Astoria Park Senior Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced annual visit at the facility using the CARE tool. LPA met with Gina Lopez and explained the reason for the visit. The facility is licensed to serve 116 non-ambulatory and 104 bedridden residents over the age of 60 years old. Facility is a two story building with delay egress system at the main entrance, a lobby, a memory care unit, several common areas indoor and outdoor such as: a library, activity rooms, game room, private dining room, large dining room, 88 resident bedrooms with private bathrooms, shower rooms in the first floor and second floor, and a commercial kitchen. LPA toured the facility with Gina Lopez and Brianna Goodlet and observed the following: No large bodies of water were observed. A total of 10 resident rooms were observed with sufficient lighting, furniture and bedding supplies. Bathrooms were observed in working condition, with grab bars, and skid strips/mats. Toilet in room #149 was clog and overflowed when flushed. Water temperature was tested in each bathroom's sink and tested between 107.2 - 117.8 degrees F., which is within the required 105-120 degrees F. Dementia unit has a working delay system in each exit door. Ceiling outside the family lounge has a crack of about 14 inches in length and a water mark of about 15x15 inches in width. Disinfecting spray was observed in the dining/kitchenette area in the cabinets without a lock. The faucet's sink (no water) is out of order in the bathroom located in same dining room, bathroom is accessible to residents. Refrigerator in the activity area was observed dirty with spills and water drip tray has water build up as thick as almost 2cm. The dementia patio was observed with a screen door laying on the floor in between sitting area and a 3x2 feet bench was observed in a passage way to an exit door. 3x2ft chairs were observed in passage way outside room #119. Commercial kitchen was observed with different refrigerators/freezers and a walking refrigerator and freezer. Sufficient food was observed for at least 2 days worth of perishables and 7 days of non-perishables. Library was observed upstairs with a cover fireplace. All common rooms for activities were furnished with sufficient lighting. (CONTINUED ON LIC 809C) Evacuation chairs were observed at the bottom of each stairway. Fire extinguishers were observed and last checked on 9/7/23. Carbon Monoxide/Smoke detectors were observed throughout the facility along with a fire sprinkler system. Last fire-emergency drill was provided on 5/24/23. Emergency Disaster Plan was last updated on 9/1/23 on LIC 610E(10/03), which is not LPA Flores reviewed medication for 9 residents, 5 resident and 5 staff files. Resident #3(R3) has a dementia diagnosed and last physician's report is dated: 3/15/22. Staff #4 and #5(S4-S5) did not have a health screening on file and S4 did not have a TB clearance. First Aid/CPR training was not observed during staff file review. Administrator's First Aid/CPR training expired on 3/23. Administrator Certificate was observed for Brianna Goodlett #6057760740 expiration date: 11/4/22. No pending application was observed in our database. Per Brianna Goodlett a renewal for administrator certificate was not submitted and executive director Erin Mahoney is to be appointed as the new administrator. Licensee is to submit all required documentation within 10 days from this visit. Deficiencies are noted on LIC 809D per Title 22 Regulations. Exit interview was conducted with Gina Lopez and a copy of this report, LIC 809D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Sep 21, 2023

Allegation investigated: Resident was hit with an object by an unknown perpetrator resulting in fracture.

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegation(s). LPA met with Dana Barcelona - Community Partner and explained the reason for the visit. The investigation consisted of the following: On 12/23/22 LPA Kruz conducted a health and safety check visit, no immediate concerns were observed. LPA Kruz requested the following documents; staff/resident roster, identification and emergency information, physician's report, preplacement appraisal information, care assessment, power of attorney, service plan for resident #1(R1). Investigation Bureau (IB) of the Department conducted the investigation, interviews, and requested additional documents. On 3/16/23 IB investigator Brian Slatic conducted interviews with staff and R1 at the facility. On 5/13/23 LPA Flores delivered findings at the facility. (CONTINUED ON LIC 9099C) Unsubstantiated The investigation revealed the following: Regarding allegation: Resident was hit with an object by an unknown perpetrator resulting in fracture. It is alleged a resident at the facility assaulted R1 resulting in a fracture. On 12/22/22 R1 complained to facility staff of chest pain due and a resident assaulting R1. Facility staff contacted 911 due to R1's complaints of chest pain. R1 was admitted to Huntington Hospital due to chest pain. During initial assessment at the hospital, R1 reported to have been assaulted by someone at the facility. Hospital followed protocol and contacted Pasadena Police Department (PPD). Hospital noted R1 was observed with a sternal fracture. On 3/16/23, Interviews with facility staff revealed the following; Administrator stated on 12/22/22 R1 reported chest pain to med-tech, facility staff initially believed it was a heart attack. On 12/22/22 Administrator was contacted by the hospital and was notified there was an injury found on R1. This let Administrator to conduct a review of facility's video system which did not reveal anyone entering R1's bedroom between 12/21/22 6:00pm and 12/22/22 7:30am. Administrator speculated R1's injury may be the result of a fall. Interview with Med-Tech revealed that on 12/22/22, med-tech was notified by caregiver that R1 complained of chest pain and decided to call 911. R1 did not mention anything about an assault at that time. Interview with dining room staff revealed R1 had come out to the dining room, "agitated" and stated, "someone came into my room and hit me on my chest," and point to another resident in the dining room. Interview with morning caregiver revealed there were no notes or reports of any incidents the night before. Caregiver conducted a check on R1 at 6:00am and there were no complaints of chest pain. During the incident in the dining room caregiver attempted to redirect R1 back to R1's room to finish dressing. R1 began complaining of chest pain and having trouble breathing. IB investigator attempted to interview R1 and was unable to collect information regarding the incident due to cognitive skills. Documents review revealed the following; last physician's report dated 7/8/22, notes R1 may be confused, have inappropriate behaviors, and/or have aggressive behaviors. No history of falls or incidents were noted. Incident report and report of suspected elderly abuse was submitted to the department on 12/23/22 by the facility. Police report notes the allegation's were documented but was unable to determined how R1 sustained the injuries. Although, R1 did sustain a fracture sternum and initially identified a perpetrator, the investigation did not find evidence to support that anyone inflicted the injury. Based on interviews conducted, and documents reviewed, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview was conducted with Dana Barcelona Community Partner and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 13, 2023 · control 28-AS-20221223091903

