Blissful Garden

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit and to deliver a notice of immediate exclusion for an individual (S1). LPA Moleski met with resident service director Ricky Ziese-Dulay and explained the purpose of the visit. Ziese-Dulay said S1 was present for training. Ziese-Dulay sent S1 home immediately after being told that S1 was excluded. LPA Moleski observed S1 being led out of the facility by staff. LPA Moleski provided a copy of the exclusion order for S1. No deficiencies were cited during this visit. An exit interview was held with Ziese-Dulay. A copy of this report will be emailed to facility representatives.the state’s words, verbatim · CDSS document, Nov 9, 2023

Allegation investigated: Resident sustained an unexplained fracture while in care. Facility modified a contract without notifying resident's responsible party. Facility did not give a copy of the contract to resident's responsible party. Facility staff did not keep a doorway free of obstruction. Facility staff did not safeguard resident's personal items.

On 10/10/23, Licensing Program Analysts (LPAs) Lavinia Muscan and Cheyenne Ratajczak arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Motu Sokimi. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: **Report continued on 9099-C** Unfounded ALLEGATION: Resident sustained an unexplained fracture while in care. Based on records reviewed and interviews, R1 has a diagnosis of osteoporosis. On 3/24/23, R1 went to the hospital and was diagnosed with a fifth lumbar vertebra compression fracture which was related to osteopenia. Based on interviews and records review, there is no indication that R1 sustained a fall at the facility resulting in the injury listed above. A review of the medical records indicated that R1’s fracture resulted from medical decline, not trauma or lack of care and supervision by facility. Based on records reviewed it was concluded that compression fractures occurred due to R1’s osteoporosis and fragile bones, therefore the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. ALLEGATION: Facility modified a contract without notifying resident's responsible party Based on records reviewed and interviews conducted on 8/16/23 and 9/19/23, there is no evidence of Admission Agreements being changed without notifying residents responsible parties, therefore the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. ALLEGATION: Facility did not give a copy of the contract to resident's responsible party. Based on records reviewed and interviews conducted, R1s responsible party did receive an Admission Agreement. The Department observed a signed contract between the responsible party and the facility. Further, the Department was notified by the responsible party that they may have misplaced the Admission Agreement. Therefore, the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. ALLEGATION: Facility staff did not keep a doorway free of obstruction. Based on facility observation on 8/16/23 and 9/19/23 there was no sign of any doorway being obstructed by anything. Therefore, the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. ALLEGATION: Facility staff did not safeguard resident's personal items. Regarding safeguarding residents’ belongings this allegation was regarding clothing items and hearing aids. All residents interviewed on 9/19/23 said they always get their own clothes back when laundry is done. If something is missing, there is a certain place where clothes are kept so that residents can look for their lost items. Staff verified that this is the case. Additionally, upon verifying the safeguards form, there were no hearing aids listed on R1’s LIC621, therefore, the allegation is UNFOUNDED. A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis. Exit interview conducted. Copy left with facility Administrator.the state’s words, verbatim · CDSS document, Oct 10, 2023 · control 59-AS-20230814163322

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Lavinia Muscan and Cheyenne Ratajczak arrived unannounced on 10/10/23 to conduct the annual inspection. During today's annual inspection, the Compliance and Regulatory Enforcement Tool was used. LPAs and Administrator Motu Sokimi toured the facility together to ensure the health and safety of residents in care. The areas toured included resident rooms, bathrooms, kitchen, common areas and outside area. The food supply is within compliance, 2 days of perishable and 7 days worth of non-perishable food items. Grab bars were present at the toilet and in the shower. All exits were unobstructed. The disaster drill is current. The administrator's certificate is current. There is a side gate for emergency access. LPAs checked the kitchen area for the ability to prepare and store food. Knives and Sharp objects found to be locked . LPAs observed cleaning products and other toxins to be locked away. LPAs observed the area used for medication to be locked and inaccessible to residents. LPAs observed smoke detectors and carbon monoxide detector at the care home are operational. Fire extinguishers are ready for emergency use. Water temperature is within compliance. In the areas toured, there were no health or safety violations observed. LPAs reviewed resident (5) and staff files (5). All resident files contained the required paperwork. All staff files contained the required paperwork. All staff have current first aid and CPR training. Facility was clean and well organized. Facility is current on fire drills. All required posting were observed. Staff training contained the required initial training. LPAs requested a copy of the LIC 500, LIC610E and current liability insurance to be sent to the Department by end of the month. Exit interview conducted. A copy of this report was printed and given to Administrator.the state’s words, verbatim · CDSS document, Oct 10, 2023

