Providence Home of Modesto

Allegation investigated: Staff speak inappropriately to residents Staff harass residents to move Staff do not ensure residents have a safe and healthful environment by exposing residents to cold air

Unannounced complaint visit made out to this facility on 06/21/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility live-in caregiver, Jaime Velasquez, and briefly interviewed at this time. This LPA requested that the facility caregiver go ahead and contact the facility designated Administrator, Michelle Jangar, to inform her that CCL was present at this time. It was learned that the facility designated Administrator stated that she would at least (2) hours before she would be able to attend the complaint visit with this LPA today. It was decided that all forms and documents would be signed and received by the facility live-in caregiver, Jaime Velasquez, in lieu of the facility designated Administrator. Current census was 3 residents. Based on interviews and information gathered throughout the course of this investigation, it was learned that facility personnel, S1, has been very aggressive towards current facility residents when discussing the matter of this facility possibly closing in the near future. It was learned that S1 has repeated reminded facility residents that they would have to move soon or not have a place to live at in the near future. Substantiated It was learned that this has been a very stressful and daunting situation for the facility residents since the closure date for this facility is approaching fast but they have been unable to secure a proper placement. It was learned that the manner in which facility staff have spoken to the facility residents has been inappropriate, and disrespectful, and needed to stop. Based on interviews and information gathered throughout the course of this investigation, it was learned that this facility has been experiencing issues with the heating/cooling units, especially for the wings, of this facility. It was learned that the east and west wings of this facility were unable to use the heater when it was cold outside and will not be able to cool the wings when the temperature starts to climb in the upcoming hot summer months. It was observed that fans were present, and in use, but maintenance of the facility in order to cool and heat to a comfortable range for the facility residents could not be maintained at this time. As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegations were valid because the preponderance of the evidence standard had been met. The following deficiencies were cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Appeal rights were printed and a copy was left with the facility caregiver, Jaime Velasquez, at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Jun 21, 2023 · control 27-AS-20230117111149

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: Jun 28, 2023

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 facility was found to be deficient as evidenced by facility staff talking and treating residents without dignity and respect as this facility was moving towards no longer maintaining an RCFE license.the state’s words, verbatim · CDSS document, Jun 21, 2023

Plan of correction: Facility representative stated that all facility personnel will be trained, for no less than (1) hour in duration, on the training topics of Resident Personal Rights from a vendorized entity. A statement of correction, along with proof of vendorized training, will be completed and submitted into CCL by the due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(b)(1)(2) · Plan of correction due date: Jun 28, 2023

A comfortable temperature for residents shall be maintained at all times. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. This facility was deficient as evidenced by the heating/cooling units for this facility were not in good working order at this time.the state’s words, verbatim · CDSS document, Jun 21, 2023

Plan of correction: Facility representative stated that the heating/cooling units for this facility will be repaired/replaced as necessary to properly heat/cool this facility within the allowed temperature ranges. A statement of correction, along with proof of repairs/replacement of these units, will be completed and submitted into CCL by the due date.

