Angelic Hands Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry. LPA began inspection with introduction and visit purpose. Upon arrival LPA learned that zero (0) clients live at this facility and there is currently one (1) staff member present. The Caregiver, Tinisha Sherley (S1) conducted the facility tour. There is an Infection Control Plan on file. Client Records-Incident Reports/Clients Rights-Information/Dental- LPA would have reviewed client records. Zero (0) records were reviewed. LPA would have reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Personnel Records/Training/and Staffing- LPA began review of employee records- Two (2) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrative organization. Synthia Marie Luna’s Administrator’s license, expiration date is 09/14/2022. The Administrator certificate was submitted on 08/15/2022. (Continued on LIC809C) (Continuation from LIC809) LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. LPA observed three (3) fire alarms and (3) carbon monoxide detectors. There was one (1) fire extinguisher on site, last recharged 08/30/2022. Based on the information received during this visit today in the areas reviewed, there are zero (0) deficiencies observed per Title 22, Division 6 of The California Code of Regulations Article 06. There will be one (1) technical violation per HSC 1569.695(c). The facility did not perform quarterly emergency drills or have record of any past emergency drills conducted. This LIC 809 was reviewed with, and a copy will be provided to the Facility representative, Tinisha Sherley, as evidenced by her signature. (Continuation from LIC809) Food Service- Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 108.0 degrees F. Laundry is done in laundry room. There is a locked room for storing laundry soap and other chemicals. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this facility. There is a secured fireplace at this facility. There is not a pool at the facility. Medications- Medications are centrally stored. There is a locked cabinet allocated for medication storage. Centrally stored medication and destruction logs are maintained separately. (Continued on LIC809C)the state’s words, verbatim · CDSS document, Aug 3, 2023

Allegation investigated: Staff are not allowing resident to leave the facility.

Licensing Program Analysts (LPAs) Javina George and Janette Romero made an unannounced visit to the facility to commence a complaint investigation in regards to the allegation listed above. LPAs were greeted and granted entry by Licensee Synthia Luna, where LPAs explained the purpose of the visit and the elements of the allegation(s). The allegation(s) was investigated, the investigation consisted of observation, interviews and record review. Regarding the allegation staff are not allowing resident to leave the facility. Per Ms. Luna Resident #1 (R1) was at the facility for about one week and in that time law enforcement was contacted three different times. R1 would call the police and request that they be taken home to their apartment. Due to R1 being determined that they were unable to live alone as they required care and supervision 24/7, R1 was not taken back to their apartment. On 7/5/23, The department received a unsual/injury report stating that R1 was transported to get a haircut and shortly after arriving at the local barbershop they began to yell help and state that they were being held hostage. After getting their hair cut R1 was Unfounded transported safely back to the facility without incident. Per Ms. Luna, at 10am, the next day 7/6/23 R1 had called Yellow cab to pick them up and take them home to their apartment. It was at this time that Ms. Luna contacted the local police department and Adult Protective Services (APS) to file a report. Ms. Luna stated that R1's last known whereabouts were at their apartment as they had received a phone call stating that R1 had fallen and was laying on the and that the fire department had to break the door down, but they were not sent out for a medical evaluation. Based on interviews the allegation Staff are not allowing resident to leave the facility is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Therefore, the department had there dismissed the complaint. An exit interview was conducted and a copy of this report was provided to Synthia Luna, Licensee.the state’s words, verbatim · CDSS document, Jul 10, 2023 · control 18-AS-20230705165403

Allegation investigated: Staff did not notify resident's POA of change in resident's condition. Staff did not meet resident’s medical care needs.

Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with caregiver Tinisha Sherley and explained the purpose of the visit. This report was also discussed with the Licensee over the phone. Department staff investigated these allegations. Allegation #1 “Staff did not notify resident's POA of the change in resident's condition". The allegation alleged that the facility refuses to provide the Power of Attorney (POA) with any reports or information regarding resident #1's (R1's) level of health and well-being. Department staff interview with the reporting party (RP) provided no additional details about this allegation. Department staff interview with the Licensee revealed that the Licensee denied this allegation. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. Allegation #2 “Staff did not meet resident’s medical care needs”. The allegation alleged that the facility’s staff does not monitor R1’s medication condition. Unsubstantiated The allegation alleged that in November 2020, R1’s physician ordered that the facility transport R1 to the hospital. However, the facility did not allow it. Department staff interview with the reporting party (RP) provided no additional details about this allegation. Department staff interview with the Licensee revealed that whenever R1 requires medication attention, R1 receives it. Department staff interview with R1 revealed that R1 does not want to leave the facility and likes the care provided. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation. A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 27, 2023 · control 18-AS-20210205124311

Allegation investigated: Facility did not provide residents authorized representative with a refund Facility did not give residents authorized representative a copy of the admissions agreement

On today's date, Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initiating an investigation with the above allegation. LPAs Colvin met with caregiver Tinisha Sherley. Below is a summary of the findings of the investigation: Regarding allegation "Facility is refusing to provide residents authorized representative with a refund": LPA Colvin conducted interviews with Administrator Synthia Luna and other parties relevant to the complaint. Administrator Synthia Luna confirmed with LPA Colvin that resident (R1) was charged on 9/18/22 for a month residency and care at the facility, and that R1 passed away prior to the conclusion of that month of care charged. Interviews reveal that R1 passed away on 9/27/22, and that R1's family picked up R1's belongings just a few days later, arounf 9/29/22. LPA Colvin inquired as to if R1's family had been provided with a refund of the remaining days of R1's care which was not used (9/30/22 - 10/18/22), and the Administrator stated that they had not. LPA Colvin explained that according to Title 22 Regulations, residents' families may not be charged for any days after the resident's belongings have been removed from the facility. Substantiated Therefore, based on interviews conducted, the allegation "Facility did provide residents authorized representative with a refund" is SUBSTANTIATED. Regarding allegation "Facility did not give residents authorized representative a copy of the admissions agreement": LPA Colvin conducted interviews with Administrator and multiple families of recent residents at the facility. Administrator stated to LPA Colvin that the Admissions Agreement for R1 was completed in R1's family's home, and that R1's family received a copy due to R1's family having a copier at their home and having made copies of other documents to provide the Administrator. Additional interviews provide conflicting information, and persons interviewed for another similar complaint (#18-AS-20220824151755) also claim to have not received a copy of the Admissions Agreement. Administrator does not have any evidence other than their interview that R1's family received a copy of the Admissions Agreement. Therefore, based on more interviews stating that they had not received a copy of the agreement than those stating that they had, the allegation "Facility did not give residents authorized representative a copy of the admissions agreement" is SUBSTANTIATED. Due to observations made by LPA Colvin, the facility was cited and deficiencies noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy this report, LIC 9099D, and appeal rights were provided to caregiver Tinisha Sherley during the exit interview. Caregiver Tinisha Sherley refused to sign the report, which is noted below. Copies left at the facility for Administrator to review.the state’s words, verbatim · CDSS document, Oct 13, 2022 · control 18-AS-20221006144016

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.652(a) · Plan of correction due date: Oct 14, 2022

Termination of admission agreement upon death of residen...refund of fees paid...and refunds: (a) A residential care facility for the elderly shall not require advance notice ...upon the death of a resident. No fees shall accrue once all personal property...is removed... This requirement was not met by: Based on interviews conducted, the Licensee did not comply with the above regulation with at least one resident. LPA Colvin confirmed that R1's family did not receive a refund for fees prepaid for R1 through 10/18/22. R1 passed away and proprty removed 9/29. This is an immediate personal rights violation of R1.the state’s words, verbatim · CDSS document, Oct 13, 2022

Plan of correction: Licensee agrees to provide R1's family with a refund of monthly rate, prorated from the date after R1's belongings were removed from the facility (9/30/22). Proof of refund shall be provided to LPA Colvin by Plan of Correction date of 10/14/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(e) · Plan of correction due date: Oct 27, 2022

