Sunshine Health Place

Allegation investigated: Resident sustained injury while in care.

Licensing program Analyst (LPA) Sandra Urena arrived unannounced to conduct a subsequent visit to deliver the findings for the allegation listed above. The LPA met with the Administrator Cilva Toume and explained the reason for the visit. On 04/28/2023, Licensing program Analyst (LPA) Sandra Urena arrived unannounced at the facility at 11:55 a.m. to conduct the initial 10-day visit to investigate the allegation listed above. The LPA was greeted by staff. Staff contacted the Administrator via phone. The LPA met with the Administrator, Cilva Toume, and explained the reason for the visit. LPA conducted staff and resident interviews. During the investigation, the LPA interviewed the complainant, the administrator, hospital staff, facility staff, Resident #1 (R1) and reviewed medical records and other related documents. Continues on LIC 9099C... Unsubstantiated Page 2. On the allegation that the ‘Resident sustained injury while in care’; it is the concern of the complainant that R1 alleged that staff broke both of their arms. To investigate the allegation, on 04/28/2023 at 12:10 p.m. the LPA interviewed R1 about fractures sustained while receiving care at the facility. R1 stated that fractures happened when they fell while they were walking towards the kitchen area; they tripped by the threshold between the hallway and the living room area. R1 stated that they fell forward, slightly to the right landing on the floor, while trying to soften the fall with their hands. R1 stated that they don’t know what made them trip, did not see anything in their way. Staff called 9-1-1, and R1 was taken to the hospital for evaluation. The LPA interviewed hospital staff on 04/28/2023 from 11:00 a.m. to 11:58 a.m. The hospital staff stated that R1 was seen at the hospital two times, the first time on 04/24/2023, and then again on 04/26/2023 due to a fall. Per the hospital staff, R1 accused facility staff of breaking their arms. However, the hospital staff added that the hospital is familiar with R1 making accusations against staff and making 9-1-1 calls for non-emergency reasons. The hospital staff contacted R1’s POA (power of attorney) and asked if they were ok with returning R1 to the facility, given the statements made by R1. The POA stated that they had no problem with R1 returning to the facility once R1 was discharged from the hospital. On 04/28/2023 at 12:20 p.m., the LPA interviewed staff #1(S1) about the fractures, and staff indicated that on 04/24/2023, R1 walking from the bedroom towards the dining room with a cup in their hands; suddenly S1 heard R1 scream and saw R1 on the floor. Per S1, they tried to assist R1 to get up but, R1 complained of pain. Staff called 9-1-1 first, then they contacted the administrator. S1 further stated that they attended to R1 while the paramedics arrived. S1 stated that R1 returned from the hospital to the facility on the same day (04/24/2023) in the evening. S1 stated that the R1 seemed sedated and slept through the night. R1 did not start complaining about pain until the next day. The R1 continued to complain about pain; consequently, R1’s POA was contacted to inform them that they would be sending the R1 back to the hospital due to the pain. When R1 returned from the hospital the second time, they came back with the diagnosis of ‘fractured upper arms’ (humerus). The humerus bone is the long bone located in the upper arm between the shoulder joint and the elbow joint. Continues on LIC 9099C... Page 3. On 04/28/2023 at 12:40 p.m., the LPA interviewed the administrator about the fractures sustained by R1. The administrator stated that R1 was taken to hospital the day of the fall; however, R1 was returned to the facility at around 9:30 p.m. on the same day. Hospital discharge papers did not indicate that R1 had sustained fractures. The following day, R1 started to complain of pain, and 9-1-1 was called again, and R1 was taken back to the hospital. Upon return, the hospital diagnosed R1 with humerus fractures. Furthermore, the administrator added that R1 refuses to use a better pair of slippers, given that the ones R1 uses now, are extremely worn out, making them a tripping hazard. The resident owns a better pair of slippers and still chooses to use the old ones. The LPA conducted a medical record review, and physician’s report on 04/28/2023. The record review was pertaining to the two admissions of R1 to the hospital due to the fall at the facility. Regarding the hospital visit on 04/24/2023, the records indicated the following diagnosis: “Extremities- Moving extremities freely x 4. Musculoskeletal-R1 denies injury. Back-Gross range of motion intact. Neurologic- Alert and oriented. R1 answers questions appropriately. No gross motor weakness. Speech clear.” The report does not indicate if R1 received X-rays for further evaluation of potential fractures or was recommended to receive X-rays. Regarding the hospital visit on 04/26/2023, the records indicated the following diagnosis: “Patient fell two days ago and broke both humerus bones (upper arms). This is treated with immobilization.” Physician’s report indicates that R1 is ambulatory. Based on the information gathered through interviews and record reviewed; the investigation revealed that although R1 sustained an injury while in care, the injury did not happen due to staff inflicting the injury. Staff have encouraged the resident to wear better slippers. The resident owns a better pair of slippers and still chooses to use the old ones. Facility staff provided R1 with immediate care, and emergency services were contacted. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jun 10, 2023 · control 29-AS-20230427135953

