Anita's Care Villa

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at 9:30 a.m. The LPA met with Administrator Jennifer Shaffer and explained the reason for the visit. The LPA,and staff toured the physical plant areas at 9:45 a.m. inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. BEDROOMS: The LPA began the inspection in bedroom area at 9:45 a.m. Bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. There are four designated client rooms and one staff room. There was a linen closet in the hallway with extra towels and linens. The LPA observed accessible over the counter medications and prescription medications in a box in bedroom #4. RESTROOMS: The two client restrooms were clean and sanitary and in operating condition with grab bars and non-skid surfaces. The bathrooms were sufficiently stocked with soap and paper towels. The hot water temperature measured in the hallway restroom at 118.2 degrees Fahrenheit. Accessible prescription mouthwash was observed by the LPA at 9:51 a.m. and unlocked cabinet in the hallway bathroom, cleaning supplies and hygiene items were observed to be unlocked under the kitchen sink. Accessible cleaning supplies were observed in bathroom inside bedroom #4. All accessible items were locked at the time of the visit. KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable food and non-perishable food. At 10:05 a.m., the LPA and the Administrator observed expired grape juice dated 5/4/2023, exposed bag of powdered mash potatoes with unverifiable expiration date, exposed pancake mix with unverifiable expiration date, moldy broccoli in the refrigerator along with expired tomatoes, cabbage, exposed cut vegetables, open bag of frozen shrimp with freezer burn, open bag of frozen waffles with freezer burn, and exposed frozen meats with freezer burn. Continues on LIC 809C... The Administrator was advised to do a deep cleaning of the kitchen and conduct an audit of their food items. Staff cleaned refrigerator and disposed of expired items at the time of the visit. Centrally stored medication is kept in a kitchen cabinet which was observed to be unlocked at the time of the visit. 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. Fire extinguisher was observed to be serviced on 4/10/2023 and fire alarm was tested at 10:28 a.m. and observed to be functioning at the time of the visit. The facility maintained a temperature of 73 degrees. All exits have functioning auditory devices. The LPA and the administrator observed the required postings in the common area. The backyard has a covered outdoor area equipped with furniture for resident use. The side gate door is self-latching however was observed to be in disrepair. Storage shack was observed to be unlocked as the door was in disrepair, storage shack contained gardening supplies and chemicals accessible to residents in care. There were no bodies of water noted. The garage is attached to the home which houses the laundry area. The garage was locked at the time of the visit. RECORDS: Residents’ records review began at 10:50 a.m., records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. 2 out of 5 records were in order. Resident #1 (R1), Resident #2 (R2) and Resident #3 (R3) were missing singed resident rights and signed consent forms additionally R1 was missing a needs and services plan. Personnel records were reviewed for, but not limited to health assessments, criminal record clearances, first aid/CPR training, and the appropriate training. All files were in order. MEDICATIONS: Medications review began at 12:45 p.m., medications are centrally stored and kept in a locked cabinet in the kitchen which was observed to be unlocked at the time of the visit. Medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record. No errors observed during the medication review. INFECTION CONTROL: 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 a single isolation room if the facility has a confirmed case of COVID-19. Continues on LIC 809C... The LPA obtained the following documents: LIC500 Personnel Report, LIC9020 Client Roster. 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 was conducted. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 2, 2023

