Diana's Care Home

Allegation investigated: Facility did not provide sufficient care/supervision resulting to resident (R1) sustaining fractured ribs.

At 4:45 pm on this day, 2/05/25, Licensing Program Analyst (LPA) Delmundo conducted an unannounced visit to deliver the findings for the above allegation. LPA met with Grace Corda Aquino, administrator, and informed the purpose of visit. During the course of investigation, the Department obtained copies of LIC9020 Register of Facility Clients/Residents, staff schedule and the following residents’ documents: Admission Agreement; LIC601 Identification and Emergency Contact Information; LIC602A Physician's Report; Pre-admission Appraisal; LIC625 Appraisal/Needs and Services Plan; Hospital After Visit Summary; Unusual Incident Reports; facility notes; medical records. .....continued on 9099C Unsubstantiated The Department interviewed residents (R1, R2, R3), staff (S1, S2, S3 and administrator) and reporting party (RP) on 9/12/23. The Nurse Practitioner (NP) was also interviewed on 9/13/23 and medical records were reviewed. R1 stated he needs assistance in transferring. R1 denied ever being abused and falling or getting injured while at the facility. R1 also denied having fracture and stated had only fractured his ribs when shot while serving in the military. The other 2 residents made no disclosures of ever being hurt and mistreated at the facility, having any complaints about the facility staff, and stated never seen any other residents get hurt or mistreated while at the facility. The four facility staff reported they did not know R1 had fractured ribs or how R1 could have sustained the injuries. They denied R1 ever falling at the facility. They stated R1 requires two person assistance during transfers, and that staff would pick R1 up from underneath R1’s armpits. Reporting Party (RP) and Nurse Practitioner (NP) both stated they did not know if the injuries R1 sustained are old or new. NP stated the medical records showed the injuries to be sub-acute but not sure, and stated the injuries could be due to infiltration. Review of medical records showed a right 2nd to 6th rib fractures. Previously, only right 4th and 5th rib fractures were seen. The fractures were noted to be “acute/subacute” fractures. Based on interviews and records review, the allegation is unsubstantiated. A finding that a complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiency cited. Exit interview conducted and copy of this report provided.the state’s words, verbatim · CDSS document, Feb 5, 2025 · control 15-AS-20230818151513

Allegation investigated: Staff did not prevent resident from physically abusing another resident Staff are not providing adequate food service to resident Staff took resident’s phone as retaliation Staff are not ensuring resident is seen by medical doctors Staff did not safeguard resident’s personal belongings Staff did not allow resident to call CCL to file a complaint Staff does not treat resident with dignity and respect Staff are not meeting residents needs

