Casa Del Sol Residence

Type of visit: Required - 1 Year

On 09/05/2023, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced visit to Casa Del Sol Residence. The purpose of today’s visit was to conduct the annual inspection. LPA met with Head Nurse, Valorie Henson. Facility is licensed for 12 non-ambulatory residents. The facility currently has 2 ambulatory resident. LPA Richard and Henson toured the physical plant and reviewed staff and resident records. The facility has 3 bedrooms and 3 bathrooms. The facility conducted a fire drill on 05/23/2023. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate residents comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. The hot water temperature tested 138.5F degrees. Food and meals are prepared in the main kitchen located in the skilled nursing facility and is brought to the residents on carts. Staff provided LPA with a waiver. The facility doesn't have a kitchen. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly. The fire extinguisher was fully charged. Carbon monoxide detector was not operational. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises During the visit, LPA observed a screening station with sanitizer in the facility entrance and additional sanitation supplies in nursing office inaccessible to the residents. LPA temperature was not checked during the visit. LPA observed staff wearing mask. Each resident has their own individual room for isolation and required postings are throughout the facility. According to the California Code Of Regulations (Title 22, Division 6, Chapter 8), There were 2 deficiencies observed at the time of visit. Therefore citations were issued at this time. Exit interview held a copy of the report and Appeal Rights were provided to Head Nurse Valorie Hanson.the state’s words, verbatim · CDSS document, Sep 5, 2023

Allegation investigated: Facility ceiling is in disrepair.

Licensing Program Analyst (LPA) Ana Soto conducted an initial complaint investigation for the allegation listed above. Today’s complaint investigation was conducted with Valorie Hanson, Social Worker Manager. The investigation consisted of following: Interviews and Record reviews. On 03/02/2023, LPA Soto interviewed S#1 - Social Worker Manager, & S#2, R#1 - R#3. LPA toured office, dining area, patio between buildings, 3 buildings ( main building and 2 east side building housing (roomsJ, H, I, L, D, and G.) LPA took pictures of water damage and personal heater in room #J and sand bags pLaed in front of outside room D back door. On 03/02/23, LPA Soto received the following documents: Resident and Staff Roster, Repair invoice (estimate,) and Previous repair invoice for roof. Based on the LPA's investigation, the investigation revealed the following. For Allegation – Facility ceiling is in disrepair. LPA toured 3 buildings and in room J there was water damage in room ceiling near both vents and bathroom ceiling. Substantiated The outside hallway had water damage also. A pipe outside the main building was broken and water was entering room D back door. They placed sand bags to keep water from entering room and fixed pipe. The heater thermostat was replaced with a new one. LPA observed heat in the building housing rooms J, H, and I, where thermostat was replaced. Interviews with S#1 & S#2, communicated that they repaired the leaks in the room with a mixture as a temporary fix, until roofers can come to fix roof. The roofing company needed the rain to stop, in order to be able fix the roof, the roof needs to be completely dry. The facility installed a new thermostat for heat. The heater is now repaired and heat restored to the building. There was a broken pipe outside the main building and they fixed the pipe and placed sand bags in front of back door of room D to stop water from entering room. Interviews with R#1, communicated that the roof was leaking a lot of water, R#1 was utilizing towels to stop the water. R#1 also had no heat in their room and used a personal heater. R#2 & R#3, communicated they had no water leaks and their rooms where at a comfortable temperature. No heat issues. The facility had the roof repaired on 01/28/23, but the roof is still not repaired. The roofing company will be repairing the roof again, the roof repaired are still within warranty period. The interviews, record reviews, and observations, concur with the above allegation, Based on LPA’s observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiency and issued a citation. An exit interview was conducted with Valorie Hanson, Social Worker Manager, and a hard copy of report and Appeal Rights providedthe state’s words, verbatim · CDSS document, Mar 2, 2023 · control 11-AS-20230228155029

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303a · Plan of correction due date: Mar 8, 2023

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. This was not met as evidence by: based on room J water leak and no heat and pipe broken outside room G main building.the state’s words, verbatim · CDSS document, Mar 2, 2023

Plan of correction: Administrator to repair roof asap. Send copy of completed repairs invocie by or on POC due date.

Allegation investigated: Staff yelled at resident. Facility assigned resident a physician without resident's consent. Resident is being retaliated against. Resident feels threatened by staff. Illegal eviction.

