Lafayette Gardens

Allegation investigated: Resident sustained unexplained injuries while in care. Staff did not inform resident's responsible party of change of health status. Staff did not seek medical attention to resident.

On 8/16/2023, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to deliver findings on the above allegations and met with Meeran Saxena. LPA explained to Saxena the purpose of the visit. On 6/20/2023, LPA conducted an initial investigation, obtained records and conducted interviews. On the same day, LPA conducted a pre-investigation with Reporting Party (RP). Resident sustained unexplained injuries while in care. Staff did not inform resident’s responsible party of change of health status. Staff did not seek medical attention to resident. Based on records review conducted by LPA, the home health nurse following up on R1 observed R1 experiencing pain in hand in the morning of 6/3/2023. continuation on Lic 9099C Substantiated The nurse reported R1’s condition to R1’s son. R1’s son then instructed Administrator to send R1 to the hospital to get checked on 6/5/2023. R1 went to a skilled nursing facility upon discharge from the hospital and did not come back to the facility. R1 moved to the facility on May 1, 2023 and moved out on June 7, 2023. A review of email conversations between Administrator and R1's son indicate the Administrator informing R1’s son that R1 does not have any fracture. And that the hand is not swollen. The administrator also states the reason could be that R1 was taking some part of the bed and has broken pots in the room. The Administrator states, “In the future, I will make sure the care staff calls you and update you regarding any decline.” A review of R1’s medical records and photo provided to CCL indicate R1 sustained bruises on both arms and a cut on the left bicep. During the interview with Administrator and Staff 1 (S1), both state R1 did not incur any fall. Administrator and S1 state R1 probably got the bruises and cut when R1 was exhibiting aggressive behavior such as crawling under the bed, throwing pots and trying to pull down picture frames. Based on record reviews conducted, Resident 1 R1) has a diagnosis of Dementia, is confused/disoriented, has aggressive, wandering and sundowning behaviors. Based on LPA interviews and record reviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22. Deficiencies are being cited on the attached LIC 9099D. Exit interview was conducted with Meeran. Appeal Rights was provided.the state’s words, verbatim · CDSS document, Aug 22, 2023 · control 15-AS-20230626112336

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(b)(1) · Plan of correction due date: Aug 23, 2023

87705 (b)(1) Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (1) Procedures for notifying the resident’s physician, family members and responsible persons who have requested notification, and conservator, if any, when a resident’s behavior or condition changes. 87705 (b)(1) Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (1) Procedures for notifying the resident’s physician, family members and responsible persons who have requested notification, and conservator, if any, when a resident’s behavior or condition changes.the state’s words, verbatim · CDSS document, Aug 22, 2023

Plan of correction: The administrator will review facility’s plan of operation regarding procedures for notifying the resident’s physician, family members, or conservator when a resident’s condition or behavior changes. Administrator will submit to CCL self-certification of understanding by POC date

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(b)(2) · Plan of correction due date: Aug 23, 2023

87705(b)(2) Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. This requirement is not met as evidenced by: Based on interviews and record reviews conducted, Resident 1 R1) has a diagnosis of Dementia, is confused/disoriented, has aggressive, wandering and sundowning behaviors. Administrator and facility staff interviewed state R1 was observed crawling under the bed, throwing flowerpots inside the room and pulling down picture frames on the wall. Despite observing R1’s aggressive behaviors, the facility did not provide safety measures to prevent R1 from sustaining bruises on both arms and a cut on R1’s left biceps which poses an immediate threat to the health and safety of clients under care.the state’s words, verbatim · CDSS document, Aug 22, 2023

Plan of correction: The administrator will review all residents Physician’s Reports and update Appraisal Needs and Services Plan addressing resident behaviors such as wandering and aggressive behavior. Administrator will send copies of updated care plan by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Aug 25, 2023

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility (1)The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.. This requirement is not met as evidenced by: Based on interviews conducted, staff observed R1 with bruise, agressive, crawling under the bed, breaking pot plants but no medical appointment was arranged which poses a potential risk tohelath and safety of clients under care.the state’s words, verbatim · CDSS document, Aug 22, 2023

Plan of correction: By POC date, Administrator will review all resident files and ensure that all residents are current with medical/dental appointments. Administrator will self-certify completion and send to CCL.

Type of visit: Case Management - Other

On this at around 10:10 am, LPA Luisa Fontanilla conducted a case management visit to amend report previously issued on 8/16/2023. LPA was met by staff Erlinda Muleta . LPA spoke with Meeran over the phone and she authorized staff to sign the report. A copy of this report was provided to Muleta.the state’s words, verbatim · CDSS document, Aug 22, 2023

Allegation investigated: Resident sustained unexplained injuries while in care. Staff did not inform resident's responsible party of change of health status. Staff did not seek medical attention to resident.

