Green Valley Care Home

Allegation investigated: Resident fell while in care due to lack of supervision. Staff did not seek medical attention to resident in a timely manner. Staff did not communicate with authorized representative of changes of resident's health status. Staff did not ensure resident was utilizing medical devices. Staff provided confidential information to an unauthorized person. Staff did not safe guard resident's personal belongings. Facility's door is in disrepair. Facility do not follow covid protocols.

On 4/3/2023 starting at 10:40 AM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct complaint investigation for the above allegations. LPA was greeted by Care Staff, Caroline Olaniyi and LPA explained the purpose of the visit. Administrator, Marjorie Osia later arrived at 11:00 AM. During the course of the investigation, LPA obtained information, reviewed records, collected documents, and interviewed staff and residents. Allegation: Resident fell while in care due to lack of supervision. On 4/2/23 at 11:10 AM, interview with S1 revealed that S2 and S3 were both on duty the day of the incident on 3/4/22. S1 stated S3 was assisting R1 in the bathroom and R1 slid off to the ground. REPORT CONTINUES ON 9099C Unsubstantiated During an interview with S2 and S3 on 4/3/22, S2 and S3 both denied of not remembering the incident. However, based on record review of R1's incident report, it indicates that a staff was assisting R1 in the bathroom when R1 during the incident. Allegation: Staff did not seek medical attention to resident in a timely manner. Based on interview with S1 and record review on 4/3/23, S3 assessed R1 and asked if R1 was in pain. R1 did not express of any pain so an ice pack was applied. When S1 arrived 10-15 minutes later, R1 expressed of pain so 9-1-1 was called. Allegation: Staff did not communicate with authorized representative of changes of resident's health status. LPA interviewed 3 staff and 3 of 3 staff stated that S1 is informed when there is a change in a resident's health condition, then S1 will then notify family. LPA discovered during an interview with S1 that S1 will text or call R1's responsible party to keep R1's responsible party updated. LPA observed a history of communication between S1 and resident's responsible party via text and progress notes. Allegation: Staff did not ensure resident was utilizing medical devices. However, interview with 2 staff revealed that staff assisted R1 with the hearing aid. However, R1 removes hearing aid. S1 stated staff will observe hearing aid on the chest or pillow, and staff will store hearing aid in the container to avoid misplacing it. Based on information obtained, facility was not assisting resident with nebulizer. However, there is no doctor's order for nebulizer. Allegation: Staff provided confidential information to an unauthorized person. Based on information obtained, facility staff disclosed of R1's passing over the phone with R1's family member. However, interview with S1 revealed that R1's family member contacted facility to notify staff about visiting R1, so staff disclosed to R1's family member of R1's passing. REPORT CONTINUES ON 9099C Allegation: Staff did not safe guard resident's personal belongings. Based on information obtained, R1 was missing a hat. However, LPA reviewed R1's LIC 621 and did not observe the hat is listed to be entrusted to the facility. Allegation: Facility's door is in disrepair. Based on information obtained, a chair was being used to close the door. However, based on observation and interview with S1 on 4/3/2023, the door in room #2 is a French door. S1 stated the facility was instructed by the local fire department to remove the latch on top and bottom of the right door in case of an emergency. On 4/3/23, S1 demonstrated to LPA that left door of the French door latches to the right door when the lock is turned to the right. Allegation: Facility do not follow covid protocols. However, LPA interviewed 2 residents and 2 of 2 residents stated they observe staff wears their face coverings. 3 of 3 staff denied allegation. Although the allegation may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and a copy of this report provided to Administrator It was alleged facility did not provide resident with notification of rent increases. However, on 10/11/22, LPA obtained a copy of rate increase notification dated January 15, 2021. This agency has investigated the complaint alleging facility did not provide a refund to authorized representatives and facility did not provide resident with notification of rent increases.. We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. Exit interview conducted and a copy of this report provided to Administrator.the state’s words, verbatim · CDSS document, Apr 3, 2023 · control 15-AS-20221003094738