Admission Agreements: (e) The licensee shall provide a copy of the signed and dated current admission agreement,...to the resident or the resident's representative...immediately upon signing the admission agreement... This requirement was not met by: Based on interviews conducted, the Licensee did not comply with the above regulation with at least one resident (R1). Administrator does not have proof that a copy was provided to R1's family, and multiple interviews state that no Admisssions Agreement has been received. This is a potential personal rights violation of R1.the state’s words, verbatim · CDSS document, Oct 13, 2022

Plan of correction: Licensee agrees to provide a copy of the Admissions Agreement to R1's family. Adminmistrator may self-certify once complete. Due by Plan of Correction date of 10/27/22.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Crystal Colvin was at the facility conducting an investigation on open complaints (#18-AS-20220824151755 & #18-AS-20221006144016) when LPA Colvin observed the following items which were addressed: Admissions Agreements/Other Fees: In reviewed of resident's (R1) Admissions Agreement, LPA Colvin observed that R1's Admissions Agreement had additional Optional Services hand written in, such as "haircuts, pedicures & manicures, transportation, private caregiver". LPA Colvin that there was no list of fees for each item, and only the basic service fee of $7,500 was listed. Deficiency cited. LPA Colvin additionally observed that the Admissions Agreement the facility used for R1 is significantly different than that which was approved by Licensing from the facility's application for a License. Deficiency cited. Pre-Admissions Fee Refunds: LPA Colvin observed that Resident 2 (R2) resided in the facility for less than three weeks and their family was not provided with any refund of the $1,500 Pre-Admission Fee. LPA Colvin notes that Title 22 Regulations has a very specific refund schedule for Pre-Admission Fees in excess of over $500. R2 should have been refunded $800 of the fee (80% of the amount over $500, or 80% of $1,000) due to passing away within the first 30-days of tenancy. Deficiency cited. Reporting Requirements: LPA Colvin observed that R2's tenancy at the facility ended due to R2's passing away at the end of the month in September. Licensing does not have any record on file of the facility reporting R2's passing, as they are required to do for each resident within seven (7) days of their passing. Deficiency cited. Resident Records: LPA Colvin did not have access to resident files during today's inspection, and Administrator was unable to provide access, as they had an appointment in another city. Deficiency cited. Since this is a repeated deficiency, LPA Colvin wil be assessing a $250 civil penalty on today's date. Based on observations made by LPA Colvin, the facility was cited and deficiencies noted on LIC809D. A copy of this report, LIC809Ds, LIC421FC, and appeal rights were provided to caregiver Tinisha Sherley, who refused to sign the report.the state’s words, verbatim · CDSS document, Oct 13, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87507(g)(5)(E)(2)(b) · Plan of correction due date: Oct 14, 2022

Admission Agreements: (g)...shall..:(5) Refund...(E) Preadmission fees shall be refunded...: 2...fees that are greater than ...($500) shall be refunded...:a. A refund of at least 80 percent...iin excess of $500...resident leaves the facility for any reason during the first month of residency. The Licensee did not comply with the above regulation with at least one resident. R2resided at the facility for less than one month before passing away. Family removed items from facility and was not provided any refund of preadmission fees. This was an immediate personal rights violation of R2.the state’s words, verbatim · CDSS document, Oct 13, 2022

Plan of correction: Licensee agrees to provide a refund of $800 to R2's family, as well as review Title 22 Regulations section 87507 in regards to Admissions Agreements, Licensee to provide LPA Colvin with proof of refund to R2's family and may self-certify that they have thuroughly read the regulation section. Due by 10/14/22

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(3)(B)(1) · Plan of correction due date: Oct 28, 2022

Admission Agreements: (g)...shall specify the following: (3) Payment provisions, including the following: (B) Rate for additional items and services, including: 1. A...description of and the corresponding fee schedule for all additional items and services not included in the fees for basic services... The Licensee did not comply with the above regulation with at least one resident. LPA Colvin observed that R1's agreement had written in additional services (hairbuts, transportation), without listing cost of these additional services. This was a potential personal rights violation of R1.the state’s words, verbatim · CDSS document, Oct 13, 2022

