Azalea Gardens

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced annual visit at this facility. LPA was greeted and granted access by staff #1 (S1). The administrator designee, Khristine Campbell met with LPA shortly after and LPA explained the purpose of the visit. The facility has an approved fire clearance for five (5) non-ambulatory and one (1) bedridden resident in Room #5 for a total capacity of 6. The facility has a Hospice waiver for two (2) residents. A tour of the physical plant inside and out was conducted at 9:15 a.m., and the following was observed: At entry LPA observed a screening area where visitors can sign in, hand sanitizer, and face masks available. LPA observed appropriate postings on a wall by the front entrance. Kitchen: LPA conducted a tour of the kitchen and observed there to be sufficient supply of two day perishables and seven day non-perishables foods, properly stored. Food storage and preparation areas are clean and clear of clutter. LPA observed all knives, sharp object, locked in a kitchen drawer inaccessible to residents in care. There is one (1) fire extinguisher located in the kitchen was fully charged with purchase date 02/12/2025. A first aid kit with an up-to-date manual was observed in a kitchen drawer. Centrally stored medications are maintained locked in a kitchen cabinet. There are cordless telephones available to residents. Common areas: LPA observed the living area, breakfast nook and formal dining area to be clean and clear of clutter. The furniture was in good repair and sits the capacity of the facility. In the breakfast nook LPA observed games and hand therapy tools to assist residents with dexterity. (Continue to LIC809-C) (Continued from LIC809) Surrounding Grounds: Entry and exits were free of obstructions. There is a covered patio with appropriate furniture. There are no bodies of water and the backyard is fenced in. Laundry and Garage: Laundry room was observed locked. Detergents and cleaning supplies are kept locked in the laundry room. The garage can be accessed through the laundry room. Bedrooms: There are five (5) resident bedrooms. Four (4) out of five (5) bedrooms are for private use. LPA observed each resident room to be properly furnished with beds, appropriate night stand, chair, bedding and have sufficient lighting and storage. LPA observed the administrator designee test a dual smoke and carbon monoxide detector at 9:24 a.m. Detectors are interconnected to other detectors located through out the facility. LPA observed detectors functioning properly. LPA observed fire doors close when smoke detectors were tested. Bathrooms: The facility has three (3) bathrooms. One (1) is located in a resident's private bedroom. Bathrooms were clean and properly supplied with hand soap, toilet paper, and paper towels. LPA observed non skid shower mats and proper grab bars by showers and toilets. LPA observe night lights leading to hallway bathroom by bedrooms. Facility has a linen closet that stores extra bedding, towels and hygiene products. LPA observed a second closet with emergency food, water and supplies for a disaster. Resident/Staff/Facility Records: At 9:57 a.m., LPA reviewed two (2) of two (2) resident records to insure compliance with licensing forms. At 10:14 a.m., medications and Centrally Stored Medication and Destruction Records were reviewed for proper documentation. Medication records are maintained manually and facility keeps Medication Administration Records (MAR) as well. At 10:18 a.m, LPA reviewed two (02) staff records to insure compliance with licensing forms. LPA reviewed facility's Liability Insurance Policy, LIC 500, emergency disaster training for fire drill conducted on 05/2025, and infection control plan reviewed 05/2025. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during todays visit. Exit Interview Conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Jul 8, 2025

Allegation investigated: Facility does not have fire clearance for bedridden residents. Facility has insufficient staffing. Uncleared adults caring for residents.

