Golden Age Home Care VIII

Allegation investigated: Staff hit resident

On 10/17/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA met with Facility Designated Administrator (FDA), Kenroy Anderson and explained the purpose of this visit. The purpose of this visit is to delivery complaint findings for the allegation above. Current census was 6. A brief interview with FDA Anderson was conducted. It was alleged that a staff member hit a resident. During the course of this investigation LPA reviewed facility records and conducted interviews. Based on interviews conducted it was learned that it was alleged that an individual who was delivering medication witnessed a staff member hit a resident. It was reported that the individual delivering medication peaked into the window and stated that the resident was being fed at the time and pushed the staff member’s hand away and in response the staff member hit the resident. Unsubstantiated It was learned through this interview that this individual could not recall where the resident was hit. An interview with facility staff was conducted. It was learned through staff interviews that the facility conducted an internal investigation and found no evidence to show that the resident was hit. Staff members present at the time of the incident denied hitting any residents. LPA also conducted an interview with the resident, however, due to medical conditions could not complete the interview. LPA reviewed facility records of pictures that were taken after the alleged incident where it was observed that the resident did not have any redness, marks or bruising around their face or body. Based on the information gathered, it is unclear if the staff member hit the resident. Based on information provided through interviews and records reviewed, this allegation is deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported. There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.the state’s words, verbatim · CDSS document, Oct 17, 2023 · control 27-AS-20230912162010

Type of visit: Required - 1 Year

On 09/16/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA was greeted by Staff Member (SM), Vanscott Smith and explained the purpose of this visit. LPA Pascua asked SM Smith go call the Facility Designated Administrator (FDA) to inform them that CCL was present at this time. Shortly after, LPA Pascua met with FDA Kenroy Anderson and explained the purpose of the visit. This facility is licensed to serve 6 residents of which all may be non-ambulatory. This facility has a hospice waiver for 4 and a dementia plan on file. Current census is 6. A brief interview with Kenroy Anderson was conducted. LPA reviewed 3 resident files and 2 staff files. 1 out 3 resident files did not have a complete Pre-Appraisal form. 2 out of 3 resident files were current and up to date. 2 out of 2 staff files were current and up to date. The Facility Designated Administrator has a current administrator certificate #6062116740 and expires on 1/2/2024. A tour of the facility was conducted. The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Jorgenson Co on 02/27/2023. The kitchen area was toured. LPAs observed a non-perishable and perishable foods in the cabinets and refrigerator. Additional food supplies were identified in the garage. LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. A tour of the garage was conducted. Additional perishable food supplies were identified. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. A technical assistance was provided for Section 87456(a)(2). The following forms and documents were requested to be updated and submitted into CCL -LIC 308 -LIC 400 -LIC 500 -LIC 610 As a result of this visit, no deficiencies were observed or cited during this annual visit. An exit interview was conducted and copy of the 809 and 809-C was provided to Licensee, Marinela Placintar.the state’s words, verbatim · CDSS document, Sep 16, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced visit today for the facility’s annual inspection. LPA met with Administrator, Kenroy Anderson Continual Administrator's Certification expires 01/02/2024. There are currently 5 residents who reside at this home and there is 2 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 115 degrees. First Aid kit is on site and complete.Toxins and cleaning supplies are locked and inaccessible. LPA verified all staff present has COVID 19 vaccine cards or exemptions on file. LPA verified all staff present is background cleared. There were no deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with Administrator, Kenroy Anderson and copy of report left at facilitythe state’s words, verbatim · CDSS document, Aug 15, 2022

Type of visit: Office

An office meeting was conducted today in the Sacramento Regional Office via Microsoft Teams. The purpose of this meeting was to discuss the 3rd quarter 2021 audit findings. Present at the meeting was Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Stephenie Doub, Licensing Program Analyst (LPA) Sarah Hurt, Jacqueline Juarez, Xiao Ni, DSS Auditors, Marinela Placintar, Licensee, and Licensee Attorney Michael Levin. Since 11/5/2020, the Department has been conducting quarterly financial monitoring due to the findings of a solvency audit. The Licensee furnished documents for the 3rd quarter of 2021 which showed despite there being funds available there is still non-sufficient fund payments, water bills not paid timely and food costs below the required food requirements. The Licensee agreed that payments may have been late in 2021, but that she is working on correcting this by hiring a new bookkeeper and incorporating each facility independently to avoid having to pay each facility bills one by one. The licensee further explained that all food receipts may not have been provided, which may be the reason for the low food costs. It was agreed that financial monitoring will continue six months from now with a smaller one-month audit. The licensee would provide all requested documents for only the month of September of 2022 to DSS Audits section by October 20,2022. The Licensee will submit applications to Licensing by next week to incorporate her facilities. The Licensee will also submit letters to Licensing and facility clients regarding the incorporation of the facilities by close of business on Tuesday 4/5/2022. The Licensee was encouraged to reach out to the Department should there be any questions regarding receipts to submit. An exit interview was conducted with Licensee Marinela Placintar and copy of this report was provided via email.the state’s words, verbatim · CDSS document, Mar 30, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Charlie Yang made an unannounced visit on 01/26/2022 for the purpose of conducting a Case Management visit. LPA Yang met with facility representative Kenroy Anderson and explained the reason for this visit. On 06/09/2021 an Office meeting was held with the Licensee Marinela Placintar, the RO and DSS Auditors. During the meeting, the RO explained the audit findings and related expectation of financial monitoring of this facility for one year. Licensee Placintar was advised of documents that needed to be provided to the Audits Department along with the dates expected to submit them to this Department. The Audits Department also sent emails to Licensee Placintar reminding her of the deadlines. The documents required for the solvency monitoring were as followed: · LIC 401 · LIC 402 · Rent roll · Utility statements · Food receipts · Monthly and quarterly bank statements These documents were to be submitted quarterly and were due for the third quarter as of October 15, 2021. As of this date, these documents have not been received. The following deficiencies were cited on the following LIC 809-D per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted with the facility representative Kenroy Anderson and a copy of this report, along with appeal rights, was provided.the state’s words, verbatim · CDSS document, Jan 26, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87755(c) · Plan of correction due date: Feb 2, 2022