Plan of correction: Licensee agrees to provide LPA Colvin and R1 with a detailed breakdown of costs for each additional fee charged to R1, per what is listed in the Admissions Agreement, as well as how frequently these services are/where provided and charged. Due by Plan of Correction date of 10/28/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87208(a)(2) · Plan of correction due date: Oct 28, 2022

Plan of Operation: (a) Each facility shall have and maintain a current, written definitive plan of operation...Any significant changes in the plan of operation...shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (2)...Admission Agreement... The Licensee did not comply with the above regulation with at least one resident. LPA Colvin observed that the Admissions Agreement for R1 was entirely different than the Admissions Agreement Licensing has on file from the application for licensure. This is a potential personal rights violation of R1.the state’s words, verbatim · CDSS document, Oct 13, 2022

Plan of correction: Licensee agrees to immediately cease using the Admissions Agreement used for R1, as LPA Colvin observed multiple Title 22 violations in the document. Licensee to either return to initial approved agreement, or create a new Admissions Agreement and submit to LPA Colvin for review prior to use. Licensee to additionally review all current resident files and deermine if any residents have a signed Admissions Agreement other than what was previously approved during facility's application for a license. Licensee to inform LPA Colvin of findings of audit. Due by Plan of Correction date of 10/28/22.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A) · Plan of correction due date: Oct 28, 2022

Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports... including...: (1) A written report shall be submitted...within seven days of the occurrence of any of the events...(A)Death of any resident from any cause regardless of where the death occurred... The Licensee did not comply with the above regulation with at least one resident. LPA Colvin observed that R2 passed away in September 2022, but Licensing never received a Death Report from the facility.the state’s words, verbatim · CDSS document, Oct 13, 2022

Plan of correction: Licensee agrees to provide LPA Colvin with a Death Report for R2. Due by Plan of Correction date of 10/28/22

From the deficiency page — Deficiency type: Type B · Section cited: CCR87506(d) · Plan of correction due date: Oct 28, 2022

Resident Records: (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours.... This requirement was not met as evidenced by: Based on observation and interview, the Licensee did not comply with the above regulation with one resident file. LPA Colvin was unable to access records for R2 during the inspection. This is a potential personal rights violation.the state’s words, verbatim · CDSS document, Oct 13, 2022

Plan of correction: Licensee agrees to provide LPA Colvin with a complete copy of R2's file by Plan of Correction date of 10/28/22. This may be subitted via email, fax, postal mail, or drop off at the Spruce Street Office in Riverside.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of completing the facility's Annual Inspection. LPA Colvin met with caregiver Tinisha Sherley and advised of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only. LPA Colvin additionally spoke with Administrator Synthia Luna via telephone, and went over the questions/areas for the Infection Control annual. Below is a summary of what was observed: Infection Control: LPA Colvin went over COVID-19 best practices for infection control and prevention with Administrator Synthia Luna, who LPA Colvin found to be successfully incorporating the several aspects of COVID-19 best practices. Residents have hand sanitizer available to them, and the bathrooms were stocked with hand soap and paper towels, except for the master bathroom, which LPA Colvin observed to be missing paper towels. Staff were able to remedy this issue during LPA Colvin's inspection, therefore, LPA Colvin will be issuing a Technical Assistance (TA) Advisory Note instead of a deficiency. While touring the facility, LPA Colvin observed postings throughout the facility for cough etiquette, social distancing, and infection control. LPA Colvin requested to view the facility's PPE supplies (gloves, masks, and sanitizer, and isolation gowns), which was located in a locked cabinet. LPA Colvin observed a minimal supply of masks and gloves, and no face shields or goggles. Staff were unaware of the presence of the missing item(s). TA Advisory Note issued due to best practices for the facility to have a 30-day supply on hand at all times. LPA Colvin went over the various recommended training for facility staff with Administrator Synthia Luna in relation to COVID-19 and confirmed that staff have been trained on various aspects of infection control, recognition of symptoms of COVID-19, and donning/doffing PPE. LPA Colvin inquired as to if staff have been fit tested for N95 masks, and Administrator Synthia Luna informed LPA Colvin that at this time staff have only been trained on donning/doffing PPE. LPA Colvin will be issuing a TA Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA Colvin will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. LPA Colvin will be providing Administrator with the information for Provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks. Additionally, LPA Colvin observed staff Tinisha Sherley to not be wearing any type of face covering. At this time, face coverings are still required in all residential facilities. LPA Colvin will be issuing a TA Advisory Note for staff not wearing a face covering. LPA Colvin observed a sign-in sheet at the front door of the facility, and confirmed that visitors and staff are being screened for symptoms prior to entering the facility. Other: LPA Colvin observed a lock with a chain (similar to what someone might put on the side of the front door inside the home for extra security) on the door of an unoccupied, but designated resident bedroom. LPA Colvin will be issuing a TA Advisory Note as staff removed the lock during today's inspection, and the room is not currently in use. LPA Colvin warned the Administrator about using these types of locks, and that we cannot have them on any resident bedroom at any time. An exit interview was conducted with Administrator Synthia Luna and a copy of this report and LIC9102 TA Advisory Notes was provided to staff Tinisha Sherley, who additionally signed for the report as Administrator was not present.the state’s words, verbatim · CDSS document, Aug 29, 2022

