Flowering Plums Assisted Living

Type of visit: Case Management - Incident

On 9/7/2022 at around 10:10AM Licensing Program Analyst (LPA) L. Ibo conducted an unannounced Case Management visit regarding an incident report that was received on 9/6/2022 . LPA met with S2 and explained the reason for the visit. LPA called Administrator Kavitha Pramod and explained the purpose of the visit. Administrator arrived at the facility around 11:15AM. The incident that was submitted for R1 occurred on 8/16/2022 where R1 was found by Police officers couple of blocks away from the facility. Based on the interview with staff, on 8/16/2022 the police officers went to the facility at around 2:30PM and informed the staff that R1 was found walking around the street. Skin tear on R1’s face was observed during the incident that prompted the Police officers call 9-1-1 and R1 was taken to the hospital. The Physician's Report indicated that R1 has dementia and that she is unable to leave the facility unassisted. Staff interviewed indicated R1 has history of wandering behavior. Medical records further revealed R1 had a fall with uncertain cause, based on interview with staff, R1 sustained skin tear on the left side of her face. Staff admitted that R1 did not have the skin tear while she was at the facility and was only observed when Police officers found her at the street. Deficiency are cited from Title 22 California Code of Regulations (see 9099D). A $500.00 civil penalty is assessed. Failure to submit proof of correction by plan of correction due date may result in additional civil penalty. Licensee will be called for a meeting at a later time. Deficiency, plan and proof of correction and civil penalty were discussed with Kavitha Pramod. Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment, LIC9098 Proof of Correction form and copy of this report providedthe state’s words, verbatim · CDSS document, Sep 7, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Sep 8, 2022

Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2)To be accorded safe... accommodations... This requirement was not met as evidence by: Based on interviews and records review, the licensee did not comply with the section, facility staff failed to ensure the safety of R1; R1 was able to AWOL which posed immediate safety risk to person in care.the state’s words, verbatim · CDSS document, Sep 7, 2022

Plan of correction: Administrator to do the following and submit proof by 9/8/2022: In-service all staff regarding regulation that was cited and submit copy of in-service training with attendees’ signatures.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87468.2(a)(4) · Plan of correction due date: Sep 8, 2022

Additional Personal Rights of Residents in Privately Operated Facilities (a).... elderly shall have all of the following personal rights: (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 is not met as evidenced by: -Based on interviews and records review, the licensee did not comply with the section above. R1 was able to AWOL unnoticed. R1 was found by Police officers couple of blocks away from the facility, R1 sustained skin tear while away from the facility. These posed immediate safety and personal rights and safety risks to person in care.the state’s words, verbatim · CDSS document, Sep 7, 2022

Plan of correction: Civil penalty is assessed. Administrator to conduct in-service training regarding the regulation that was cited and submit proof by POC date. A $500.00 civil penalty is assessed.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(j) · Plan of correction due date: Sep 8, 2022

Care of Persons with dementia: The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidenced by: Based on observation, licensee failed to ensure that an auditory device or other staff alert feature to monitor exits is placed on exit doors, which poses a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Sep 7, 2022

Plan of correction: Licensee shall have fucntional auditory device/alert feature placed on each exit door at facility. In-service all staff regarding teh regulation that was cited and submit copy of in-service training with attendees’ signatures.

Type of visit: Prelicensing

On 5/13/2022 Program Analyst (LPA) L. Ibo made a scheduled visit to this facility for the purpose of completing a Pre-licensing inspection. LPA met with Applicant Kavitha Pramod. LPA observed 5residents were present during today’s visit. At 10:30 AM, LPA toured the entire premises indoors and outdoors. The facility has 6 bedrooms including master bedroom, 2 bathrooms including master bathroom, one story house per facility sketch. 6 bedrooms are designated for residents. LPA observed 1 fire extinguisher which was in the kitchen. Smoke detectors and carbon monoxide detectors were observed operational. The facility received a fire clearance dated 4/7/2022 with an approval for a total capacity of 6 residents, approved for ONLY 5 non-ambulatory residents and bedroom #3 is for ambulatory residents only. LPA observed a locked cabinet for centrally stored medications at the kitchen area. Kitchen and dining room floors are clean and sanitary, food preparation area has an operating ventilation fan, there are no pesticides, poisons, or other toxins stored in any food storage or preparation area, cleaning supplies are kept separate from food supply. The facility has a supply of 7 days of non-perishable and have at least 2 days nonperishable food. There are enough amounts of tableware, tables, dishes, and utensils. There are enough amounts of equipment for the storage, preparation of food. All equipment and dishes are clean and in good repair and there is at least 1 dining room convenient to the kitchen. Hot water temperature was tested at 115.4 degrees Fahrenheit. Refrigerator temperature was observed at 37 degrees Fahrenheit and freezer was observed at 0 degrees Fahrenheit. Continue LIC809C... 5 Bedrooms were observed furnished with a bed, bedding, and nightstand, a chair, and a closet space. There were no bodies of water present at the facility. Outside pathways to security exit gate were unobstructed. There is confidential storage for personnel and resident records. There are games, activity supplies, and reading materials available. There is an outdoor area, that appears comfortable and furnished for residents to entertain friends and relatives. LPA observed the first aid kit was complete with manual. All exit doors in the facility are equipped with auditory signals. LPA verified there is an active telephone line in the facility, which is currently operating. During today's visit, LPA reviewed LIC 610E Emergency disaster plan/Fire and Earthquake drill requirements with applicant. LPAs observed the facility had the necessary posters in place (Complaint poster, LTCO poster, Rights to Council, etc). COVID-19 posters were also displayed in the main entrance, common areas and the bathrooms. Comp III is being waived. No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted with Applicant Kavitha Pramod and a copy of report provided.the state’s words, verbatim · CDSS document, May 13, 2022

Type of visit: Office

On 04/14/2022, applicant/administrator participated in COMP II. Identification of the applicant and administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant and administrator confirmed the understanding of the California Code Title 22 Regulations. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing readinessthe state’s words, verbatim · CDSS document, Apr 14, 2022