Abundant Grace Senior Living

Allegation investigated: Staff did not administer resident's medication as prescribed

Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegation. The LPA met with Administrator, Kanisha Arzu, and informed her of the purpose for her visit. A report was received by the Department alleging a resident in care, Resident One (R1), did not receive one of their medications which caused the resident to be hospitalized on 10/11/2023. Administrator, Kanisha, was interviewed; she reported R1 was admitted to the facility on 10/05/2023 from a skilled nursing facility (SNF). She reported R1's medications were received at admission, however, necessary equipment to administer one of the medications was not available. Text messages between the Administrator and the SNF Discharge Coordinator were received from the facility. The text messages revealed a request was made by the Administrator on 10/06/2023 to obtain the necessary equipment so R1's medication could be administered. Text messages from 10/10/2023 show the SNF Discharge Coordinator reported there was still no response provided from their intake team regarding the medication equipment. The SNF Discharge Coordinator was Unsubstantiated interviewed and reported they believed the equipment for R1's medication was not provided; however, instruction was given on how to administer the medication with alternate equipment. Per Administrator and staff, alternate equipment was not available. An inspection of R1's medication and medication equipment could not be conducted due to the resident's medication no longer being available at the facility. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted; this report was reviewed with Administrator Arzu and a copy was provided.the state’s words, verbatim · CDSS document, Oct 19, 2023 · control 18-AS-20231012101521

Type of visit: Required - 1 Year

On 7/24/2023, at 11:45 a.m., Licensing Program Analyst (LPA) Janette Romero arrived unannounced at the facility to conduct an annual required visit. LPA was greeted and granted entry by Administrator Kanisha Arzu who was informed of the purpose of visit. The facility is made up of four (4) resident bedrooms and two (2) bathrooms. The facility is approved for six (6) non-ambulatory residents of which one (1) may be bedridden. The facility also has a hospice waiver for six (6) residents. During the visit, there was five (5) residents and two (2) staff present. LPA conducted a tour of the facility’s interior and exterior and observed the following: Kitchen: LPA toured the kitchen and observed kitchen to be clean. Food is stored in a safe and healthful manner. LPA observed the facility met the requirement for a 2-day supply of perishable food and 7-day of non-perishable food items. Cleaning solutions and knives/sharp instruments are secured in a locked kitchen cabinet. Fire extinguisher is charged and mounted on kitchen wall. Dining and Living room: LPA toured the dining and living/family room area. LPA observed area to be clean and furniture in good condition. Facility has six recliner chairs available for the residents. LPA observed residents in their rooms and in common areas. Hallway: LPA toured the hallway and observed hallway to be clean with no pathway obstruction. Carbon monoxide & smoke detectors were tested and functioning properly. Continued on LIC809-C.. Centrally Stored Medications: LPA observed a first aid kit with required components. Medications were secured in a locked kitchen cabinet. LPA reviewed physical medications for two residents as well as the Medication Destruction Record and no discrepancies discovered. Bedrooms: Resident bedrooms were clean, and each furnished with a bed, chair, closet, clothing storage and lighting. Bathrooms: Bathrooms were clean, and had a working toilet, wash basin, and grab bar in the shower. Bathroom sink hot water temperatures measured at 124- and 132-degrees Fahrenheit. Facility has warning signs to caution residents of hot water temperatures. The facility has clean towels, blankets, and linen, available in different colors for residents in care. Laundry/Garage: LPA observed laundry room and garage to be clean. Washing machine and dryer are in good repair. Emergency food supplies, water and incontinent supplies are stored in the garage. Records: Staff present have a criminal record clearance on file and are associated to the facility. Staff training is up to date. Yard/Outside Area: Covered patio seating is available for the residents. A brick wall secured the entire backyard. All outdoor pathways were free of obstructions. No bodies of water were observed. There were no firearms or ammunition observed at the facility, and LPA was informed the facility will not store firearms or ammunition on the premises. LPA did not observe any deficiencies. An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator Arzu.the state’s words, verbatim · CDSS document, Jul 24, 2023

