Valley View Care Home III

Type of visit: Required - 1 Year

On 08/07/23 around 09:15 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a required annual inspection. LPA was greeted by one care staff upon entry and explained the purpose of the visit. Joel Aliping, Administrator (ADM) currently holds a standard certificate #(6016976740) exp. 05/24/2024. The facility’s fire clearance was approved for six (6), three (3) may be non-ambulatory residents. Upon entry, LPA observed one (1) resident watching television and the other lounging in his/her recliner chair. LPA and ADM toured the facility including, but not limited to common areas, bathrooms, bedrooms, kitchen, garage, and backyard. LPA observed mask, cough etiquette, social distancing and hand washing signs posted throughout. Routine safety drills are rotational between AM and PM schedules monthly, and was last completed 07/2023. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All hand washing stations were equipped with soap, paper towels and garbage cans. There is a surplus of PPE centrally stored in the garage that is accessible to all care staff. Hot water temperature in the shared residents' bathroom was measured at 106.4 degrees Fahrenheit (F) and the facility's temperature was 78 degrees (F). Fire extinguisher was observed full and purchased 08/06/23. Smoke/Carbon Monoxide detectors were observed operational and two (2) first aid kits are complete. continued on LIC809C... ...continued from LIC809. LPA reviewed three (3) staff files; they were complete with criminal background clearances, and three (3) completed resident files. The following forms are to be updated and submitted to CCLD: -LIC500 Personnel Report -LIC308 Designation of Administrative Responsibility -LIC610 Emergency Disaster Plan -An updated copy of Administrator Certificate(s) (Reviewed) -Liability Insurance Exit interview conducted and a copy of this report provided to ADM.the state’s words, verbatim · CDSS document, Aug 7, 2023

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Facility failed to meet reporting requirements:

Amended report to update findings on 04/24/23 at 10:00 AM from 04/12/23 at 09:00 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint findings for the above allegation. LPA met with Emily Aliping, Co-Administrator (Co-ADM) and explained the purpose for the visit. Facility failed to meet reporting requirements: SUBSTANTIATED During the course of the investigation LPAs L. Holmes and L. Francisco conducted interviews, reviewed emails, after visit summaries, weight records, medical records, incident reports and files for Residents’ (R1, R2 and R3). LPA L. Holmes reviewed seven (7) Incident Reports on file with CCL dated from 05/14/18 to 10/21/21 for R1, R2, R3 and R4. Three (3) of the seven (7) reports did not reference notification to the Responsible Party(s) RP), or to the Regional Center of the East Bay (RCEB). ...continued on LIC9099C Substantiated ...amendment continued from LIC9099 Interviews with W1 revealed that the incident involving R1 diagnosed with pneumonia on 03/01/2020 was not reported to RCEB until 03/13/20, twelve (12) days later. On 04/12/23, S1 did not provide any additional documentation, UIR’s, faxes or emails as proof notification within twenty-four (24) hours or seven (7) days for R1. Type B Deficiency is cited per California Code of Regulations, Title 22, and listed on LIC 809D. Failure to submit Proof of Corrections (POC's) by Plan of Correction date and/or repeat deficiencies within 12-month period may result in civil penalties. Exit interview conducted, Appeal Rights and a copy of this report provided to Co-ADM. ...amendment continued from 9099A The menu consisted of a variety of foods and beverages including, but not limited to, coffee, juice, milk, oranges, pineapples, carrots, salmon, spaghetti, and chicken. On 02/16/23 LPA observed C2 preparing a hot meal on the stove top and preparing place settings to serve lunch for the residents in care. On 11/2/2021 LPA Francisco requested for records for R3 and on subsequent visit 2/16/2023 LPA Holmes requested additional records for R1 and R2 that included physicians reports, after visit summary for medical appointments attended, and weight records for 2020 and 2021. Medical records revealed R3 had a history of being underweight since 06/29/2013. Documentation showed R2 and R3 had slight weight gain during 2021. Interview with W2 in November 2021 stated R3 was improving and eating. Allegation: Licensee does not assist resident with obtaining medical care R1's attending hospital was Kaiser Permanente, Richmond, CA. W1 and S1 did not provide documentation for time period surrounding the allegations for the year 2021. Documentation was received for R2 from appointments attended at Contra Costa Health Services (CCHS) in Martinez, CA and San Pablo, CA for various appointments in February 2021. Each month from May to July 2021 R2 returned for patient recheck visits in ophthalmology without any noted concerns. Documentation was also received for R3’s medical appointments attended at Sutter Health in Berkeley, CA for various appointments in January, February, and May 2021, additionally R3 had monthly visits with podiatrist from January to June in 2021. Documentation did show there were overdue vaccines and rescheduled appointments. S1 stated that overdue or rescheduled appointments may have been related to COVID-19 procedures or residents' behavior. S1 and S3 was able to secure a physician for facility visits. Based on interviews and record review the allegations above may have happened or is valid, however there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 12, 2023 · control 15-AS-20211028125726