Due to system error; this report is a recreation of complaint report visit date: 06/03/22. Signature is on original report hardcopy that's on file. Licensing Program Analyst (LPA) Jey Cardenas conducted an initial 10- day complaint visit to the above facility to investigate allegations listed above. Upon arrival at the facility LPA meet with staff (S1) LPA explained the reason for today’s visit and conducted a Covid-19 risk assessment. The investigation consisted of the following: LPA Cardenas reviewed Resident#1 (R1) file and obtained copies of Physician report, admission agreement, progress notes, doctors progress notes, and care plan. LPA Interviewed Staff#1-Staff#3 (S1-S3) and Residents#1-5 (R1-R5) Resident#6 (R6) was not at the facility at time of visit. LPA toured plant. It is being alleged that: S1 recently yelled at resident for not seeing a doctor and threatened with an eviction. The Facility assigned a doctor without resident’s consent and resident feels retaliated against for filing a complaint. On 6/3/2022 LPA Cardenas reviewed physician report: diagnosis includes depression, paranoia, and Diabetes. On 6/3/22 LPA Cardenas interviewed W1 who indicates being pleased with Unsubstantiated the care and supervision the facility is providing, no concerns regarding abuse. W1 has not seen an eviction notice for R1. Regarding allegation Staff yelled at resident. On 6/3/2022 LPA Cardenas interviewed S1-S3 who indicate that residents haven’t complained about staff yelling at them, nor has staff witnessed other staff yelling at residents. On 6/03/22 LPA Cardenas interviewed residents; R2-R4 indicate staff don’t yell at them. R5 likes the facility, no other comments nor complaints. Regarding allegation Facility assigned resident a physician without resident's consent. On 6/3/22 LPA Reviewed R1 care plan- “discussed facility contract regarding need to have a doctor to check in as often as needed.” Per psych notes resident was seen, chart reviewed, care plan discussed with staff. Resident presents paranoid, guarded delusional, restless, and intervalley pre-occupied. Residents is paranoid that food is being poisoned. Resident has poor insight to illness. Per Personnel progress notes dated 11/4/21; There has been a change of MD services per resident refusal to see Dr. Peck. Per family instructions another MD has been assigned. On 6/03/22 LPA Cardenas interviewed S1-S3 who indicate residents have the option to choose their own physician, however, there is also a facility doctor available if needed. Facility Dr. Peck provided medical services to R1 since admission through 03/20/21, R1 refused to continue seeing him and accused Dr. Peck of looking at resident the wrong way. S2 indicates that R6 is not at the facility because resident is at physician of choice. Facility doesn’t force physicians on residents. On 6/3/22 LPA Cardenas interviewed residents R2 and R3 indicate they have the option to choose their own doctor. R4 didn’t answer question. Regarding allegation Resident is being retaliated against. On 6/3/2022 LPA Cardenas interviewed S1-S3 who indicate that residents haven’t complained about feeling retaliated against by staff. On 6/03/22 LPA Cardenas interviewed residents; R2-R4 who indicate they haven’t felt retaliated against. Regarding allegation Resident feels threatened by staff. On 6/3/2022 LPA Cardenas interviewed S1-S3 who indicate that residents haven’t complained about staff threatening them, nor has staff witnessed other staff threatening residents. On 6/03/22 LPA Cardenas interviewed residents; R2-R4 indicate staff have not threatened them. Regarding allegation Illegal eviction. On 6/3/2022 LPA Cardenas interviewed S1 who indicates that none of the residents have been issued an eviction notice at this time. Facility would like to avoid an eviction and is working with R1s family to ensure resident receives appropriate medical care due to R1s continued refusal.Based on LPA’s interviews and record reviews, LPA did not find sufficient evidence to support the allegations, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report to be provided to facility representative.the state’s words, verbatim · CDSS document, Jun 3, 2022 · control 11-AS-20220526104318

Type of visit: Case Management - Other

***Due to system error; this report is a recreation of case management report visit date: 06/03/22. Signature is on original report hardcopy that's on file. Licensing Program Analyst (LPA) Jey Cardenas conducted a case management visit to the above facility during a complaint investigation control number 11-AS-20220526104318. LPA met with Staff#1 who was not associated to the facility. LPA Conducted a Covid-19 risk assessment. On today 6/3/22 LPA Cardenas is assessing a civil penalty for not being associated. Staff works at skilled nursing center area and is assisting the assisted living facility. Staff indicates she has been working and assisting the AL for about a year. Exit interview conducted, a copy of this report provided to staff, deficiency entered on LIC809D report and appeal rights provided.the state’s words, verbatim · CDSS document, Jun 3, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 97355(e)(2) · Plan of correction due date: Jun 4, 2022

Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement not met as evidenced by: On 6/3/22 LPA meet with staff#1 who was not associated to the facility. This poses an immediate health and safety risk.the state’s words, verbatim · CDSS document, Jun 3, 2022

Plan of correction: Submit A signed criminal background clearance transfer request LIC9182, a copy of idividuals Driver license or valid identification card and LIC508, criminal record statement by POC.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jennifer Jones conducted an unannounced visit to Casa Del Sol Residence. The purpose of today’s visit was to conduct the annual inspection. LPA met with Head Nurse, Valorie Henson. Facility is licensed for 12 non-ambulatory residents. The facility currently has 2 ambulatory resident. LPA Jones toured the physical plant and reviewed staff and resident records. The facility has 3 bedrooms and 3 bathrooms. The facility conducted a fire drill on 8/16/20121. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate residents comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Food and meals are prepared in the main kitchen located in the skilled nursing facility and is brought to the residents on carts. Staff provided LPA with a waiver. LPA was unable to tour kitchen due to covid 19 restrictions. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA was unable to review administrator file and certificate during the visit but was advised by staff that a temporary administrator is standing in while the active administrator is out of town. Cont C During the visit, LPA observed the facility infection control practices. LPA observed a screening station with sanitizer in the facility entrance and additional sanitation supplies in nursing office inaccessible to the residents . LPA observed a sign in sheet and temperature log for visitors. LPA's temperature was checked during the visit. LPA observed staff wearing mask. Each resident has their own individual room for isolation and required postings are throughout the facility. Staff advised LPA that visitors can meet with residents with an appt. Deficiencies cited on 809D Exit interview conductedthe state’s words, verbatim · CDSS document, Sep 1, 2021