Canterbury Woods

Allegation investigated: Staff did not ensure resident in care had clean clothing Resident's hygiene needs were not properly met Staff did not ensure facility was free of pests Resident was not provided proper food service

On 9/13/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Executive Director Elvyra Abare. 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. Resident 1(R1) was admitted on 2/20/2023. As part of R1's Service Agreement(contract), laundry service was provided weekly. Based off of interviews, R1 regularly declined assistance with showers, and would tell facility staff that she was clean. Based on a physician's assessment dated 7/6/2023, R1 was able to bathe and groom themself with reminders. Staff observed ants in the apartment of R1. After observing ants, staff applied "Ant Advion" and placed a work service order to spray for the ants on 6/15/2023. R1 kept two cats as pets in her apartment. R1 was assessed as independent in the category of food and nutrition. Three meals and snacks were made available to R1 on a daily basis, and staff observed R1 to regularly attend meals in the dining room. During inspection, facility food service appeared to be of adequate quality and quantity, and snacks were availble for residents in both common and personal refrigerators. Unsubstantiated Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Sep 13, 2023 · control 24-AS-20230725093000

Allegation investigated: Resident in care became severely dehydrated

On 9/13/2023, Licensing Program Analyst (LPA) D. Ayers conducted an unannounced complaint inspection. LPA met with Executive Director Elvyra Abare. 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, reviewed records, and conducted interviews. Resident 1(R1) was admitted to the facility on 2/20/2023. R1 was reassesed for a change of level in care by facility staff on 3/1/2023. At this time R1 was assessed as independent in the category of "Nutrition and Meals". On 7/17/2023, R1 was taken to the emergency room by paramedics due to collapsing while ambulating in the facility. According to the examining physician on 7/17/2023, the chief concern for R1 was hypotension. R1 was provided discharge instuctions for "dehydration" and "acute kidney injury". 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. Substantiated 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 the administrator, whose signature below confirms receipt of these rights.the state’s words, verbatim · CDSS document, Sep 13, 2023 · control 24-AS-20230725093000

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(f)(4) · Plan of correction due date: Sep 22, 2023

87464 Basic Services: (f)(4)Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. This requirement was not met as evidenced by: Based on records review and interviews, the licensee did not ensure that 1 out of 25 assisted living residents received adequate personal assistance, resulting in 1 resident being treated for dehydration and acute kidney injury, which presents a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 13, 2023

Plan of correction: Administrator has stated that she will implement a hydration station in the assisted living dining room. Director of Health Services will revise safety check plan to include encouraging residents to take fluids.

Type of visit: Required - 1 Year

On 9/13/2023, Licensing Program Analyst(LPA) D. Ayers arrived unannounced to conduct a Required Annual Inspection. LPA met with Executive Director Elvyra Abare and announced the purpose of the visit. Administrator Certification is current with renewal date 7/10/2024. LPA toured the facility inside and outside. All passageways and exits were clear and free from obstruction. Fire extinguishers were recently serviced and facility has a sprinkler system. Facility regularly conducts emergency drills in cooperation with local fire authority. LPA toured the facility kitchen and observed an adequate supply of perishable and non-perishable foodstuffs. Kitchen and all common areas were clean, well-lit, and odor-free. Facility had adequate supply of emergency food and first aid supplies. LPA reviewed emergency-disaster plan. LPA toured a sample of resident bedrooms and bathrooms, which were observed to be clean, with all fixtures and appliances functioning properly. Bathrooms were clean and were equipped with required grab-bars and non-skid mats. LPA observed centrally stored medications in assisted living to be properly stored and secured, and medications appeared to be administered properly. Narcotic medications were secured in a locked canister within the medication cart and all doses were recorded. LPA reviewed a sample of resident and staff files. Files contained required documentation and records. LPA requested the following files to be provided to CCLD by 9/20/2023: LIC 500, LIC 308, LIC610E, and LIC 9020a. 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, Sep 13, 2023

Type of visit: Case Management - Incident

LPA Shawna Doucette arrived at the facility unannounced to conduct a Case Management regarding an incident that was reported on 06/15/23 by Administrator Elvyra Abare. LPA met with Administrator. LPA interviewed Administrator. LPA obtained copies of staff file. LPA obtained copies of R1's file. LPA will request copy of police report and medical records regarding this incident. LPA will return at a later date if necessary regarding this incident. And exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 20, 2023

