Dean Estate

Allegation investigated: Licensee admitted resident without a medical assessment signed by a physician within one year

Licensing Program Analysts (LPAs) Cassie Yang and Cheyenne Ratajczak arrived uannounced to open and deliver the finding of the allegation listed above. LPAs met with Assistant Administrator Kassie Howell, and explained the purpose of the visit. This investigation, LPAs conducted file review and interviews for the following allegation. Results are as follow. Please see LIC 9099-C. Unfounded Allegation: Licensee admitted resident without a medical assessment signed by a physician within one year. The Department conducted interview and file review. Based on interview with S1, it revealed facility was licensed October 2022. Based on file review, LPA observed facility to be licensed on 10/25/2022. Additionally, based on file review, it revealed R1 was admitted to the facility with a medical assessment- LIC 602A PHYSICIAN'S REPORT FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY (RCFE) signed and dated 08/24/2022. File review revealed R1 was admitted to facility with a medical assessment that is within a year. The following allegation is unfounded. UNFOUNDED-means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted and a copy of the report and appeal rights provided. Allegation: Licensee prohibited resident from having phone calls. The Department conducted interviews with S1 and S2 regarding this matter. Interview with S1 on 4/21/2023, it revealed that S1 has contacted Power of Attorney(s) prior to allowing R1 speak on the phone with other individuals, due to safety reasons. Interview revealed S1 is unsure if R1 is able to speak to others without Power of Attorney's approval. Based on interview with S2 on 10/6/2023, it revealed S2 confirmed to have inform family members that S2 will need to speak to R1's Power of Attorney frist before letting family members speak to R1. Based on file review, it revealed R1's Power of Attorney does not have limitation of visitations. The allegation is SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following allegation cited above is substantiated, please see LIC9099-D. Exit interview conducted, and a copy of the report and appeal rights was provided.the state’s words, verbatim · CDSS document, Oct 19, 2023 · control 59-AS-20231018154926

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Oct 27, 2023

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations... This requirement is not met as evidenced by: Based on interviews, Licensee did not comply with the section cited above as S1 and S2 informed LPA they contacted R1's Power of Attorney prior to allowing R1 talk on the phone with R1's family members which poses a potential risk for residents in care.the state’s words, verbatim · CDSS document, Oct 19, 2023

Plan of correction: Licensee will submit a statement of compliance to the following regulation cited. Provide POC to LPA by 10/27/2023 via email.

Type of visit: Required - 1 Year

On 10/5/2023 at 1:45PM, Licensing Program Analysts (LPAs) Cassie Yang and Cheyenne Ratajczak arrived unannounced at the facility to conduct a Required 1- year annual inspection utilizing the care tool. LPAs met with caregiver, Kassie Howell, and explained the purpose of the visit. Facility is licensed for six bedridden and hospice waiver for six. Facility is found to be in compliance to licensure. During today's inspection, LPAs and Caregiver conducted a tour of the interior and exterior of the facility. Areas toured included but not limited to: six private residents room, four bathroom, kitchen, backyard, storage area, and common areas. LPAs observed the fire extinguisher to be last serviced on October 14, 2022. LPAs informed Caregiver that fire extinguisher should be serviced annually to ensure it is in good condition. LPAs observed sharps, toxins, and medications to be locked and secured. LPAs observed five out of six residents LIC 602 Physician's Report to be dated in 2022. LPAs informed caregiver that LIC 602s should be updated annually to ensure no change in conditions for residents in care. Additionally, LPAs provided California Code Regulation 87506 Resident Records to caregiver as reference. LPAs and Caregiver completed the care tool together and found the facility to be in compliance. Exit interview conducted and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 5, 2023

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a case management visit. LPA met with Licensee, Karl Ramos, and explained the purpose of the visit. LPA conducted a tour of the facility and spoke with six out of six residents. LPA observed four residents in the common areas and two residents in their private rooms. No deficiencies observed during today's visit. Exit interview conducted, and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Apr 21, 2023

Type of visit: Post Licensing

On 3/14/2023, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a post-licensing inspection utilizing the post-licensing inspection tool. LPA met with Assistant Administrator (Asst Admin), Noel Estillore, and explained the purpose of the inspection. Today's census is 6 with (1) resident on hospice services. Facility is licensed for capacity of 6 and hospice waiver of 6. At entrance, LPA observed S1 to not have a mask on. LPA informed S1 of PIN 23-02 ASC, licensee is to follow strictest guideline as CCLD is requiring all staff and visitors to wear mask indoor. LPA observed S1 to put on mask immediately. LPA additionally informed Asst Admin of the recent PIN 23-05 ASC of the informational call discussing anticipated new guidelines. LPA and Asst Admin conducted a tour together to ensure the health and safety of residents in care. In areas toured included but not limited to the common areas, kitchen, dining room. laundry room, staff restroom, resident private bedrooms and bathrooms. LPA observed the Administrator Certificate to be updated. LPA and Asst Admin discussed the required documents to be submitted to LPA to change Administrator of the facility. LPA observed the require postage posted on the wall. LPA observed the kitchen to have sharps and medication to be locked and secured. LPA conducted a file review of resident records (2) of (6). LPA was unable to conduct personnel file review as the files were stored next door at a sister facility. LPA and Asst Admin completed the post-licensing inspection tool. As a result of today's inspection, no deficiencies cited. Exit interview conducted and a copy of the report was left at the facility.the state’s words, verbatim · CDSS document, Mar 14, 2023

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Prelicensing

On 10/12/2022, Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility and met with Administrator, Karl Ramos, to conduct Pre-licensing inspection. LPA toured the interior and exterior of the facility with Administrator. Fire extinguisher is current. The facility has (6) six residents bedrooms and six (6) bathrooms. LPA observed required furniture, and lighting throughout the facility. LPA observed knives/ sharps area were locked. LPA observed toxic and cleaning supplies locked in the laundry room. LPA observed food supplies of non-perishables for a minimum of one week and perishable foods for a minimum of two days. Bathrooms are clean, sanitary, and in good repair. The hot water temperature was measured in the kitchen at 105 degrees Fahrenheit. First aid kit was completed with bandages, tweezers, scissors, and thermometer. LPA observed centrally stored medications area were locked and inaccessible to residents in care. LPA observed one (1) fire extinguisher, smoke and carbon monoxide detectors in the facility. Licensing complaint poster are posted as required. Component III presentation conducted with Administrator. LPA observed that the facility is ready to be licensed. This report will be submitted to the Central Applications Bureau (CAB) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAB. Additional requirements may still be required. An exit interview was conducted with administrator.the state’s words, verbatim · CDSS document, Oct 12, 2022