Amalia's Residence

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jenny Olson arrived at the facility unannounced to conduct a required annual visit at 2:00 p.m. When LPA arrived, there was one staff and six residents present. LPA was greeted by Administrator and informed them of the reason for the visit. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. KITCHEN: Knives are stored in a locked drawer in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. Common areas: Living and dining room furniture were observed to be in good condition. At around 3:00 p.m., smoke detector(s) and carbon monoxide detector were tested and operational at the time of the visit. There is a fireplace in the living room, which is screened and inaccessible. LPA observed required postings throughout the common space. The fire extinguisher was purchased on 04/05/2023. The backyard has a covered outdoor area equipped with furniture for client use. No bodies of water noted. The washer and dryer are in the garage. Restrooms: The two resident restrooms were clean and sanitary and in operating condition with a non-skid mat. The bathroom was sufficiently stocked with soap and paper towels. Around 3:15 p.m., the hot water temperature measured in the kitchen at 114.7 degrees Fahrenheit. Bedrooms: There are four (4) resident rooms, which were furnished. A linen closet was located outside of the rooms, which stocked extra linens and towels. Records: LPA reviewed resident and staff records around 2:10 p.m. LPA reviewed five (5) resident files for, but not limited to, the following: signed admission agreements, current medical assessments with TB results, and current needs and services plan. Files were complete. Continued on 809-C LPA reviewed five (5) staff files for, but not limited to, the following: personnel records, health screening, criminal record statements, current first aid certification. 1/5 staff did not have current first aid certification. MEDICATIONS: Medications review began around 02:45 p.m. The medications are centrally stored and locked in a closet in the dining room. Medications are labeled and checked for expiration dates. INFECTION CONTROL: The facility has an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. At 3:30 p.m., LPA interviewed two (2) staff members and two (2) residents. During today’s visit, the LPA obtained copies of the following: staff roster, resident roster, and current liability insurance. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 8, 2023

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Staff violated residents personal rights

Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegation above. LPA conducted the 10 day visit and requested relevant documents on 6/19/23. LPA Olson interviewed reporting party and Administrator on 6/19/23. LPA Olson met with Dexter Price, Administrator and explained the purpose of the visit. On the allegation: Staff violated residents personal rights. It was alleged that Resident 1 (R1) was being mistreated because they were rudely told they would have to leave and go somewhere else. LPA interviewed R1 who stated staff said R1 would be evicted if they didn’t follow the rules. LPA interviewed Administrator who said that R1 is very private and refuses to communicate with staff when there is an issue and won’t allow anyone to speak to the doctor or home health nurse to ensure the facility can properly care for R1. R1 confirmed that they refused to allow the facility to communicate with their doctor or home health nurse and have rights under HIPPA and will sue anyone who violates their HIPPA rights. Continued on 9099-C Unsubstantiated R1 stated “It’s no one’s business what is going on with me.” The facility would be unable to meet R1’s needs if they are not allowed to know what the needs are, and not being able to meet a resident’s needs is a valid reason for eviction. LPA asked about the tone that staff stated they would have to go and R1 said no staff did not have a rude tone but it sounded like a threat. R1 promised to be more cooperative and allow nurses and doctor’s to communicate relevant information in order to be able to provide care because they wanted to stay at the facility. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of the report issued.the state’s words, verbatim · CDSS document, Jul 31, 2023 · control 29-AS-20230619100031

Allegation investigated: Staff violated resident’s personal rights

Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegations above. LPA conducted the 10 day visit and requested relevant documents on 6/1/23. LPA interviewed reporting party, residents, Administrator on 6/1/23, and 6/19/23 and Staff 1 on 6/15/23. LPA Olson met with Dexter Price, Administrator and explained the purpose of the visit. On the allegation: Staff violated resident’s personal rights. It was alleged that Staff 1 (S1) rudely said to a resident “why didn’t you plan this thing out at a better time, why didn’t you go poop earlier?” LPA interviewed residents, who stated S1 is very rude, things have to be on S1’s time, and everyone has to do what S1 wants. Multiple residents interviewed indicated S1 tried to force another resident to cut their hair when the resident did not want to, and it made some residents uncomfortable. Residents stated S1 “has an attitude, is really bossy, wants things [S1’s] way, takes control and tells us what to do. [S1] tries to run our life…” and will get in your face if really mad. Continued on 9099-C Substantiated LPA interviewed S1, who admitted that they may have gone too far in verbally pushing residents. S1 stated they really care for the residents, including R1, and they remind them of their father and they treat R1 like they do their father. S1 stated their father is in a home and needs reminders and to be told to do things but they realize R1 is not their father and they may need to stop treating them like their father. Based on the information obtained. The allegation is deemed Substantiated at this time. Exit interview conducted, copy of report, deficiencies and appeal rights issued. The doctor’s office was confused why the Administrator didn’t bring R1 at the correct time. Administrator stated R1 is refusing to allow staff to communicate to the doctor’s office, OT and PT but they need to be able to communicate to confirm the time of appointment and possibly reschedule if there are conflicts with transportation arrangements or other appointments. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of report issued.the state’s words, verbatim · CDSS document, Jul 31, 2023 · control 29-AS-20230601142856

