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Allegation investigated: Resident sustained unstageable pressure injuries due to staff neglect

On 9/28/2023 at 2:15 PM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to conduct a complaint visit. LPA explained the purpose of the visit with Administrator Telesha Clarke. During the complaint visit LPA obtained information, reviewed records, collected documents, and interviewed staff. It was alleged a resident sustained an unstageable pressure injury while in care. During an interview with S1 they stated that they did have a resident who had a pressure injury during that time frame. This resident was on hospice when the ulcer developed and was being addressed in the hospice care plan that the facility was following. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 28, 2023 · control 15-AS-20230626160238

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

On 07/27/23 at 08:55 am Licensing Program Analysts (LPA) J. Clancy-Czuleger arrived unannounced to do an annual inspection. LPA meet with staff Fran West and explained the purpose of the visit. House manager Telesha Clarke joined later. LPA inspected the facility inside out. There is no body of water. Physical plant is consistent with the facility sketch received by Central Application Bureau (CAB) and approved by the fire department. LPA inspected the living room, dining area, kitchen, bedrooms, hallways, bathrooms, side and backyards. Bedrooms were observed appropriately furnished with adequate lighting and drawers. Facility has sufficient towels, extra bed sheets and comforters. Equipment and supplies for residents' personal hygiene are available and on site. Dinner and silver wares were observed sufficient for residents' use. Food supplies checked and observed good for seven days of non-perishables. Facility was observed equipped with refrigerator, microwave, dishwasher, washer and dryer. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. Activity supplies were available. Outdoor activity space was observed furnished with tables, chairs and shade. The facility has a mitigation plan. Fire extinguishers were observed fully charge and tags showed serviced 04/16/2023. At 10:08 am LPA reviewed 3 residents records. At 11:45 am, LPA reviewed 2 staff records and 2 of 2 were fingerprint cleared and associated to the facility. Continued on LIC809C... ...Continued from LIC 809 The following deficiency was observed during the visit: The resident records were not completely stored at the facility (This is a repeat violations) staff records are missing from the facility The toilet in room 3 was not clean and is broken There is no PUB 475 posted The Facility was cited, and citations can be found on the LIC 809-D. A total of $1000 of Civil Penalty is being assessed for repeat violation. Exit interview conducted. Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 27, 2023

Type of visit: Case Management - Health Checks

On 06/27/2023 at 12:00 PM, Licensing Program Analyst (LPA) J. Clancy-Czuleger conducted an unannounced Health & Safety inspection. LPA met with Administrator, Telesha Clarke. LPA toured facility including but not limited to the bedrooms, bathrooms, common area, kitchen, medication room, and outdoor area. 7-days of non-perishables and 2-days of perishable food supplies were present. Resident's medications were kept locked in the medication room. Smoke and carbon monoxide detectors are combined and observed throughout the facility and the bedrooms. First-aid kit was complete. Fire extinguisher was observed to be full and last inspected 04/16/2023. No accessible bodies of water were observed. Indoor and outdoor passageways were free of obstruction. No deficiencies are cited on this date. Exit interview conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Jun 27, 2023

Allegation investigated: Resident wandered from the facility

On 09/29/2022 at 12:40 PM, Licensing Program Analysts (LPA), J. Clancy-Czuleger arrived unannounced to deliver complaint findings for the above allegations. LPA met with Telesha Clarke, Administrator and explained the reason for the visit. During the course of investigation, LPA obtained information, collected documents and interviewed staff and witnesses. Based on interview with staff (S1), it was revealed that R1 had AWOL’ed from the facility on more than one occasion. S1 also stated that there were staff at the facility during that time but were asleep. On the allegation Facility does not have adequate night supervision, Based on LPA’s interviews and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22 has been cited. Exit interview conducted. A copy appeal rights, and this report provided. Substantiatedthe state’s words, verbatim · CDSS document, Sep 29, 2022 · control 15-AS-20220809095150

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(4)(A) · Plan of correction due date: Oct 6, 2022

Licensees who accept and retain residents with dementia...Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty... This requirement is not met as evidenced by: The facility having a resident AWOL, and the staff were not awake when the police arrived to assist in returning her to the facility.the state’s words, verbatim · CDSS document, Sep 29, 2022

Plan of correction: Licensee shall complete an LIC500, verifying facility is adequately staffed at all times. Licensee shall submit to licensing, a copy of current LIC500 by POC date.

Type of visit: Case Management - Deficiencies

On 08/11/2022 at 9:58 AM Licensing Program Analysts (LPA) J. Clancy-Czuleger conduct a Case Management. LPA met with Telesha Clarke, Administrator. While LPA conducted a complaint investigation (15-AS-20220809095150) on 08/11/2022, LPA observed the facility did not have the resident records at the facility. The deficiency was 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 provided.the state’s words, verbatim · CDSS document, Aug 11, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Aug 18, 2022

The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on observation and record review, Licensee did not comply with the regulations cited above by not having 4 out of 6 resident records at the facilitythe state’s words, verbatim · CDSS document, Aug 11, 2022

Plan of correction: Administrator agreed to put together and complete files for all residents and submit a copy of all documentation to CCLD by POC

Type of visit: Required - 1 Year

On 07/28/2022 at 11:03 am Licensing Program Analysts (LPAs) J. Clancy-Czuleger and H. Humpal arrived unannounced to conduct infection control inspection LPAs meet with staff Francyne West and explained the purpose of the visit. Administrator Telesha Clarke joined later. During the Infection Control Inspection, LPAs toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen, and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. The facility has a mitigation plan. Fire extinguishers were observed fully charge and tags showed serviced in March 2022. The following deficiency was observed during the visit: LPA's observed that the chemicals under the kitchen sink were not locked up The Facility was cited and citations can be found on the LIC 809-D. Exit interview conducted. Appeal Rights and a copy of this report provided. Exit interview conducted.the state’s words, verbatim · CDSS document, Jul 28, 2022