Sacred Hands Living II

Type of visit: Required - 1 Year

On 09/22/23 at 1:12PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct an annual required inspection. LPA met with administrator (ADM) and explained the purpose of the visit. LPA toured the facility including but not limited to the front entrance, screening station, 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 sanitizers were observed at the screening station. Emergency Disaster Plan, Complaint poster, Personal rights, Cough/sneeze etiquette, proper hand-washing signs were observed 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, paper, medications locked in cabinets. Comfortable temperature is maintained at 74 deg F. Hot water temperature was measured at 115 deg F. Facility has a mitigation plan in place and the infection control leader is the administrator. Inside and outside pathways were free of obstruction and fire hazards. Smoke and Carbon monoxide detectors were operational. Fire extinguisher was observed fully charged (purchase date 06/2023). LPA reviewed 5 staff and 5 resident files. LPA also conducted 2 staff and 2 resident interviews during visit. Updated copies of the following documents were collected for facility file:  LIC500- Personnel Report  Resident Roster  LIC308- Designation of Facility Responsibility  LIC610E- Emergency/Disaster Plan including infection control plans  Evidence of Liability Insurance No deficiencies observed during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 22, 2023

Type of visit: Required - 1 Year

On 9/23/22 at 4:15 PM, 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 one staff wearing face mask and one resident resting inside his bedroom. LPA toured the facility including but not limited to common areas, kitchen, bedroom, and shared bathrooms. to front entrance, screening station, hand washing stations, 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 76 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 09/26/22: · 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, Sep 23, 2022

Type of visit: Case Management - Other

On 09/14/22 at 12PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced case management visit, met with staff (S1) and spoke to administrator (ADM) on the phone who authorized S1 to act on her behalf and sign the reports. LPA explained the purpose of the visit with S1 and ADM. During visit, LPA observed 1 staff (S1, wearing a face mask) and 2 residents at the facility, Routine COVID screening was done by staff to LPA at the front entrance. LPA toured the facility and confirmed the absence of former staff (S2) at the facility. ADM confirmed with LPA that S2 has not worked at the facility since 2020. ADM stated she will update the Guardian Portal to permanently disassociate S2 from the staff roster today, 09/14/22. No deficiency cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 14, 2022

Allegation investigated: Resident sustained pressure injury while in care Resident did not get medical attention in a timely manner

On 04/08/22 at 2:30PM, 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 sustained pressure injury while in care Investigation Finding: SUBSTANTIATED Based on interviews and record reviews, resident (R1) was first admitted at the facility on 12/21/2021 where administrator observed R1 only had one stage two pressure injury to his lower back. Home Health RN who performed the initial assessment for R1 at the facility remembered seeing a “small stage 2” pressure injury on R1’s buttocks. She did not remember seeing any other pressure injuries on R1 during her initial assessment. Review of hospital records dated 01/21/22 show R1 had 5 unstageable pressure injuries with photos taken shortly after R1’s arrival to the emergency room of the hospital on 01/18/22. R1 was found to have a “stage 4” or “unstageable” wound on his lower back and had 3 other different sores all in different signs of healing on his right hip. Administrator confirmed with investigator that R1’s various pressure injuries occurred while in care at the facility. The preponderance of evidence has been met. Therefore, this allegation is substantiated. Continued on next page, LIC 9099-C Substantiated Allegation: Resident did not get medical attention in a timely manner Investigation Finding: SUBSTANTIATED Based on interviews and record reviews, the facility did not seek medical attention in a timely manner for resident (R1). Despite home health nurse’s recommendation on 01/14/22 to immediately transport resident (R1) to the hospital due to visual signs of R1’s altered baseline/acute changes in mental status/suspected fever (hot to the touch) and Hypoxia (low blood oxygen level). Both authorized representative (POA) and administrator refused to transport R1 to the hospital on 01/14/22. Administrator stated to investigator that R1 was just “tired and dehydrated”. R1 was finally transported to the hospital on 01/18/22 where he was admitted and diagnosed with urinary tract infection and sacral wounds. The preponderance of evidence has been met. Thus, this allegation is substantiated. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POCs) 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, Apr 8, 2022 · control 15-AS-20220120081118