The state marks this report as 6 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

During Licensing Program Analyst (LPA) Crystal Colvin's inspection at the facility for a complaint investigation (#18-AS-20220824151755), LPA Colvin was unable to access records for prior resident (R1), despite providing Administrator with a reasonable amount of time (1 hour - LPA arrived at 9:30am for Annual Inspection and informed Administrator of requested documents for Complaint at 9:54am) after LPA Colvin requested the records via telephone. Deficiency cited. Based on LPA Colvin's observations, the facility was cited and deficiency issued. LPA Colvin conducted an exit interview with caregiver Tinisha Sherley as Administrator was not present at the facility during the inspection. A copy of this report, LIC809D and appeal rights was provided. ***LPA Colvin experienced technical diificulties during printing process, so additionall time is added. Reports emailed to Administrator while LPA Colvin present at facility.the state’s words, verbatim · CDSS document, Aug 29, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87506(d) · Plan of correction due date: Aug 30, 2022

Resident Records: (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours.... This requirement was not met as evidenced by: Based on observation and interview, the Licensee did not comply with the above regulation with one resident file. LPA Colvin was unable to access records for R1 during the inspection. This is an immediate safety risk to residents.the state’s words, verbatim · CDSS document, Aug 29, 2022

Plan of correction: Licensee agrees to provide LPA Colvin with a complete copy of R1's file by Plan of Correction date of 8/30/22. This may be subitted via email, fax, postal mail, or drop off at the Spruce Street Office in Riverside.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility for an annual inspection. LPA met with caregiver Tinisha Sherley. LPA Bueno informed Sherley of the nature of the visit and LPA Bueno phoned administrator Synthia Luna to verify some questions relative to infection control. LPA toured the facility inside and out. The facility has no bodies of water. The facility has charged fire extinguishers, smoke alarms, and carbon monoxide detectors. Cleaning supplies and sharps were kept in a safe and locked room. LPA observed at least two (2) days supply of perishable food items and seven (7) days supply of nonperishable food items. The facility menu was available for review. The client bedrooms had the required furniture and sufficient lighting. Facility had a supply of additional linen and hygiene items. LPA observed that the facility has a mitigation plan to mitigate the spread of COVID-19 in the facility. One central entry point and sign-in policy has been designated for universal entry screening. Routine symptom screening has been initiated at entry for all staff, clients, and visitors. LPA observed hand sanitizer throughout the facility and adequate supply of PPE and paper supplies. All residents have at least a 30 day supply of medications. Administrator confirmed by phone that the facility has an alarm system that automatically notifies local police department and paramedic for ease of emergency notification. LPA Bueno observed no health and safety concerns at the time of visit. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted where this report was discussed and a copy of this report was also provided to Sherley at the conclusion of the inspection.the state’s words, verbatim · CDSS document, Aug 19, 2021