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Apr 19, 2023

87211 Reporting Requirements (a) Each licensee shall furnish...such reports...including, but not limited to, the following: (1) A written report shall be submitted...to person responsible for the resident within seven days…-This requirement has not been met as evidenced by: Based on LPAs records review and interviews, Licensee/Administrator failed to ensure that a written report of the residents’ occurrences were submitted to the responsible party and CCL.the state’s words, verbatim · CDSS document, Apr 12, 2023

Plan of correction: Licensee/Administrator agreed to review regulation 87211 with staff, report incidents to RP’s and CCLD, self-certify completion, and submit written proof to CCL by POC date.

Type of visit: Case Management - Other

On 04/12/23 at 10:05 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver complaint finding for #15-AS-20211028125726. A case management is being conducted and LPA met with Emily Aliping, Co-Administrator (Co-ADM) and explained the reason. The “After visit summaries” for R2 revealed the following on the noted dates: On 07/07/21, overdue visits for COVID-19 vaccine (2-Pfizer 2 dose series); overdue since 02/21/21, postponed to 05/19/21 and 07/02/21. The Shingles vaccination sequential (2 of 2) was overdue since 03/19/21. On 08/04/21, ophthalmology visit was rescheduled for R2 by S1. Proof of R1, R2, and R3’s dental and ophthalmology exams, and/or attempts to schedule exams were not provided to CCL by 03/24/23 when requested from S1 on 02/16/23. Deficiency is cited per California Code of Regulations, Title 22, and listed on LIC 809D. Failure to submit Proof of Corrections (POC's) by Plan of Correction date and/or repeat deficiencies within 12-month period may result in civil penalties. Exit interview conducted, Appeal Rights and a copy of this report provide to Co-ADM,the state’s words, verbatim · CDSS document, Apr 12, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(6) · Plan of correction due date: Apr 19, 2023

87464 Basic Services (f) Basic services shall at a minimum include: (6) Arrangements to meet health needs, including arranging transportation, as specified in Section 87465, Incidental Medical and Dental Care Services. -This requirement has not been met as evidenced by: Based on LPAs records review and interviews, Licensee/Administrator failed to ensure R2’s vaccinations were current and provide proof of residents dental and ophthalmology exams.the state’s words, verbatim · CDSS document, Apr 12, 2023

Plan of correction: Licensee/Administrator agreed to review regulation 87464 and resident records in order to make arrangements to meet health needs of residents in care. Submit written proof of self-certification to CCL by POC date.

Allegation investigated: Appropriate administrator is not present on the facility premises a sufficient number of hours

On 02/16/2023 at 09:15 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an initial 10-day complaint visit. Upon arrival, LPA met with Care Staff Margarita Dulagan and explained to the reason for the visit. Joel Aliping, Administrator arrived about 10 minutes later. During the investigation, LPA interviewed Staff #1 (S1), Staff #2 (S2), Staff #3 (S3, and Witness #1 (W1). LPA reviewed Guardian and sent an email to S1 and S3 requesting the facility’s LIC 308, LIC 500, and Resident Roster. During the visit, LPA interviewed S3, obtained a Resident Roster and Direct Care Staff Schedule. continued on LIC 9099C... Substantiated ...continued from LIC 9099 While conducting interviews on 02/13/23, S1, S2, and W1 stated that S3 was in the Philippines. S1 stated that he/she is the Administrator of Valley View Care Home II and that S2 and W1 were overseeing the residents while S3 was out of the country; S3 is the Co-Administrator at Valley View Care Home III. Although S1 and S3 are both Administrators and Licensees, S1 states that S3 oversees this facility. W1 confirmed working or volunteering 2 -3 hours a day as needed at the facility helping with groceries and prescriptions to help S3 while out of the country. Guardian records revealed that W1 is not associated with the facility. S2 stated that he/she has been providing 24 hours of care since 12/25/22 with the companionship of W1. Although S1 is also the Co-Administrator and Licensee for this facility, S1 said that she is the Administrator and only oversees Valley View Care Home II. Per RP, this facility is vendored by RCEB and sufficient staff was not on the premises since 12/25/2022. S3 did not inform CCL of his/her absence, there is not an LIC 500 or LIC 308 on file. The most current Direct Care Staff Schedule is dated 10/31/2022 to 11/06/2022 with S2 and S3 as the care staff. Based on LPA’s interviews conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D and civil penalty assessments on LIC 421. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Feb 16, 2023 · control 15-AS-20230210082022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(d) · Plan of correction due date: Feb 16, 2023

