Golden Age VI

Type of visit: Required - 1 Year

On 10/24/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by Staff Member (SM), Farah Bailey and explained the purpose of the visit. LPA asked that SM Bailey call the Facility Designated Administrator to inform them that CCL was present. Shortly after, LPA met with Facility Designated Representative (FDR), Kenroy Anderson and explained the purpose of the visit. There was one other staff member present at the facility, Raffy Corla. Shortly later, LPA met with Licensee, Marinela Placintar. LPA reviewed 6 resident files and 3 staff files. 5 out 6 resident files did not have a complete 602, Pre-Apprasial, and Needs and Services Plan. 3 out 3 staff files were complete and up to date. It was learned that the facility does not have an administrator that does not have a current administrator certificate. A tour of the facility was conducted. A tour of the kitchen was toured. Knives were observed to be locked and made inaccessible. Food supply was observed to ensure that there was a 2 day supply of perishable food supply and 7 day non-perishable food supply. The refrigerator was observed to have a flat of eggs, 2 loafs of bread, a gallon of milk, 2 half empty containers of juice, half a bell pepper, half of a onion, and a head of lettuce. A tour of the backyard was conducted. LPA observed the cement walkway was lifted about 5 inches off the original pavement. It was observed by the LPA that there were miscellaneous items such as floss, receipts, batteries, bottle caps all throughout the fences and front of the facility. A tour of the garage was conducted. An additional regriferator unit was observed. Additional hygiene items were identified. A tour of the laundry was conducted. Toxins, laundry supplies, and other cleaning supplies were observed to be locked and made inaccessible. A tour of the resident bedrooms was conducted. LPA observed a strong smell of urine in 3 out of 4 bedrooms. Furniture and furnishings were observed to be in good repair and meet the residents needs. A tour of the bathrooms were conducted. Hot water temperature was taken to ensure compliance with Title 22 regulations. A medication cabinet was located in the kitchen. Along with the Facility Designated Representative, LPA observed, compared, and reviewed medication with medication dispensing logs. First aid kit was reviewed and had all the required components. Fire extinguisher was observed and was last serviced by Jorgenson Co on 02/27/2023 and is in compliance at this time. Smoke detectors and carbon monoxide was observed to be in working condition. The following forms and documents were requested to be updated and submitted into CCL -LIC 308 -LIC 400 -LIC 500 -LIC 610 -Liability Insurance Per California Code of Regulations (CCR) – Title 22 – Division 6, Chapter 6, deficiencies were observed during today’s visit. Citations can be found on the LIC 809 – D. Failure to correct deficiencies may result in civil penalties. Appeal Rights were provided to facility. An exit interview was held, and a copy of the report was provided in-person and sent via email.the state’s words, verbatim · CDSS document, Oct 24, 2023

Type of visit: Required - 1 Year

On 10/12/2022 at 1:00pm, Licensing Program Analyst (LPA) Arielle Pascua arrived at this facility unannounced to conduct an annual infection control visit. LPA Pascua was greeted by staff member, Paulette Campbell and was asked to call the Licensee, Marinela Placintar to let her know that licensing was present at this time. Upon arrival the LPA observed a centralized screening point equipped with hand sanitizer and masks. Shortly after, LPA Pascua met with Facility Designated Representative, Bianca Placintar explained the purpose of the visit. The purpose of the visit is to conduct an annual infection control visit. This facility has a hospice waiver for 3. There was one other staff member present in the facility at this time, Raffy Corla. The current census was 6. At 1:15pm, LPA Pascua initiated a a tour of the facility. At 1:15pm, LPA Pascua toured the kitchen area. LPA Pascua observed a sufficient amount of 2-day perishable food supply in the refrigerator and a 7-day non-perishable food supply in the pantry for 6 residents. Knives were observed to be locked and made inaccessible to the residents at this time. Cleaning supplies were also observed to be locked under the kitchen sink and made inaccessible to the residents in care. A fire extinguisher was also observed to be in the kitchen and was annually inspected by Jorgenson Co on 03/18/2022. At 1:20pm, LPA Pascua toured resident bedroom #1. Resident furniture was observed to be sufficient to meet their needs at this time. At 1:25pm LPA Pascua also toured a bathroom connected to resident bedroom #1. Hot water temperature was measured to be 112 degrees. Grab bars were observed to be stable and in good repair at this time. From 1:30pm-1:40pm, LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with the staff member, Paulette Campbell, the LPAs observed, reviewed, and compared resident medication and electronic medication dispensing logs. First Aid Kit was present and contained all of the required components. At 1:45pm, LPA Pascua toured resident bedroom #2. Resident furniture was observed to be sufficient to meet their needs at this time. A linen closet located in the hallway and additional locked storage for cleaning supplies were identified and made inaccessible to the residents in care. At 1:50pm, LPA Pascua toured resident bedroom #3. Resident furniture was observed to be sufficient to meet their needs at this time. LPA Pascua identified a linen closet. Linen was sufficient to meet the resident's needs at this time. At 2:00pm, LPA Pascua toured a shared resident bathroom. Hot water temperature was measured to be 112 degrees. Grab bars were observed to be stable and in good repair at this time. At 2:05pm, LPA Pascua toured the garage. A washer and dryer to wash residents bedding and clothing was identified. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. At 2:10pm, LPA Pascua toured the live-in staff bedrooms and bathrooms. 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. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. 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 Facility Designated Representative, Bianca Placintar.the state’s words, verbatim · CDSS document, Oct 12, 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 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: Required - 1 Year

Licensing Program Analyst (LPA) Arlene Garcia conducted an unannounced annual / Infection Control visit on this date. LPA was greeted by Paulette Campbell, Caregiver (S1) and met with MARINELA PLACINTAR, Administrator (AD). LPA and S1 inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, and dining room areas. LPA observed sufficient 7 days non-perishable and 2 days perishable food supplies.. Hot water temperature measured at 105.6 degrees in residents bathroom with the S1 which is in required range of 105 to 120 degrees. Fire Drill conduced . Fire extinguisher maintained expired 10/5/21. Fire alarm and carbon monoxide functional. LPA and caregiver observed centrally stored medications. LPA observed medications for R2 in refrigerator unlocked. LPA reviewed staff and resident files. LPA observed adequate 30 day PPE supply. LPA observed sharps locked. LPA observed toxins under sink in kitchen and under sink in residents bathroom unlocked and accessible to residents. . 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 Marinela Placintar and a copy of report given at the conclusion of the visit to administrator.the state’s words, verbatim · CDSS document, Oct 25, 2021

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Oct 26, 2021

87705(f)(2) Care of Persons with Dementia Care of Persons with Dementia (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants shall be inaccessible to residents with dementia. This requirement has not been met as evidenced by: The Licensee did not ensure toxins were locked as LPA observed cleaning supplies and toxins in the living room, bathroom and garage. This violation posses an immediate health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2021

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Oct 26, 2021

87465(h)(2) Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement has not been met as evidenced by: The Licensee did not ensure medications were locked in refridgerator. This violation posses an immediate health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2021

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Nov 5, 2021

87608(a)(3) Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement has not been met as evidenced by: The Licensee did not ensure residents using hospital beds had a physicians order. This violation posses an potential health and safety risk to the residents in care.the state’s words, verbatim · CDSS document, Oct 25, 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