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Apr 9, 2022

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 sustaining pressure injuries while in care which posed an immediate health & safety risk to resident.the state’s words, verbatim · CDSS document, Apr 8, 2022

Plan of correction: Immediate civil penalty of $500 assessed during visit. By POC due date, administrator agrees to conduct in-service staff retraining on proper care and supervision of residents and will submit to CCLD copy of completed staff retraining.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Apr 9, 2022

The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis… This requirement was not met as evidenced by resident not getting medical attention in a timely manner which posed an immediate health & safety risk to the residentthe state’s words, verbatim · CDSS document, Apr 8, 2022

Plan of correction: By POC due date, Administrator agrees to submit to CCLD completed in-service staff retraining on following proper emergency protocol to ensure residents’ health needs are met in a timely manner.

Type of visit: Case Management - Health Checks

On 01/20/22 at 12:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a Health and Safety check as a result of the department receiving a priority 1 complaint. LPA explained the purpose of the visit with administrator. During the health and safety check, LPA observed a total of 2 staff members and 3 residents at the facility. LPA toured facility including but not limited to bedrooms, kitchen, bathroom, and common areas. LPA observed 2 residents in the living room, one resident eating lunch and the other resident watching TV. The 3rd resident was observed resting inside her bedroom. 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, Jan 20, 2022

Allegation investigated: Administrator(s) not at the facility for a sufficient amount of hours

On 11/04/21 at 4:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a subsequent complaint visit and met with administrator (ADM) to deliver the investigation findings. LPA explained the purpose of the visit with ADM. Allegation: Administrator(s) not at the facility for a sufficient amount of hours. Investigation Finding: Substantiated Upon interview, the Licensee who serves as the Administrator indicated being the Administrator for 3 facilities and spending 2 hours per day at each facility. Therefore, the Licensee/Administrator is not meeting the requirement of being at the facility for 20 hours per week. The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided. Substantiated Allegation: Insufficient Staff Investigation Finding: Unsubstantiated Upon records review and interviews, the RP asserted that during visits there was only 1 staff person present. The facility produced the staff schedule for the subject time period which illustrated a sufficient number of staff per the Appraisal Needs and Services available for the residents in care at the time. Neutral witnesses, including those who visited the facility in an official capacity, were unable to confirm the number of staff present during the subject time period. Although it was not possible to determine the sufficiency of staff present during the subject time period, during visit to the facility on 10/27/21 the Department found only 1 staff person present, which was not sufficient to meet the needs and services per the appraisals and Physician assessments for the residents in care. The facility is cited under a Case Management report dated 11/04/21. Allegation: Staff do not provide activities for residents Investigation Finding: Unsubstantiated Per interviews, S1 stated that residents are encouraged by staff to engage in activities including gardening, walking around the inside of the facility & the backyard, watching television, reading, and games. This was corroborated by a resident who was identified as being mentally capable. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are unsubstantiated. Exit Interview conducted and a copy of this report provided to Administrator.the state’s words, verbatim · CDSS document, Nov 4, 2021 · control 15-AS-20201208133623

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Nov 29, 2021

(a) The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section... This requirement was not met as evidenced by administrator not being at the facility for sufficient amount of hours which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 4, 2021

Plan of correction: By POC date, administrator agreed to submit to CCLD a self certifcation that she has read, understood and will comply with Title 22 Section 87405 regulations.

Allegation investigated: Staff mismanages residents' medication Medical assessment was not done on resident Food services are inadequate

