A Loving Heart Senior Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 12:40 p.m. The LPA was greeted by the Administrator Diorena Rock and informed them of the reason for the visit. The LPA and the Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS/BATHROOMS: Beginning at 1:00 p.m. the LPA inspected the bedroom and bathroom areas. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are six designated client rooms and one staff room. Medications are located in a locked cabinet in the kitchen. The three client restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. At 1:04 p.m. the LPA observed accessible clorox wipes in resident room #1. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured at 110.4 degrees Fahrenheit in the hallway bathroom. KITCHEN: The LPA toured the kitchen/food service area. Knives and additional cleaning supplies are stored inaccesible and locked in the garage. At, 1:38 p.m. the LPA observed unlocked refrigerated medications in the kitchen refrigerator. At 1:46 p.m. the LPA observed a variety of expired foods ranging from canned sliced mangoes expired 1/20/23, expired vegetables, expired mayonnaise dated 5/3/23, expired imitation crab dated 9/9/23, expired sour cream dated 10/9/23, expired teriyaki sauce dated 12/11/22, moldy Brie and Swiss cheese, expired phyloo dough dated 3/6/21, expired prosciutto dated 9/16/23, expired pickles dated 9/29/22, expired roast pork dated 6/14/23, expired milk dated 10/8/23 and 10/23/23, expired romaine lettuce and expired egg whites dated 8/16/22. Kitchen appliances were in operable condition. Despite the expired foods observed the facility had a sufficient supply of perishable and non-perishable food at the time of visit. **Continued LIC 9099-C** COMMON AREAS: At the time of the visit, living room and dining room furniture was observed to be in good condition. There is a fireplace in the living room, which is screened and inaccessible. The facility maintained a comfortable temperature of 73 degrees. Smoke detector(s) and carbon monoxide detector were tested at 2:15 p.m. and operational at the time of the visit. There are two fire extinguishers which were fully charged and last serviced on February 16, 2023. The LPA did not observe all required postings as facility sketch, emergency disaster plan and resident rights were not posted however Administrator was in possession of the required postings and advised the they will put them up. OUTDOOR AREA: The backyard has a covered outdoor area equipped with furniture for client use. There is a side gate for client use that is single latched. There is a gated pool which is inaccessible to residents in care. Exits are free of obstructions. The garage is where the washer and dryer are held, including additional refrigerator with perishable food items. Emergency food and water are kept in the garage. Due to time constraints, the LPA will return at a later date to complete the inspection. The LPA obtained the following documents: - LIC500 Personnel Report - LIC9020 Client Roster - Liability Insurance The following deficiencies were observed (See LIC 809-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. Exit interview conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 26, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Brian Balisi arrived at the facility unannounced to conduct a required annual visit. Upon arrival LPA was screened by Rocky Diorena - Administrator and LPA explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures. At approximately 9am, LPA along with Administrator toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Fire extinguishers were observed fully charged and last serviced in February of 2022. At 9:05am, LPA observed (5) residents having breakfast at the dining table. (1) client was at a doctor's appointment. Kitchen appliances were observed to be relatively clean and appeared to be in operable condition. LPA observed a sufficient supply of perishable and non-perishable food properly stored. Sharp objects were observed stored in a locked drawer to the left of the sink. LPA observed resident bedrooms furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. Entryway closet was observed to store a (30) day supply of PPE, toiletries, cleaning supplies and coats. Hallway closet was observed to store clean linen and network devices. Restrooms were observed to be relatively clean, sanitary and in operating condition with grab bars and non-skid mats. Hot water measured between 105 - 120 degrees Fahrenheit. Infection control signs were observed posted throughout facility to promote hand washing, cough/sneeze etiquette, and physical distancing Continued from 809 LPA observed the back patio, which has a covered outdoor area with a appropriate seating for outdoor use. There is a self-latching gate on the side and back of the facility designated for an emergency exits. There is a swimming pool located in the rear of the facility. LPA observed pool to be inaccessible to residents in care with a high fence and its' entrance locked. LPA also observed a shaded patio area located in the front of the facility. LPA observed furniture appropriate for outdoor use. Garage is attached to the facility and was observed to be inaccessible to residents in care. Garage was observed to store (2) refrigerators and non-perishable foods all properly stored. LPA also observed cleaning supplies, incontinence supplies and miscellaneous supplies for facility use. INFECTION CONTROL: The LPA spoke with Administrator regarding the facility’s infection control practices. upon entry, the facility has a central entry point for symptom screening, temperature checks, and sanitation station. The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate each bedroom as an isolation room if the facility has a confirmed case of COVID-19. COVID-19 testing will be conducted twice a week when there is a positive case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate at this time. No deficiencies were observed at this time. Exit interview conducted. Report issued and a copy of the report was provided via email.the state’s words, verbatim · CDSS document, Oct 14, 2022

