Affirmative's Elite Home

Type of visit: Required - 1 Year

On September 28, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with Licensee, Bonnie Haragos , introduced herself, and stated the purpose of the visit. LPA Mixson toured the facility and inspected the inside and outside of the facility. The facility is a single story home located at 1729 Summit Dr. Escondido, Ca. 92027. Physical Plant: The physical plant is clean, neat, and orderly. Outdoor and indoor passageways are free of obstruction at the time of the inspection. The facility has four bedrooms, and each room has the required furniture and storage space, and sufficient lighting. All rooms were equipped with the required items as per Title 22 regulations. The facility had two bathrooms and the water temperature was tested and was within regulations. The restrooms were equipped with liquid soap and paper towels. The LPA toured the kitchen, living room and the TV room. The kitchen area was clean, organized, and free or odors. One caregiver was present preparing a meal. All food requirements were met, the seven day supply of non perishables, and the two day supply of perishable. The LPA inspected the common areas, and the laundry area. Smoke detectors were in the green and operable. The fire extinguisher was in the green, and last reviewed for services in 2023. Carbon monoxide alarms, along with smoke detectors were observed, and were operable. There was a locked and centralized storage area for medications. Medications are contained in bubble packs and are delivered by a pharmacy. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and sufficient space for family visitors, inside and outside. The LPA observed the previous Community Care Licensing (CCL), forms which are required to be available at the facility for public review for three years. LPA Mixson reviewed two staff files, five resident files, and conducted two staff interviews and two resident interviews. There were no observable Title 22, Division 6 Regulation violations observed and/or cited during todays visit. An exit interview was conducted and a copy of this report was provided to the Licensee.the state’s words, verbatim · CDSS document, Sep 28, 2023

Allegation investigated: Violation of a resident's personal rights

Licensing Program Analyst(LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegation above. LPA met with Caregiver Nieves Betancourt and explained the purpose of the visit. LPA also spoke with Administrator Ronni Haragos via telephone. Regarding the allegation "Violation of a resident's personal rights", it was alleged that the personal rights of Resident #1(R1) were violated when they were prohibited from attending their day center due to the fear that they would bring germs back to the facility and cause the other residents to become ill with either the flu or COVID. It was further alleged that LIC Haragos would not permit R1 to board the bus to the day center. It was also alleged that when R1 recently moved from the facility LIC Haragos moved all the other residents into a back room and would not permit R1 to say goodbye to them. The investigation revealed LIC Haragos had inquired with LPA on November 30, 2022 regarding the legality of preventing a resident from leaving the facility to attend a day program throughout the flu season, specifically through the end of March. On December 1, 2022, LPA informed LIC Haragos that it was unlawful to restrict any resident’s movement to and from the facility. Interview conducted with LIC Haragos revealed she asked R1 if it "would be OK" if they did not attend their day program and if they "could stay (CONTINUED ON LIC9099-C) Substantiated (CONTINUED FROM LIC9099) out until the end or flu season, end of March" in order to prevent R1 from getting sick and causing the other residents to become sick as well. LIC Haragos also provided a written statement attesting to her proposal to R1. Interviews conducted and records reviewed also revealed on December 3, 2022, LIC Haragos asked members of R1's family if “they could possibly keep R1 home from PACE through the flu season which would be till the end of March”. There was no evidence found that R1 was prohibited from boarding the day program bus. Review of video footage of the day R1 moved from the facility revealed residents were in the dining room for lunch at the time of R1's departure however, there was no effort made by R1's family to take R1 into the dining room to say goodbye. Based on LPA’s observations, interviews conducted, and records reviewed, 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), is being cited on the attached LIC 9099 D. An exit interview was conducted and a copy of this report was provided along with Appeal Rights and LIC811- Confidential Names list.the state’s words, verbatim · CDSS document, Feb 16, 2023 · control 18-AS-20230131104737

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2 · Plan of correction due date: Feb 17, 2023

Additional Personal Rights of Residents in Privately Operated Facilities-(a)In addition to...rights listed in Section 87468.1, residents in...residential care facilities for the elderly shall have the following personal rights:(3)To be encouraged and assisted in exercising their rights...as residents of the facility... be free from interference...in exercising their rights. This requirement was not met as evidenced by: LIC did not ensure the personal rights of R1 were maintained. Based on interviews and records reviewed, LIC interfered with R1's decision to attend their day program. This poses an immediate personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 16, 2023

Plan of correction: As discussed with Administrator Haragos, the facility will submit a written statement of understanding of the regulation cited and the importance of maintaining the personal rights of all residents in care. POC to be submitted to LPA by due date of 2/17/2023.

Type of visit: Office

Licensing Program Analyst(LPA) Tricia Danielson and Licensing Program Manager(LPM) Deborah Mullen met with Licensee(LIC) Bonnie Haragos and Administrator(AD) Ronni Haragos at the Riverside Adult and Senior Care Regional Office for an informal meeting to discuss concerns Community Care Licensing(CCL) has regarding the Licensee's disregard of information obtained from CCL regarding the lawfulness of a proposed plan by the facility. On November 30, 2022, LIC Haragos emailed LPA Danielson asking if it was "lawful" to prevent a resident from leaving the facility to attend a day program through the flu season, specifically until the end of March, in order to possibly prevent the spread of germs to other residents. On December 1, 2022, LPA Danielson responded to LIC Haragos' email informing her that it was not lawful to do so and provided recommendations for infection control measures the facility could take to mitigate the spread of any germs. On December 2, 2022, LIC Haragos emailed LPA Danielson again asking if there was anything else the facility could do besides practicing infection control measures. On December 3, 2022, LIC Haragos text messaged Resident #1's (R1's) family and asked them if it would be OK with them if R1 did not attend their day program to possibly prevent the spread of germs to other residents. On December 5, 2022, LPA Danielson responded to LIC Haragos' 12/2/22 email and reiterated the unlawfulness of restricting a resident from movement to and from the facility. During a facility visit on February 3, 2023, LPA Danielson interviewed LIC Haragos who reported she had asked R1 if they would be OK with staying home from the day program to help prevent the spread of germs to other residents. During today's meeting, LPM Mullen discussed LIC Haragos' disregard of the information provided to her by LPA Danielson. AD and LIC Haragos reported their intentions may have been misrepresented in their email communications with LPA Danielson and that there was no ill will intended in their actions related to R1. LPM Mullen expressed understanding of the intent of the emails sent by LIC Haragos. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 9, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct an annual inspection with emphasis on infection control. LPA met with Licensees/Administrators Ronni and Bonnie Haragos and explained the purpose of today's visit. Five (5) of five (5) residents in care were present during today's visit. During the inspection, LPA interviewed Licensee's regarding the facility's infection control measures and inspected the facility for regulatory compliance. LPA observed appropriate postings in the facility which were in accordance with the Department's guidelines. LPA observed that the facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolation, and properly caring for residents with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms. No deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 16, 2022

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.