87355 Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. -This requirement is not met as evidenced by -Based on interviews and review of records, the licensee did not comply with the above Regulation by not associating and obtaining Criminal Record Clearance for the W1 which poses a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Feb 16, 2023

Plan of correction: On 02/13/23 W1 agreed to not assist residents in care at the facility. Administartor to submit documentation to Guardian or CCLD for Criminal Record Clearance on 03/02/2023

From the deficiency page — Deficiency type: Type B · Section cited: HSC 87411(a) · Plan of correction due date: Feb 23, 2023

87411 Personnel Requirements – General (a)Facility personnel shall at all times be sufficient in numbers...Additional staff shall be employed... to perform office work, cooking, house cleaning, laundering... -This requirement is not met as evidenced by Based on interviews and review of records, the Administrator/Licensee did not comply with the above Regulation by facility personnel not being sufficient in numbers.the state’s words, verbatim · CDSS document, Feb 16, 2023

Plan of correction: Administrator to submit an updated LIC 500, read the regulation 87411 and submit self-certification to CCLD by POC date.

Allegation investigated: Resident(s) sustained multiple injuries while in care at facility Staff did not meet incontinence needs of residents/clients resulting to septic shock Staff yelled in front of resident(s) or client/s

On 10/03/2022 at around 10:45AM, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to deliver complaint findings for the allegations above. Upon arrival, LPA met with Administrator Joel Aliping and explained to the reason for the visit. During the course of the investigation, the Department conducted interviews with staff, residents/clients, health providers, and complainant. Clients medical records and facility file, incident report, and facility’s correspondence with health providers were obtained and reviewed. …Continued to LIC9099C… Unsubstantiated Allegation: Resident(s) sustained injuries while in care at facility. During the course of investigation, records review indicated that C3 was brought to emergency room on 1/6/2022 due to chief complaint of “resident getting weaker”. Upon admission at the emergency department, records review indicated that C3 was referred to a doctor for wound evaluation for “potential or confirmed pressure injury sacrum/buttock” , records indicated that wound is closed, none serous filled blister, no odor, no edema noted, records also indicated that wound is “not pressure injury”, another hospital records indicated that C3’s right and left heel had wound, however hospital records did not indicate the stage of wound, records reveal no sign of infection, skin was dry and intact. C3 was not admitted to the hospital due to other reason. LPA was unable to prove or disapprove that administrator or facility staff neglected the clients in care. Allegation: Staff did not meet incontinence needs of residents/clients resulting to septic shock Based on interview, staff are changing diapers as needed. Interview with staff reveal that clients are check every 2-3 hours for incontinence care. Staff stated that client/s would be cleaned and sometimes showered after an accident on top of the regular showers scheduled for clients in care. Although C1, C3 & C6 was diagnosed of septic shock, there were no indication of the cause and records review did not indicate that this was due to facility failed to meet incontinence needs of the clients. Allegation: Staff yelled in front of resident(s). LPA conducted interviews with clients and staff. LPA tried to interview clients in care but the clients are non-verbal and did not respond to any of the interview questions. Staff denied yelling at the residents or clients in care and denied knowing any incident/s of yelling towards the clients. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Oct 3, 2022 · control 15-AS-20220202131752

Type of visit: Case Management - Other

On 10/3/2022, Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct a Case Management visit. LPA met with Administrator Joel Aliping, LPA explained the purpose of the visit. During the facility tour, LPA observed second floor porch area was unorganized, there was overhanging tree branches by the stairs going down to the backyard which potentially obstructing anyone going down that stairs. LPA explained to Administrator the importance of maintaining the facility clean and organize and to refer to the citation cited. The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights providedthe state’s words, verbatim · CDSS document, Oct 3, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Oct 10, 2022

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. Based on record review, Licensee failed to organize and clean the facility which poses potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Oct 3, 2022

Plan of correction: Administrator agrees to cut the overhanging branches at the second-floor porch and organize the porch. Administrator agreed to send a picture as proof of correction to CCL by POC date.