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff shaved resident without resident’s consent.

On 03/08/2023, Licensing Program Analysts (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Motu Sokimi. Prior to visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: **Report continued on 9099-C** Substantiated Staff shaved resident without resident’s consent. An investigation has been conducted regarding the above allegation. During an interview S1 stated that they asked R1 what happened to R1’s face. R1 stated that while he was in the shower, S2 dry shaved R1 on their face with no cream, just water. R1 also stated that they were not asked if they wanted to be shaved. Based on interviews conducted, S2 violated R1’s personal rights therefore the allegation above is substantiated. Based on the departments observations, interviews conducted, and record(s) reviewed, the preponderance of evidence standard has been met, therefore the above allegation(s) is/are found to be SUBSTANTIATED. California Code of regulations are being cited on the attached LIC9099D. Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents. Appeal rights were provided. Staff are mishandling resident’s medication. The department conducted an investigation regarding the allegation above. It has been alleged that staff are administering PRN medications to residents without a physician's order as required. Based on interviews conducted and records reviewed, LPA observed all resident PRN medications have physician orders therefore this allegation is UNFOUNDED. This agency has investigated this complaint. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Staff has not assigned resident a PCP. An investigation has been conducted regarding the above allegations. Based on Title 22 regulations, Section 87465 (a)(1), the licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. The facility is not required to assign a resident a primary care physician however, during the investigation it was learned that R1 does have a primary care physician. It should be noted that this allegation is not valid as it is not a violation of Title 22 regulations. Based on records review and interviews, the allegation listed above is UNFOUNDED. This agency has investigated this complaint. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Staff is financially abusing resident in care. An investigation has been conducted regarding the above allegations. Interviews were conducted with residents and staff regarding the allegation. Based on interviews conducted, there is no evidence that any staff at the facility are financially abusing and/or that financial maleficence has occurred therefore the allegation above is UNFOUNDED. This agency has investigated this complaint. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents. Staff is not providing adequate food service to residents in care. An investigation has been conducted regarding the above allegations. LPAs observed the facility food supply as well as interviewed residents regarding the food service. Based on observation and interviews, the facility keeps the required amount of food supply in the facility. Additionally, resident interviews indicated that residents are satisfied with the food service at the facility and feel that they have enough food to eat at every meal therefore the allegation above is UNFOUNDED. This agency has investigated this complaint. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Staff do not meet personnel requirements. An investigation was conducted in the above allegation. LPA conducted interviews and reviewed staff files showing that staff have TB and physicals on file. Therefore, the allegation is unfounded. This agency has investigated this complaint. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents. Staff are not properly trained. An investigation was conducted in the above allegation. LPA reviewed records and conducted staff interviews regarding staff training. Findings found that staff have received in class and shadow trainings per Title 22 requirements. It was noted that some staff stated they wouldn’t mind more trainings. Although the facility is providing required training, it appears additional training is needed therefore the allegation above is unsubstantiated. 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, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Mar 8, 2023 · control 25-AS-20221027174134

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Mar 9, 2023

Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on statements obtained, facility failed to have staff treat R1 with dignity, which poses an immediate health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Mar 8, 2023

Plan of correction: By 03/09/2023, all staff shall be trained on treating residents with dignity. A written statement shall be submitted to LPA via email.