On 8/16/2023, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to deliver findings on the above allegations and met with Meeran Saxena. LPA explained to Saxena the purpose of the visit. On 6/20/2023, LPA conducted an initial investigation, obtained records and conducted interviews. On the same day, LPA conducted a pre-investigation with Reporting Party (RP). Resident sustained unexplained injuries while in care. Staff did not inform resident’s responsible party of change of health status. Staff did not seek medical attention to resident. Based on records review conducted by LPA, the home health nurse following up on R1 observed R1 experiencing pain in hand in the morning of 6/3/2023. continuation on Lic 9099C Substantiated The nurse reported R1’s condition to R1’s son. R1’s son then instructed Administrator to send R1 to the hospital to get checked on 6/5/2023. R1 went to a skilled nursing facility upon discharge from the hospital and did not come back to the facility. R1 moved to the facility on May 1, 2023 and moved out on June 7, 2023. A review of email conversations between Administrator and R1's son indicate the Administrator informing R1’s son that R1 does not have any fracture. And that the hand is not swollen. The administrator also states the reason could be that R1 was taking some part of the bed and has broken pots in the room. The Administrator states, “In the future, I will make sure the care staff calls you and update you regarding any decline.” A review of R1’s medical records and photo provided to CCL indicate R1 sustained bruises on both arms and a cut on the left bicep. During the interview with Administrator and Staff 1 (S1), both state R1 did not incur any fall. Administrator and S1 state R1 probably got the bruises and cut when R1 was exhibiting aggressive behavior such as crawling under the bed, throwing pots and trying to pull down picture frames. Based on record reviews conducted, Resident 1 R1) has a diagnosis of Dementia, is confused/disoriented, has aggressive, wandering and sundowning behaviors. Based on LPA interviews and record reviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22. Deficiencies are being cited on the attached LIC 9099D. Exit interview was conducted with Meeran. Appeal Rights was provided.the state’s words, verbatim · CDSS document, Aug 16, 2023 · control 15-AS-20230626112336

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(b)(1) · Plan of correction due date: Aug 23, 2023

87705 (b)(1) Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (1) Procedures for notifying the resident’s physician, family members and responsible persons who have requested notification, and conservator, if any, when a resident’s behavior or condition changes. This requirement is not met as evidenced by: Based on interviews and record reviews conducted, facility did not notify R1’s Responsible Person on R1’s change in condition which poses an immediate risk to health and safety of clients under care.the state’s words, verbatim · CDSS document, Aug 16, 2023

Plan of correction: The administrator will review facility’s plan of operation regarding procedures for notifying the resident’s physician, family members, or conservator when a resident’s condition or behavior changes. Administrator will submit to CCL self-certification of understanding by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(b)(2) · Plan of correction due date: Aug 30, 2023

87705(b)(2) Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. This requirement is not met as evidenced by: Based on interviews and record reviews conducted, Resident 1 R1) has a diagnosis of Dementia, is confused/disoriented, has aggressive, wandering and sundowning behaviors. Administrator and facility staff interviewed state R1 was observed crawling under the bed, throwing flowerpots inside the room and pulling down picture frames on the wall. Despite observing R1’s aggressive behaviors, the facility did not provide safety measures to prevent R1 from sustaining bruises on both arms and a cut on R1’s left biceps which poses an immediate threat to the health and safety of clients under care.the state’s words, verbatim · CDSS document, Aug 16, 2023

Plan of correction: The administrator will review all residents Physician’s Reports and update Appraisal Needs and Services Plan addressing resident behaviors such as wandering and aggressive behavior. Administrator will send copies of updated care plan by POC date.

Type of visit: Case Management - Other

On this day, LPA Luisa Fontanilla conducted a case management related to complaint #15-AS-20230626112336 and met with Meeran Saxena. During the course of investigation, LPA reviewed R1's admission agreement and interviewed R1's responsible person regarding refund. Based on the admission agreement, R1 moved to the facility on May 1, 2023. On June 7, 2023, R1's family notified the facility that R1 is not going back to the facility. R1 paid the facility two-months for rent which covered the first month May 1-June 1, 2023 and the 30-day notice to vacate. Based on records review and interviews conducted, R1 is not due for any refund as indicated in the admission agreement. No deficiency noted.the state’s words, verbatim · CDSS document, Aug 16, 2023

Type of visit: Required - 1 Year

On 2/8/2023 starting at 8:40 a.m., Licensing Program Analyst (LPA) Catherine Lin arrived unannounced to conduct Infection Control Inspection. LPA met with Administrator and disclosed the purpose of the visit. During the Infection Control Inspection, LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. There is one central entry point for universal screening for staff, residents and visitors. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Facility has Mitigation Plan, Emergency Disaster Plan, and maintains record of routine screening for residents, staff and visitors. THE FOLLOWING DEFICIENCIES WERE OBSERVED: · At 9:20 a.m., LPA observed resident R1 who have dementia didn't have updated physician's report on file, the latest one was dated on 1/25/2021. · At 9:20 a.m., LPA observed resident R1 who have dementia didn't have updated needs and services plan on file, the latest one was dated on 1/21/2021. Facility didn't have Infection Control Plan (LIC9282), Administrator will submit the plan to CCL 2/28/2023. The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies by POC date and/or any repeat deficiencies within a 12-month period may result in additional Civil Penalties.the state’s words, verbatim · CDSS document, Feb 8, 2023

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 2/18/2022 starting at 3:55 p.m., Licensing Program Analyst (LPA) Catherine Lin arrived unannounced to conduct Infection Control Inspection. LPA met with lead caregiver Sonora Cruz while Administrator Meeran Saxena was absent. LPA disclosed the purpose of the visit and have Administrator authorize Sonora for the inspection and sign on the report.. During the Infection Control Inspection, LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen and backyard. There is one central entry point for universal screening for staff, residents and visitors. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Facility has Mitigation Plan, Emergency Disaster Plan, and maintains record of routine screening for residents, staff and visitors. THE FOLLOWING DEFICIENCIES WERE OBSERVED: · At 4:20 p.m., LPA observed unlocked centrally stored medications located at the corner of the dinning room. Staff locked it up during inspection. · At 4:21 p.m., LPA observed unlocked knives in the basket located on the top of refrigerator in the kitchen. Staff couldn't find a place to lock up knives. LPA advised caregiver to lock them up in the medication cabinet for now until Administrator has better solution. The above deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies by POC date may result in additional Civil Penalties. Exit interview conducted with lead caregiver. LIC809D, Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 18, 2022

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.