Type of visit: Case Management - Other

Licensing Program Analyst(s)(LPA) Mary Flores conducted a case management visit to follow up on corrections needed during pre-licensing visit conducted on 9/12/22. LPA Flores met with Brianna Goodlet - applicant's representative. On 9/12/22 LPA Flores, Mora, and Ramirez observed the following corrections needed: Applicant is to fix the loose outlet cover plate in room #145 and hole in the wall in room #103. Applicant is to ensure the water temperature is maintain between 105 and 120 degrees F. in rooms #160, 159, 156, 153, 152, 150, 149, 145, 141, 139. Applicant is to ensure bathrooms in rooms #141 and 153 have skid strips/mats. Applicant is to ensure resident #1(R1) in room#155 and resident #2(R2) #256 do not store medication in their rooms. On 10/17/22 LPA Flores conducted a tour with Gina Lopez - staff and observed the following: Cover plate in room #145 was installed. Hole in wall in room #103 was repaired. Water temperature in rooms # 160, 159, 156, 153, 152, 150, 149, 145, 141, 139 was tested and tested between 110.3 to 117.8 degrees F., which is within the required water temperature. Skid strips were observed in rooms #141 and 153 showers. No medication observed in room #155 and in room #256 resident #2 has medication but an updated physician's report dated 9/19/22 indicates resident can stored on medication. Physical plant is following Title 22 Regulations. Exit interview was conducted with Brianna Goodlet - Applicant's Representative and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 17, 2022

Type of visit: Prelicensing

Licensing Program Analyst(s) (LPA) Mary Flores, Luis Mora, and Kimberly Ramirez conducted an announced pre-licensing visit at the facility. LPAs met with Brianna Goodlet - Applicant's Contact Person and explained the reason for the visit. Facility has a fire inspection clearance conducted on 7/11/22 for 116 non-ambulatory and 104 bedridden residents over the age of 60 years old. Facility is a two story building with delay egress main entrance, a memory care unit, several common areas, 88 resident bedrooms and bathrooms, shower rooms, and a commercial kitchen. LPAs conducted a tour of the facility with Brianna Goodlet, Brandon Collins Vice President, and Jennifer Siegel Regional Wellness Director and observed the following: Outdoor facility was observed in good repair. No large bodies of water were observed. Commercial kitchen was observed clean and sanitize, sufficient food was observed for at least 2 days worth of perishables and 7 days of non- perishables. Refrigerator(s) temperature was observed under 40 degrees F., and freezer(s) temperature was observed under 0 (zero) degrees F. TV area has a cover fireplace. All rooms have sufficient lighting, furniture, and bedding. Room #145 was observed to have outlet cover plate hanging from lamp cord and room #103 was observed to have a hole in the wall of about 2 inches by 4 inches above the resident's clock. Water temperature was measure in each resident's bathroom and tested between 101.6 - 120 degrees F., which is not within the required 105 - 120 degrees F. Facility has a sprinkle fire system and carbon monoxide detectors were observed in each room. Skid strips/mats were missing in room #141 and #153. Medication was observed in room #256. Cleaning supplies were observed in room #155. All common areas were observed in good repair, with sufficient furniture. Evacuation chairs were observed on top of staircases. First Aid kit was reviewed and had all the required items. Files and medication were reviewed for 9 residents and 7 staff files were reviewed. Facility is following infection control protocols throughout the facility. (CONTINUED ON LIC 809C) PPE supplies were observed sufficient for 30 days. LPAs conducted Composition III with Brianna Goodlet Applicant's Contact Person. The following items need to be corrected and proof of correction needs to be submitted to licensing within 7 days: Applicant is to fix the loose outlet cover plate in room #145 and hole in the wall in room #103. Applicant is to ensure the water temperature is maintain between 105 and 120 degrees F. in rooms #160, 159, 156, 153, 152, 150, 149, 145, 141, 139. Applicant is to ensure bathrooms in rooms #141 and 153 have skid strips/mats. Applicant is to ensure resident #1(R1) in room#155 and resident #2(R2) #256 do not store medication in their rooms. Exit interview was conducted with Brianna Goodlet Applicant's Contact Person and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 12, 2022

Type of visit: Office

Facility Type: RCFE Application Type: CHOW Capacity: 220 Census (if any clients in care): 75 Method: Telephone call with CAB Applicant/administrator participated in COMP II via telephone call with the analyst at CAB. Identification of the applicant and administrator was verified by correctly answering identity verification questions. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicants have been advised to transmit signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Jul 27, 2022