Betd San Fernando Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nadia Shahbazian met with Elizabeth Tiku for an Annual Required visit and inspection of the facility. LPA explained the reason for the visit. The facility is a one story home, located in a residential neighborhood and consists of five (05) bedrooms, of which one (01) bedroom is for staff, and three (03) bathrooms. This Residential Care for Elderly (RCFE) is approved for residents ages 60 and above. Facility is fire cleared for one (01) ambulatory, five (05) non-ambulatory residents, of which one (01) may be bedridden in room #3 and a hospice waiver for six (06) residents. Currently there is one (1) resident on hospice. At 12:15pm, with the assistance of administrator, LPA took a tour of the physical plant. Required postings were observed in the dining room. The smoke/carbon monoxide detectors are hardwired and interconnected. At 12:30pm smoke/carbon monoxide detectors were posted and observed to function properly. The fire extinguisher is located in the kitchen with purchase date of 10/30/2024. Common Areas: These included the living room and dining room. The common areas were properly furnished with tables, chairs, sofas. There is a television set and a cabinet with games in the living room. There is a linen closet in the hallway, next to bedroom # 1. Facility provides internet and cable access . Kitchen: The kitchen appliances and fixtures were functional and consisted on stove, oven, refrigerator, microwave and dishwasher. Kitchen surfaces and appliances are clean and food is marked purchase or expiration dates. LPA found a sufficient supply of perishable (2 days) and non-perishable (7 days) foods at the facility, with plenty of dishes in the cupboards. Knives and sharp objects were stored in a locked cabinet in the kitchen. (Continued on LIC 809-C) Bedrooms/Bathrooms: There were five (5) total bedrooms but bedroom #2 is currently used as office/staff bedroom. All of the bedrooms, in use by residents were were properly furnished with appropriate beddings, chairs, cabinets and sufficient lighting and linens. There are three (3) bathrooms designated for staff and residents' use. All bathrooms were properly supplied and had functional fixtures and required non-skid mats. Hot water temperature was measured between 114.1 and 122.4 degrees Fahrenheit. Surrounding Grounds: There are no bodies of water present. There are exit doors in bedrooms 3, 4, and 5, and in the kitchen, leading to the backyard. Facility uses the main door as the emergency exit but there is a side gate as emergency exit, as well. All walkways and exit passages were free of obstruction. There is patio furniture with an umbrella, appropriate for outdoor use. There is an attached garage, currently used as storage. LPA observed a refrigerator for staff use in the garage. There are locked cabinets for storage of chemicals and detergents, and a washer and dryer in the garage. There is a locked storage room and a locked shed in the backyard for storing items. Medications: Medication and Medication Records are kept locked in a kitchen cabinet. Medications for 2 out of 4 residents were counted and records were reviewed for accuracy of administration. LPA observed two first aid kits and a first aid manual in the medication cabinet. Resident Files: LPA conducted a file review of all 4 resident records to ensure compliance of licensing forms, including physician records, appraisal and needs and other required documents. Staff Files: LPA conducted a file review of staff records to ensure forms and training are up to date and compliant with licensing forms. Pursuant to Title 22 Division 6 of the CA Code of Regulations, deficiencies observed during the visit. Citation and appeal rights were provided. Exit Interview Conducted / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, Sep 30, 2025

Allegation investigated: Resident sustained an unexplained injury due to staff neglect.

On 02/04/2025 at 09:45 am Licensing Program Analysts (LPAs) Lorena Casillas and Nadia Shahbazian conducted an unannounced complaint visit to investigate the above stated allegation. LPAs were greeted by staff member who granted access and called Administrator, Elizabeth Tiku. LPA Casillas spoke to Administrator and was told that Administrator would arrive shortly. Entrance interview conducted. At 10:30 am LPAs conducted a physical plant tour. During the investigation, interviews and record reviews were conducted from 10:30 am to 2:00 pm. LPA Casillas requested copies of resident roster, LIC 500, Liability Insurance and Administrator Certificate. LPAs requested copies of pertinent information relevant to the investigation including but not limited to admission agreements, resident medical records, and any information pertaining to residents in care. Continued on LIC9099-C Unsubstantiated Allegation: Resident sustained an unexplained injury due to staff neglect. It is alleged that a resident sustained an unexplained injury due to staff neglect. Regarding this allegation it is reported that Resident #1 (R1) sustained an injury of unknown origin on 1/29/2025. It was stated that when Staff #1 (S1) left R1 for the night on 1/28/25 when S1’s shift ended, R1 had no visible injuries, however when S1 returned the next day, R1 had an injury to R1’s right arm. This injury of unknown origin caused R1 to be taken to the emergency room for further evaluation. LPA Casillas interviewed Administrator and it was revealed that Administrator checked on R1 the morning of 1/29/25 at 09:30am and performed grooming needs for R1, this included a body check and there were no visible injuries. Later at approximately 10:40 am Administrator states that S2 made them aware that there was bruising and swelling to R1’s right arm. This was cause for alarm and Administrator called 911 that resulted in R1 visiting the emergency room. Administrator states that R1 did not cry out or alert any of the staff that R1 was hurt or in distress and that they are not sure as to how R1’s arm was injured as R1 is nonverbal and could not communicate with staff. Furthermore, Administrator stated that as soon as they were made aware of the bruising, they took immediate action and called 911. LPA Casillas was able to conduct a phone interview with S1 and S1 revealed that when their shift was over on 1/28/25, R1 seemed in good condition and that they are not sure how R1 was injured as they did not witness any falls or injuries, nor have other staff members mentioned any incidents. LPA Casillas’ interview with Staff #2 (S2) revealed that they also do not know how R1 was injured as they have not witnessed any falls or injuries and S2 is not sure as to a possible cause of injury. LPA Casillas attempted to interview R1 however, as previously stated, R1 is non-verbal and LPA was not able to obtain information. LPA Casillas along with S2's assistance was able to observe R1’s arms from fingertips to shoulders and there were no other visible injuries aside from R1's right arm in a cast, there was no visible bruising or swelling. Interviews with Resident #2 and #3 (R2, R3) also revealed that they have not witnessed any injuries, falls or any staff hurting any residents. During LPAs record review of R1’s medical records there was no indication on how this injury was obtained, furthermore there is no record that this was an injury due to staff neglect, records only indicate that there was a fracture due to an injury of unknown origin and that 911 services were called to assist R1. Therefore, based on observations, interviews and record reviews, this allegation of "Resident sustained an unexplained injury due to staff neglect." is deemed unsubstantiated. No citation issued. Exit interview conducted. Copy of report given to Administrator.the state’s words, verbatim · CDSS document, Feb 4, 2025 · control 31-AS-20250131082825