Type of visit: Required - 1 Year

On 09/23/2022 at 2:30 PM, Licensing Program Analysts (LPAs) P. Watson and L. Francisco arrived unannounced to conduct an annual Infection Control Inspection. LPAs met with Administrator, Marjorie and explained the purpose of the visit. During the Infection Control Inspection, LPAs toured facility with Marjorie including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen, and backyard. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Visitors policy is posted on the front entrance. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, Covid questionnaires, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Common touched surfaces are disinfected at least once daily. Bathrooms are equipped with liquid soap, paper towel and trash bins with touchless lids. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for residents and staff. LPAs observed facility passages inside and out free of obstruction. At 3:00 pm, LPAs reviewed 3 staff records and 3 of 3 have current first aid training and associated to the facility. Continue on 809 C. The following deficiency was observed during inspection: -At approximately 2:40 pm LPAs observed a resident living in a designed room for caregivers The following forms are to be updated and submitted to CCLD 9/30/2022: - LIC500- Personnel Report - LIC308- Designation of Administrative Responsibility - LIC610E- Emergency Disaster Plan - An updated copy of Administrator certificate The following deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiency by POC date may result in additional Civil Penalties An immediate $500 Civil Penalty is being assessed. Exit interview conducted and a copy of this report provided along with Appeal rights.the state’s words, verbatim · CDSS document, Sep 23, 2022

Allegation investigated: Facility failed to update resident's medical assessment

On 11/1/2021 starting at 2:00 PM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct complaint investigation for the above allegation. LPA met with Administrator and explained the purpose of the visit. During the complaint invesgiation, LPA reviewed records and interviewed Administrator. Based on information obtained, facility failed to update resident's medical assessment. During a Case Management visit on 10/18/2021, LPA reviewed two resident's (R1 and R2) physician's report and LPA observed R1's physician's report was last updated on 8/14/2020. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted. Appeal rights and a copy of this report provided. Substantiatedthe state’s words, verbatim · CDSS document, Nov 1, 2021 · control 15-AS-20211022082651

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5) · Plan of correction due date: Nov 12, 2021

CARE OF PERSONS WITH DEMENTIA (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5)Each resident with dementia shall have an annual medical assessment as specified...least annually.. This requirement was not met as evidenced by: Based on record review, Licensee did not comply with regulation cited above. On 10/18/21, LPA observed R1's medical assessment was last completed on 8/14/2021 which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Nov 1, 2021

Plan of correction: Deficiency cleared during visit. LPA observed an updated Medical Assessment completed on 10/22/2021 for R1.

Type of visit: Required - 1 Year

On 10/18/2021 at 11:50 AM, Licensing Program Analyst (LPA) L. Francisco arrived unannounced to conduct Infection Control Inspection. Administrator, Marjorie Osia later arrived at 12:03pm and LPA explained 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. Facility has a sufficient 2-day perishable and one week non-perishable food supply. There is one central entry point for universal screening for staff, residents and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette, social distancing and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has a mitigation plan and maintains record of routine screening for residents and staff. No deficiencies cited during visit. Exit interview conducted with Administrator. Due to technical difficulties, LPA provided a copy of report via email.the state’s words, verbatim · CDSS document, Oct 18, 2021

Type of visit: Case Management - Other

On 10/18/2021 starting at 1:10 PM, Licensing Program Analyst (LPA) L. Francisco conducted a Case Management concurrently with Infection Control Inspection to discuss information obtained regarding bedridden room (Room #2). LPA met with Administrator, Marjorie Osia and explained the purpose of the visit. Although room #2 was approved for bedridden, it was determined by Fire Inspector during an inspection completed on 10/12/2021, that room #2 does not meet Fire Code requirements for bedridden. LPA reviewed resident's (R1) physician report and LPA observed R1 is not bedridden. LPA advised Administrator to not accept bedridden residents in room #2 until further guidance. LPA requested to submit a copy of updated floor plan to CCL by 10/22/2021. No deficiencies cited during visit. Exit interview conducted with Administrator. Due to technical difficulties, LPA provided a copy of report via email.the state’s words, verbatim · CDSS document, Oct 18, 2021