Allegation investigated: Facility did not allow residents responsible person to select their own Physician Facility is not following their visiting policy

Licensing Program Analyst (LPA), Martha Guzman Chavez conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 11/22/2021 by LPA’s M. Guzman Chavez and A. Smith. On today’s visit, LPA Guzman Chavez met with Administrator, Diorena Rock. Entrance interview conducted. During the initial visit on 11/22/2021, LPA’s Guzman Chavez and Smith conducted and interview with the Administrator at 11:43 a.m., began interviews with five residents at 2:25 p.m., and interviewed a family member of a resident at 1:38 p.m. The LPA’s also reviewed files and obtained copies of pertinent documents. LPA Guzman Chavez also interviewed other resident family members on 4/07/2022 between 2:27 p.m. and 4:16 p.m. ...Continued on LIC 9099C... Unsubstantiated ...Conitnued from LIC 9099... It was alleged that facility did not allow residents responsible person to select their own physician. It was reported that facility did not allow Resident #1’s (R1’s) family to speak to any doctors and ignored R1’s HMO group plan that was used when R1 was admitted. Interviews with the Administrator revealed that they ‘introduced’ R1’s family to their current Primary Care Physician (PCP), and the family ‘agreed’ to switch doctors. Additionally, R1’s first appointment with the new PCP was on 6/16/2021, and since then became R1’s PCP. Furthermore, interviews with random resident family members revealed that facility never spoke to them about any other doctor as they had their own up on admitting their family member to the facility. However, interviews with other random resident family members revealed that facility recommended a doctor when arriving at the facility, but they ‘never felt obligated’ to choose a specific PCP for their family members. Although facility recommends a PCP upon admittance, it is not a requirement for the family members to switch PCP. Based on interviews, the Department does not have sufficient evidence to support the allegation of “facility did not allow residents responsible person to select their own Physician”. Therefore, the allegation is deemed Unsubstantiated at this time. Also alleged was facility is not following their visiting policy. It was reported that facility only allowed R1’s family members to visit on Sunday’s. Review of records revealed that facility had implemented a visitation plan which stated, ‘visitors to be scheduled in advance’, ‘be subject to staff availability’, and ‘a limitation to the number of visitors to enter at any one time’. On 08/27/2021, the Department sent out a Provider Information Notice (PIN) Summary 21-17.2-ASC to all licensed facilities with best practices for visitation which stated, ‘limit the number of visitors on the facility premises at any one time to avoid having large groups congregate’. Per Administrator interviews, they try to create a schedule so there aren’t overlapping visits or too many families visiting at the same time. Administrator stated to suggesting Sunday’s from 11am – 1pm as the set date and time for R1’s family to visit R1. Interviews conducted revealed that R1’s family members were asked not to come unannounced and it was better to schedule in advance. Interviews with random family members revealed that earlier in the pandemic, they had to call ahead to make sure it was okay to come visit. Although family members were asked to call ahead and schedule, there were no concerns in doing so afterwards as a family member stated, ‘we usually send a text message giving them a heads up that we are on our way’. Based on interviews and record review, the Department does not have sufficient evidence to support the allegation of “facility is not following their visiting policy”. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. No citations issued. A copy of report provided via email. COntinued from LIC 9099A... It was alleged that facility is not allowing residents responsible person access to residents records. On 11/14/2021, Resident #1’s (R1’s) Power of Attorney (POA) had verbally asked facility to obtain any of R1’s records. But they were told that they were entitled to none and could not see any files. Interviews with the Administrator revealed that if someone puts in a request for records, they prepare the documents, and the receiving party has to ‘sign off’ on the documents that were received. Per record review, on 11/18/2021, R1’s POA submitted a written request to the Administrator of A Loving Heart Senior Care requesting ‘copies of all resident