Angel Wings Care Home I

Allegation investigated: Staff use a metal stick on the front door to keep residents from exiting the facility Staff are not trained Staff mismanaged resident's medications

On 06/01/23 at 5:15PM, Licensing Program Analyst (LPA) D Panlilio conducted an unannounced complaint visit, met with administrator (ADM). LPA conducted interviews & record reviews and delivered investigation findings to ADM. LPA explained the purpose of the visit with ADM. Allegation: Staff used a metal stick on the front door to keep residents from exiting the facility Investigation Finding: Substantiated During investigation, staff (S1) confirmed with LPA that witness (W1) visited the facility on 05/22/23 and that staff used a metal stick on the top left part of the front door to keep residents from exiting (photos have been included). Continued on next page, LIC 9099-C Substantiated Based on LPA’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff used a metal stick on the front door to keep residents from exiting the facility was found to be substantiated. Allegation: Staff are not trained Investigation Finding: Substantiated During investigation, LPA observed facility's emergency/disaster record was last updated on 01/01/2022 with an outdated list of staff/contacts information. On 05/30/23, witness (W1) confirmed with LPA that staff (S1) did not have knowledge on how to access residents’ emergency contacts/responsible persons records. LPA observed resident's (R1, R2, R3) medication administration records dated 06/01/23 were left blank when prescribed medications were administered in the morning. Based on LPA’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff are not trained was found to be substantiated. Allegation: Staff mismanaged resident’s medications Investigation Finding: Substantiated During investigation, LPA confirmed with staff (S1) that on 05/22/23, witness (W1) observed staff (S1) did not have knowledge of resident (R1)’s prescription medications. Witness (W1) stated that R1’s administration records were not filled out when VA nurse visited on 05/17/23. LPA also observed R1, R2 and R3 medication administration records for June 1, 2023 was left blank after medications were administered to residents in the morning (photos have been included). Based on LPA’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff are not trained was found to be substantiated. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. 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.the state’s words, verbatim · CDSS document, Jun 1, 2023 · control 15-AS-20230526114818

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Jun 23, 2023

To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night… This requirement was not met as evidenced by staff used a metal stick to prevent residents from exiting the facility front door which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 1, 2023

Plan of correction: By POC due date, Administrator agreed to submit to CCL written self-certification that staff has read, understood and will comply with Title 22 Section 87468.1 to ensure that residents can leave or depart the facility at any time and not to be locked into any room, building or on facility premises by day or night.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87461(f)(2) · Plan of correction due date: Jun 23, 2023

Emergency care requirements shall include the following: (2) The name, address and telephone number of each emergency agency to be called in the event of an emergency, including but not limited to the fire department, crisis center or paramedical unit or medical resource, shall be posted in a location visible to both staff and residents. This requirement was not met as evidenced by staff not having knowledge of how to access residents’ emergency contacts/responsible persons records when asked which posed a potential safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 1, 2023

Plan of correction: By POC due date, Administrator agreed to submit to CCL written self-certification that staff has read, understood and will comply with Title 22 Section 87461 to ensure that residents’ records are readily available for review and reference by staff, licensing inspections and third party agencies.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(6) · Plan of correction due date: Jun 23, 2023

When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement was not met as evidenced by staff (S1) did not have knowledge of resident (R1)’s prescription medications which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 1, 2023

Plan of correction: By POC due date, administrator agrees to complete and submit to CCLD in-service staff retraining certifications on timely medication administration in compliance with Title 22 Section 87465 incidental medical and dental care regulations.

Type of visit: Required - 1 Year

On 02/17/23 at 2:11PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct infection control inspection. LPA met with administrator and explained the purpose of the visit. LPA observed 4 residents watching TV duiring 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, clients 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 74 deg F. Facility has a mitigation plan in place and maintains records of routine screening for clients 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 02/21/23: · 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 17, 2023

Type of visit: Required - 1 Year

On 03/02/22 at 1:50PM, 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 with 3 residents watching TV while the other 3 residents were observed resting inside their bedrooms. Facility has a completed mitigation plan in place dated 04/01/2021 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. LPA observed screening station located near the front entrance with visitor's log, hand sanitizer, gloves, face masks and no touch temperature probe. Routine symptom screening (+/-) temperature and symptom check) is done at entry for all staff, residents and visitors. LPA observed COVID-19 signages posted in common areas to promote hand washing, 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. Continued on next page LIC 809-C A written Emergency/Disaster plan dated 01/01/22 was posted in a bulletin board next to the living room. Centrally stored medications were locked in kitchen cabinets. Sharp objects were locked in the kitchen drawers. Toxic chemicals were locked in the laundry room. LPA observed COVID signages posted outside of isolation room (Stop Droplet precautions & Proper donning & doffing of PPEs). Facility has conducted staff training on infection prevention, symptoms, transmission and proper donning & doffing of PPE. Trash bins with lid operated with foot pedal were located inside bedrooms, bathrooms and kitchen. Infection control designated leader is the administrator. All staff and residents have been fully vaccinated & boosted since October 2021. There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the garage. Facility room temperature was maintained at 74 degrees Fahrenheit. 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 observed fully charged. Smoke and Carbon monoxide detectors were operational. LPA obtained copies of documents below from administrator: · 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, Mar 2, 2022