Type of visit: Required - 1 Year

On 11/29/2022 Licensing Program Analyst (LPA) Lavinia Muscan, arrived at the facility unannounced to conduct an annual visit using the infection control tool visit. LPA met with Facility Administrator, Motu Sokimi and explained the purpose of the visit. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured she used hand sanitizer shortly before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. LPA and Administrator toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, outside area and common restrooms. Facility has a 2 day perishable and a 7 day non-perishable amount of food. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. Facility has 14 residents 5 of which are on hospice. Additionally, the facility submitted a capacity change for 46 non-ambulatory residents. On 11/23/22 a fire clearance was approved for the change. LPA inspected facility capacity change and approved. Changes will reflect in CCL Licensing System. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Nov 29, 2022

Type of visit: Case Management - Other

Licensing Program Analysts (LPA) Lavinia Muscan conducted unannounced case management visit on 10/31/2022. This visit is to confirm ORDERS TO INDIVIDUAL FOR IMMEDIATE EXCLUSION FROM ALL FACILITIES. LPA met with Administrator and stated the purpose of visit. Facility understands this is an Immediate Exclusion effective 10/31/2022 and S1 is excluded and cannot be allowed to work, live in, and/or have contact with clients in any residential facility licensed by the California Department of Social Services. Therefore, the Department orders the facility to remove S1 from any contact with clients and not allow this employee to be physically present in the facility. Exit interview conducted, a copy of this report provided on this date. A signature on these forms acknowledges receipt of these forms.the state’s words, verbatim · CDSS document, Oct 31, 2022

Allegation investigated: Not enough staff to meet the needs of the residents Questionable Death Resident(s) developed a severe UTI while in care

LPA visited the facility on 9/9/2022 to complete the complaint. LPA has spoken with the Administrators, interviewed staff and residents, reviewed documentation. Regarding the allegation of questionable death, the allegation was in reference to a resident who passed in May 2022. From interviews with 5 staff, and review of records LPA learned that R1 had an infection prior to passing. The resident was receiving hospice services. LPA learned that the facility had contacted hospice, that at first hospice was reluctant to do any medication, but upon repeated requests by the facility, antibiotic was started and administered to the resident. There is no evidence that facility staff did or did not do anything that might have contributed to the death. Therefore, the allegation is UNFOUNDED. Regarding resident developing a UTI while in care, the allegation is not in and of itself a violation of a regulation. Through interview of four staff and review of records LPA learned of two different residents did have UTI’s in the spring. However, it appears that the facility staff did follow up with requesting medical attention, and the residents were given medications. Therefore, LPA finds nothing to substantiate any neglect on the part of the staff. Therefore, the allegation is UNFOUNDED. Unfounded Regarding the allegation that there is Not enough staff to meet the needs of the residents, through interview of 5staff and 4 residents, LPA learned that there were times earlier in the year when staff called in or quit, when staff in the facility was short. LPA learned that there were times when outside agency staff was called in to assist. However, in speaking with staff and residents, LPA found no evidence to prove that the number of staff led to any resident’s needs not being met. Therefore, the allegation is UNFOUNDED. A finding that the allegation is UNFOUNDED means that it is false, could not have happened, and/or is without a reasonable basis. Regarding the allegation that Residents medical information was not accessible during an emergency, from interview of 5 staff, LPA learned that the facility did have the information for residents. It appears that at the time of the alleged violation, the facility had just initiated a new process of printing out client’s information sheet from a computer. It is not clear exactly what happened at the time, but it is possible that staff present were not able to make the computer work correctly, and is not totally clear what might have taken place. LPA is not able to find conclusive evidence to prove what took place, and it appears adequate information was given to allow treatment. Allegation is UNSUBSTANTIATED. Regarding the allegation that residents were left unsupervised while in care, from interview of 5 staff and 4 of 15 residents (LPA spoke with residents who were present in May when the complaint was filed, and who were able to recall incidents in May. There is no proof that there was any time when there were NO staff present in the home; it appears that at a minimum there was at least one licensee or staff there at all times. LPA is not able to conclude whether residents were “supervised” or “unsupervised” if there were individual staff in the facility. Therefore, the allegation is UNSUBSTANTIATED. Regarding the allegation that Methamphetamine (Crack) found by employee in employee bathroom; again, LPA cannot ascertain that this in and off itself necessarily constitute a violation of a regulation. Also, from interviews of 5 staff, LPA learned that one employee did find a bag with a powdery white substance in the employee bathroom on the floor. The person in the room before that employee was from a temporary agency, was spoken to and never worked at the facility again. It is not proven that that particular person did or did not leave the substance in the bathroom. LPA learned that the staff bathroom is always kept locked, so residents do not have access to that room; therefore they did not have access to the substance. There is also no proof that any staff or anyone else actually used the substance, or if it actually was an illegal substance or what it was. Therefore, LPA is not able to prove whether there was or was not any effect whatsoever on any resident or their care from staff; however no issues have been reported. The allegation is UNSUBSTANTIATED. A finding of Unsubstantiated means that although the alleged violation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Appeal rights provided, exit interview conducted.the state’s words, verbatim · CDSS document, Sep 9, 2022 · control 25-AS-20220516104657

