Finest Living at Crestwood

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 10:04 a.m., the LPA was greeted by staff. At 10:48 a.m., the LPA spoke with the Administrator over the telephone. The Administrator was not available during the time of the visit and authorized, staff Alex Garcia to sign the report. This annual had a specific emphasis on infection control practices and procedures. At 10:30 a.m., the LPA, along with the staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. BEDROOMS: The LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:28 a.m., the hot water in all the three (3) resident restrooms measured between 99.1 and 100.7-degree Fahrenheit. At 10:48 a.m., the LPA spoke with the Administrator regarding the water temperature. The Administrator stated that the water temperature will be adjusted, and a water temperature log will be completed. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in a locked kitchen drawer. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:29 a.m., hot water measured at 100.5-degree Fahrenheit. Continued on LIC-809-C. COMMON AREA: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers to be fully charged and last serviced on 10/30/2022. At 10:29 a.m., the smoke detectors and carbon monoxide detectors were tested and functioned properly. The LPA observed cameras in the common areas. Medications are located in a locked closet near the living room. OUTDOOR SPACE: At 10:37 a.m., the LPA observed the back patio which has a covered outdoor area for resident use. Passageways were free and clear from obstruction. GARAGE: The garage is attached to the house. Laundry units are located inside the garage. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the garage. There is a upstairs storage which remains inaccessible to the residents. INFECTION CONTROL: During today’s visit, the LPA spoke with the staff regarding the facility’s infection control practices. The LPA observed a 30-day supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. The facility’s policies and procedures as it pertains to infection control are adequate. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 809-D). Civil Penalty assessed in the amount of $250. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted. Today's report and appeal rights were provided via email. Civil penalties issuedthe state’s words, verbatim · CDSS document, Jan 7, 2023

Allegation investigated: Facility staff fail to safeguard residents’ belongings from damages

Licensing Program Analyst (LPA) Angel Ascencio conducted a subsequent visit to deliver final findings to the above facility. LPA met with staff member at 11:30 a.m. who was authorized to sign the report. Administrator Adelaida Cruz was not able to join LPA Ascencio during visit. On 11/07/2022, the Department received a complaint alleging that regarding facility staff failed to safeguard the resident’s belongings from damages. On 11/08/2022, LPA Ascencio conducted a facility tour starting at 11:48 a.m. At 12:17 p.m., Resident #1 (R1) room was observed to have rat droppings underneath a red sofa chair and inside the walk-in closet. At the time, LPA did not observed damages to R1’s personal belonging. Interview with R1’s Family member, on 12/01/2022 starting at 9:35 a.m. revealed that the sole of R1’s shoe was eaten by rodents inside the home. R1’s family stated they mentioned this to staff members, but staff were not fazed by the news of rodents and damages to R1’s shoe. R1’s family added that even though the rats ate the sole of the shoes, the shoe is usable and is currently still being used by R1. Continued on LIC 9099 - C Substantiated On 12/15/2022, starting at 11:39 a.m., LPA Ascencio observed R1’s left shoe having been eaten at the toe of the foot, and heel, while the left shoe had more damages that included heel of the shoe and toe area of the shoe. Staff members stated they are not sure what happened to the shoes but they are placed now on top of the filling cabinet to prevent further damages. Based on interviews and observation, the allegation facility staff failed to safeguard the resident’s belonging from damages is substantiated at this time. 1 citation was issued during today's visit. Pursuant to Title 22, Division 8, Chapter 8 of the California Code of Regulations, the following deficiencies were cited. ( Refer to LIC 9099 - C) Exit interview conducted. Copy of the report, and appeal rights provided to Admin via email.the state’s words, verbatim · CDSS document, Dec 15, 2022 · control 29-AS-20221107150416

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Dec 30, 2022

87217 Safeguars for Resident Cash, Personal Property, and Valuables (b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirement is not met as evidenced by: Based on interviews and observation, the licensee did not comply with the section cited above as R1's personal property was not safeguarded by the facility which poses a potential health, safety and personal rights rist to person in care;the state’s words, verbatim · CDSS document, Dec 15, 2022

Plan of correction: Admin will provide R1's family member a new pair of shoes of equal value. Admin will send LPA the proof of purchase by 12/30/2022.