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Sarah Hurt conduct a Case Management (Incident) visit.. LPA Hurt met with Vicki Zufelt and explained the purpose of today's visit. LPA Hurt toured the facility including dining areas, common areas, and resident bedrooms. LPA observed the facility elevator to be out of service, and assisted living residents are not able to get downstairs. Vicki Zufelt stated the elevator has been out of service for two weeks as it needs a specific part that has not come in yet. LPA Hurt received an Incident by Reported documenting facility Staff 1 has been rough when providing care for Resident 1. Resident 1 stated Staff 1 has been rough with his care for the last month and a half. Resident 1 stated he mentioned to Staff 1 several times the care she was providing when assisting him with dressing was directly causing him pain in legs, and she would ignore or say " I did it just like this yesterday and you were fine." Resident 1 stated Staff 1 they would express his legs were hurting as he felt they were being wrapped too tight on several occasions. The following deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Staff facility nurse Vicki Zufelt, and a copy of this report along with appeals rights provided.the state’s words, verbatim · CDSS document, Jan 20, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 2, 2023

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The following requirement has not been met as evidenced by: The facility elevator has been out of service for several weeks leaving assisted living residents unable to get downstairs which poses a potential, health, safety, or personal rights to residents in care.the state’s words, verbatim · CDSS document, Jan 20, 2023

Plan of correction: Vicki Zufelt will send proof of elevator repair to LPA Hurt by 02/02/2023 POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1 · Plan of correction due date: Jan 23, 2023

87468.1 Personal Rights of Residents in All Facilities (a) 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. The following requirement has not been me as evidenced by: Based on interviews Resident 1 was provided care that made him uncomfortable which poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jan 20, 2023

Plan of correction: Vicki Zufelt will send proof of personal rights, and elderly care training for Staff 1 and send proof to LPA by 1/23/2023.

Type of visit: Case Management - Incident

On 1/4/2023 at 1:34 p.m. Licensing Program Analyst (LPA) B. Miranda conducted an unannounced Case Management visit. LPA met with Administrator (AD) Elvyra Abare. LPA was greeted and allowed entry into the facility. LPA did a small tour of the facility while going to R1's room. LPA observed R1's room and interviewed R1. Interview will be entered on LIC812. LPA also interviewed AD and obtained R1's LIC 600. No citations issued per the California Code of Regulations Tittle 22. LPA reviewed report with AD Elvyra Abare and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 4, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Marybeth Donovan conducted an unannounced Required - 1 Year Annual Inspection to include Infection Control site visit and met with Elvyra Abare Executive Director. The census is 144 of which 22 residents reside in Assisted Living (AL). LPA toured the facility inside and out to include entrance, lobby, main dining room, and exterior. In LPA inspected AL bedrooms, bathrooms, and dining area. All fire exit routes were free and clear of obstructions. Medications are stored in a locked medication cart. Toxins, cleaning supplies, knives and sharp objects are secured. At noon time LPA observed lunch service in AL to include minestrone soup and Florentine pasta salad with a chicken entrée. Alternative menu is available to residents. Facility observed to have designated entry point for COVID 19 symptom screening with questionnaire. Bathrooms observed to be supplied with hygiene products. Hand sanitizer available to residents and visitors. LPA reviewed the facility policies and procedures to include screening, visitation, isolation, disinfecting, training, PPE usage and personal rights. Designated staff have been Fit Tested. Facility held Flu vaccination clinic on 9/28/2021 and COVID 19 Booster Vaccination Clinic is scheduled for 10/18/2021. No citations issued per the California Code of Regulations Tittle 22. LPA reviewed report with Elvyra Abare Executive Director and a copy of this report emailed due to technical issues.the state’s words, verbatim · CDSS document, Sep 29, 2021

Type of visit: Case Management - COVID-19

Licensing Program Analyst (LPA) Marybeth Donovan conducted a Technical Assist (TA) Visit via FaceTime with Elvyra Abare Administrator, Helen Shi Program Clinical Consultant (PCC) and Jackie Jin Licensing Program Manager. The purpose of the visit was to provide technical assistance for Infection Prevention and Control guidelines for Adult and Senior Care facilities. LPA conducted a tour of the facility. LPA and PCC reviewed the facility policies and procedures to include screening, isolation, disinfecting, staffing, training, PPE usage, Doffing and Donning of PPE, and visitation. The following recommendations were discussed: 1. Post Hand washing signs inside common area bathrooms. 2. Maintain Isolation Room PPE cart with supplies for immediate use. 3. Continue ongoing staff training on infection prevention and control measures. LPA reviewed report with Elvyra Abare Administrator and copy emailed for signature.the state’s words, verbatim · CDSS document, Sep 14, 2021