks per current guidance. LPA initiated a tour of the facility at approximately 9:15 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. Water temperature in bathrooms measured at 110.8 , 112.6, and 113.3 degrees F which is within the range of 105 to 120 degrees F allowed per regulation. Extra hygiene products and linens were available. Cabinet 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. Fire extinguisher was last inspected February 20, 2023. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational. Five staff five resident files were reviewed. All staff reviewed has current CPR and 1st Aid training Certification.Administrator Certificate for Administrator Aira Melanie U Monte 6056005740 expires 08/29/2024. Medications and medication records were reviewed. Administrator and lPA discussed their Emergency Disaster Plan and Infection Control Plan. There were no deficiencies cited at this time. Continue on LIC 809-C Licensee/Administrator to submit updates of the following documents by 4/13/2023 to SRRO: LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facilities Residents Infection Control Plan (If changes) Current Administrators Certificate Liability Insurancethe state’s words, verbatim · CDSS document, Mar 23, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Hansen conducted an unannounced case management and met with David Lockerbie, Licensee. The purpose of this case management inspection is to follow up on staff being associated to facility. On 07/12/2022 LPA conducted Post-Licensing inspection of facility. LPA noticed a new staff member and inquired name. LPA was unable to locate name on guardian checklist and contacted Regional Office to confirm. Staff was just being associated that day. LPA discussed with Administrator that all individuals working, volunteering, living in the facility, must be background checked and cleared by DOJ along with associated to the facility prior to being at the facility. LPA completed inspection and left signed LIC809 & LIC809-C with directions to send Community Care Licensing (CCL) requested documents. On 07/15/2022 LPA received requested document (LIC 500 Personnel Report) from facility, along with other requested documents. LPA was unable to locate Staff (S1) on guardian, called Administrator who informed, S1 is an employee at facilities sister facility and has been working at Alta Care Home since 07/18/2022. LPA checked with CCL and although S1 has been background cleared and is associated to other facility S1 is not associated to this facility. LPA explained to Administrator again, unless an individual is background cleared and associated to the facility, they cannot be there per regulations and then emailed Administrator Guardian Information to sign up to get account to complete associations and transfers. LPA checked Guardian, as of 07/28/2022 S1 is still not associated. LPA confirmed S1 has cleared fingerprints in the system but is not and never was associated to this facility. Immediate Civil Penalties are being assessed in the amount of $500 due to staff S1 not being associated to the facility. *****Total Civil Penalties issued today in the amount of $500.00 Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) 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. Exit interview conducted and appeal of rights provided..the state’s words, verbatim · CDSS document, Jul 28, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jul 29, 2022

87355(e)(2) Criminal Record Clearance...Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by: Based on interview & record review Administrator didn’t comply w/section cited above in 1 out of 4 staff weren’t associated to facility which poses a potential health, safety or personal rights risk to persons in care. During visit on 7/28/2022 LPA observed staff S1 was working w/residents and not associated to facility this day.the state’s words, verbatim · CDSS document, Jul 28, 2022

Plan of correction: LIcensee/Admin agrees to associated S1 by POC date 07/29/2022. Admin agrees to ensure any staff working or residing in the facility are fingerprint cleared and associated. Due to Administrators failure to associate S1 to the facility Civil Penalties are being issued today in the amount of $500.00.

Type of visit: Post Licensing

Licensing Program Analyst (LPA) Hansen conducted an unannounced post-licensing infection control inspection to this facility and was welcome by Licensee Laarni & David Lockerbie. Facility has 3 residents with 1 dementia diagnosis. At entrance there is a credenza with binder for visitors to input temperatures and hand sanitizer were LPA had temperature taken by Licensee and logged. During tour of the facility on 7/12/2022 with licensee Laarni, 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 1/26/2022. Hot water temperature measured between 110.6 degrees F and 112.1degrees F in 2 out of 2 resident’s bathroom faucets which are within Title 22 acceptable regulation of 105 to 120 degrees F. Toxins are stored in a locked hallway closet & locked cabinet under sink. 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. Infection Control: Facility has submitted a mitigation program plan that was approved and have submitted Infection Control Plan. Posters have been placed at facility. Facility has PPE supply stored in the front hallway credenza and garage. Residents’ medications are centrally stored and locked in cabinets above the office desk. Facility has a 30-day supply of medication for residents. Residents do not wear masks inside the facility. Facility offers activities of walks and puzzles. In addition, facility has a designated area for visitors in the backyard, living room, and/or in the bedrooms when possible. Residents have also available Zoom and telephone calls when contacting with family members and others. Staff had PPE training required on file and have been N-95 fit tested except one new staff who just started 7/12/2022 which will be completed this month. Continue LIC 809-C LPA reviewed Licensing Information System (LIS) with licensee who stated that is correct and updated at this time. In addition, LPA advised facility to contact County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. LPA was presented with proof of CPR & 1st Aid certification for staff which files were reviewed. Administrator Certificate’s for Aira Melanie Monte # 6056005740 Exp. 8/29/2022 All staff have received COVID booster vaccinations and exclusively 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 7/27/2022 to SRRO: LIC 308 Designated LIC 500 Personnel Summary LIC 9020 Register of Facility Resident’s Proof of Liability Insurancethe state’s words, verbatim · CDSS document, Jul 12, 2022

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Hansen conducted a pre-licensing inspection and met with Licensee Laarni & Dave Lockerbie & Administrator Aira Melanie Monte. Fire clearance has been approved for 6 nonambulatory residents by the Petaluma Fire Department. LPA will conduct a component III orientation with Licensee/Administrator’s Laarni & Dave Lockerbie/Aira Melanie Monte. Facility has a dementia care program and a request for hospice waiver for 2. LPA toured facility and observed: Facility is a one floor residence in good repair and at a comfortable temperature. Hot water temperature checked 111.7 degrees F to 114.4 degrees F in resident's bathrooms as required by Title 22 Regulations and Fire Extinguisher was last checked on 1/26/2022. The facility has a phone line designated for resident’s use. There is an ample supply of personal hygiene products, bedding and linens, utensils, dishes, and cookware. Personnel and residents' records will be stored in locked office desk in middle of facility-living room. Locked cabinets above office wall will contain centrally stored medications. Facility plans on having awake staff. Licensee’s rent back adjacent home at 98 Alta Dr. for easy access. The facility has five resident’s bedrooms, one of which is shared, three bathrooms (one staffs) facility has a kitchen, laundry room in garage, living room area, office, and dining room. Facility plans on having several different activities available for residents as desired. There is outdoor porch space for activities and visiting. Resident's & Personnel records, medication, first aid supplies, and toxins will be locked. Postings noted to be current and in compliance with guidelines. Locked cabinets for sharps in kitchen and cleaning/laundry supplies in locked cabinet in garage. First aid kit was observed. Emergency supplies located in the office and PPE cabinet observed in front hallway credenza. All exits have egress alarms. Mitigation Plan has been approved 4/11/2022. Continue on LIC809-C Facilities back bedroom exit #3 has small wooden deck out the sliding glass door needing to step down and around the corner needing to step up again to exit property (pics LIC 812). Licensee will put ramps in both locations and send to LPA prior to accepting residents. Facility is cleared for licensure. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Apr 14, 2022

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 Census (if any clients in care): zero Method: Telephone call with administrator & licensee COMP II Participants: Aira Melanie Monte & Laarni Lockerbie Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. Identification of the applicant and administrator was verified by photo ID. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. RO has been advised to transmit signed LIC 809 with copy of photo ID to CAB.the state’s words, verbatim · CDSS document, Mar 30, 2022