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Jul 31, 2023

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above when Staff 1 (S1) did not speak to residents with dignity which was a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 31, 2023

Plan of correction: Licensee agreed to schedule training for all staff on personal rights by 7/31/23, and submit proof of training to CCL.

Allegation investigated: Staff not assisting resident with motorized wheelchair as needed.

Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegations above. LPA conducted the 10 day visit and requested relevant documents on 6/19/23. LPA Olson interviewed reporting party and Administrator on 6/19/23. LPA Olson met with Dexter Price, Administrator and explained the purpose of the visit. On the allegation: Staff not assisting resident with motorized wheelchair as needed. It was alleged Resident 1 (R1) purchased a motorized scooter on their own and asked staff to assist them getting on it, and was told “no, they can’t do that” and they couldn’t use their motorized scooter unless they had a prescription. LPA interviewed Administrator who stated the staff would need training by R1’s nurse or therapist to know how to properly and safely transfer R1 into the scooter. Administrator also stated they know they also require a prescription for a postural support and faxed the doctor for an order. Continued on 9099-C Unsubstantiated LPA interviewed R1 who stated they just wanted to be put from their wheelchair to the motorized chair and why do staff need training and permission from their doctor, “it is my right to be in any chair I want and I should get any and all help I ask for.” On 6/27/23 LPA received an email from Administrator which included a letter from R1’s doctor stating “(R1) has been a patient in my practice for some time. Upon the review and recommendation of physical therapist, as well as myself, we ALL felt that it was in (R1’s) best interest medically that (R1) NOT have a motorized scooter or wheelchair, as these would impede (R1’s) motivation to improve motor skills on (R1’s) own and get better.” Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of report issued.the state’s words, verbatim · CDSS document, Jul 31, 2023 · control 29-AS-20230616141521

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Olson conducted an on-site 1-year infection control annual visit to the facility above on 10/20/2022 around 12:00 PM. LPA met with Dexter Price, Administrator/Licensee and explained the purpose of the visit. LPA took a physical plant tour of the facility with Staff. The facility has an entry point at the front door where everyone entering completes sign-in, symptom questionnaire and temperature screening on all staff and visitors wanting to come into the facility. The entry station has hand sanitizer along with a thermometer. The staff screen residents for symptoms and temperature at least once a day and documentation is kept on file. Increased monitoring is conducted if any change of condition is noted or any residents are showing any signs, symptoms, or a temperature. Signs are posted on the front door, entry area regarding Covid-19. Staff makes sure residents have a mask when leaving the facility on outings into the community. All staff wear face coverings in the facility and when on outings with residents. Facility has areas for visiting inside and outside. The facility also offers virtual and telephone communications to all residents in care. Staff, residents, and visitors are informed of the facilities infection control policies. New residents and staff will be tested, and negative results received before working or residing in the facility. The facility has procedures and plans for screening, isolation, testing, when to call 911 and notifying all responsible parties and agencies when needed. The Administrator is in charge of infection control and provides training and education to staff, residents and visitors. Facility has submitted an Infection Control Plan and Emergency Infection Control plan. Continued on 809-C Staff will use full PPE with N95 masks and face shields when around with any pending or confirmed cases of Covid-19. Facility has plans in place for residents in isolation. Precautionary Droplet signs will be posted on any room with quarantine or isolated individuals. PPE supplies will be located right outside those rooms when required. Facility has a 30-day supply of PPE on hand. Facility has plans for delivering medications and meals to any quarantined/isolation resident rooms. Facility Administrator has a plan in place for when and whom to notify in an outbreak or other emergencies. Administrator will keep a line list of all vaccinated and tested staff/residents in care with dates/results. Facility has conducted training on infection prevention, symptoms, transmission, and PPE use. Facility has non-punitive sick leave polices for staff. Sick staff are requested to stay home and not report to work if ill. Residents’ medication is delivered in 30-day supplies to the facility. The facility ensures proper cleaning is done on frequently touched surfaces and between any individuals sharing of space or items. Sinks were well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in a locked closet. Facility does realize guidance changes and the most up to date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. Administrator Certificate is valid. Smoke and Carbon Monoxide Detectors present and working. All infection control protocols are implemented and are being followed. At approximately 12:15 AM, LPAs reviewed Department of Social Services, Community Care Licensing Division, Licensing Information System (LIS), Facility Personnel and facility staff roster and determined all staff have been associated to the facility and received a criminal background and/or fingerprint clearance prior to their employment. Exit interview conducted. Report issued via email to administrator.the state’s words, verbatim · CDSS document, Oct 20, 2022