Type of visit: Required - 1 Year

Unannounced annual visit made out to this facility on 06/21/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility live-in caregiver, Jaime Velasquez, who was briefly interviewed at this time. This LPA requested that the facility caregiver go ahead and contact the facility designated Administrator, Michelle Jangar, to inform her that CCL was present at this time. It was learned that the facility designated Administrator stated that she would take her at least (2) hours before she would be able to attend the annual visit with this LPA today. It was decided that all forms and documents would be signed and received by the facility live-in caregiver, Jaime Velasquez, in lieu of the facility designated Administrator. Current census was 3 residents. It was learned that there weren't any residents under the care of home health at this time. There weren't any residents under the care of hospice at this time. Tour of this facility was conducted. Kitchen area was toured. Cabinets and drawers were reviewed. Drawers and cabinets housing cleaning supplies were observed to be locked and made inaccessible to the residents at this time. Dining room, living area, and all other areas designated for resident use were observed to be maintained and observed to be in compliance at this time. A tour of the resident bedrooms was conducted. Furniture and furnishings were observed to be present and maintained in compliance at this time. A tour of the resident restrooms was conducted. Grab bars and non skid mats were observed to be present and in compliance at this time. Hot water temperatures were taken and measured to make sure that they were within the allowed range of 105-120 degrees. Medication cabinet, located as a medication unit in the dining area, was reviewed. Policies and procedures for dispensing, handling, and overall documentation of the resident medications were discussed with the facility live-in caregiver at this time. Food supply was reviewed for 2-day perishable and 7-day nonperishable food quantities. Additional food storage units were observed to be present in the staff living quarters. Fire extinguishers were observed to be placed throughout this facility and were annually inspected on 11/08/2022 by the local fire equipment company, Cal-State Fire Extinguisher Company, and in compliance at this time. First aid kit was observed to be present and contained all of the required components at this time. Linen closet, located in facility hallway, was observed to contain a sufficient supply of blankets, sheets, and towels for resident use. Laundry area, located next to the dining room, was observed to be locked and made inaccessible to the residents at this time. Exterior grounds of this facility was toured. Facility perimeter fence, side gate, and emergency exits were reviewed. Additional shed in the backyard was reviewed and observed to be locked and made inaccessible to the residents at this time. Additional housing unit was observed to be locked and used solely for storage by the Licensee. The following forms were requested to be updated and submitted into CCL: LIC 308 LIC 400 LIC 500 LIC 610 The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. Appeal rights were printed and reviewed with the facility live-in caregiver, Jaime Velasquez, and a copy was given to him as well. Exit Interviewthe state’s words, verbatim · CDSS document, Jun 21, 2023

Type of visit: Office

A Non-Compliance office meeting was conducted today in the Santa Rosa Regional Office via Microsoft Teams. Present in the meeting were acting Regional Manager Stephenie Doub, Licensing Program Manager Kimberley Mota, Licensing Program Manager Liza King, Auditor Diana Chapman, Audit Manager Jacqueline Juarez, Licensing Program Analyst Araceli Canela, Licensee Warren Delfin, Facility Administrator Michelle Jangar, Facility Administrator Renato Yamat, and Facility finance staff Maximina "Ami" Landicho. This Non-Compliance Plan Conference is being conducted to discuss concerns identified by the Licensing Agency in regard to the findings of a recent solvency Audit that was conducted for the following facilities Providence Home of Aragon #486803945; Providence Home of Fairfield #486803888; Providence Home of Hillview #486803890; Providence Home of Vallejo #486803850 and Providence Home of Modesto #50270093 owned and/or operated by Warren Delfin. The financial audit documents showed the licensee does not have a sound financial plan and has negative equity. The facility is generating enough income to meet its expenses; However, expenses are not being paid; the amount of money being sent out of the facility account is negatively affecting the licensee’s solvency. Licensee is not managing finances of the facility in a manner that ensures solvency and there is a lack of control over the finances. Operating expenses were reviewed for Bank statements and cash reserves; Utilities; Rent; and Food. The licensee did not pay operational expenses timely. In Addition, there are tax liens against the facility. Continue report see LIC809-C Facility was placed on a compliance plan for 1 year. Licensee has been advised that failure to complete the agreed upon actions by the dates given, will result in this Department taking the following action(s): Facility agrees to provide quarterly financial documents for the month of May/June/July 2023; by August 18,2023. Records for the month of August/September/October 2023 by November 17,2023. Records for November/December 2023 and January of 2024 by February 16, 2024, and February/March/April 2024 by May 17, 2024. Facility agrees to ensure proper bookkeeping and having adequate Finance staff and not commingle funds between all five (5) licensed facilities. Facility agrees to submit copies of proper 60-day resident eviction notices regarding Providence Home of Modesto #50270093 by May 5, 2023. Facility to ensure food costs are related to the resident census per facility. Failure to comply with the terms and conditions of the one-year compliance plan may result in administrative action. Facility is subject to increased quarterly monitoring to ensure compliance. Licensee was provided the following regulations: CCR, Title 22, Division 6, Chapter 8, Section 87213, Finances CCR, Title 22, Division 6, Chapter 8, Section 87205, Accountability CCR, Title 22, Division 6, Chapter 8, Section 87555, General Food Service Requirement CCR, Title 22, Division 6, Chapter 8, Section 87405, Administrator Qualifications and Duties No citations were issued at this time. LPA will review and issue citations that may be warranted. A copy of this report was emailed to Administrator/Licensee, signature in file.the state’s words, verbatim · CDSS document, May 1, 2023