Allegation investigated: Facility staff failed to safeguard resident’s personal belongings.

Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial complaint inspection regarding the above allegation. The LPA met with caregivers at 10:32 AM and explained the reason for the inspection. There were two caregivers and six residents present when the LPA arrived. Administrator Aida Cruz was contacted and advised of the visit. The Administrator is currently out of town and unable to come to the facility, although the LPA was able to conduct telephone interviews with her during the visit. Community Care Licensing Division (CCLD) received the complaint of 'Facility staff failed to safeguard resident’s personal belongings' alleging pictures were removed from Resident #1's (R1) wall without R1's permission. The LPA conducted a physical plant tour of the facility with Staff Alex Garcia. At 10:42 AM, the LPA attempted to conducted an interview with Resident #1 (R1) but R1 was unable to provide any information to the LPA at this time. Report continued on LIC 9099-C. Substantiated Report continued from LIC 9099. The LPA conducted interviews with Staff #1 (S1) at the facility and with the Administrator on the telephone between 10:43 AM and 11:00 AM. At 11:18 AM, the LPA conducted file review. During the physical plant tour, the LPA observed photo frames in a box in R1's bedroom. During the telephone interview with the Administrator, she stated they painted R1's bedroom about a month or two ago and removed pictures from the wall. Although, they had not got around to putting the pictures back on R1's walls. The Administrator said last week, R1's family member came over to the facility and put the pictures on the walls R1 wanted back up. Based on the information obtained, there is sufficient evidence to support allegation of Facility staff failed to safeguard resident’s personal belongings occurred as R1's personal belongings were removed from the wall and were not put back on in a timely response. Therefore the allegation is deemed SUBSTANTIATED at this time. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Report reviewed with the Administrator telephonically and the report was signed by staff Alice Resolme. A copy of the report and appeals was emailed.the state’s words, verbatim · CDSS document, Nov 17, 2022 · control 29-AS-20221110164605

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(27) · Plan of correction due date: Dec 1, 2022

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(27) To keep, have access to, and use their own personal possessions,..... This requirement is not met as evidenced by: Based on interviews and observation, the licensee failed to comply with the section cited above, as the licensee did not ensure R1's personal possessions (photos) were returned back on the wall after painting, which is a personal rights violation to R1 in care.the state’s words, verbatim · CDSS document, Nov 17, 2022

Plan of correction: The Administrator shall submit proof from R1's conservator that all R1's photos that she wants hung on the wall have been re-hung. Proof shall be submitted to CCLD by 12/01/2022.

Allegation investigated: Staff do not dispense medication as prescribed Staff do not assist resident with grooming

Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegations listed above. LPA arrived at the facility at 11:02AM and initially met with facility staff. Licensee was contacted via telephone and indicated she would arrive at the facility shortly. Licensee Adelaida (Aida) Cruz arrived at 11:55AM. Entrance interview conducted. During today's visit, LPA toured the facility with Staff #1 (S1) at 11:22AM, attempted resident interviews between 11:26AM and 11:40AM, conducted staff interviews at 11:44AM, 01:40PM, and 01:59PM, conducted a medication audit for Resident #1 (R1) at 12:21PM, reviewed relevant documents at 1:10PM, and interviewed Licensee throughout the visit. The following was then determined: It was alleged that staff do not dispense medications as prescribed. A medication audit was conducted for R1's prescribed medications at 12:21PM. The medication list initially given for LPA to review was dated REPORT CONTINUED ON LIC 9099-C Substantiated table feeding two (2) of the residents. Shortly after LPA's arrival, one of the staff retrieved a tray with empty plate from a resident room. LPA observed most of the food was consumed while residents were at the dining room table and left the table once their plates and bowls were mostly empty. Licensee showed LPA text messages from the facility staff showing the resident meals for the past 3 days and a note with the amount consumed by each resident. Interview with staff and residents revealed that all residents come to the table for meals and eat their meals together at the table, with the exception of one resident who chooses to eat lunch and dinner in their room. Staff provide assistance with feeding 2 of the residents at the dining room table during meal time. Staff interview revealed that sometimes R1 does become tired during mealtime. When R1 becomes tired at the meal, staff indicated it is unsafe to continue to feed R1, due to choking risk, so they will feed R1 an Ensure drink when this happens. Staff interview also revealed that R1 does finish most meals, and they feed R1 first to try to avoid R1 becoming tired during their meal. Based on interview and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation that "staff feed resident less than 3 meals per day" is deemed UNSUBSTANTIATED at this time. The complaint also alleges that staff isolate resident, indicating R1 is left in their room with the door closed. Upon arrival at the facility, LPA observed 5 of 6 residents all seated at the dining table, including R1. After lunch time, LPA observed R1 remained in the common area of the facility for approximately 30 minutes following lunch before being brought to their room to rest. LPA observed other residents in the common areas throughout the visit. LPA also observed doors to resident rooms to remain open during today's visit. Interview revealed that residents are allowed to remain outside their rooms or with their bedroom doors open, unless they are resting or as needed for resident privacy during direct care. Based on interview and observation, although the allegation may be valid, at this time there is insufficient evidence to support the allegation or that a violation occurred; therefore the allegation that "staff isolate resident" is deemed UNSUBSTANTIATED at this time. No citations issued for these allegations. Exit interview conducted. A copy of the report was provided via email. Continued from LIC 9099... 11/26/2021. Current Medication Administration Record (MAR) and Centrally Stored Medication record were reviewed for November 2022. Record review revealed that staff were utilizing a medication list from 11/26/2021 to determine which medications R1 is prescribed and to order medications. However, R1 has been under hospice care since 07/21/2022 and the medication list for the period of 09/22/2022-11/20/2022 contains different medications prescribed. Interview revealed that R1 only takes 2 regularly scheduled medications, however the list provided by hospice indicates daily medications Hydroxine hydrochloride, Multivitamin, Trazodone hydrochloride. None of these regularly prescribed medications were present at the facility during today's visit. Additional medications listed as PRN (as needed) Ativan 0.5mg, Betamethasone dipropionate, Lactulose, Levsin 0.125mg, Zophran 4mg were not present at the facility. Interview also revealed that R1's Docusate Sodium was unable to be administered due to waiting on the prescription for delivery. MAR indicated the Docusate Sodium was administered only once on 11/10/2022, however the prescription label is dated 11/07/2022, was divided between two bubble packs and had 3 softgels removed from the bubble packs. Medication review also revealed that R1 has multiple medications ordered as needed (PRN), however, there is no documentation from the physician regarding the parameters by which to administer PRN medications or if R1 is able to determine the need for PRN medication. MAR review revealed R1 has not taken any PRN medications during November 2022, the time period observed. Based on interview and record review, the allegation that "Staff do not dispense medication as prescribed" is deemed SUBSTANTIATED at this time. The complaint also alleges that facility staff do not assist with grooming. Staff interview revealed that R1 receives showers once a week with the hospice shower aide. Staff provide additional showers for R1 if needed. Facility staff shower other residents, however there are two (2) who refuse showers. Shower refusal is not documented, nor is there a process for informing residents' responsible party in the event of a refusal. Regarding additional hygiene needs, interview revealed that toenails are only cut by a podiatrist and due to scheduling conflicts with the current provider, this service has been unable to be provided as of late. Licensee indicated she plans to change to an alternate provider to remedy the situation, but hasn't yet. LPA observed Resident #2 (R2) to have long toenails and R2 stated they cannot cut their own. One resident has a mobile manicurist who visits the resident at the facility, but the other residents do not receive this service. Licensee will inquire as to whether R1's responsible party will allow for this service to be provided. Interview revealed that R1 does wear gloves to limit scratching. Hospice nurse was able to recently assist in trimming Report Continued on LIC 9099-C Continued from LIC 9099-C... R1's nails. Record review revealed that R1 does require assistance with grooming and hygiene needs. Based on interview and observation, the allegation that "staff do not assist resident with grooming" is deemed SUBSTANTIATED at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted with Licensee Aida Cruz. Today’s reports and appeal rights were reviewed and provided via email.the state’s words, verbatim · CDSS document, Nov 10, 2022 · control 29-AS-20221108142907

