Trevista Antioch

Allegation investigated: Staff left resident in soiled sheets for extended period of time Staff are not meeting resident's care needs Facility is short staffed

On 08/11/23 at 11:23 AM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with executive director (ED) to deliver the findings of above allegations. LPA explained the purpose of the visit with ED. Allegation: Staff left resident in soiled sheets for an extended period of time Investigation Finding: Unsubstantiated During investigation, LPA reviewed resident’s (R1) records and observed R1 has resided at the facility since 08/22/2018. She was admitted into hospice care on 03/17/2022 and relocated to the memory care unit due to declining health and dementia. ED stated staff changed memory care residents’ sheets daily or as needed. Review of R1's charting notes confirm R1's sheets were changed daily. Continued on next page, LIC 9099-C Unsubstantiated Allegation: Staff left resident in soiled sheets for an extended period of time Investigation Finding: Unsubstantiated Continuation... Review of R1’s care plan show staff provided R1 full assistance with R1’s bathing/showering (2X per week) and daily assistance with dressing/undressing, toileting and wandering. Review of R1’s care plan also showed daily routine checks done by staff every 2 hours as instructed by hospice care team. Based on interviews and record reviews which were conducted, 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 that staff left resident in soiled sheets for an extended period of time is unsubstantiated. Allegation: Staff are not meeting resident’ s care needs Investigation Finding: Unsubstantiated During investigation, LPA reviewed R1’s care plan dated 04/20/2022 which showed nail care was provided by a certified podiatrist every month on the 31st day or as needed since R1 was a high risk for complications following nail care. ED stated R1 left the facility 05/24/22 and moved to another facility. ED stated R1’s authorized representative met with him in May 2022 because they wanted to move R1 back to the facility due to better care than the facility they moved R1 into. Based on interviews and record reviews which were conducted, 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 that staff are not meeting resident’s care needs is unsubstantiated. Allegation: Facility is short staffed Investigation Finding: Unsubstantiated During investigation LPA observed the memory care unit has 24 dementia residents assisted by 4 staff (2 caregivers, 1 activities assistant and 1 resident care director) on each shift. Residents in care were observed well groomed, odor free and comfortable in their surroundings. Review of R1’s care plan dated 04/20/22 show staff provided R1 full assistance with activities of daily living - bathing (2X per week); toileting, dressing/undressing, grooming, incontinence care, wandering daily with routine checks done every 2 hours as well as implemented hospice care teams’ instructions while in care. 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 that facility is short staffed is unsubstantiated. Exit Interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 11, 2023 · control 15-AS-20220404100947

Allegation investigated: Resident’s room is unsanitary Resident’s hygiene needs are not being met