Type of visit: Case Management - Other

Unannounced case management visit made out to this facility on 01/26/2023 by Licensing Program Analysts (LPAs) Charlie Yang and Kimberly Viarella who were met by the facility live-in caregivers, Jaime Velasquez and Cecelia Abieros, who were briefly interviewed. This LPA requested that facility personnel go ahead and contact the facility designated Administrator, Michelle Jangar, to inform her that CCL was present at this time. Phone call was taken and this LPA did have a brief conversation with the facility designated Administrator at this time. It was discussed that the caregiver who was present, Jaime Velasquez, was able to accept and sign all forms and documents from Licensing for today's visit. The purpose of this visit was to relay to this facility that the following had to be included in the eviction notices that were going to be given to the current residents: The Regional Office is inaccurate, it lists Fresno not Sac South. A current care plan should accompany the notice. Relocation Evaluation Based on the current service plan, the facility is responsible to prepare a relocation evaluation for each resident including recommendations on the type of facility that would meet the needs of the resident; and a listing of facilities, within a 60-mile radius of the closing facility, that meet the resident’s needs. (HSC 1569.682(a)(1)) The facility must meet with the resident and his/her legal representative to discuss the relocation evaluation within 30 days of issuing the eviction notice. (HSC 1569.682(a)(3)) The facility shall not accept new residents or enter into new admission agreements after it has issued the written notice of eviction. (HSC 1569.682(a),(b)) There were no deficiencies observed or cited during today's case management visit. Exit Interviewthe state’s words, verbatim · CDSS document, Jan 26, 2023

Type of visit: Case Management - Health Checks

Unannounced case management visit made out to this facility on 12/12/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the live-in caregivers, Jaime Velasquez and Cecilia Abieras, who were briefly interviewed at this time. Also present was another female third party contractor. Current census was (3) residents. The purpose of this visit was to conduct a Health and Safety check on the facility and current residents at this time. This LPA requested that the caregivers go ahead and contact the facility designated Administrator, Michelle Jangar, to inform her that CCL was present at this time. A brief conversation was held with Jangar at this time. The following deficiencies were observed and cited on the following LIC 809-D pursuant to Title 22 Rules and Regulations, Health and Safety Codes. This facility was cited and civil penalties were issued in the amount of $500 at this time per the LIC 421BG. Appeal rights were printed and a copy was given to the facility staff person Velasquez at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Dec 12, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Dec 13, 2022

Criminal Record Clearance All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or: This facility was deficient as evidenced by the presence of an individual who was not properly fingerprint cleared and associated to this facility at the time of this LPA's visit. This posed an immediate threat to the Health, Safety, and Personal Rights of the residents in care.the state’s words, verbatim · CDSS document, Dec 12, 2022

Plan of correction: Facility designated staff person stated that this individual who was not properly fingerprint cleared and associated to this facility must be removed immediately from the premises. A statement of removal will be completed and submitted into CCL by the due date. This individual will not be allowed back into this facility until the proper fingerprint clearance has been attained with proper association.

Type of visit: POC

LPA Jason Lund arrived at the above facility unannounced to conduct a proof of correction (POC) visit. LPA Lund was met by care staff Staff Jaime Velesquez and explained the reason for the visit. LPA Lund spoke with Administrator, Michelle Jangar and explained the reason for the visit. Current census three. LPA toured the facility and the three residents’ rooms (Eight through twelve) Air Conditioner is working in the three residents’ rooms and is currently at 75 degrees. The facility is waiting for parts for the rooms one through seven. No Deficiencies cited at this time. Exit Interview with Staff Jaime Velesquez and Administrator, Michelle Jangar over the phone and report left.the state’s words, verbatim · CDSS document, Jun 23, 2022