Allegation investigated: Resident sustained unexplained injuries while in care. Staff refused to accept resident back to the facility after a hospital visit. Staff are not responding to requests for communication about resident in a timely manner.

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Administrator Cilva Toume and explained the reason for the visit. To investigate, the LPA interviewed staff on 01/30/2023 at 1:44 p.m. and 1:55 p.m. The LPA spoke with a family member of Resident #1 (R1) on 01/30/2023 at 1:07 p.m. and on 1/31/2023 at 3:12 p.m. The LPA also interviewed a staff person at a collateral facility at 1/31/2023 at 1:25 p.m. and, the LPA obtained relevant records. The allegations above pertain to Resident #1 (R1). The investigation revealed that R1 did not reside at this facility and resided at a congregate living facility, which is licensed by the California Department of Public Health. Per the investigation, the allegations are deemed Unfounded at this time. A finding of Unfounded means that the allegations are either false, could not have happened, and/or is without a reasonable basis. Nothe state’s words, verbatim · CDSS document, Feb 1, 2023 · control 29-AS-20230130093413

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 1:45 p.m. The LPA met with Administrator Cilva Toume and explained the reason for the visit. The LPA 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. KITCHEN: Knives were locked inaccessible in the kitchen cabinets, and the chemicals are kept in the garage. Appliances were in operable condition. The facility had a sufficient supply of perishable and non-perishable food. BEDROOMS: Bedrooms were furnished appropriately; beds were observed with clean linens and rooms had sufficient lighting. All direct exits were clear, and no obstructions were noted. RESTROOMS: Restrooms were clean and sanitary with grab bars and non-skid surfaces. At 2:10 p.m., water temperature measured at 124 F. Upon observation, the Administrator adjusted the water tank. Restrooms were fully stocked. Hand-washing signs were observed in all restrooms. COMMON SPACES: There was a hallway closet with extra linens and towels. Smoke and common monoxide detectors were operable at that time. Medications were locked and inaccessible in the kitchen cabinet. Fire extinguisher was fully charged but there was no proof of purchase or it being serviced within the past twelve (12) months. The backyard had furniture and a covered area for resident use. There was an in-ground pool but it was locked at the time of the visit. The side gate was self-latching. While touring the facility with the Administrator, the garage was observed to be unlocked during today’s visit. The washer and dryer were in the garage, along with additional supplies. As the garage was observed to be unlocked at the time of the visit, the chemicals and cleaning supplies were accessible, and over-the-counter medication was observed in the refrigerator in the garage. INFECTION CONTROL: There was a central entry point for screening and temperature checks. The LPA was appropriately screened upon entry into the facility. Staff were wearing appropriate face coverings. Infection Control signs were observed at the entrance into the facility. The facility’s cleaning protocol was sufficient. There was record of staff and resident vaccinations. The Administrator is up to date regarding testing, visitation and vaccine requirements. The Administrator communicated that they needed additional Personal Protection Equipment (PPE); however, they have a sufficient supply at this time. The facility continues to conduct surveillance testing of staff and residents on a regular basis. The facility's procedures as it pertains to infection control are adequate. Observed deficiencies noted on LIC 809D. Exit interview conducted, and a copy of this report issued. Appeal rights discussed.the state’s words, verbatim · CDSS document, Dec 5, 2022

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.