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Nov 28, 2022

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section, as R1's medications were not administered as prescribed, as they were not present in the facility, which poses an immediated health risk to residents in care.the state’s words, verbatim · CDSS document, Nov 10, 2022

Plan of correction: Licensee agreed to complete a medication audit of R1's medications with hospice to ensure all medications are accounted for on the MAR, centrally stored record, and present in the facility. Additional training will be provided to staff by a qualified professional and training will be completed and record of trainingwill be sent to CCL by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(4) · Plan of correction due date: Nov 28, 2022

87464 Basic Services (f) Basic services shall at a minimum include:(4) Personal assistance and care as needed by the resident... and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports This requirement is not met as evidenced by: Based on interview and observation, the licensee did not comply with the above cited section, as residents observed did not have their nails and toenails appropriately groomed and showers refusals are not regularly documented, which poses an immediate health risk to residents in care.the state’s words, verbatim · CDSS document, Nov 10, 2022

Plan of correction: Licensee indicated that shower refusals will be documented going forward and that R1's nails were recently trimmed. Licensee will inquire with R1's Responsible Party whether R1 can have regular manicure care. Licensee will also change podiatrist providers and schedule service. Licensee will inform CCL by POC due date of the next scheduled podiatrist visit.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced Case Management - Deficiencies inspection due to deficiencies observed during the 11/10/2022 complaint investigation inspection. The LPA observed the following: During medication audit for Resident #1 (R1) which began at 12:21PM, LPA observed Triacinolone Acetone Cream 1% is not labeled for R1. An additional medication Chronik Tonic is not listed on the Centrally stored medication record, nor is it on R1's current prescription list. It was listed on the 11/26/2021 list of R1's medications. The Chronik Tonic was observed to be not properly labeled. Staff indicated this medication had not been administered to the resident. During record review, which began at 01:20PM, LPA observed a physician's report for R1, who has a diagnosis of Dementia, dated 04/13/2021. Additionally, R1 had no needs and service appraisal completed. Licensee indicated R1's hospice nurse had recently completed a head to toe assessment for R1 so a new Physician's Report could be completed by the Doctor. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted with Licensee Aida Cruz. Today’s reports and appeal rights were reviewed and provided via email.the state’s words, verbatim · CDSS document, Nov 10, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(e) · Plan of correction due date: Nov 28, 2022

87465 (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician...and a label on the medication...of the following information. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the above cited section, as R1's medication Chronik Tonic and Triaminolone Acetonide were observed to be not labeled and the Triaminolone Acetonide was expired in 07/20, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 10, 2022

Plan of correction: During today's visit, the expired medication was removed. Licensee agreed to audit all residents' medications to ensure all medications are properly labeled and unexpired. Licensee will complete the audit and inform LPA of audit results by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87705(c)(5) · Plan of correction due date: Nov 28, 2022

87705 Care of Persons with Dementia (c) (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458... and a reappraisal done at least annually... include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Based on record review, R1, who has a diagnosis of dementia, had a medical assessment dated 04/13/2021 and no reappraisal in their file, which poses a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Nov 10, 2022

Plan of correction: Licensee agreed to obtain a recent medical assessment for R1 and complete a needs and service appraisal for R1. Proof will be sent to CCL by POC due date.

Allegation investigated: Licensee failed to keep the facility free of rodents and/or insects.