On 08/11/23 at 1PM, Licensing Program Analyst (LPA) D Panlilio conducted a subsequent visit and met with executive director (ED) to deliver the findings of above allegations. LPA explained the purpose of the visit with ED. Allegation: Resident’s room is unsanitary Investigation Finding: Substantiated During investigation, witness (W1) stated she visited resident (R1) at the facility on several dates (11/30/21, 12/01/21, 01/22/22, 02/12/22, 05/01/22). On 06/21/22, LPA reviewed photos of R1’s room which showed fecal stains on R1’s toilet stand, bedroom wall, chair, rug, floors, sheets, light fixture, unflushed fecal matter inside the toilet and R1’s soiled pajamas and underwear. Continued on next page, LIC 9099-C Substantiated Allegation: Resident’s room is unsanitary Investigation Finding: Substantiated Continuation... W1 stated she reported these conditions to executive director (ED) who stated he would handle with staff. W1 visited R1 again on 12/01/21 with the bathroom in the same unsanitary condition, stained rugs not removed and washed. On 01/22/22, W1 visited R1 and found poop on the toilet and pajamas full of poop thrown in the shower. Based on interviews and record reviews which were conducted, the preponderance of evidence standard has been met and the above allegation(s) that resident’s room is unsanitary was found to be substantiated. Allegation: Resident’s hygiene needs are not being met Investigation Finding: Substantiated During investigation, witness (W1) stated family visited resident (R1) at the facility on several dates (11/30/21, 12/06,21) and reported to staff that R1 had not had a shower with hair greasy. W1 stated R1 was finally showered by staff on 12/07/21. W1 stated that from 12/10/21 until 12/13/21, R1 was again not given a shower. ED stated a care conference was held with W1 and R1’s family on 12/15/21. R1’s shower schedule was discussed as well as R1’s weight loss and meal menu. W1 stated staff showered R1 on 01/06/22. Review of R1’s care plan showed R1 required full assistance with weekly showering, wash, shampoo and dressing/undressing to maintain good personal hygiene and cleanliness. On 02/12/22, W1 stated she visited R1 and found her hair greasy again, she had no underwear on and was full of poop. W1 stated the bathroom floor had dried poop and asked staff to clean the room asap. Rather than wait for staff to show up, W1 and W2 stated they gave R1 a shower, washed her hair and placed clean underwear on her and fresh clothes. Continued on next page, LIC 9099-C Allegation: Resident’s hygiene needs are not being met Investigation Finding: Substantiated Continuation... LPA reviewed photos on 06/21/22 which showed R1 with matted, greasy hair, underwear full of fecal matter, dried fecal stains on wall, chair and rug. Review of R1’s care plan showed staff will assist resident to set up toothbrush and toothpaste for oral care at least 2X per day with occasional reminders/cues with using toothbrush/toothpaste/floss or denture maintenance. LPA reviewed a photo of R1’s dental decay when R1’s family took her to the dentist for dental cleaning on 05/23/22. Based on interviews and record reviews which were conducted, the preponderance of evidence standard has been met and the above allegation(s) that resident’s hygiene needs are not being met 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. Allegation: Facility staff failed to provide adequate care and supervision, resulting in resident sustaining significant weight loss Investigation Finding: Unsubstantiated Continuation... LPA reviewed R1’s care plans which showed her weight in January 2022 at 99.8 pounds and 87.2 pounds in May 2022. W1 stated R1’s weight was at 80.6 pounds. LPA observed R1’s medication records showed R1’s primary care physician prescribed R1 to drink ensure nutritional shakes twice daily with a start date of 02/10/2022. Review of R1’s care plan dated 03/28/22 show a care conference was held by staff and her medical provider to address R1’s weight loss and lab work was ordered. Staff stated R1 refused to eat lunch and dinner due to poor appetite. Review of R1’s care plan dated 06/22/22 show staff provided R1 with nutritional shakes ordered by the doctor daily at 8AM, 12PM, 5PM. Staff stated R1 also had snacks twice daily. Based on interviews and record reviews which were conducted, 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 that staff failed to provide adequate care and supervision resulting in resident sustaining significant weight loss is unsubstantiated. Allegation: Facility is providing inadequate food service Investigation Finding: Unsubstantiated During investigation, LPA interviewed staff (ED, S1) who stated that they implemented resident’s (R1) care plan which was full assist with special diet, providing a nutritional shake ordered by the doctor daily at 8AM, 12PM, 5PM and as needed. Staff (ED, S1) stated R1 does not eat much and refuses to drink all flavors of ensure nutritional shakes because she dislikes the taste. Staff stated they provided R1 with food that she likes such as egg, fruit, dessert. R1 also had snacks twice daily. Staff stated that despite their efforts, R1 continued to lose weight due to poor appetite. Staff (S1) stated they are cutting R1’s food at each meal and assisting her with setting up her food while in care. 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 that facility is providing inadequate food service is unsubstantiated. Continuation on next page, LIC 9099-C Allegation: Resident’s laundry needs are not being met Investigation Finding: Unsubstantiated During investigation, LPA reviewed housekeeping schedules which showed weekly laundry was provided by staff to all 24 memory care residents to keep all clothing and linens clean. Staff (ED) stated each residents’ clothing, beddings, linens and towels were kept in dedicated laundry baskets that were laundered and delivered back by staff weekly. 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 that resident’s laundry needs are not being met is unsubstantiated. Allegation: Facility restroom is in disrepair Investigation Finding: Unsubstantiated During investigation, staff (ED) stated that on 05/01/22, the common hallway restroom toilet was reported clogged. LPA confirmed with staff (S2) that the common hallway restroom toilet was unclogged the same day. On 06/22/22, LPA observed common hallway restroom toilet was not clogged, flushing properly and in good repair. 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 that facility restroom is in disrepair is unsubstantiated. Exit Interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 11, 2023 · control 15-AS-20220621120143

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a)(1) · Plan of correction due date: Sep 8, 2023

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met as evidenced by resident’s unsanitary room which posed a potential health & safety risk to resident in care.the state’s words, verbatim · CDSS document, Aug 11, 2023

Plan of correction: By POC due date, ED agreed to complete and submit to CCL in-service staff retraining certifications on the timely cleaning, sanitation and handling of residents’ dirty personal belongings in compliance with Title 22 Section 87303 regulations.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Sep 8, 2023

A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by resident’s hygiene needs not being met which posed a potential health & safety risk to resident in care.the state’s words, verbatim · CDSS document, Aug 11, 2023

Plan of correction: By POC due date, ED agreed to complete and submit to CCL in-service staff retraining certifications on providing residents with routine assistance in medical and dental care in compliance with Title 22 Section 87465 regulations.