On 05/12/2025 at 10:30 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint investigation at the location mentioned above. LPA was greeted by Staff #1 (S1) who granted access. S1 called the administrator designee to inform them LPA was at the facility. LPA spoke to the administrator designee Khristine Campbell via facility telephone. Administrator designee informed LPA they would meet LPA at the facility. LPA explained to administrator designee the purpose of the visit. At approximately 10:40 a.m., LPA conducted a physical plant tour of the facility and reviewed the facility sketch and facility's Fire Clearance (STD850). At 11:05 a.m., LPA reviewed Resident #1 (R1's) file and obtained copies of R1's Physician's Report, and Appraisal/Needs and Services. From approximately 11:25 a.m. to 11:44 a.m. LPA conducted an interviews with R1 and S1. Resident #2 (R2) did not respond to LPA's questions and resident #3 (R3) was asleep during the visit. At approximately 12:00 p.m., LPA met with the administrator designee and conducted an interview. (Continue to LIC9099) Unsubstantiated (Continued from LIC9099) LPA reviewed R2's and R3's record and obtained copies of R2's and R'3's, Physician's Reports, and Appraisal/Needs and Services. Allegation: Facility does not have fire clearance for bedridden residents. In regards to the allegation, it was reported the facility had multiple bedridden residents without proper fire clearance. A review of facility's approved Fire Clearance completed on 03/02/2018, revealed that only room #5 is approved to retain a bedridden resident. Review of three (03) out of (03) residents' Physician's Report revealed that R1 is bedridden. During physical plant tour LPA Rios observed R1 in bedroom #1, which is not cleared for a bedridden resident. LPA's interview with the administrator designee revealed the physician's report was not filled out correctly and for the purpose of fire clearance R1 is non ambulatory as they only require assistance with transferring and not repositioning. According to the administrator designee a new report was being provided to the facility. LPA observed R1 in a wheelchair during visit. LPA's interview with R1 revealed they did not need assistance with repositioning. LPA was provided with a new copy of R1's Physician's Report with a status of non ambulatory. R2 and R3 who are non ambulatory based on their physician's report were in rooms designated for non ambulatory residents. Based on record review, observation, and interviews there was insufficient evidence to corroborate the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Allegation: Facility has insufficient staffing. In regards to the allegation, it was reported that the administrator designee is the only staff. Interviews with C1 and S1 reveal that they have no issues or concerns about staffing. Interview with R1 revealed they are fine with response time and have no issues with incontinent care. Interview with S1 revealed they have not witnessed soiled undergarments at the start of their shift. Interview with the administrator designee, denied the allegation. According to the administrator designee they work the night shift. Review of Personnel Report (LIC500) indicates that facility has two caregivers scheduled and a third caregiver on-call. Residents appraisal's do not indicate behaviors of wandering or sundowning. LPA observed residents to be clean, and the facility was free of odors from incontinence. Based on interviews, record review and observation, there was insufficient evidence to corroborate the allegation. Therefore, the findings are Unsubstantiated at this time. (Continue to LIC9099-C) (Continued from LIC9099-C) Allegation: Uncleared adults caring for residents. In regards to the allegation, it was reported that a staff has a criminal history and does not have fingerprint clearance. The reporting party identified this staff by their first name, but no last name or additional description given. During the complaint investigation, LPA was able to identify staff with the same first name, but could not confirm if this was the staff related to this allegation. LPA reviewed staff records and LIC500. All staff on LIC 500 were fingerprinted and background cleared. Interview with R1 and staff did not express any concerns about staff. Based on record review and interviews, there was insufficient evidence to corroborate the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. No other health and safety issues were observed at this time. Exit interview conducted, report signed and delivered.the state’s words, verbatim · CDSS document, May 12, 2025 · control 31-AS-20250508145939

Allegation investigated: Resident sustained multiple pressure injuries and developed clots in their lungs due to staff neglect.

Licensing Program Analyst (LPA) Evelin Rios conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegation. LPA met Khristine Campbell the administrator designee and explained the reason for the visit. It was reported that Resident#1(R1) developed blood clots in their lungs as well as pressure injuries on their ears and buttocks, as a result of facility neglect. The initial visit was made by LPA Rios on 1/17/24 At 1:20 p.m., LPA conducted a physical plant tour, reviewed facility files, and obtained copies of facility’s personnel report, register of facility residents, visitor log, R1’s identification and emergency information, progress notes, physician’s report, preplacement appraisal, resident appraisal, appraisal/needs and services plan, and an unusual incident report. The complaint was referred to Investigations Branch (IB) on 1/17/24, and accepted as a full investigation, assigned to Investigator Juan Lozano and reassigned to Investigator Douglas Real on 3/7/24. During the course of the investigation, IB Investigator Real interviewed the facility Administrator, staff, residents, and hospital staff. Investigator also obtained and reviewed R1’s hospital records. (Continue to LIC9099-C) Unsubstantiated (Continued from LIC9099) Regarding the allegation that facility employees neglected or failed to provide an appropriate level of supervision which resulted in Resident#1(R1) developing blood clots in their lungs as well as pressure injuries on their ears and buttocks, IB Investigator Real interviews revealed the facility residents had no complaints and a family member of one resident interviewed reported being happy with the level of care being provided by the facility. The facility employees denied the allegation. R1 left the facility on 1/5/24 and was seen in the hospital on 1/6/2024 with no marks or injuries identified. R1 was diagnosed with pneumonia and no abuse or neglect concerns were noted in the records. On 1/7/2024, R1 was readmitted to the hospital and diagnosed with blood clots in their lungs and a UTI. On 1/8/2024, R1 was transferred to another hospital for further treatment and it was reported that R1’s family member spoke with R1’s hospital doctor and reported abuse concerns alleging that R1 was never moved and left in bed at all times. The doctor concluded that R1’s immobility (as reported by R1’s family member) most likely led to the blood clots in their lungs. R1’s family member was interviewed and did not recall telling anyone R1 was not moved and in bed at all times while they were residing at the Azalea Gardens facility. R1’s hospital doctor was interviewed and could not definitively identify the cause of the R1’s blood clots. The doctor also advised R1 had no pressure injuries on their ears or buttocks, but R1 had a blister on their buttocks and a small bilateral bruise on each ear of unknown cause. The information and evidence obtained did not sufficiently support the allegation, thus based on the information obtained and the interviews conducted the allegation is deemed Unsubstantiated. Exit Interview Conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Aug 20, 2024 · control 31-AS-20240111145340