Licensing Program Analyst (LPA) Angel Ascencio conducted an initial complaint visit to the above facility. LPA met with staff member at 11:46 a.m. Administrator Adelaida Cruz arrived at the facility at 12:50 p.m. Entrance interview conducted. On 11/07/2022, the Department received a complaint regarding licensee failed to keep the facility free of rodents and/or insects. On 11/08/2022, LPA Ascencio conducted a facility tour starting at 11:48 a.m. At 11:50 a.m., the activity area/medication cabinet was observed to have rodent droppings by a corner outlet plug. At 11:57 a.m., LPA observed the attic which contained a mouse trap with multiple roden droppings surrounding the area. Staff #1 (S1) stated that they had a rat problem a few weeks back. The rats were observed to wander about the kitchen and the hallways. Pest control has been out to the home and placed traps everywhere. At 12:17 p.m., Resident #1 (R1) room was observed to have rat droppings underneath a red sofa chair. LPA asked staff to move the chair. Continued on LIC 9099-C Substantiated Additional droppings were observed under the chair. Admin spoke to LPA at 1:10 p.m. and stated pest control came out in September 2022. Pest control advised us that there are entry points in the house the rats are coming in. Staff have since fenced off those entry points. Admin added that there is no more rat problem. LPA Ascencio stated that LPA observed rat dropping throughout the facility. If the facility did not have anymore rats, there should not have been any rat droppings observed. Admin stated the rat droppings were not removed accordingly. Based on interviews and observation, the allegation Licensee failed to keep the facility free of rodents and/or insects is deemed substantiated at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D): Exit interview conducted, today's reports, civil penalty and appeal rights were reviewed and emailed to the Administrator.the state’s words, verbatim · CDSS document, Nov 8, 2022 · control 29-AS-20221107150416

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 18, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on interviews and observation, the licensee did not comply with the section cited above as rat droppings were observed throughout the facility which poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 8, 2022

Plan of correction: Admin will conduct a deep-clean of the faciity. Admin will contract pest control company to inspect the home. Admin will submit proof of pest control by 11/18/22.

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Office

An Office Meeting was held via Microsoft Teams. The purpose of the meeting is to discuss the Decision and Order dated July 12, 2022. In attendance are: Licensing Program Manager (LPM) Kristin Heffernan, Licensing Program Analyst (LPA) JoAnn Rosales and Licensee Representative/Administrator Adelaida Cruz. During today's meeting LPM reviewed the Decision and Order, and ensured the licensee understands that S1 is prohibited from being a licensee, owning a beneficial ownership interest of 10 percent or more in a licensed facility, or being an Administrator, Officer, Director, Member, or Manager of a licensee or entity controlling a licensee, and, further, from employment in, presence in, and contact with clients of, any facility licensed by the Department or certified by a licensed foster family agency, or any resource family home, for the remainder of S1's life, unless and until S1 successfully petitions for reinstatement pursuant to Government Code section 11522. Licensee stated that S1 has not worked at the facility since 2014. Licensee stated that S1 worked less than a month at the facility and not in the capacity of a caregiver. Licensee stated that S1 never worked at their other licensed facility Finest Living at Arcade #565801730. Licensee is aware that the effective date of the Decision and Order is July 22, 2022 and that the order is to be posted in common areas of both of their facilities. Exit interview conducted, today's report was reviewed and emailed to the Administrator.the state’s words, verbatim · CDSS document, Jul 26, 2022