Allegation investigated: Staff made inappropriate sexual advances to resident in care.

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for a subsequent complaint visit to deliver the findings. The LPAs met with Administrator Cilva Toume and explained the reason for the visit. During the initial visit conducted on 10/22/2021, LPA Salia Walker conducted a plant tour at 9:50 a.m., interviewed staff from 9:05 a.m. – 10:41 a.m., completed a file review from 11:06 a.m. – 11:48 a.m., and interviewed residents from 10:41 a.m. – 1:05 p.m. During a visit conducted on 11/19/2021, LPA Ashley Smith and LPA Elsie Campos conducted observations from 9:00 a.m. - 9:45 a.m., interviewed a Resident #1 (R1) at 9:05 a.m., interviewed staff at 9:45 a.m. and 1:10 p.m., conducted a medication audit from 10:10 a.m. - 11:00 a.m., and observed a resident's bedroom at 10:40 a.m. CONT 9099-C Unsubstantiated Regarding the allegation: Staff made inappropriate sexual advances to resident in care It was alleged that Staff #1 (S1) made sexual advances towards R1. A file review revealed that a similar allegation was made in complaint control # 29-AS-20210603101611, in which R1 made claims that staff at this facility were sexually abusing them. That allegation was unsubstantiated. Interviews with witnesses, staff, and residents negated claims that this took place. During that investigation, the LPA interviewed S1, whom commented that R1 continually made allegations that S1 was a ‘homosexual’ and making sexual advances toward R1, yet S1 repeatedly negated these claims and stated that the claims made them uncomfortable. Interviews conducted with staff revealed that they have not observed their coworkers acting inappropriately with residents, and were trained to report all types of abuse, both observed, overheard, and/or disclosed. Regarding this complaint, it was confirmed that S1 no longer works at this facility due to the repeated claims. Resident interviews revealed that residents feel comfortable residing in this facility and believe they are being treated well. Residents denied claims of abuse from staff and stated that staff maintained appropriate relationships and boundaries with the residents. Based on the investigation, there is insufficient evidence to support the claim that staff made inappropriate sexual advances to R1. This allegation is deemed Unsubstantiated at this time. No deficiencies cited regarding this allegation at this time. Exit interview conducted. A copy of the report was issued. Regarding the allegation: Staff are not administering medication(s) to resident according to physician’s instructions. It was alleged that R1 was not getting their medications consistently. Interviews with residents revealed that in general, they believed they received their medication on time and were unaware of any errors. During the medication audit conducted on 11/19/2021, it was revealed that the facility could not account for R1’s Atorvastatin, as it was not centrally stored with R1’s other medications. Staff interviews revealed that when the Atorvastatin was delivered, R1 got upset that it was being centrally stored and allegedly argued with Staff #2 (S2) about the medication. As such, S2 admitted that they gave R1 the medication to store in their room. As such, staff were unable to ensure that R1 was taking the Atorvastatin according to physician’s instructions. In addition, a review of the Centrally Stored Medication and Destruction Record (CSMDR) revealed that R1’s prescribed evening dosage of Quetiapine (Seroquel) was documented as Refused in the section Start Date. Interviews further confirmed that R1 had a prior history of refusing the evening dosage of Quetiapine. As such, rather than offer R1 their evening medication of Quetiapine and giving R1 the option to refuse, S1 admitted to not giving R1 their evening medication as prescribed on 11/19/2021. S1 claimed that they stored it in their room, and then threw the medication away. The LPA could not identify evidence to demonstrate that R1’s repeated refusal was communicated to R1’s primary care physician. During a visit conducted on 11/19/2021, LPA Smith was granted access to tour R1’s room. The LPA observed several loose pills in R1’s drawer, which were identified as Quetiapine pills. In addition, the LPA observed two bottles of medications. One medication was identified as Crestor, and the other pill box had a mix of multiple unidentified medications. After touring R1’s room, the LPA alleged that the loose Quetiapine pills were from times in which staff attempted to assist R1 with the evening dosage of Quetiapine and rather than observing R1 taking the medication, the pill(s) were left with R1 and staff assumed that R1 took the medication. Based on the investigation, there is sufficient evidence to support the claim that staff were not assisting R1 with the self-administration of medication(s) according to physician’s instructions. This 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). Exit interview conducted. A copy of the report, and appeal rights, were issued.the state’s words, verbatim · CDSS document, Jan 10, 2022 · control 29-AS-20211021091951