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management – Other inspection at the facility due to a Civil Penalty not being assessed during complaint investigation control number 29-AS-20220104110534. The LPA met with Administrator Jennifer Shaffer. Entrance interview conducted. It was revealed during the course of the investigation, that although Resident #1 (R1) had three (3) pressure injuries when admitted to the facility. R1 developed additional pressure injuries while in care. On 6/24/2022, LPA Arroyo substantiated allegation: resident developed pressure injuries while in care as R1 was reassessed after 90 days of being admitted to the above facility and was noted to have new wounds which included one (1) unstageable pressure injury on the right malleolus and two (2) stage 3 pressure injuries on the right hip and on the right buttock. Additionally, facility was cited on a separate case management-deficiencies on 6/24/2022 for admitting and retaining R1 in the facility with a stage 3 or higher pressure injury without being on hospice and there were no records indicating that an exception request was submitted in order for R1 to be admitted or to remain at the facility. Civil penalties in the amount of $500 is being assessed today for citation previously issued on 6/24/2022 for deficiency 87615(a)(1) – Prohibited Health Conditions. Due to a glitch in the system, the LIC 421IM for the immediate $500 civil penalty was unable to be assessed through citation previously issued on 6/24/2022 and therefore, will be issued manually. Exit interview. Appeal Rights discussed. Copy of the report provided to the Administrator via email.the state’s words, verbatim · CDSS document, Dec 1, 2022

Allegation investigated: Resident developed pressure injuries while in care

Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegation. The initial visit was conducted on 1/13/2022 by LPA Guzman Chavez. On today’s visit, LPA Arroyo met with Administrator, Jennifer Shaffer. Entrance interview conducted. During the initial visit on 1/13/2022, at 1:35 p.m., LPA Guzman Chavez toured the facility, conducted interviews with the administrator, two staff, one resident, and obtained copies of pertinent documents. Medical Records were also obtained during the course of the investigation. It was alleged that “resident developed pressure injuries while in care”. It was reported that Resident #1 (R1) had 2 open wounds and a scab when admitted to the facility, and later on developed new wounds. ...Continued on LIC 9099C... Substantiated ...Continued from LIC 9099... Information obtained revealed R1 was admitted to the facility on 12/02/21 as non-ambulatory, requiring continuous bed care in assisting with repositioning, and required assistance of another person with activities of daily living (ADL’s) including bathing, dressing, and toileting. Record review of R1’s Resident Appraisal stated R1 was unable to move lower extremities, needed help with transfers, legs were swollen, and noted R1 to have a sore on their heel. Before admission to the facility, on 11/27/2021, R1 was assessed by DaranCare Home Health. During the assessment, R1 was noted to have a Stage 3 pressure injury on the left heel, with measurements of 2cm x 3cm x 0.2cm; and a Stage 2 pressure injury on right lateral malleolus, with measurement of 1cm x 1cm x 0.2cm. On 11/23/2021, three (3) facilities were contacted on behalf of R1 by their social worker and two (2) declined resident due to needs and services R1 required. However, Anita’s Care Villa accepted R1. Additionally, R1’s Admissions Agreement signed on 11/24/2022 states under Basic Services, facility will provide assistance with personal activities of daily living including dressing, eating, toileting, bathing, grooming, mobility tasks, and other personal care needs. According to R1’s medical records, R1 was scheduled for wound care for pressure injuries from 11/08/2021 to 01/06/2022 from DaranCare Home Health. Interviews conducted with facility staff and medical records review, confirmed that R1 was admitted to the facility with at least two (2) pressure injuries and both Staff and Administrator were aware of R1 having pressure injuries. Yet, R1 was still admitted to the facility. On 1/03/2022, R1 was reassessed again after 90 days and was noted to have new wounds. On 1/03/2021, R1 was noted to have an Unstageable pressure injury on the right lateral malleolus, with measurements of 3.5cm x 2.5cm x 0.5cm; a Stage 3 pressure injury on the right hip, with measurements of 0.75cm x 1.75cm x 0.2cm; and a Stage 3 pressure injury on the right buttock, with measurements of 1.5cm x 1.5cm x 0cm. Administrator stated that R1’s repositioning requirement every 2 hours by Home Health was a different level of care. Additionally, staff stated they were turning R1 every 2 hours while in bed, and the new pressure injuries were from R1 sitting on their wheelchair all day. However, facility did not have any records indicating how often they were repositioning R1. Moreover, Home Health nurse stated that new wounds are due to pressure from lying and not sitting. ...Continued on LIC 9099C... ...Continued from LIC 9099C... Furthermore, nurse notes revealed that nurse was continuously providing education to the caregivers on the importance of turning and repositioning R1 every 2 hours. Although R1 was receiving appropriate wound care from Home Health for the stage 3 and unstageable pressure injuries while at the facility by DaranCare Home Health, a stage 3 and unstageable pressure injuries are considered a Prohibited Health Condition. There were no records indicating that an exception request was submitted in order for R1 to be admitted or to remain at the facility. Based on the information and documentation obtained and reviewed, the allegations of “resident developed pressure injuries while in care” is deemed Substantiated at this time. Per California Code of Regulations (CCR), Title 22, see LIC 9099-D for deficiencies cited. Exit interview. Appeal Rights discussed. Copy of the report sent to the Administrator via email.the state’s words, verbatim · CDSS document, Jun 24, 2022 · control 29-AS-20220104110534