files’. Yet, the Administrator denied ever being asked about reviewing or obtaining records. Additionally, Administrator claimed, ‘when people ask, I give it to them’ and added that R1’s responsible party requested records on 11/21/2021, which she then informed them that they were ‘in the process of updating the records’. Although documents were finally released, they were not released to the requesting party within the time allotted by regulations. Therefore, based on interviews and documents obtained and reviewed, the allegation “facility is not allowing residents responsible person access to residents records” is deemed Substantiated at this time. It was also alleged that facility increased resident rate without a change in residents’ level of care. Facility sent R1’s POA an email on 8/19/2021 that explained how the level of care of R1 had changed since being admitted to the facility. Record review of HH nurses notes from 6/18/2021 revealed R1 was initially assessed as ‘unable to transfer self and is unable to bear weight or pivot when transferred by another person’. Also, assessment noted R1 to be ‘totally dependent in toileting’. Interviews with the Administrator revealed that R1’s care needs ‘drastically changed’ and they had to pay staff more. Additionally, per the Administrator, after R1’s hospitalization, R1 could no longer bear weight, legs were swollen, needed to go to the bathroom more often, and needed regular transfer assistance. Although an email was provided to R1’s family, the Administrator admitted to not providing an updated appraisal or physician’s report as they stated they ‘could not keep up with all the paperwork’. Additionally, the Administrator gave R1’s POA notice regarding fee increase but did not discuss the change in care plan with both R1’s POA and PCP. Based on all information gathered during the course of the investigation, the above allegation, “facility increased resident rate without a change in residents’ level of care” is deemed Substantiated at this time. ...Continued from LIC 9099C... Continued from LIC 9099C... It was further alleged that facility retained resident with a prohibited health condition and facility did not meet residents’ needs. It was reported that on 11/21/2021, R1 was evaluated and found to have a pressure injury on their sacrum. Information obtained revealed R1 was admitted to this facility on 06/14/2021 as non-ambulatory, wheelchair bound and had been previously assessed to have a history of skin condition or breakdown. Record review of Physician’s Orders revealed R1’s PCP referred R1 to Infinite Home Health (HH) on 6/24/2021 for wound care as R1 had a skin tear on their right leg. HH nurse was going to the facility every weekday to perform wound care and assess R1’s level of pain. During these visits, HH nurse was also conducting full body checks. On 10/11/2021, HH nurse notes stated R1 had four (4) open wounds and hx issues to buttocks. Additionally, HH nurse continuously educated facility staff on ‘repositioning and protection of bony prominences’ and staff ‘verbalized understanding of education provided’. Interviews revealed R1 was taken out of the facility for a doctor’s appointment on 11/12/2021. Administrator stated that when R1’s family took R1 out of the facility for two (2) hours with the vascular doctor, they obtained a bruise. Consequently, R1 was assessed on 11/15/2021 by a skilled nurse with deep tissue injury / unstageable wound to sacrum. Although both the facility and HH were continuously providing wound care to R1, record review revealed the Administrator was made aware of the pressure injury on R1’s sacrum on 11/15/2021 and both acknowledged and signed off on the nurse’s notes. Furthermore, the Administrator did not have R1 transferred to a hospital or contact R1’s PCP to obtain further instructions regarding the need for higher level of care. Facility retained R1 in the facility for another six (6) days with the unstageable wound. Based on the information and documentation obtained and reviewed, the allegations of “facility retained resident with a prohibited health condition” and “facility did not meet residents’ needs” are deemed Substantiated at this time. The following deficiencies are 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. An immediate $500 civil penalty is being assessed today. The licensee was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f). Exit interview conducted. Citation issued. Appeal Rights discussed. A copy of report provided via email.the state’s words, verbatim · CDSS document, Apr 14, 2022 · control 29-AS-20211116133659