Type of visit: Case Management - Deficiencies

On 02/04/2025 Licensing Program Analysts (LPAs) Lorena Casillas and Nadia Shahbazian arrived at facility above to conduct an initial 10-day complaint investigation for complaint 31-AS-20250131082825. This Case Management is related not to the original complaint visit. During facility records review it was discovered that Administrator does not have a valid Administrator Certificate. Administrator certificate shows to have been expired on 12/10/2024, Administrator admitted to not having completed all necessary continuing education hours required for recertification. Based on interview with Administrator and Administrators own admission there is no qualified and currently certified Administrator at the facility. Furthermore, it was also discovered that facility does not have valid liability insurance coverage. LPAs advised Administrator that there will be citations issued. Citations issued. Appeals rights discussed and provided. Exit interview conducted and a copy of the report given to Administrator.the state’s words, verbatim · CDSS document, Feb 4, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Feb 11, 2025

87405(a) Administrator Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. Tthis was not met as evidence by: Based on interview and record review the Administrator failed to renew Administrator certificate, this poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 4, 2025

Plan of correction: Administrator discussed and agreed to submit all required documentation for certificate renewal by POC due date and will email LPA Casillas verification.

From the deficiency page — Deficiency type: Type B · Section cited: HSC1569.605 · Plan of correction due date: Feb 11, 2025

1569.605 Liability Insurance. On and after July 1, 2015, all residential care facilities for the elderly…shall maintain liability insurance ...of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000)…This was not met as evidence by: Based on record review, facility does not currently have valid or active liability insurance, this poses a potential health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Feb 4, 2025

Plan of correction: Administrator will purchase liability insurance and will submit proof via email to LPA Casillas by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Abeye Duguma met with Elizabeth Tiku for a Required One (01) Year visit. LPA explained the reason for the visit. A tour of the physical plant was conducted at around 9:00 AM and the following was noted: There is one (01) entrance being utilized at the facility. The facility has a total of five (05) bedrooms, of which one (01) bedroom is for staff, and three (03) bathrooms. The facility is fire cleared for one (01) ambulatory, five (05) non-ambulatory of which one (01) may be bedridden in room #3 and a hospice waiver for six (06). The facility is currently occupying four (04) residents. The facility has outdoor furniture with a covered shaded area for residents and visitors. The facility does not have a swimming pool/body of water. Laundry detergents, cleaning agents and other toxins are locked away. Kitchen is sufficiently stocked with at least two (02) days perishable and seven (07) days non-perishable food. Frozen foods are wrapped and stored appropriately. Food storage and preparation areas are clean and inaccessible to pests. Knives and sharps are observed to be locked and inaccessible to residents. The living and dining room are neat and clean. The facility maintains a comfortable temperature at 73°F. The smoke and carbon monoxide detectors are hardwired, interconnected and observed to be operational. Fire extinguisher is located near the kitchen and observed to be fully charged. (continued on LIC 809-C) The residents' rooms are adequately furnished with appropriate lighting system. Hallways are well lit. Residents have enough personal hygiene product provided by the licensee. The bathroom was checked for cleanliness and proper operations. The hot water temperature was measured at 116.9°F. Towels and washcloths are not shared. There was enough clean linen available in the cabinets. LPA observed medication to be locked and inaccessible to residents. Facility maintains a complete first aid kit. No health and safety hazards noted during the visit. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 19, 2024