Type of visit: Post Licensing

LPA Jason Lund arrived at the above facility unannounced to conduct a post-licensing and an annual/required visit. LPA Lund was met by care staff Staff Jaime Velesquez and explained the reason for the visit. LPA Lund spoke with Administrator, Marilyn Jalilae and explained the reason for the visit. Administrator, Marilyn Jalilae gave permission for Staff Jaime Velesquez to help LPA Lund conducted the visits and sign required paperwork. Current census three residents. Tour of the facility was conducted. Kitchen area was toured. Cabinets and drawers were observed to be in good repair and contained all required dishes, cook ware, and flatware sufficient to meet the needs of the residents at this time. Cabinets storing knives and cleaning agents were observed to be locked and made inaccessible to the residents at this time. It was observed that there was a gate that latched separating the kitchen area from the common dining area. Food storage units were reviewed and observed to be set at the proper temperatures for the refrigerator and freezer components. Common areas were toured such as the living room, dining room, and all other areas intended for resident use. Furniture and furnishings were observed to be in good repair and able to meet the needs of the residents at this time. A tour of the resident bedrooms was conducted. it was observed that resident bedrooms were furnished and maintained to meet the needs of the residents at this time. Resident restrooms were toured. Grab bars and non- skid mats/surfaces were observed to be present and in good repair at this time. Linen closet was observed to contain all of the necessary components sufficient to meet the needs of the residents at this time. LPA Observed that the Air Conditioning was not working in the Residents rooms and the Air Conditioner is not currently working in the Residents rooms. Fire extinguishers and carbon monoxide detectors were observed to have been annually serviced by the local fire authority on 11/10/2022 and in compliance at this time. Facility office area was toured. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. First aid kit was observed to be present and contained all necessary components at this time. Laundry area was toured. It was observed that all cleaning agents, detergents, and supplies were locked and made inaccessible to the residents at this time. A tour of the exterior grounds was conducted. A review of the perimeter fence, side gates, and exterior exits were conducted and observed to be in good repair at this time. As a result of this visit, see deficiencies cited, per Title 22 Regulations, Division 6. Exit interview conducted, appeals rights provided. Exit Interview with Staff Jaime Velesquez and Administrator, Marilyn Jalilae over the phone and report left.the state’s words, verbatim · CDSS document, Jun 18, 2022

Type of visit: Required - 1 Year

LPA Jason Lund arrived at the above facility unannounced to conduct a post-licensing and an annual/required visit. LPA Lund was met by care staff Staff Jaime Velesquez and explained the reason for the visit. LPA Lund spoke with Administrator, Marilyn Jalilae and explained the reason for the visit. Administrator, Marilyn Jalilae gave permission for Staff Jaime Velesquez to help LPA Lund conducted the visits and sign required paperwork. Current census three residents. Tour of the facility was conducted. Kitchen area was toured. Cabinets and drawers were observed to be in good repair and contained all required dishes, cook ware, and flatware sufficient to meet the needs of the residents at this time. Cabinets storing knives and cleaning agents were observed to be locked and made inaccessible to the residents at this time. It was observed that there was a gate that latched separating the kitchen area from the common dining area. Food storage units were reviewed and observed to be set at the proper temperatures for the refrigerator and freezer components. Common areas were toured such as the living room, dining room, and all other areas intended for resident use. Furniture and furnishings were observed to be in good repair and able to meet the needs of the residents at this time. A tour of the resident bedrooms was conducted. it was observed that resident bedrooms were furnished and maintained to meet the needs of the residents at this time. Resident restrooms were toured. Grab bars and non- skid mats/surfaces were observed to be present and in good repair at this time. Linen closet was observed to contain all of the necessary components sufficient to meet the needs of the residents at this time. LPA Observed that the Air Conditioning was not working in the Residents rooms and the Air Conditioner is not currently working in the Residents rooms. Fire extinguishers and carbon monoxide detectors were observed to have been annually serviced by the local fire authority on 11/10/2022 and in compliance at this time. Facility office area was toured. Medication cabinet was observed to be locked and made inaccessible to the residents at this time. First aid kit was observed to be present and contained all necessary components at this time. Laundry area was toured. It was observed that all cleaning agents, detergents, and supplies were locked and made inaccessible to the residents at this time. A tour of the exterior grounds was conducted. A review of the perimeter fence, side gates, and exterior exits were conducted and observed to be in good repair at this time. As a result of this visit, see deficiencies cited, per Title 22 Regulations, Division 6. Exit interview conducted, appeals rights provided. Exit Interview with Staff Jaime Velesquez and Administrator, Marilyn Jalilae over the phone and report left.the state’s words, verbatim · CDSS document, Jun 18, 2022