Licensing Program Analysts (LPAs) K. Nguyen and P. Manalo arrived unannounced to conduct investigation on the above allegation. LPAs explained the purpose of the visit to administrator (AD) Grace Reano- Aquino. Allegation: Staff did not prevent resident from physically abusing another resident: Unsubstantiated During the course of investigation LPAs conducted residents’ files reviewed, interviews residents, and staffs. It was alleged that Staff did not prevent resident from physically abusing another resident, however after LPAs interviewed with R1, R1 stated “the resident that tried to hurt me is not here anymore, and that no one witness or sees it”. LPAs interviewed 4 staff and 4 out of 4 stated that they have never witness, nor heard any incidents of residents physically abusing another resident. LPAs interviewed resident, R2 stated that R2 have not witness any residents physically abused. Therefore, the allegation is unsubstantiated. Allegation: Staff are not providing adequate food service to resident: Unsubstantiated During the course of investigation LPAs conducted interviews with residents, and staffs. Residents stated that the facility gives residents different varieties food choices. Staffs stated that food are provided to residents are by their choices, but some residents have special foods diet, so we have to follow the doctor orders. Therefore, the allegation is unsubstantiated. Report continues on LIC 9099c... Unsubstantiated Allegation: Staff took resident’s phone as retaliation: Unsubstantiated During the course of investigation LPAs reviewed R1 files indicated that R1 is diagnose with schizo affective. LPAs interviewed 4 staff 4 out of 4 stated that R1 is not medication compliance. R1 stated “My mind is clear, and I don’t want to take any medication”. S1 stated R1 phone is with the facility due to R1 excessive calling the police. LPAs confirmed with R1 family member that they are aware that R1 phone is with the facility staff. LPAs noted that R1 is conserved by San Mateo County Public Guardian, and R1 conservator/ family members asked the facility to keep R1 phone, which are not to retaliation. Therefore, the allegation is unsubstantiated. Allegation: Staff are not ensuring resident is seen by medical doctors: Unsubstantiated During the course of investigation LPAs conducted residents’ files reviewed, and staffs interviewed. After reviewing R1 records of doctor visit/ notes showed R1 doctor seen R1 at the facility once a month, and as needed. S1 and S2 indicated at time R1 doesn’t want to see R1 doctor. Therefore, the allegation is unsubstantiated. Allegation: Staff did not safeguard resident’s personal belongings: Unsubstantiated During the course of investigation LPAs conducted interviewed with R1, and staffs interviewed. R1 stated that some of R1 paper are missing. LPAs reviewed LIC 621 and when asked R1 regrading the missing paper LPAs observed that R1 was not able to explain what exactly what was missing in R1 belonging. LPAs observed R1 pull out papers from different folders indicating that R1 believes that R1 paper is missing. 4 out of 4 staffs indicated that R1 is very specific about R1 belonging, therefore staff is not able to touch R1 belonging without R1 being present. Therefore, the allegation is unsubstantiated. Report continues on LIC 9099c... Allegation: Staff did not allow resident to call CCL to file a complaint: Unsubstantiated During the course of investigation LPAs conducted interviewed with R1, and staffs interviewed. R1 stated that staff didn’t let R1 used the phone when someone is in used of the facility phone. S1 and S2 stated that “we never said no to R1 only when the phone is being used by other residents, so we asked/ explained to R1 that R1 have to wait”. S1 and S2 stated that majority of the time R1 is the one that used the facility phone. Therefore, the allegation is unsubstantiated. Allegation: Staff does not treat resident with dignity and respect: Unsubstantiated During the course of investigation LPAs conducted interviewed residents and staffs. All indicated that staffs treated residents with respect and do not put any residents down. 4 out of 4 staffs states “they have not seen, witness, heard, or themselves disrespect or put any residents down”. R3 stated that “I get treated with respect here”. Therefore, the allegation is unsubstantiated. Allegation: Staff are not meeting residents needs: Unsubstantiated During the course of investigation LPAs conducted residents and staff’s interview. 4 out of 4 staff indicated that we observed residents and look at the needs and service plan to assist residents. Residents indicated that the staff at the facility meet all their needs. Therefore, the allegation is unsubstantiated. 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 Unsubstantiated. An exit interview is conducted, and this report provided.the state’s words, verbatim · CDSS document, Aug 13, 2024 · control 15-AS-20240806083244

Type of visit: Required - 1 Year

On 2/20/2024 at 9:45am, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced 1-Year Required inspection. LPA met with Grace Reano-Aquino, Administrator. The Administrator currently holds a certificate (#6000611740) that expires on 07/07/2025. The facility’s fire clearance was approved for thirty five (35) residents. LPA toured the facility with Administrator including but not limited to bedrooms, bathrooms, kitchen, common area, back and side yard. The facility consists of nineteen (19) total bedrooms, and six (6) bathrooms. No bodies of water observed. A comfortable temperature is maintained at 70 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 119.2 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 03/20/2023. Emergency Disaster Plan was posted. First aid kit was observed to be complete. LPA reviewed seven (7) staff files and nine (9) resident file which were all found to be complete. Continued on LIC809C. Continue from LIC 809 LPA observed the following deficiencies: · At 10:10am, LPA observed Raid, Lysol, Clorox wipes unlocked at an unattended reception area. · At 10:14am, LPA observed pre-poured medication located in resident room #3. · At 10:49am, LPA observed a shed used for staff living quarters. · At 10:54am, LPA observed locked gate. LPA requested the following documents to be submitted to CCLD by 2/29/2023. · Resident Roster · LIC 308 Designation of Administrative Responsibility · LIC 309 Administrative Organization · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan (9 pages) · Liability Insurance The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. *An immediate $500.00 civil penalty will be assessed on today's date for associations.* Exit interview conducted. A copy of the LIC421BG, this report and appeal rights providedthe state’s words, verbatim · CDSS document, Feb 20, 2024

