Archway of Carmel

Type of visit: POC

On 10/12/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Proof of Correction inspection. LPA met with Administrator Cyril Tupino and announced the purpose of the inspection. This visit was conducted to verify that the Administrator had followed the agreed upon plan of correction for the deficiency which was cited on 8/29/2023. LPA toured the facility. LPA reviewed staff training logs and medication administration records. No deficiencies were cited during the inspection. A copy of the report was provided and exit interview conducted with Administrator.the state’s words, verbatim · CDSS document, Oct 12, 2023

Allegation investigated: Staff did not maintain accurate records regarding resident in care. Food services are inadequate. Facility does not provide accurate information to resident(s) regarding how to file grievances in regard to facility. Staff do not follow adequate food safety practices. Staff used medication to restrain resident in care. Staff did not respond to requests for communication regarding resident in a timely manner.

On 8/29/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with caregiver Maria and contacted Licensee Cyril Tupino. The purpose of this visit is to deliver the finding of the investigation completed by the Department. Licensee granted permission for staff to sign this report on his behalf. LPA conducted a tour of the facility, interior and exterior, to ensure there are no potential or immediate health and safety risk at the facility. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. Facility medication administration records were complete, and medications appeared to be administered properly. Facility staff only administered pro re nata(PRN) medications on an as needed basis and properly documented doses. Facility staff adhere to a monthly meal menu which meets requirements and offer alternative options to residents. LPA observed staff to utilize gloves and proper sanitary practices when preparing meals and washing dishes. Resident admission agreements include information on how to file grievances, and required postings on grievances are posted in the facility in a prominent place. Unsubstantiated Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has not been met; therefore, the above allegations are found to be unsubstantiated at this time. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 29, 2023 · control 24-AS-20230410092729

Allegation investigated: Staff gave resident crushed medication(s) without a doctor's order.

On 8/29/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with caregiver Maria Carrillo and contacted Licensee Cyril Tupino. The licensee agreed that staff could sign the reports on his behalf. The purpose of this visit is to deliver the finding of the investigation completed by the Department. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. Based off of interviews and records, facility staff did crush Resident 1's(R1) medications and place them in food. Although facility staff claimed that this was due to R1's inability to swallow and was done at the request of R1's responsible party, medications were crushed without a physician's order. Continued on LIC9099C Substantiated Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has been met; therefore, the above allegations are found to be substantiated at this time. Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiency was observed and cited on LIC 9099-D. Failure to correct the deficiency may result in civil penalties. An exit interview was conducted, and a copy of this report provided. Appeal Rights (LIC 9058) was provided to facility staff, whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Aug 29, 2023 · control 24-AS-20230407155801

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(5)(D) · Plan of correction due date: Sep 5, 2023

87465 Incidental Medical and Dental Care: (a)(5)(D)Assistance with self-administration does not include forcing a resident to take medication, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. This Requirement was not met as evidenced by: Based on interviews comducted and records reviewed, facility staff crushed R1's medications and placed them in food without having physician's orders to do so for 1 out of 5 residents, which presents a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 29, 2023

Plan of correction: Licensee agreed to provide staff with training regarding proper handling of medications. Licensee agreed to provide statement of understanding regarding requirements for physician orders for medications.

Allegation investigated: Staff did not properly manage resident's incontinence care resulting in infections. Staff did not seek timely medical care for resident. Staff did not ensure that resident received their medication in a timely manner. Staff did not put appropriate measures into place for a resident who was a fall risk. Staff did not inform resident's responsible person of resident's incidents. Staff handled resident in a rough manner. Staff did not respond to resident’s requests for assistance in a timely manner. Staff did not assist resident with their hygiene needs in a timely manner.

On 8/29/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with caregiver Maria and contacted Licensee Cyril Tupino. The purpose of this visit is to deliver the finding of the investigation completed by the Department. Licensee granted permission for staff to sign this report on his behalf. LPA conducted a tour of the facility, interior and exterior to ensure there are no potential or immediate health and safety risk at the facility. During the course of the investigation, the department inspected the facility, conducted interviews, and reviewed records. Resident 1(R1) was admitted to the facility on 12/22/2022. R1 developed a unirary tract infection on 3/24/2023. Facility staff requested the hospice agency order medications to treat the infection that same day. R1 fell from their wheelchair on 3/24/2023: R1's responsible party was informed of the incident on 3/25/2023. According to statements from witnesses who did not work for the facility, R1's hygeine needs were being met and staff were properly managing their incontinence care. Unsubstantiated Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has not been met; therefore, the above allegations are found to be unsubstantiated at this time. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 29, 2023 · control 24-AS-20230407155801

Type of visit: Required - 1 Year

On 6/29/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced at the facility to conduct a Required Annual Inspection. LPA met with lead Caregiver Maria Carrillo and spoke with Licensee Cyril Tupino via telephone. Administrator certificate was current with expiration date 10/28/2023. There were 2 residents on hospice at the time of the inspection. LPA toured the facility inside and outside. Pathways and doors were clear and free from obstruction. Smoke-detectors and carbon-monoxide detectors were present and operational. Facility was clean and odor free. LPA observed sufficient amount of perishable and non-perishable foodstuffs. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, odor free, and water temperature was within required temperature range. Sharp items and detergents were secured in a locked cabinet in the kitchen. A locked cabinet in the garage was observed to store resident medications, and medications appeared to be administered properly. The fence had a self-locking latch mechanism, and there was adequate outdoor seating for residents. LPA reviewed facility plan of operations and emergency disaster plan. LPA reviewed resident files: staff files will be reviewed on another date. LPA requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan, and a copy of current Administrator’s Certificate to update the facility file. No deficiencies were cited during the inspection, exit interview conducted with Licensee, a copy of the report was provided.the state’s words, verbatim · CDSS document, Jun 29, 2023