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced One (1) year Required visit at this facility. LPA met with the administrator designee Khristine Campbell who granted access and LPA explained the purpose of the visit. The facility is a single-story dwelling with six (6) bedrooms of which five (5) are for resident use. The facility has an approved fire clearance for five (5) non-ambulatory and one (1) bedridden resident in Room #5 for a total capacity of 6. The facility has a Hospice waiver for two (2) residents. While the administrator assisted residents with breakfast LPA reviewed two (2) of two (2) resident records to insure compliance with licensing forms. Records are kept locked in a kitchen cabinet. Centrally Stored Medication and Destruction Records were reviewed for proper documentation. Medication records are maintained manually. Facility keeps Medication Administration Records (MAR) as well. A tour of the physical plant was conducted at 11:00 a.m. with the administrator designee and the following was observed: There is only one entrance being utilized at the facility, there are required postings posted by the main door. Screening area is located immediately upon entrance. Sign in sheet, hand sanitizer, and masks are available. Kitchen: LPA conducted a tour of the kitchen and observed there to be sufficient supply of two day perishables and seven day non-perishables foods, properly stored. Food storage and preparation areas are clean and clear of clutter. LPA observed all knives, sharp object, locked in a kitchen drawer inaccessible to residents in care. There is one (1) fire extinguisher located in the kitchen observed to be fully charged with purchase date 04/30/2024. LPA observed the first aid kit with manual up to date in a kitchen drawer. Common areas: LPA observed the living area and dining area to be clean. The furniture was in good repair and sits the capacity of the facility. Breakfast nook also stores games and crafts for residents to use.(Continue to LIC809-C) (Continued from LIC809) Bedrooms: LPA inspected five (5) out of five (5) resident bedrooms. Four (4) out of five (5) bedrooms are for private use. LPA observed each resident room to be properly furnished with beds, appropriate night stand, chair, bedding and with sufficient lighting and storage. LPA observed the administrator designee test a dual smoke and carbon monoxide detector at 11:36 a.m. Detector are interconnected to other detectors located through out the facility. LPA observed detectors functioning properly. LPA observed door alarms on exit and entry doors on and functioning properly. Bathrooms: The facility has three (3) bathrooms. One (1) is located in a resident's private bedroom. LPA observed all bathrooms to be clean and properly supplied with hand soap, toilet paper, paper towels and trash bins with lids. LPA observed non skid shower mats and proper grab bars by showers and toilets. LPA observed a closet with emergency food, water and supplies for a disaster. LPA observed a linen closet with extra linens, and toiletries for the facility. Laundry and Garage: Laundry room was observed locked. Detergents and cleaning supplies are kept locked in the laundry room. The garage can be accessed through the laundry room which is maintained locked. Surrounding Grounds: Entry and exits were free of obstructions. There is a covered patio with appropriate furniture and fitness equipment for resident use. There are no bodies of water. Staff Records: LPA reviewed staff records to insure compliance with licensing forms. Medications: Centrally stored medications are maintained locked in a kitchen cabinet. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during todays visit. Exit Interview Conducted. A copy of this report provided.the state’s words, verbatim · CDSS document, Aug 20, 2024