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a) · Plan of correction due date: Jan 17, 2022

87465(a)(5) Incidental Medical and Dental Care. (5) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above regarding R1’s evening dosage of Quetiapine or Atorvastatin, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 10, 2022

Plan of correction: The Administrator agreed to the following: 1. Submit a Statement of Understanding, noting how the facility will maintain compliance with Regulation 87465. Submit statement to CCL by POC date. 2. Complete an in-service medication training for staff. Be sure to discuss protocol for administering medications and documenting refusals. Submit proof of completion to CCL by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(i) · Plan of correction due date: Jan 17, 2022

87465(i) Incidental Medical and Dental Care. Prescription medications which are not taken with the resident ... which are otherwise to be disposed of shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above, as staff admitted to improperly disposing of R1’s medications in the trash can, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 10, 2022

Plan of correction: The Administrator has agreed to do the following: Complete an in-service medication training for staff. Be sure to discuss protocol for administering medications and documenting refusals. Submit proof of completion to CCL by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ashley Smith arrived at the facility unannounced to conduct a required annual visit at 10:00am. This annual had a specific emphasis on infection control practices and procedures. When the LPA arrived, there was two staff and six residents present. The LPA met with Administrator Cilva Toume and explained the reason for the visit. The LPAs 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. KITCHEN: Knives are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: The LPAs observed the single-occupancy resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed all the required postings in the foyer, bathroom and the common spaces. The backyard has a covered outdoor area with furniture for resident use. There is an in-ground pool; at 10:20 a.m., whereas the lock was engaged, the LPA was able to open the gate without issue. The LPA observed that the self-latch was rusted. Once observed, the Administrator ensured that the gate was locked within five minutes of observing the unlocked gate. The LPA observed that the gate was locked at 11:28 a.m. The LPA explained the reason as to why a citation was being issued for a zero-tolerance violation. The Administrator believed that the citation should have been waived, as the gate was secured within five minutes. INFECTION CONTROL: During today’s visit, the LPA spoke with the 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 LPAs observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The Administrator asked for additional PPE supplies. 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 has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. Observed deficiencies noted on LIC 809D. Exit interview conducted, and a copy of this report issued. Civll penalties assessed. Appeal rights discussed.the state’s words, verbatim · CDSS document, Jan 10, 2022

Allegation investigated: Facility staff are sexually abusing resident. Facility staff are physically abusing resident. Facility staff are mentally abusing resident. Facility staff are putting glass in resident's food.

