Angel Wings Care Home II

Allegation investigated: Facility did not provide an adequate assessment to resident in care Staff do not provide proper mobility assistance to resident in care

On 10/06/23 at 4:30PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with staff (S1) and spoke with administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA gathered information and delivered investigation findings to S1 and ADM. LPA explained the purpose of the visit with ADM. Allegation: Facility did not provide an adequate assessment to resident in care Investigation Finding: Substantiated During investigation, LPA interviewed staff (ADM) and witness (W1) who confirmed that resident (R1) was not adequately assessed which resulted in facility not being prepared for R1’s mobility requirements (hospital bed and hoyer lift required for daily care) prior to being admitted at the facility on 09/23/23. Continued on next page, LIC 9099-C Substantiated ADM stated R1 was first admitted at the facility on 09/23/23 without the medical bed and hoyer lift required for her care. Based on records review, interviews conducted, and observations made, the department has investigated the above allegation that facility did not provide an adequate assessment to resident in care. The preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. Allegation: Staff do not provide proper mobility assistance to resident in care Investigation Finding: Substantiated During investigation, staff (ADM, S1) and witness (W1) confirmed with LPA that resident (R1) was first admitted at the facility on 09/23/23 without the hospital bed and hoyer lift in place for R1’s use prior to admittance. R1 was sent to the hospital for UTI on 09/25/23. W1 stated hospital had to order R1’s hospital bed and hoyer lift as well as schedule home health visits for R1 when she was ready for discharge on 09/29/23. ADM stated they requested hospital to give them a few days to prepare for R1's return due to positive COVID cases at the facility. S1 stated R1's daughter removed all personal belongings on 10/01/23 and R1 did not return to the facility. Based on records review, interviews conducted, and observations made, the department has investigated the above allegation that staff do not provide proper mobility assistance to resident in care. The preponderance of evidence standard has been met, therefore the above allegation was found to be substantiated. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided. ADM stated R1 was first admitted at the facility on 09/23/23. ADM stated R1 was sent to the hospital on 09/25/23 due to urinary tract infection (UTI). R1 was treated for UTI at the hospital and was ready for discharge on 09/29/23. ADM stated she never evicted R1. ADM stated she requested hospital to give them a few days to prepare for R1's return since they were still waiting for her medical bed and hoyer lift to arrive. ADM stated R1's family member was notified of COVID positive residents and staff at the facility. S1 stated R1's personal belongings were removed by family member on 10/01/23 and R1 did not return to the facility. Based on records review, interviews conducted, and observations made, the department has investigated the above allegation of improper eviction. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation of improper eviction to resident is unsubstantiated. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 6, 2023 · control 15-AS-20230929120538

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c) · Plan of correction due date: Oct 31, 2023

Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs… This requirement was not met as evidenced by staff failing to conduct a proper pre-placement appraisal on resident which posed a potential health & safety risk to resident in care.the state’s words, verbatim · CDSS document, Oct 6, 2023

Plan of correction: By POC due date, administrator agreed to submit to CCL completed in-service staff retraining certifications on proper pre-admission appraisal for residents in compliance with Title 22 Section 87457 regulations.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87459(a) · Plan of correction due date: Oct 31, 2023

The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living… This requirement was not met as evidenced by staff failing to provide proper mobility assistance to resident which posed a potential health & safety risk to resident in care.the state’s words, verbatim · CDSS document, Oct 6, 2023

Plan of correction: By POC due date, administrator agreed to submit to CCL completed in-service staff retraining certifications on functional capabilities in compliance with Title 22 Section 87459 regulations.

Type of visit: Required - 1 Year

On 02/22/23 at 1:30PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct infection control inspection. LPA met with staff (S1) and spoke with administrator on the phone who authorized S1 to act on her behalf and sign the report. LPA explained the purpose of the visit with staff and administrator. LPA observed 2 staff wearing face masks and 2 residents watching TV. The other residents were resting inside their bedrooms during visit. LPA toured the facility including but not limited to the front entrance, screening station, hand washing stations, kitchen, bathrooms, bedrooms and common areas. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, visitor’s logs, no touch thermometer, additional face masks and hand sanitizer were observed at the screening station. Cough/sneeze etiquette, social distancing signs were posted in common areas. Facility has a sufficient 2-day perishable and 7-day non-perishable food supply. Facility has a 30-day supply of PPEs maintained at a central location and easily accessible for staff. Comfortable temperature is maintained at 75 deg F. Facility has a mitigation plan in place and maintains records of routine screening for residents and staff. The infection control leader is the administrator. Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 02/23/23: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan including infection control plans · Evidence of Liability Insurance No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 22, 2023