Type of visit: Required - 1 Year

On 02/23/23 at 3:15PM, 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 5 staff wearing face masks assisting residents in the activities room and visitation areas. 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 74 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 02/24/23: · 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 23, 2023

Allegation investigated: Staff are not able to adequately communicate with residents Staff are not cleaning up after residents are done eating

On 09/13/22 at 12:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced complaint visit, met with executive director (ED), gathered information and delivered investigation findings to ED. LPA explained the purpose of the visit with ED. During visit, LPA toured the memory care unit with ED and introduced LPA to 3 staff (S1, S2, S3) working the AM shift. ED stated that all staff are required to speak and write in english prior to employment. ED stated that most staff are bilingual (Spanish & English) and are required to communicate in english to residents and other staff. LPA spoke to S1, S2 and S3 in english and they responded back to LPA in english. LPA observed 3 staff asking residents if they wanted more juice or water in english during their lunch meals. Residents responded back to staff with requests for additional water, juice or other entrees. Continued on next page, LIC 9099-C Unsubstantiated LPA observed meals were served in plates and trays to residents on each dining table with drinks. LPA did not observe any coffee cups on the floor in the dining or bedroom areas. LPA observed some meals were delivered and served inside residents' bedrooms on tray tables. LPA observed S3 assisting a resident inside her bedroom with her lunch meal during visit. LPA also observed staff clearing used meal trays, plates and cups from the dining tables as soon as residents are done with their meals. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are unsubstantiated. No deficiencies cited during visit. Exit Interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 13, 2022 · control 15-AS-20220912114903

Type of visit: Case Management - Health Checks

On 06/22/22 at 3:10PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a Health and Safety check as a result of the department receiving a priority 1 complaint. During the health and safety check, LPA observed a total of 8 staff and 24 residents at the memory care unit. LPA toured facility with administrator, including but not limited to bedrooms, kitchen, bathroom, and common areas. LPA observed 10 residents having snack in their common dining room while another 8 residents were relaxing in the visitation area. The rest of the residents were observed sleeping inside their bedrooms. The facility was observed to be in good repair. Common pathways were observed clear and free of fire hazards. Facility temperature was at 72 deg F. LPA observed residents to be comfortable in their surroundings. Residents in care appear to be safe and there are no imminent health/safety concerns on today's date. No deficiencies cited during the health and safety check. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 22, 2022

Allegation investigated: Resident was attacked by another resident while in care

On 01/05/22 at 3PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced subsequent complaint visit, met with administrator, explained the purpose of the visit and delivered investigation findings. Allegation: Resident was attacked by another resident while in care Investigation finding: SUBSTANTIATED Based on LPA’s interviews which were conducted and record review(s), on 04/08/2020 at 6:35PM, facility staff fournd resident (R1) sitting on the floor with resident (R2) sitting on the couch. R1 stated R2 hit him on the face. Staff assessed R1 and observed R1 had a bump on the head and scratch on the nose. 911 was called and R1 was transported to the hospital. The preponderance of evidence standard has been met, therefore the above allegation(s) was found to be substantiated. Continued on next page, LIC 9099-C Substantiated Deficiency is 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 via email. R1 was sent to the hospital the same day (10/16/2020) and was cleared by the hospital to return to the facility with no new medications, Xray, CT scan all clear. On the second incident dated 10/19/2020, R1 had another un-witnessed fall at his apartment. Staff observed R1 had a significant bruise on his left leg and what looked like a broken nose. Staff immediately called 911 and sent R1 to the hospital for evaluation. Administrator stated that R1 never returned back to the facility from the hospital. R1 decided to relocate to another facility. 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. Exit Interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Jan 5, 2022 · control 15-AS-20201020142344

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Jan 5, 2022

To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by R1 being attacked by another resident which posed a potential health & safety risk to resident in carethe state’s words, verbatim · CDSS document, Jan 5, 2022

Plan of correction: Administrator corrected deficiency on 04/08/2020. Both residents were immediately redirected by staff and monitored to ensure their safety.