On 11/04/21 at 4:30PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted a subsequent complaint visit and met with administrator (ADM) to deliver the investigation findings. LPA explained the purpose of the visit with ADM. Allegation: Staff Mismanages Residents’ Medication Investigation Finding: Substantiated Upon records review, the Department found that R1s medication records were inadequate and the medication list provided by the Reporting Party did not match the Centrally Stored Medication record. The facility also did not have the MD medication order. Allegation: Medical Assessment was not done on Resident Investigation Finding: Substantiated Upon records review, the Department found that the facility had failed to obtain a required Medical Assessment by a physician. Continued on next page, LIC 9099-C Substantiated Allegation: Food Services are Inadequate Investigation Finding: Substantiated Upon investigation, the Department was informed by the Licensee that food supplies are obtained every Monday; however, neutral witnesses who had visited the facility in an official capacity performed an evaluation on 12/16/20 (a Wednesday) and observed that there was an inadequate amount of fresh fruit and vegetables to meet the requirement of 2 days of perishable foods for the number of residents in care at that time. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or 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: Resident’s toileting needs are not being met Investigation Finding: Unsubstantiated The Reporting Party asserted that R1 was not being assisted with her toileting needs. The Department found that the facility had failed to develop a required Appraisal Needs and Services report to ascertain the toileting needs that R1 may or may not have needed based upon her capability. Although it was not possible to determine whether R1 required toileting assistance that was not being provided, the facility is cited under a Case Management report dated 11/04/21. Allegation: Resident’s bathing needs are not being met Investigation Finding: Unsubstantiated The Reporting Party asserted that R1 was not being assisted with her bathing needs. The Department found that the facility had failed to develop a required Appraisal Needs and Services report to ascertain the bathing needs that R1 may or may not have needed based upon her capability. Although it was not possible to determine whether R1 required bathing assistance that was not being provided, the facility is cited under a Case Management report dated 11/04/21. Allegation: Untrained Staff Investigation Finding: Unsubstantiated The Department found that the staff that were scheduled during the subject time period had the records from an acceptable training organization reflecting the required subjects and hours required. However, per interview with staff, adequate competency and understanding of dementia care was not exhibited. Although the facility produced adequate records of staff training, the facility failed to ensure staff competency and is cited under a Case Management report dated 11/04/21 Allegation: Facility Kitchen Equipment is in Disrepair Investigation Finding: Unsubstantiated The Department found that the facility’s stove became inoperable and that the facility addressed the situation in a timely fashion. The Licensee contacted PG&E, who reported to the facility on 12/1/20 and disconnected the unit. Receipts illustrated that on the same day the facility purchased a new stove but that there was an installation delay due to the COVID pandemic; however, it was installed on 12/18/21. Neutral witnesses who had visited the facility on multiple occasions during the subject time period reported that they were aware of the status of the stove but observed that the facility had an alternate means of preparing hot food and the residents were provided with three meals per day. The neutral witnesses had no concerns regarding the meals provided. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are unsubstantiated. Exit Interview conducted and a copy of this report provided to Administrator. erns regarding the meals provided.the state’s words, verbatim · CDSS document, Nov 4, 2021 · control 15-AS-20201208114253

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e) · Plan of correction due date: Nov 29, 2021

For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information... This requirement was not met as evidenced by R1's medical records not matching the centrally stored logs which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 4, 2021

Plan of correction: By POC date, administrator agreed to self certify that all residents' centrally stored records match their doctors' orders and submit copies to CCLD.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: Nov 29, 2021

Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year... This requirement was not met as evidenced by facility failing to secure a medical assessment for R1 prior to admission which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 4, 2021

Plan of correction: By POC date, administrator agreed to self certify that she has read, understood and will comply with Title 22 Section 87458 Medical Assessment.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(26) · Plan of correction due date: Nov 29, 2021

(26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises... This requirement was not met as evidenced by insufficient food supplies at the facility which posed a potential health & safety risk to residents in carethe state’s words, verbatim · CDSS document, Nov 4, 2021

Plan of correction: By POC date, administrator agreed to self certify that she has read, understoon and will comply with Title 22 Section 87555 General Food Service Requirements.

Type of visit: Case Management - Other

On 11/04/21 at 6:19PM, while at the facility for another reason, Licensing Program Analyst (LPA) Daisy Panlilio observed the following deficiencies : · Failure of facility staff to develop R1’s appraisal needs and services plan (for toileting and bathing) prior to resident’s admission on 11/01/2020. · Staff competency - interview with staff, adequate competency and understanding of dementia care was not exhibited. Although the facility produced adequate records of staff training, the facility failed to ensure staff competency. · Insufficient staff for the current period – Review of R3’s needs & Services plan require full staff assistance when experiencing effects of Parkinson’s disease. Review of R4’s Physician’s report show R4 require staff assistance and monitoring due to frail physical health condition and old age. Residents currently in care require there be more than 1 staff person present at the facility to ensure residents’ proper care and supervision. · Failure to address changes in resident’s physical, mental, emotional and social functioning needs. LPA observed R2 and R4’s physicians reports were more than a year old dated 10/15/2019 and 06/15/2019 respectively. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or 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, Nov 4, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87457(c)(1) · Plan of correction due date: Nov 29, 2021