Allegation investigated: Resident was not checked on or turned for extended period of time Residents care needs are not being met

On 06/23/22 at 12:20PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced subsequent visit and met with administrator to deliver the findings of above allegations. LPA explained the purpose of the visit with administrator. Allegation: Resident was not checked on or turned for extended period of time Investigation Finding: UNSUBSTANTIATED Based on interviews and record reviews, resident (R1) was admitted at the facility on 08/31/21. Review of R1’s appraisal report shows him as ambulatory (able to walk without a walker). On 12/30/21, staff called 911 because staff observed R1 had a fever and developing blisters on both his heels. Review of hospital discharge report show R1 was treated for blisters on his heels and released back to the facility on 12/31/21 with wound care instructions. Continued on next page, LIC 9099-C Unsubstantiated On 01/03/22, staff called medical advice nurse and requested a regular home health nurse to follow up for wound management. S1 left a message with R1’s primary care physician and authorized representative for after emergency room visit. On 01/04/22, staff called 911 again because R1 had increased cough, chills and fever. Staff observed R1 started having difficulty moving around and his mobility has sharply decreased. Staff stated that they observed little blisters forming throughout his body despite all the interventions that they implemented by elevating his heels, frequent repositioning and diaper changes. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. Allegation: Resident’s care needs are not being met Investigation Finding: UNSUBSTANTIATED Based on interviews and record reviews, LPA's review of incident report dated 12/23/21 show staff observed R1 developed a fever and forming blisters on both heels. Staff called 911 on 12/30/21 and R1 was treated at the hospital and released back to the facility. Staff followed wound care instructions, treated the blisters, bandaged them and elevated R1’s legs . Staff also noticed that R1 started to develop a bed sore on his butt and contacted his primary care physician to request a home health nurse for R1. Staff stated R1 started to develop more bed sores at his hips on 01/03/22 despite staff turning him every 2 hours, assisting with his walks and hydrating him. Staff called 911 again on 01/04/22 and was taken to the hospital for evaluation and treatment. R1 was treated for fever and increasing bed sores. He was later admitted at a skilled nursing facility from the hospital. On 02/11/22, R1 returned back to the facility under hospice care. Other residents at the facility stated their care needs are being met by staff. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is unsubstantiated. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Jun 23, 2022 · control 15-AS-20220105161401

Type of visit: Required - 1 Year

On 01/07/22 at 03:10PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with administrator. LPA observed 2 staff wearing face masks during visit. LPA observed 4 residents watching TV during visit. Facility has a mitigation plan in place dated 01/04/21 to mitigate the spread of COVID-19. LPA discussed the completed mitigation plan (LIC 808) with administrator as well as COVID-19 infection control practices. LPA inspected the facility inside and outside. One central entry point has been designated for universal entry screening with the station located near the front entrance with visitor's log, hand sanitizer, gloves, face masks and no touch temperature probe. COVID-19 signs are posted throughout the facility to promote handwashing, cough/sneeze etiquette and physical distancing. Facility documents daily temperatures and COVID-19 symptom checks for staff and residents. Pathways were observed to be free of obstruction and fire hazards. A written Emergency/Disaster plan dated 01/04/22 was posted near a Lan line phone in the office. Centrally stored medications were locked in kitchen cabinets. Sharp objects were locked in the kitchen drawers.Toxic chemicals were locked in the garage. Continued on next page LIC 809-C Infection control designated leader is the administrator. All staff and residents have been fully vaccinated since November 2021.There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the pantry. Facility room temperature was maintained at 70 degrees Fahrenheit. Resident's bedrooms and bathrooms have COVID-19 signages. Administrator is on site a minimum of 20 hours a week to oversee proper business operation and compliance with COVID-19 infection control practices. Fire extinguisher was fully charged and last inspected on 04/15/2021. Smoke and Carbon monoxide detectors were operational. Adequate supplies of PPE were also observed stored in the garage. Facility follows daily cleaning, sanitation of frequently touched common surfaces using Clorox and Lysol disinfectants. The facility has auditory signals on each sliding door in the resident's room for exit. Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 07/10/22: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan · Evidence of Liability Insurance No deficiencies cited during this visit. Exit interview conducted and a copy of this report provided to administrator.the state’s words, verbatim · CDSS document, Jan 7, 2022