Allegation investigated: Resident is being illegally evicted Facility is incorrectly billing an SSI resident

On 01/05/22 at 4:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced subsequent complaint visit, met with administrator, explained the purpose of the visit and delivered investigation findings. Allegation: Resident is being illegally evicted Investigation Finding: SUBSTANTIATED Based on interviews and record reviews, LPA confirmed with administrator that resident (R1) was given a 30 day notice of eviction by the facility dated 05/03/2021 due to non-payment of the rate of basic services from 11/01/2020 to 04/30/2021. Effective date of termination was 06/02/2021. The facility has been informed of the resident's SSI status but they have proceeded with the eviction process. The preponderance of evidence standard has been met, therefore the above allegation(s) was found to be substantiated. Continued on next page, LIC 9099-C Substantiated Allegation: Facility is incorrectly billing an SSI resident Based on interviews and record reviews, LPA confirmed with neutral witness (W1) that R1 continues to be billed at the market rate even though facility have been informed of the resident's SSI eligibility and have been requested to send a bill for the correct amount. The preponderance of evidence standard has been met, therefore the above allegation(s) 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 via email.the state’s words, verbatim · CDSS document, Jan 5, 2022 · control 15-AS-20210706122616

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87368.1(b)(1) · Plan of correction due date: Jan 5, 2022

(b) All residents in all residential care facilities for the elderly shall be protected from all of the actions specified in this subsection (1) Deny admission to a facility, transfer or refuse to transfer a resident within the facility or to another facility, or discharge or evict a resident from a facility... This requirement was not met as evidenced by improper eviction of resident (R1) which posed a potential health & safety risk to resident in carethe state’s words, verbatim · CDSS document, Jan 5, 2022

Plan of correction: Administrator corrected deficiency on 07/28/2021 where R1's notice of eviction was revoked.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(e) · Plan of correction due date: Jan 5, 2022

If the resident is an SSI/SSP recipient, then the basic services shall be provided and/or made available at the basic rate at no additional charge to the resident. This requirement was not met as evidenced by resident being charged the market rate which posed a potential health & safety risk to resident in carethe state’s words, verbatim · CDSS document, Jan 5, 2022

Plan of correction: Administrator corrected deficiency on 07/28/2021. R1's monthly invoices from 11/2020 until 07/2021 were adjusted to reflect the appropriate SSI rate.

Allegation investigated: Staff did not respond to resident's calling for assistance

On 01/05/22 at 5:25PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced subsequent complaint visit, met with administrator, explained the purpose of the visit and delivered investigation findings. Allegation: Staff did not respond to resident's calling for assistance Investigation Finding: SUBSTANTIATED Based on LPA's interviews and record reviews, staff (S1) admitted to wellness coordinator that on 07/12/2021 she took resident (R1) to the toilet and never came back for more that 2 hours because she turned her radio down. The preponderance of evidence standard has been met, therefore the above allegation(s) was found to be substantiated. Continued on next page, LIC 9099-C Substantiated Deficiency is 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 via email.the state’s words, verbatim · CDSS document, Jan 5, 2022 · control 15-AS-20210715151325

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(4) · Plan of correction due date: Jan 5, 2022

Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications This requirement was not met as evidenced by staff not responding to resident's calling for assistance which posed a potential health & safety risk to residents in carethe state’s words, verbatim · CDSS document, Jan 5, 2022

Plan of correction: Administrator corrected deficiency on 07/16/21. Incident was internally investigated and staff terminated. Administrator conducts monthly staff meetings to remind all staff to follow established care and supervision protocols at all times.

Type of visit: Required - 1 Year

On 01/05/22 at 1:55PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with administrator. Facility has a completed mitigation plan in place dated 01/23/2021 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 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. Facility has 3 spacious living/visitation areas inside for social distancing among residents. Continued on next page LIC 809-C LPA observed PPE cart located outside of 1st floor isolation wing. 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 since January 2021.There was at least 7 days of nonperishable and 2 days of perishable foods. PPE supplies were observed stored in the 3rd floor storage room. Facility room temperature was maintained at 72 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. No deficiencies observed during visit. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Jan 5, 2022