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 in comparison with the admission criteria specified in Section 87455... This requirement was not met as evidenced by failure of staff to complete a needs/services/appraisal for R1prior to admission which posed a potential health & safety risk to resident in carethe state’s words, verbatim · CDSS document, Nov 4, 2021

Plan of correction: By POC date, administrator agreed to submit self certification to CCLD that she has read, understood and will comply with Title 22 Section 87457 Pre Admission Appraisal.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468.2(4) · Plan of correction due date: Nov 29, 2021

(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs... This requirement was not met as evidenced by staff not exhibiting understanding of providing proper dementia care which posed a potential health & safety risk to residents in carethe state’s words, verbatim · CDSS document, Nov 4, 2021

Plan of correction: By POC date, administrator agreed to submit self certification to CCLD that staff has completed hands on training on dementia care.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(4) · Plan of correction due date: Nov 29, 2021

There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal... This requirement was not met as evidenced by insufficient staff to meet the needs of current residents which posed a potential health & safety risk to residents in carethe state’s words, verbatim · CDSS document, Nov 4, 2021

Plan of correction: By POC date, administrator agreed to submit to CCLD proof of correction that there is sufficient staff to provide proper care and supervision to current residents.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87466 · Plan of correction due date: Nov 29, 2021

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs... This requirement was not met as evidenced by R2 and R4’s physicians reports were more than a year old dated 10/15/2019 and 06/15/2019 which posed a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Nov 4, 2021

Plan of correction: By POC date, administrator agreed to submit self certification to CCLD that she has read, understood and will comply with Title 22 Section 87466 Observation of Resident

Type of visit: Case Management - Other

On 11/04/21 at 6:46PM, while at the facility for another reason, Licensing Program Analyst (LPA) Daisy Panlilio discussed with administrator (ADM) COVID-19 infection control mitigation procedures. ADM stated that witness (W1) would visit resident (R2) every day by using a side entrance leading to her bedroom. LPA advised ADM that per PIN 20-38-ASC, best practices for indoor visitation include facility to designate one area to enter the facility and a different area to exit the facility. ADM agreed to comply with this COVID-19 requirement during visit.the state’s words, verbatim · CDSS document, Nov 4, 2021

Type of visit: Required - 1 Year

On 10/27/21 at 11:40AM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an infection control annual inspection and explained the purpose of the visit with administrator. LPA observed 3 staff wearing face masks during visit. Comfortable temperature was observed at 72 degrees F per thermostat reading. LPA observed 4 residents resting inside their bedrooms. Facility has a completed mitigation plan in place dated 04/26/2021 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, COVID-19 questionnaire, hand sanitizer 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 the front entrance and hallway areas. LPA advised Administrator to post more COVID-19 signages in the living room and bathroom 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. LPA observed a visitation area for residents to use with social distancing protocols practiced. Continued on next page LIC 809-C A written Emergency/Disaster plan dated 07/21/2021 was posted in a common hallway leading to the living room. Centrally stored medications and sharps were observed locked in the kitchen closet. Toxic chemicals were locked in the hallway closet. LPA observed sufficient PPE located inside the garage. Facility has conducted staff training on infection prevention, symptoms, transmission and proper donning & doffing of PPE. Two trash bins with lid operated by foot pedals were located in the kitchen. Infection control designated leader is the administrator. All staff and residents have been fully vaccinated since February 2021.There was at least 7 days of nonperishable and 2 days of perishable foods. Emergency food supplies were observed stored in the garage. Administrator oversees proper business operation and compliance with COVID-19 infection control practices at the facility. Fire extinguisher was observed fully charged. Smoke and Carbon monoxide detectors were operational. Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 10/28/2021: · 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, Oct 27, 2021