Licensing Program Analysts (LPAs) Ashley Smith and Salia Walker arrived unannounced for a subsequent complanit visit to deliver findings for the above allegations. The LPAs met with Administrator Cilva Toume and explained the reason for the visit. On 06/03/2021, the Department received a complaint, alleging that facility staff were abusing Resident #1 (R1) sexually, physically, and mentally. It was also alleged that the staff were grinding up glass and putting it in R1’s food. LPA Zabel Chochian conducted the initial visit on 06/07/2021 and during that visit, interviewed five residents and reviewed records from 12:30 p.m. to 1:30 p.m.. LPA Smith conducted a subsequent visit on 06/25/2021 and interviewed six residents from 9:35 a.m. – 10:45 a.m., and interviewed staff at 9:54 a.m., and 11:02 a.m., and 11:16 a.m.. Also, the LPA interviewed a family member for R1 on 6/22/2021 at 5:05 p.m.. CONT 9099-C Unsubstantiated Regarding the allegation: Facility staff are sexually abusing resident It was alleged that staff were going into R1’s room at night and sexually abusing R1. The interview with R1 revealed varying statements in which R1 did not identify whom was harming R1, as R1 stated that it happened while they were in a deep sleep. When asked if they were touched inappropriately, R1 claimed that they did not ‘blame anyone’ in the home and did not reference any encounters but believed that a staff in the home was sexually attracted to them. R1’s family member stated that they were comfortable with R1 residing in this facility and stated that due to R1’s mental health diagnosis, R1’s family member believed that R1’s claims have the potential to lack validity. R1’s family member stated that facility staff treat R1 well and had no concerns with the provided care. Interviews conducted with staff revealed that they have not observed their coworkers acting inappropriately with residents, and were trained to report all types of abuse, both observed, overheard, and/or disclosed. Staff denied all claims that they were physically, sexually, or mentally abusing any resident in this facility. Resident interviews revealed that residents felt comfortable residing in this facility and confirmed that they observed appropriate interactions from the staff. Based on the information obtained, there is insufficient evidence to support the claim that facility staff were sexually abusing R1. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: Facility staff are physically abusing resident. It was alleged that staff physically abused R1, which resulted in R1 sustaining a broken jaw. When asked if they had been harmed, R1 made claims that they believed that they had a broken jaw and that it happened while they were asleep. However, R1 was unable to specify who harmed them. Interviews and records review confirmed that R1 never suffered a broken jaw while residing at this facility. R1’s family member stated that they were comfortable with R1 residing in this facility, had never witnessed unexplained bruising on R1, and confirmed that due to R1’s mental health diagnosis, believed that R1’s claims have the potential to lack validity. R1’s family member stated that facility staff treat R1 well and had no concerns with the provided care. Additional resident interviews revealed that residents feel comfortable residing in this facility and believe they are being treated well. Residents denied claims of abuse from staff and stated that staff maintained appropriate relationships and boundaries with the residents. Interviews conducted with staff revealed that they have not observed their coworkers acting inappropriately with residents, and were trained to report all types of abuse, both observed, overheard, and/or disclosed. Staff interviews revealed that if R1 communicated any ailments that they would conduct body checks to assess for any unexplained bruising. The Administrator stated that they trust the staff working alongside the residents and denied having any knowledge of any incidents of abuse in this facility. Based on the information obtained, there is insufficient evidence to support the claim that facility staff were physically abusing R1. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: Facility staff are mentally abusing resident. It was alleged that facility staff were disrespecting R1, by not listening to R1 when they communicate concerns. During the 6/25/2021 visit, the LPA observed staff appropriately interacting with R1 and were responsive to R1’s claims and needs. The LPA did not observe staff yelling, negating R1’s claims, nor did the LPA observe staff dismiss any of R1’s claims. R1’s family member stated that facility staff treat R1 well and had no concerns with the provided care. Resident interviews revealed that residents feel comfortable residing in this facility and believe they are being treated well. Residents stated that R1 was also treated well but admitted that R1 would sometimes get into verbal altercations with staff, make false accusations against staff and would often call 9-1-1. However, residents stated that R1’s behaviors were observed to be independent from any negative or adverse interaction from staff. Based on the information obtained, there is insufficient evidence to support the claim that facility staff were mentally abusing R1. This allegation is deemed Unsubstantiated at this time. Regarding the allegation: Facility staff are putting glass in resident's food. It was alleged that staff were putting glass in R1’s food. When questioned about food service in the home, R1 had complimentary things to say in regard to their preferred meals, and stated that staff would follow their dietary restrictions. Whereas R1 denied claims that glass was being placed in the food, R1 stated that there was ‘something wrong’ with the food yet did not elaborate when questioned. If anything, R1 claimed that the medication they took had affected their stomach. R1’s family member stated that they were comfortable with R1 residing in this facility and confirmed that due to R1’s mental health diagnosis, believed that R1’s claims have the potential to lack validity. Additional resident interviews revealed that residents feel comfortable residing in this facility and believe they are being treated well. Residents negated claims that items were being placed in the food and communicated that they were being fed well. Lastly, staff denied claims that glass or other foreign objects were placed in R1’s food, and confirmed that they upheld all dietary preferences for the residents. Based on the information obtained, there is insufficient evidence to support the claim that facility staff are putting glass in R1’s food. This allegation is deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Jul 12, 2021 · control 29-AS-20210603101611