Type of visit: Required - 1 Year

03/09/22 at 09:40 am, Licensing Program Analyst (LPA) L. Holmes conducted an unannounced infection control annual inspection. LPA met with Administrator, Joel Aliping and informed him of the purpose of the visit. The facility had (2) two additional care staff and (2) two residents present. The facility's COVID-19 mitigation plan is on file. LPA started the inspection with Joel Aliping. Hand sanitizer is outside at the front door. LPA observed a screening station located at the entrance with a visitor's log, thermometer, masks, gloves, and hand sanitizer. Routine symptom screening and temperature checks are done for all staff, residents and visitors. Residents are screened for COVID-19 symptoms and temperatures upon return from daily outings also. An adequate supply of centrally stored PPEs were observed in the garage. There were at least 7 days of non-perishables and 2 days of perishable foods. Fire extinguisher observed fully charged and showed last inspected on 03/28/2021. First aid kit present and stocked. Joel M. Aliping Standard Certificate 6016976740 is valid from 05/25/2020 to 05/24/2022. LPA recommended the following: 1. Add 20 seconds to handwashing signs in the kitchen, wash basin in the garage, upstairs and downstairs bathrooms,. 2. Add covered garbage cans to upstairs and downstairs bathrooms,. 3. Remove towels after each use in the upstairs bathroom and kitchen. 4. Create an isolation cart for isolation room number 2. 5. The downstairs screen door of the patio door is torn near the handle. The size is about 2 by 3 inches long. Advised to repair or replace screen door by 03/23/22.the state’s words, verbatim · CDSS document, Mar 9, 2022

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Other

On 02/04/2022 starting at 2:10 PM, Licensing Program Analysts (LPAs) L. Ibo & L. Holmes conducted a health and safety check as a result of department receiving a priority 1 complaint. LPAs met with S2, LPAs called Administrator Joel Aliping, Administrator arrived at the facility after 45mins, LPAs explained the purpose of the visit. During the health and safety check, LPAs toured the building including but not limited to common areas, bathrooms, bedrooms and outdoor area. . Food supply was checked and there is an adequate supply of 2 day perishables and 7 day non-perishables. LPAs observed rooms were furnished appropriately, clean and in good repair. All bathrooms and showers were equipped with grab bars and safety/nonskid floors/mats. Hot water temperature in random resident's bathroom was measured at 107.5 degrees Fahrenheit. There is an empty swimming pool located at the backyard which was gated and locked. All indoor and outdoor passageways were kept free of obstruction and fire hazards. There is an active telephone line to use for emergency purposes. ...Continued to LIC80C... LPAs observed the following: Second floor bathroom faucet was leaking. Cleaning products was inaccessible to clients in care. – corrected during the visit. Kitchen cabinet door and second floor patio screen door was not in good repair. Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12-month period may result in civil penalties. Deficiencies and plan and proof of corrections were discussed with Joel Aliping. Exit interview conducted and a copy of this report and appeal rights was provided.the state’s words, verbatim · CDSS document, Feb 4, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80087(g) · Plan of correction due date: Feb 4, 2022

80087(g): Buildings and Grounds: Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement was not met as evidence by: Based on LPAs observation, Administrator failed to ensure cleaning products are was inaccessible to clients, which poses an immediate health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Feb 4, 2022

Plan of correction: Staff locked chemical products and moved to locked cabinet. Deficiency was cleared during the visit,

From the deficiency page — Deficiency type: Type B · Section cited: CCR80087(a) · Plan of correction due date: Feb 15, 2022

80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidence by: Based on LPAs observation, Administrator failed to ensure that kitchen cabinet, faucet sink and second floor screen door by the patio is in good repaid, which poses an potentia health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Feb 4, 2022

Plan of correction: Administrator agreed to repair the kitchen cabinet, faucet sink and screen door by POC date, proof of correction need to submit to CCL by POC date.