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Praveen Singh arrived to conduct an unannounced Case Management inspection in relation to the Department receiving a priority complaint. Prior to initiating the inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA spoke with Administrator and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. LPA met with Administrator and discussed the purpose of the visit. During the inspection, LPA toured the interior of the facility including but are not limited to: common areas, dining area, and hallways. In the areas toured no immediate health and safety violations were observed. LPA observed passageways were free of obstruction. Administrator stated the facility is well equipped with personal protective equipment (PPE). No deficiencies cited during inspection. Exit interview conducted and copy of this report emailed to Administrator.the state’s words, verbatim · CDSS document, May 23, 2022

Type of visit: Required - 1 Year

Unannounced annual visit utilizing the infection control domain was performed by LPA Michael Smith. Contact with Sheri Kimbro. A review of staff records on 12/7/21 indicates that all facility staff and other individuals who require caregiver background checks have received criminal record clearances. As a result of this visit, there were no deficiencies. However, 5 technical violations were issued. Exit interview conducted.the state’s words, verbatim · CDSS document, Dec 7, 2021

Type of visit: Case Management - Other

CM visit regarding follow up visit to inspect the removal of piled construction material and debris from an unoccupied room. Room has been cleared out and is ready for occupancy. No deficiencies were cited during today's visit.the state’s words, verbatim · CDSS document, Sep 24, 2021

Type of visit: Case Management - Licensee Initiated

Case management visit to increase facility capacity. Michael Smith LPA and Sheri Kimbro administrator were present. There are currently 10 residents. Facility was granted an increase in fire clearance from 12 to 25 residents on 8/5/21, for a total of 25 residents, in which 15 can be non-ambulatory and 10 bedridden seniors 60 and over. Administrator’s certificate expires on 1/25/22. Facility was inspected both indoors and outdoors. Outdoors was clean, tidy with adequate shading. There are locked cabinets for personnel and client records. Facility has a First Aid kit and centrally stored locked cabinet for medication. Facility has appropriate linens for the bedrooms and baths. Bedrooms have adequate lighting and storage. Water faucets are marked hot and cold with the hot water temperature was measured at 107'. Smoke detectors were present. Facility has a fire suppression system throughout. Fire extinguisher indicators revealed a full charge. Toxins and chemicals are appropriately locked in a cabinet. Hazardous debris were noted in the far South West room which was locked upon inspection. The room shall be cleaned out and remain unoccupied until the debris are removed. LPA will return in 7 days to note the removal of items. This issue will not prevent the increase of capacity during today's visit. All adults ages 18+ who reside here and are not clients, and all staff shall be fingerprinted and pass a criminal background check, prior to being present at the facility. Upon return to the office, LPA will update facility license. A new license will be forwarded at that time.the state’s words, verbatim · CDSS document, Sep 14, 2021