87755(c) Inspection Authority of the Licensing Agency The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). This facility Licensee failed to meet the set deadlines for submission of all requested forms and documents into CCL.the state’s words, verbatim · CDSS document, Jan 26, 2022

Plan of correction: This facility representative stated that all requested forms and documents will be completed and submitted into CCL by the required due date of 02/02/2022.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Arlene Garcia arrived at this facility unannounced to conduct a case management visit. LPA met with Tyron Cooper, Caregiver S1 and explained the purpose of the visit. LPA Garcia toured the facility with S1. COVID wellness check conducted. Sufficient PPE supplies. LPA observed comfortable living accommodations. LPA observed 2-day perishable and 7-day non-perishables. LPA observed lights functional. During this visit, it appeared that staff was sufficient. S1 reported there was a sufficient number of staff. S1 reported S1 gets paid on time. S1 reported S1 had no issues or concerns. LPA advised S1 that the Department is performing Golden Age facilities 3rd quarter, 2021 financial monitoring review. LPA requested the Administrator provide the following documents for period July - September / 2021. Administrator AD to submit to the Department no later than the close of business day on Monday January 3rd, 2022. 1. LIC 401/401A Form for the month of September 2021. 2. LIC 403/403 A Form for the month of September 2021. 3. All utility monthly billing statements including cable, water, garbage, electricity and gas for the period from July 2021 to September 2021. 4. Monthly Bank Statements for period from July 2021 to September 2021. 5. All food receipts for all the facilities for period from July 2021 to September 2021 6. Rental Roll including resident name and rental payment for the period from July 2021 to September 2021. Exit interview conducted with S1. . Copy of report provided.the state’s words, verbatim · CDSS document, Dec 30, 2021

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arlene Garcia conducted an unannounced annual / Infection Control visit on this date. LPA met with Marinela Placintar, Administrator. LPA conducted gateway questions prior to visiting facility. AD completed symptom check upon entry and sign in sheets available to document all visitors. LPA and AD, inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, and dining/ living room areas. LPA observed sufficient 7 days non-perishable and 2 days perishable food supplies.. Hot water temperature measured 115.7 degrees in residents bathroom with the AD. Last Fire Drill conduced dated 05/01/21. Fire extinguisher maintained 7/20/2021. Fire alarm and carbon monoxide functional. LPA observed sharps and toxins locked. LPA and AD observed centrally stored medications. LPA reviewed 2 staff and 6 resident files. LPA observed all staff files complete. Administrator Certificate valid until 6/23/2022. Staff and visitors enter the facility through ringing the locked front door, sanitizer and thermometer were observed. COVID signs posted in front entry way. Sign in sheets available at entry way. All persons in facility fully vaccinated LPA observed 30 days PPE supply. LPA observed resident in room sleeping in recliner. File review had no exception on file for recliner use. AD stated they were not aware they needed to request an exception. AD stated resident is on hospice and recliner was brought in 2 weeks ago.. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited today in violation of California Code of Regulations. Exit interview held with AD and a copy of report given via email.the state’s words, verbatim · CDSS document, Aug 31, 2021

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Sep 10, 2021

Waivers and Exceptions (b) The Department shall have the authority to approve the use of alternate concepts, programs, services, procedures, techniques, equipment, space, personnel qualifications or staffing ratios, or the conducting of experimental or demonstration projects under the following circumstances: (2) The applicant or licensee shall submit to the Department a written request for a waiver or exception, together with substantiating evidence supporting the request. This requirement is not met as evidenced by: Based on interviews and records review, the administrator did not ensure facility has an approved exception letter from Community Care Licensing for the use of recliners in lieu of beds. This posed a potential health and safety risk to the resildents.the state’s words, verbatim · CDSS document, Aug 31, 2021

Type of visit: Office

An office meeting was conducted today in the Sacramento Regional Office via WebEx. The purpose of this meeting was to discuss audit compliance. Present at the meeting was Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Stephenie Doub, Jacqueline Juarez and Lisa Ni, DSS Auditors, and Marinela Placintar, Licensee. On November 5, 2020 an Office meeting was held to discuss the audit findings. It was agreed during the Office meeting that the licensee would provide monthly documentation to the audit department for solvency monitoring. The documents required are as follows: · LIC 401 · LIC 402 · Rent roll · Utility statements · Food receipts · Monthly and quarterly bank statements The Licensee furnished documents for the 3rd quarter of 2020 which showed non-sufficient fund payments, water bills not paid timely and food costs below the required food requirements. The Licensee agreed that payments may have been late in 2020, but that she has corrected the problem by setting up automatic payments for the accounts. The licensee further explained that all food receipts may not have been provided, which may be the reason for the low food costs. It was agreed that to better understand the financial solvency of the facility, the licensee would provide all requested documents for the 2nd quarter of 2021 (April, May and June) to DSS Audits section by July 31, 2021. The Licensee was encouraged to reach out to the Department should there be any questions regarding receipts to submit. An exit interview was conducted with Licensee Marinela Placintar and copy of this report was provided via email.the state’s words, verbatim · CDSS document, Jul 21, 2021