Canton Cottage

Allegation investigated: Resident sustained fracture while in care Facility failed to meet reporting requirements Facility did not notify resident's POA of an incident. Facility failed to meet resident's needs

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Tuesday, September 19, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Licensee Jose Umana and Administrator Elsa Roman. LPA Bunker explained the purpose of today's visit. The investigation consisted of the following: During the course of the investigation Interviews were conducted with staff 1-6 (S1-S6) and residents 2-5 (R2-R5). LPA Bunker asked questions relevant to the nature of the complaint. During the visits on 02/14/2023 and 09/19/2023, we toured the entire facility buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during the visits. We observed and reviewed the resident’s folder, physician's report, medical records, admission agreement, I.D. and emergency information, medication, medication log, medical assessment, consent forms, appraisal & needs service plan. LPA Bunker requested copies of supporting documents. See continued LIC9099-C page 2 Unsubstantiated Continued LIC9099-C page 2 Allegation #1: Resident sustained a fracture while in care. Staff members 1-6 (S1-S6) stated resident sustained a fracture while in care from a fall. The facility had no control over the fall and could not have prevented the resident from falling. The resident was in his bedroom in his recliner chair after breakfast and had an unwitnessed unforeseen fall. The facility staff immediately went to the resident's bedroom to check on the resident and provided assistance. The hospice nurse called 911 immediately and paramedics transported the resident to the hospital where he was diagnosed with a left femur fracture. S1-S6 stated that the facility staff are well-trained, adhere to Title 22 Regulations, and took all necessary precautions. Allegation #2: Facility failed to meet report requirements Staff 1-6 (S1-S6) members interviewed stated a written special incident report (SIR) was reported and submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence. Staff 1-2 (S1-S2) stated this report includes the resident's name, age, sex, date of admission; date and nature of the event; attending physician's name, findings, and treatment, and disposition of the case. S1-S2 stated a follow-up SIR was also reported regarding the death of the resident, the cause of death, and where the death occurred. S1-S2 stated that the incident did not occur because of neglect and lack of supervision. S1-S6 stated staff could not have prevented the fall from happening. S1-S6 denied the allegation. Allegation #3: The facility did not notify the resident's POA of an incident Staff 1-6 (S1-S6) stated that the facility gave the resident’s information to the paramedics and Long Beach Memorial Hospital. The hospice nurse and Administrator came to the facility immediately after the resident had fallen. The Hospice nurse and the Administrator informed the resident POA of the incident. The staff is not aware of how long it took the POA to locate the resident. The Administrator stated they give the paramedics the resident, physician reports, medications, and contact information. The Administrator stated they reported the Special Incident Report and informed Community Care Licensing and all the appropriate agencies in a timely manner. See continued LIC9099-C page 3 Continued 9099-C page 3 Allegation #4: Failed to meet resident's needs Staff 1-6 (S1-S6) stated the facility staff did not fail to meet the resident's needs. S1-S6 stated staff went to the resident's bedroom and immediately provided assistance to make sure the resident was okay. S1-S6 stated the facility staff are providing residents with care and supervision as necessary to meet the resident's needs. S1-S6 stated they assist residents with their daily needs. Investigation revealed the following: Staff 1-6 (S1-S6), stated that on 01/29/2023, not sure of the exact time. The resident was in his bedroom sitting in his recliner chair after breakfast and had an unwitnessed unforeseen fall. The facility staff immediately checked on the resident. The resident reported pain in his left hip area. Staff contacted the administrator, the hospice nurse, and 911. The resident was transported by paramedics to Long Beach Memorial Hospital where he was diagnosed with a left femur. The resident had surgery which was successful, however, the resident did not regain consciousness after the procedure. The resident was placed on palliative care and passed away at the hospital. S1-S6 and residents 2-5 (R2-R5) interviewed denied the allegations. S1-S6 stated that the incident did not occur because of neglect or lack of care and supervision. S1-S6 stated staff couldn't have prevented the resident from falling. It was not the staff’s fault and it was an accident. S1-S6 stated that the facility staff are well-trained and competent, adhere to Title 22 Regulations, and took all necessary precautions. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to Administrator. There were no deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Sep 19, 2023 · control 11-AS-20230213132727

Type of visit: Case Management - Deficiencies

On 08/28/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted a case management inspection visit at this facility. LPA met with caregiver Kristen Prisco and explained the purpose of the visit. During a required annual inspection visit on 08/19/223, LPA and was informed that staff #2 and #6 had the required TB test and staff #4 had the required CPR/First Aid certificate completed and just did not have it included in the personnel files. The administrator failed to submit proof of completed for staff #2, #4 and #6 by agreed due date 08/21/23. The licensee violated 87458 Personnel Records and 87411 Personnel Requirements General Title 22 Regulations. California Code of Regulations (Title 22, Division 6, Chapter 8), deficiencies were observed, and citations were issued (ref. LIC 9099-D). An exit interview conducted with Kristen Prisco a copy of report and appeal rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *.the state’s words, verbatim · CDSS document, Aug 28, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a)(1) · Plan of correction due date: Sep 11, 2023