Allegation investigated: Staff took the resident's debit card away. Staff took the resident's wheelchair away. Staff do not want the resident to talk on the phone. Staff will not give the resident the telephone number of the facility.

Licensing Program Analyst (LPA) Olson and Licensing Program Manager (LPM) Burley conducted an unannounced initial complaint visit to start the investigation. LPA met with Administrator Amalia Ilbian and explained the purpose of the visit. LPA toured the facility. LPA interviewed staff and residents. Licensee Dexter Price arrived shortly and LPA also interviewed him. LPA conducted staff interviews at 9:45am and 10:15 am, resident interview at 10:00am, and a credible witness interview at 2:20pm. On the allegation: Staff took the resident's debit card away. Resident 1 (R1) stated they did not want to answer questions related to this question. Licensee stated R1 handles their own finances and provides the licensee the monthly fees, and the licensee took them to the bank to withdraw the monthly fees. Due to R1’s diagnosis of schizophrenia, R1 threw themself on the ground in the bank and experienced behaviors. The licensee started taking R1 to the ATM machine instead. Continued on 9099-C Unsubstantiated The licensee stated R1 sometimes did not want to go to the ATM machine and wrote the licensee a letter requesting he withdraw money from the bank for him and gave the licensee R1’s debit card and permission to make the withdrawal on their behalf. Licensee stated he gives R1 the debit card back right after, and R1 has a lockbox where R1 can keep valuables locked. The licensee could not provide a record lag to verify these transactions but will in the future. R1 did not state that any money was missing from their account. A credible witness interviewed stated R1 has told them about other issues, but did not state there were any issues with the debit card or money missing. LPA counseled licensee about keeping proper records should they assist any residents in the future. On the allegation: Staff took the resident's wheelchair. R1 stated they do not use a wheelchair in the facility, and use it sometimes when they go outside. R1 stated they did not want to talk about the wheelchair. R1 later stated that their caregiver assists them with the wheelchair when leaving the facility. The licensee and staff stated R1 uses the wheelchair if he goes out somewhere but does not use it in the facility. Licensee and staff stated R1 can have access to the wheelchair anytime R1 wants it. Based on the information obtained, the allegation is deemed Unsubstantiated. On the allegation: Staff do not want the resident to talk on the phone. R1 stated they did not want to talk about this. Licensee stated R1 wanted a cell phone through a free cell phone program but could not obtain one. Licensee stated R1 wanted a flip phone so the licensee bought R1 one with the licensee’s own money. R1 confirmed they have a cell phone and have had one for a year. Licensee stated residents have access to the facility phone, but they only have one line for everyone. Licensee stated he bought a Facebook Portal for the facility for residents to share to video chat with family and friends. Credible Witness interviewed stated R1 had their own cell phone and did not believe there were any issues related to R1 talking on the phone. Based on the information obtained, the allegation is deemed Unsubstantiated. On the allegation: Staff will not give the resident the telephone number of the facility. R1 stated they did not want to talk about this. Licensee and staff stated they have never withheld the facility phone number from residents or staff. Licensee stated the telephone number is posted on the facility bulletin board in the kitchen that all residents have access to. LPA observed the bulletin board and verified the phone number was posted for all residents to access. Based on the information obtained, the allegation is deemed Unsubstantiated. Exit interview, report given.the state’s words, verbatim · CDSS document, Mar 10, 2022 · control 29-AS-20220308131317