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Angel Ascencio arrived at the facility unannounced to conduct a required annual visit at 2:00 p.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Adelaida Cruz and discussed the reason for the visit. Entrance interview conducted. The LPA, along with Administrator, toured the physical plant areas inside and outside at 2:45 p.m. to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. BEDROOMS: The LPA observed the resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are 7 total bedrooms – six (6) bedrooms are private for resident use, and one (1) staff room. RESTROOMS: 3 restrooms were observed to be clean and sanitary and in operating condition. Showers were also observed to have grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products in each restroom, as well as hand washing posters. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA did not observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. Smoke detectors and carbon monoxide was observed to be in operable condition at the time of visit. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. The garage was observed locked and contained the emergency food supply and locked storage cabinet for laundry supplies. Continued on LIC 809 - C KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit. Admin stated they are still waiting on the construction company for permit to finish remodeling the kitchen. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices at 3:00 p.m. There is 1 entry into the facility. Upon entry, the facility has a central point for symptom screening. LPA noted that the facility is allowing visitors for both indoor and outdoor visitation. The LPA did not observed an adequate supply of Personal Protective Equipment (PPE). The Admin stated they have PPE at home and will be bringing to facility. They will reach out to case LPA if in need of additional PPE. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. The following recommendations were made: - Post PINs and educate staff, residents, and families on changing policies and procedures from the Department - Required COVID - 19 poster, cough etiquette poster, etc. - PPE LPA inspected water temperature for kitchen, and two (2) restroom. Water temperature exceeded range of 120 degrees F. Admin stated they will lower temperature. The following deficiencies were observed (See LIC 9099-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. One (1) citations was issued during today’s visit. Exit interview conducted. A copy of the report and appeal rights was provided via email.the state’s words, verbatim · CDSS document, Feb 14, 2022

Allegation investigated: Facility does not have operable smoke detectors in resident rooms Facility did not obtain a permit from the City for kitchen remodel Facility failed to provide adequate food service Resident room smelled of urine

Licensing Program Analyst (LPA) JoAnn Rosales conducted a complaint investigation visit. LPA met with Administrator Adelaida Cruz. During today's visit LPA toured the facility with staff Alex Garcia, interviewed staff and residents, reviewed resident records and obtained copies of pertinent documents. Concerns were that resident rooms had inoperable smoke detectors. During facility tour with staff Garcia starting at 10:06 am LPA observed a smoke detector in resident #1 (R1)'s room hanging by the wiring from the ceiling. Staff stated that the smoke detector has not been working for 2 weeks and needs a battery. During facility tour at 10:23 am with staff Garcia LPA observed a smoke detector in R2's room hanging by the wiring from the ceiling. R2 stated that when they moved into the facility that is how the smoke detector was. Staff Garcia tested all smoke detectors which are hired wired and they were all operational however, the smoke detector in R1's room was chirping due to battery needing to be replaced. Staff replaced the battery however, the smoke detector continued Continued on 9099C Substantiated to chirp. Concerns were that the facility did not obtain a permit from the City for kitchen remodel. During facility tour starting at 9:59 am with staff Garcia LPA observed kitchen entrance with plastic sheeting taped to the wall and kitchen completely empty with no cabinets or appliances. Staff Garcia stated that the boxes located in the dining area were the kitchen cabinets that arrived yesterday. Administrator stated at 11:31 am that Code Enforcement was at the facility last week and asked for permits for the kitchen remodel. Administrator stated that their contractor is getting the permits. Administrator stated that they were not aware that they needed to have permits for the kitchen remodel. Concerns were that the facility failed to provide adequate food service as there is no kitchen for food preparation. During facility tour starting at 10:32 am LPA observed a propane stove in the backyard where staff Alicia Resolme was cooking food in pots with lids. LPA also observed staff cutting onions on a cutting board sitting on a backyard table. LPA observed staff leave the cut onions on the cutting board and flies around the area. Administrator stated at 11:35 am that they will prepare meals inside instead of outside the facility. Concerns were that a resident room smelled like urine. While testing smoke detector in R3's room at 11:28 am LPA observed a strong smell of urine. Staff Garcia stated that the resident empties their urine bag in a commode chair in their room and they check it every 2 hours. Interview with R3 revealed that they do have a pendant to press for assistance however they do not smell the urine as their sense of smell is gone. Based on the information obtained during the course of the investigation the allegations are deemed substantiated at this time. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Civil penalty assessed in the amount of $500.00. Exit interview conducted. Today's reports, civil penalty and appeal rights were reviewed and emailed to the Administrator.the state’s words, verbatim · CDSS document, Oct 12, 2021 · control 29-AS-20211007151918