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Apr 14, 2022

87615(a)(1)Prohibited Health Conditions Persons who require health services or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: Stage 3 and 4 pressure sores (dermal ulcers). This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the section cited above as R1 developed an unstageable pressure injury and was retained at the facility without being under hospice care, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 14, 2022

Plan of correction: The Administrator has agreed to the following: 1.) Do an in-house training with staff on Regulation 87615 and submit proof to CCL by 4/29/2022. 2.) Submit a Statement of Understanding, detailing how the facility will maintain compliance of Regulation 87615 and submit to CCL by 4/29/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87668.2(a)(19) · Plan of correction due date: Apr 14, 2022

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning… changes are documented and brought to the attention of the resident's physician and the resident's responsible person. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above as the facility did not properly report or document R1’s change in health condition with both R1’s PCP and POA, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 14, 2022

Plan of correction: The Administrator has agreed to submit a Statement of Understanding, detailing how the facility will maintain compliance of Regulation 87466 and submit to CCL by 4/29/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(19) · Plan of correction due date: Apr 29, 2022

87468.2(a)(19) Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately... (19) To have prompt access to review all of their… records shall be provided within two (2) business days… This requirement was not met as evidenced by: Based on interviews, and record review, the licensee did not comply with the section cited above as they failed to produce requested records to POA within the time allotted by regulation of two (2) business days, which poses a potential risk to the personal rights of residents in care.the state’s words, verbatim · CDSS document, Apr 14, 2022

Plan of correction: The Administrator has agreed to submit a Statement of Understanding, detailing how the facility will maintain compliance of Regulation 87468.1 and submit to CCL by 4/29/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(c) · Plan of correction due date: Apr 29, 2022

87463(c) Reappraisals. (c)The licensee shall arrange a meeting with the resident, the resident’s representative and a representative of the resident’s HH when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above as the licensee did not inform R1’s POA about the change in R1’s condition, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 14, 2022

Plan of correction: POC: The Administrator has agreed to submit a Statement of Understanding, detailing how the facility will maintain compliance of Regulation 87463 and submit to CCL by 4/29/2022.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an unannounced Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint control # 29-AS-20211116133659). The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint. During the course of the investigation, interviews conducted revealed that Resident #1 (R1) was transported to the hospital in July 2021. However, no incident report was provided to Community Care Licensing (CCL). Additionally, on 12/08/2021 Incident Report from 11/24/2021 reporting a 36-hr blackout at the facility and Incident Report from 11/12/2021 reporting R1 was observed with bruising on their sacrum were not submitted timely within the seven (7) days of occurrence as required by the California Code of Regulations. Pursuant to CCR, Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC LIC809-D). Exit interview conducted. Citation issued. Appeal Rights discussed. A copy of report provided via email.the state’s words, verbatim · CDSS document, Apr 14, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Apr 29, 2022

87211(a)(1)(D) Reporting Requirements. A written report shall be submitted to the licensing agency ... within seven days of the occurrence: Any incident which threatens the welfare, safety, or health of any resident. This requirement is not met as evidenced by: Based on interviews and documents received, the licensee did not comply with the section cited above as one (1) incident report was never received and two (2) other incident reports were not received by CCL within 7 days of occurrence, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 14, 2022

Plan of correction: The Administrator has agreed to submit a Statement of Understanding, detailing how the facility will maintain compliance of Regulation 87211 and submit to CCL by 4/29/2022.