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(d) · Plan of correction due date: Jun 25, 2022

87464(d) Basic Services. A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457…This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as the facility did not ensure that R1’s care needs were met, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2022

Plan of correction: The Administrator has agreed to submit a Statement of Understanding, explaining the steps the facility will follow to avoid similar issues from happening again and to ensure compliance to regulation regarding meeting basic care needs of the residents and submit to CCL by 7/01/2022.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Martha Arroyo arrived at the facility unannounced to conduct a required annual visit at 10:00 a.m. This annual has a specific emphasis on infection control practices and procedures. The last annual conducted at this facility was on 05/20/2019. The LPA was greeted at the door by staff, Cornelio. Staff called Administrator and she was explained the reason for today's visit. Entrance interview conducted. At 10:16 a.m., the LPA began the physical plant tour with staff, Apreal of the common areas, kitchen area, resident bedrooms, bathrooms, staff room, and outdoor area to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen/dining area to be clean and kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. The LPA observed the kitchen refrigerator to be fully stocked at the time of visit. Knives and sharps are locked in a cabinet inaccessible to residents. Medications were observed in a locked cabinet in the kitchen inaccessible to resident in care. BEDROOMS: The LPA observed the resident rooms, which were furnished appropriately with clean linens, furnishings, and sufficient lighting. RESTROOMS: Resident restrooms are clean and sanitary and in operating condition with grab bars and non-skid surfaces. Restrooms are sufficiently stocked with hand liquid soap and paper towels. The LPA observed two bathrooms for resident use. The first bathroom was measured at 104 degrees Fahrenheit and the second bathroom measured at 96.8 degrees Fahrenheit. ...Continued on LIC 809C... ...Continued from LIC 809... COMMON SPACES: The LPA observed the living room area which is clean and properly furnished with seating, a table, and television for resident use. The fire extinguishers were fully charged and were last serviced 04/2022. All exits have functioning auditory devices. The LPA observed one (1) resident in the living room watching television during time of visit. GARAGE AND GROUNDS: The garage is locked and attached to the house. The LPA observed a covered patio area with patio furniture including a table and chairs for resident use. Facility has one (1) fence gate that self-latches with clear passageways for emergency exit use. No large bodies of water accessible to residents at the time of visit. During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. The LPA observed appropriate signage which promoted good hand hygiene, physical distancing, symptoms of COVID-19, CDSS PINS, and Emergency Exit plans posted at the time of visit. The facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. Staff were observed wearing face coverings. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. All staff and residents are fully vaccinated and boosted. No identified staffing concerns. The facility is in compliance regarding the requirements for indoor and outdoor visitation. The facility’s policies and procedures as it pertains to infection control are adequate. Pursuant to Title 22, California Code of Regulations, the following deficiencies will be cited (refer to LIC 9099-D) Exit interview conducted. Appeal Rights discussed. A copy of this report was sent via email to Administrator.the state’s words, verbatim · CDSS document, Jun 24, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management - Deficiencies inspection at the facility due to a deficiency observed during complaint investigation control number 29-AS-20220104110534. The LPA met with Administrator Jennifer Shaffer. Entrance interview conducted. Per record review, on 12/02/2021, Resident #1 (R1) was admitted to the facility with a Stage 3 pressure injury on the left heel, with measurements of 2cm x 3cm x 0.2cm; and a Stage 2 pressure injury on right lateral malleolus, with measurement of 1cm x 1cm x 0.2cm. Still, R1 was admitted to and retained in this facility with a Stage 3 or higher without being on hospice. Furthermore, Medical Records obtained and reviewed from 1/03/2021 indicated R1 had an Unstageable pressure injury on the right lateral malleolus, with measurements of 3.5cm x 2.5cm x 0.5cm; a Stage 3 pressure injury on the right hip, with measurements of 0.75cm x 1.75cm x 0.2cm; and a Stage 3 pressure injury on the right buttock, with measurements of 1.5cm x 1.5cm x 0cm. Additionally, a stage 3 and unstageable pressure injuries are considered a Prohibited Health Condition. There were no records indicating that an exception request was submitted in order for R1 to be admitted or to remain at the facility. Per California Code of Regulations (CCR), Title 22, see LIC 9099-D for deficiencies cited. Exit interview. Appeal Rights discussed. Copy of the report sent to the Administrator via email.the state’s words, verbatim · CDSS document, Jun 24, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Jun 25, 2022

