Carver Senior Homes 2

Allegation investigated: Staff handles resident roughly Staff does not treat resident with respect

Licensing Program Analyst (LPA) Jerome Haley made an unannounced follow up visit to gather additional information on the complaint allegations above. LPA Haley was greeted by staff and explained the reason for the visit upon entry. Staff contacted Administrator (AD) Isaiah Tashiro via telephone who arrived a short time later and was present for the remainder of the visit. After conducting additional interviews and gathering more details on the complaint allegations, it was determined findings would be delivered at the end of the visit. Regarding the investigation into the complaint allegations above, the initial visit was completed November 17, 2022, and 5 individuals were interviewed. A follow up visit was made July 12, 2023, and 7 additional individuals were interviewed. 2 interviews were conducted outside the facility via telephone for a total of 14 interviews conducted. Continued on LIC9099C Unsubstantiated After conducting 14 interviews with individuals, the investigation revealed the following: 12 of 14 individuals interviewed were unable to corroborate the allegations as reported. Furthermore, 8 of the 12 individuals who were unable to corroborate the allegations, actually denied the allegations. Based on the information gathered during the investigation through interviews, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed Unsubstantiated. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 12, 2023 · control 22-AS-20221116151607

Allegation investigated: Staff did not provide a skilled professional to properly care for resident’s ileostomy.

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to deliver the findings on the complaint allegation above. LPA identified himself and discussed the purpose of the visit with staff. Staff called Licensee/Administrator (AD) Carmen Nicolas via telephone and LPA Haley explained to her the reason for today's visit. The investigation into the allegation “Staff did not provide a skilled professional to properly care for resident’s ileostomy” revealed the following: During the initial visit October 20, 2022 LPA Haley interviewed the licensee, staff, and residents. During the interview process with multiple individuals, LPA Haley received information that confirms the allegation above is true. Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6. An exit interview was conducted, a copy of this report, LIC809D, and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Nov 17, 2022 · control 22-AS-20221014145836

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87621(a)(2) · Plan of correction due date: Nov 17, 2022

Colostomy/Ileostomy (a) Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a colostomy or ileostomy under the following circumstances: (2) If assistance in care of the ostomy is provided by an appropriately skilled professional. This requirement is not being met as evidenced by: During interviews with the licensee/Administrator LPA Haley was told they have not been trained by a skilled professional to provide care for the residents ileostomy.the state’s words, verbatim · CDSS document, Nov 17, 2022

Plan of correction: Licensee/Administrator agrees to have a skilled professional train all staff members on proper Colostomy/Ileostomy care before admitting a resident who needs ostomy care. Licensee/Administrator agrees to provide this training to the department before admitting a new resident who needs ostomy care.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jessica Cho arrived at Carver Senior Homes 2 to conduct an unannounced Required 1 Year Inspection with an emphasis on Infection Control. At 2:00pm, LPA Cho was greeted and granted entry by Caregiver Rebecca De Las Alas. Also present was Caregiver Arturo Guerrero. LPA spoke to Administrator (Admin) Karmian Calangi over the telephone and authorized Caregiver Guerrero to participate in the exit interview and sign the evaluation report. LPA completed the Coronavirus 2019 (COVID-19) screening procedure upon entry. There are no active COVID-19 cases as of today. LPA observed a check-in station with a thermometer. Facility does not document temperatures of visitors on the sign-in sheet. LPA observed the required COVID-19 precautionary signs posted throughout the facility. The Complaint Poster (PUB475) was observed in the size of 11"x14" which did not meet the size requirement. PUB475 was purchased during the visit. The facility is licensed for six non-ambulatory residents and has a hospice waiver for four. There are currently five residents living in the facility of which one is receiving hospice care. At 2:10pm, LPA Cho conducted a tour of the physical plant with Caregiver Rebecca De Las Alas. There are a total of five resident bedrooms and two resident bathrooms. There is a private staff bedroom and bathroom. LPA checked the resident bedrooms. The resident bedrooms had the required furnishings. The resident bathrooms were checked. Grab bars were secure, the toilets worked properly, the showers were free of mold/mildew, and slip mats were in place. Resident bath towels and personal hygiene supplies were adequately stocked including hand soaps and paper towels. LPA observed hand washing signs in the bathrooms. The hot water temperature in the resident bathrooms measured at 113.3 degrees Fahrenheit in Bathroom #1 and 117.7 degrees Fahrenheit in Bathroom #2. Perishable and non-perishable food supplies were checked and adequately stocked at the time of the visit. The fire extinguisher was mounted, fully charged, and serviced on 07/28/2022. Smoke/carbon monoxide detectors and auditory devices were tested and operational. Medications, toxins, and sharps were locked and inaccessible to the residents. LPA Cho toured the outside grounds. No body of water was present. There was shading and sufficient seating for residents. The exit gate was self-closing and self-latching. Walkways around the facility were clear of hazards, and LPA observed sufficient supply of emergency food/water and PPEs. Based on the observations made during today's visit, no deficiency is cited in this review as per Title 22 Division 6 of the California Code of Regulations. Advisory Notes (LIC9102s) were issued during the visit. An exit interview was conducted with Caregiver Arturo Guerrero, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 14, 2022

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Kathrina Chin conducted an unannounced visit for the purpose of conducting a required annual visit. LPA were greeted by Fe Manapat, caregiver and Virgilio De Guzman, Administrator arrived approximately fifteen minutes later. LPA explained the purpose of the visit. LPA toured the facility. There are six residents residing in the facility and no active COVID-19 cases. All residents appeared clean and well taken care of. LPA observed required postings in the facility as well as hand washing signs in the restrooms. All restrooms observed had ample soap/sanitizer and appeared clean. Resident bedrooms appeared clean and sanitary and had all required components. LPA observed the emergency disaster and evacuation plans. Facility has back-up emergency food and water supply as well as PPE supplies. LPA reviewed the COVID-19 mitigation plan of the facility. Smoke detectors, carbon monoxide and auditory exit alarms were tested and were operational. Bathrooms were observed to be in good repair; and provided with grab bars and non-skid floor mats. Hot water was measured at 120 degrees Fahrenheit. Facility met the minimum two day perishable and seven day non-perishable food stock requirements. Medications, cleaning supplies and sharp items were inaccessible to residents in care. Fire extinguisher was mounted and charged. The grounds were free of tripping hazards. No deficiencies cited this review as per Title 22 of the California Code of Regulations. An exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Dec 14, 2021