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Staff did not safeguard resident's cash resources

On 1/24/2024 at 09:05 AM, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct the initial 10-day complaint inspection of the facility pertaining to the allegation above. Upon arrival, LPA stated the purpose of the visit to Administrator Grace Reano-Aquino. The complainant alleged that the staff did not safeguard resident's cash resources. The complaint concerned Resident R1. The LPA interviewed R1, who stated, "from April to November 2023, I saw nothing." The LPA reviewed R1's financial records. During the record review, the LPA observed R1's signed receipts confirming that they had received all of the monies they were supposed to have received, disproving R1's claim that they had not received any cash between April and November 2023. The allegation is false, could not have happened, and/or is without a reasonable basis, therefore, the allegation is UNFOUNDED. Exit interview conducted and a copy of this report provided for Administrator via email. Unfoundedthe state’s words, verbatim · CDSS document, Jan 24, 2024 · control 15-AS-20240117134508

Allegation investigated: Resident not being provided appropriate dietary meals.

On this day, Licenisng Program Analysts (LPAs) Luisa Fontanilla and Alona Gomez arrived at the facility to deliver finding for the above allegation and met with Administrator Grace Aquino. LPAs explained to Grace the purpose of the visit. On 3/21/2023, Oakland Regional Office received a complaint with the allegation "Resident not being provided appropriate dietary meals." On 3/22/2023, LPA L. Fontanilla conducted 10-day investigation. On 10/13/2023, LPAs L. Fontanilla and A. Gomez interviewed Administrator and 3 staff. All staff interviewed state the facility provided R1 with diabetic meals. However, staff interviewed state R1's family would bring foods such as pasta, burritos, nachos and frozen foods for R1. Staff also state that family was made aware about R1's dietary restrictions. ****continuation on Lic9099C" Unsubstantiated During the visit, Administrator showed LPAs a photo of R1 eating salad, beef, and Jell-O. However, the facility was unable to provide LPAs a copy of R1's special diet menu. Based on interviews conducted and photo proof presented, the allegation that the resident was not provided appropriate dietary meals is unsubstantiated. 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 unsubstantiated. There is no deficiency noted.the state’s words, verbatim · CDSS document, Oct 13, 2023 · control 15-AS-20230321085000

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: Case Management - Other

Licensing Program Analysts (LPAs) Luisa Fontanilla and Alona Gomez conducted a case management visit in connection with the investigation of complaint 15-AS-20230321085000 and met with Grace Aquino. During the course of investigation, it was revealed that several unlicensed staff checked Resident 1 (R1) blood sugar. In addition, the facility does not have an approved exception to admit/retain R1 who has Diabetes and unable to manage own blood sugar checks. Deficiencies are cited per Title 22 California Code of Regulations (refer to Lic 809D) Exit interview was conducted with Grace and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Oct 13, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628(a) · Plan of correction due date: Oct 20, 2023

87628(a) Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by: Based on interviews conducted, several unlicensed staff check R1’s blood sugar which poses an immediate threat to the health and safety of clients in care.the state’s words, verbatim · CDSS document, Oct 13, 2023

Plan of correction: Administrator will evaluate 13 diabetic residents to determine who are able to check own blood sugar and will send result to LPA by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR876161(a) · Plan of correction due date: Oct 20, 2023

87616(a) Exceptions for Health Conditions (a) As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. This requirement is not met as evidenced by: Based on interviews conducted, the facility admitted R1 who is diabetic but unable to manage own glucose testing. Curently, facility admitted 13 diabetic residents without approved exceptionthe state’s words, verbatim · CDSS document, Oct 13, 2023

Plan of correction: Administrator will submit request for exception for residents who are unable to manage diabetes.