87412 Personnel Records (a)The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information:(11) A health screening as specified in Section 87411. This requirement was not met as evidenced by: Based on record review, the licensee failed to staff #2&#6 (S2) & (S6) had health screening for TB. This violation possesses a potential Health or Personal Rights risks to residents.the state’s words, verbatim · CDSS document, Aug 28, 2023

Plan of correction: Licensee shall ensure all residents conduct a health screening for TB. Licensee also agreed to have test results as proof of correction and will be submitted to CCLD by 09/11/23 to ernand.dabuet@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR87411(c)(1) · Plan of correction due date: Aug 28, 2023

87411 Personnel Requirements - General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidenced by: Based on record review, the licensee failed to ensure staff #4 (S4) had First Aid/CPR completed. This violation possesses a potential Health or Personal Rights risks to residents.the state’s words, verbatim · CDSS document, Aug 28, 2023

Plan of correction: Licensee shall ensure staff #4 will complete First Aid/CPR training. Licensee also agreed to have results as proof of correction and will be submitted to CCLD by 09/11/23 to ernand.dabuet@dss.ca.gov

Type of visit: Required - 1 Year

On 08/19/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met administrators Jose Umana and Elsa Roman and explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory, of which (1) may be bedridden elderly adults ages 60 and above. Currently, the facility has (1) hospice resident in care. The facility is approved for (2) hospice resident. The facility is a single-story structure located in a residential neighborhood. It consists of the following: (4) residents' rooms, (2) bathrooms, a living area, a dining area, a kitchen, an outside seating area, and a garage utilized for storage. LPA toured the physical plant. There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the resident's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 114.8 degrees F. A comfortable temperature of 75 degrees F. was maintained in the facility. LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Fire extinguishers were charged. A review of the Medication Records Administration (MAR) was observed to be maintained in order and complete. (Evaluation Report continues LIC 809-C) During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on 07/14/23. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 02/01/23 through 02/01/24. An audit of resident #1-#6 (R1-R6) service files and staff #1-#6 (S1-S6) personnel files. Interviews were conducted with (5) residents and (2) staff. The facility has the current administrator's certification on file for Elsa Roman #6040880740 Expiration 06/23/24. The facility is not current on (CCL) license dues and an invoice was provided. DEFICIENCY: Records revealed resident #1(R1) diagnsosed with dementia does not have a current medical assessment and appraisal. The last medical/appraisal is dated 04/08/21 and 04/14/21. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies has been observed and citation issued (ref. LIC 9099-D). An exit interview conducted with Jose Umana and a copy of report and appeal rights provided. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) are cleared. *the state’s words, verbatim · CDSS document, Aug 19, 2023

Type of visit: Required - 1 Year

On 08/06/22, Licensing Program Analyst (LPA) Ernand Dabuet conducted an unannounced annual required visit with a primary focus on Infection Control measures using the CARE Inspection Tool. LPA met with administrator Elsa Roman and explained the purpose of today’s visit. The facility is licensed to operate for (6) non-ambulatory of which (1) may be bedridden elderly residents ages 60 and above. The facility is approved for (2) hospice residents. The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) residents' rooms, two (2) common bathrooms, a living area, a dining area, a kitchen, and an outside covered patio area. LPA toured the physical plant. There were no obstructions on the premises. All rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of the visit. Bathrooms were found to be within Title 22 regulations and were operational. The water temperature measured 110.6 F. A comfortable temperature of 74 degrees was maintained in the facility. LPA observed the facility to be appropriately furnished at the time of the visit. Storage areas for personal hygiene and objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. The facility has (1) fire extinguisher that is charged, and smoke detectors operable. A working landline telephone remains available. The medication administration record (MAR) was reviewed and found to be accurate and maintained in order. Evaluation Report continues on LIC 809-C INFECTION CONTROL: During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed staff wearing face coverings, LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted. A review of staff tests and residents' vaccination along with daily temperature checks were conducted. The facility has an approved Mitigation Plan Report on file with CCLD. The facility has submitted Infection Control Plan for 2022 with CCLD. DEFICIENCIES: LPA identified at 1:51 pm knives under the kitchen sink were exposed in an unlocked cabinet. At 1:52 pm LPA identified (2) knives inside the dishwasher. At 1:54 pm, LPA identified cleaning solutions and other hazardous materials under bathroom sink #2 in an unlocked cabinet and accessible to residents in care. Deficiencies are issued and an exit interview is conducted with Elsa Roman. A copy of this report is provided along with the appeal rights.the state’s words, verbatim · CDSS document, Aug 6, 2022

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.