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Yolanda Delgado conducted an announced visit to the facility for purpose of a Pre-Licensing evaluation. At approximately 9:30 AM, LPA met with Licensee/Administrator Kanisha Arzu. An initial application for to operate a Residential Care for the Elderly facility (RCFE) was submitted to the Central Applications Bureau (CAB) on 1/5/2022 for a total capacity of five (5) non-ambulatory and one (1) bedridden residents. Fire clearance was granted on 4/27/2022. LPA Delgado observed the following: Structure: Facility was a one-story house with four (4) resident bedrooms, two (2) resident bathrooms, living room, dining area and kitchen. There was an attached two car garage in the back of the house. Heating/Cooling System: Central heating and air conditioning system installed with a central panel located in the hallway to control entire house. Bedrooms: Each resident bedroom #2 (shared) , #3 (shared), #4 will accommodate any non-ambulatory resident, bedroom #1 will accommodate bedridden residents. 4 resident bedrooms were adequately furnished with bed, chair, closet, appropriate linens, adequate lighting, and an operable smoke alarm. Bathrooms: The (2) resident bathrooms has a working toilet, wash basin, and shower with an adequate supply of paper towels, toilet paper, and soap. At 10:00 AM, LPA tested the water temperatures in the resident bathrooms. LPA verified water temperature was measured at 138 degrees Fahrenheit. Kitchen/Laundry: An adequate supply of dishes, glasses, utensils, pots and pans were observed. There were no Knives/sharp instruments observed, Licensee advised they will be secured in a locked drawer located in the kitchen cabinet . There was adequate room for food storage. LPA observed the stove to be operational. Refrigerator/freezer were in working condition. (CONTINUED ON LIC 809C) (CONTINUED FROM LIC 809) and had sufficient storage for perishable food. There was adequate seating for meals for all clients. Laundry room with washer and dryer was located inside the home. Laundry detergents and cleaning supplies were observed in locked cabinet inside the laundry room away from residents. Living/Family room: There was a living room with 6 reclining chairs for all clients and a TV. Linens and Hygiene Supplies: An adequate supply of linens was stored in a cabinet in the main hallway of the residence. Yards/Outside: Patio table, 6 chairs, a bench with shade were observed in the backyard. There was a gate on the North side and South side of the property with a self-latching from the exterior doors that needs to be repaired. All outdoor pathways were free of obstructions. Emergency Phone Numbers, and Exit Plan: Facility sketch were observed posted in the Dining area, Laundry room and each resident's bedrooms. Obudsman poster was not observed and Let-Us-No poster observed. General items: One (1) fire extinguishers were charged and located in the kitchen. Seven (7) smoke alarms and one (1) carbon monoxide detectors were tested and were observed to be in working order. Client records will be stored in a locked yellow cabinet in the Staff office. First Aid kit with required components, and locked area for medication storage was observed. LPA observed a facility phone and it was verified to be operational as evidenced by LPA dialing the number to trigger a ring. Emergency water supply was observed however the required 72-hour emergency food supply was not discernible from the regular food supply. Component III was completed on this day as well. (CONTINUED ON LIC 809C) (CONTINUED FROM LIC 809) Pre-Licensing is incomplete and the following corrections to be resolved by 6/30/2022: Add the camera locations on the Facility sketch Add the camera use to the Facility plan of operations for residents/representatives to be aware of cameras in facility obtain a separate 72-hour emergency food supply obtain additional emergency water obtain and post visiting policy obtain 30-Days of PPE supplies obtain night lights for main hallway obtain night lights for kitchen/dining area obtain Obudsman poster obtain generator for emergency power obtain additional keys for facility vehicle replace locks on cabinet doors in laundry room replace locking mechanism for South and North exterior gate doors replace trash cans with lids repair padding to the bottom of the exterior door in Bedroom #1 readjust water temperatures for kitchen sink, bathroom sinks and showers between the temperature of 105 degrees Fahrenheit and no greater than 120 degrees Fahrenheit and verified by a licensed Plumber. remove black inactivated cameras from the the premises An exit interview was conducted, and a copy of this report was given. "Pre-Licensing deficiencies have been resolved. Pre-Licensing is now complete."the state’s words, verbatim · CDSS document, Jun 23, 2022

Type of visit: Office

Facility Type: RCFE Application Type: Initial Capacity: 6 COMP II Participant: Kanisha Arzu, Managing Member/Administrator Interview Method: Telephone interview On 5/12/22, applicant/administrator participated in COMP II. Identification of the applicant/administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, applicant/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, May 12, 2022