87615(a)(1) Prohibited Health Conditions. (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained...: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by: Based on interview and records review, the licensee did not comply with the section cited above, as they admitted and retained R1 in the facility with a prohibited health condition, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 24, 2022

Plan of correction: The Administrators agree to do the following: Review Regulation 87615 and submit a Statement of Understanding, detailing how the facility will maintain in compliance moving forward and submit to CCL by 07/01/2022.

Allegation investigated: Facility failed to provide resident's records to resident's authorized representative

Licensing Program Analyst (LPA), Martha Guzman Chavez conducted an initial 10-day complaint visit to the above facility. Upon arrival, LPA Guzman Chavez met with Administrator Jennifer Shaffer and explained the reason for the visit. Entrance interview conducted. During today’s visit, the LPA toured the facility at 9:15 a.m., interviewed the Administrator at 9:30 a.m., and obtained copies of pertinent documents relevant to the investigation. It was alleged that on 05/18/2022, “Facility staff failed to provide resident's records to resident's authorized representative.” It was reported that on 5/16/2022, a letter requesting all medical records was sent to Anita’s Care Villa by the law firm representing the Power of Attorney (POA) of a resident. Additionally, the Authorization for the Release of Medical Information was also attached to the request. Continued on LIC 9099C... Substantiated Continued from LIC 9099... During the course of the investigation, it was revealed that documents were not released to the requesting party within the time allotted by regulations. Furthermore, interviews and documentation reviewed revealed that the request made by the POA’s representative was received by the facility on 5/18/2022. Additional interviews revealed that facility had reached out to POA’s representative to acknowledge request being received; however, they felt they would not be able to gather all documents together by the deadline given as there were hundreds of pages. Review of documents revealed that resident’s files and medical records were not provided to the POA’s representative by 5/20/2022. Based on interviews and documents obtained and reviewed, the allegation “Facility failed to provide resident's records to resident's authorized representative is deemed Substantiated at this time. Pursuant to Title 22, California Code of Regulations, the following deficiency will be cited (refer to LIC 9099-D) Exit interview conducted, citations issued, appeal rights discussed, and a copy of this report sent via email.the state’s words, verbatim · CDSS document, May 31, 2022 · control 29-AS-20220523095227

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(19) · Plan of correction due date: Jun 3, 2022

87468.2(19) Additional Personal Rights of Residents in Privately Operated Facilities. (19)To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied 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 meet the section cited above as they failed to produce records requested by POA’s Representative, which poses a potential risk to the personal rights of residents in care.the state’s words, verbatim · CDSS document, May 31, 2022

Plan of correction: The Licensee has agreed to provide LPA with tracking number of documents mailed to POA Representative, which will be delivered by today 5/31/2022 and will submit a Statement of Understanding detailing the importance of Regulation 87468.2 and submit by 6/03/2022.