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87203 · Plan of correction due date: Oct 12, 2021

87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement is not met as evidenced by: Based on LPA's observations, the licensee did not comply with the section cited above as smoke detector in R1's room was inoperable which poses an immediate safety risk to persons in care.the state’s words, verbatim · CDSS document, Oct 12, 2021

Plan of correction: Staff replaced smoke detector in R1's bedroom during facility visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: Oct 25, 2021

Alterations to Existing Building or New Facilities. Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Based on LPA's observations, the licensee did not comply with the section cited above as the kitchen cabinets and appliances were all removed from the kitchen which poses a potential safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 12, 2021

Plan of correction: Administrator stated that she will submit a building permit for kitchen remodel to CCL by 10/25/21.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(15) · Plan of correction due date: Oct 22, 2021

87555 General Food Service Requirements(b)(15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination. This requirement is not met as evidenced by: Based on LPA’s observations, the licensee failed to ensure that staff were preparing food inside the facility which poses a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Oct 12, 2021

Plan of correction: Administrator stated that they will have staff prepare meals inside the facility away from insects. Administrator stated that they will provide documentation of staff food service training to CCL by 10/22/21.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 18, 2021

87303 Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on LPA’s observations, the licensee failed to ensure that staff were emptying R3's commode chair frequently to avoid urine smell which poses a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 12, 2021

Plan of correction: Administrator stated that they will have staff empty R3's commode chair more frequently to avoid urine smell in R3's room.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) JoAnn Rosales conducted a Case Management - Deficiencies visit at the facility. LPA met with Adelaida Cruz. During today's visit LPA toured the facility with staff Alex Garcia and reviewed resident records. During facility tour at 10:11 am LPA observed Triamcinolone Acetonide Cream, Hydrocortisone Cream, Desonide Cream in an unlocked case in resident #1 (R1's) room accessible to residents. Staff Garcia stated that they do not know the combination to the lock to lock it so they placed the items in a locked medication closet. During facility tour at 10:15 am with staff Garcia LPA observed wood glue in the dining room accessible to residents. Staff stated that the glue belongs to the contractor working on the kitchen remodel. During facility tour at 10:16 am with staff Garcia LPA observed melatonin, vitamin D3, vitamin C, calcium, vicks vapo rub, aspirin 81 mg, spironolactone 25 mg, amlodipine besylate, carvedilol 12.5 mg, atorvastatin calcium, zestril and nicotine transdermal system patch in an unlocked staff room accessible to residents. Staff stated that they left the door unlocked when they went to answer the front door when LPA arrived. During facility tour at 10:27 am with staff Garcia LPA observed antibiotic + Pain relief cream and alcohol prep pads in R2's room accessible to residents. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, today's reports and appeal rights were reviewed and emailed to the Administrator.the state’s words, verbatim · CDSS document, Oct 12, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Oct 22, 2021

87705 Care of Persons with Dementia(f)(2) The following shall be stored inaccessible to residents with dementia: Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on LPA's observations and record review, the licensee did not comply with the section cited above as over the counter medication, nutritional supplements, vitamins, alcohol and toxic substances were observed accessible to residents which posed an immediate health risk to persons in care.the state’s words, verbatim · CDSS document, Oct 12, 2021

Plan of correction: Staff placed medications in a locked medication closet and locked staff room door. Wood glue was placed in an inaccessible location. Administrator stated that they will provide documentation of staff training regarding regulation 87705(f)(2) to CCL by 10/22/21.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(h)(2) · Plan of correction due date: Oct 22, 2021

87465 Incidental Medical and Dental Care Services (h)(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 is not met as evidenced by: Based on LPA's observation, the licensee did not comply with the section cited above as staff and resident medications were accessible to residents which posed an immediate health risk to persons in care.the state’s words, verbatim · CDSS document, Oct 12, 2021

Plan of correction: Staff locked staff room door. Staff place resident medications in a locked medication closet. Administrator stated that she will provide documentation of staff medication training to CCL by 10/22/21.