Emanuel Home Care

Allegation investigated: Neglect/lack of supervision resulting in pressure injury Neglect/lack of supervision resulting in multiple bruises

Licensing Program Analyst (LPA) Yolanda Delgado conducted a subsequent complaint visit to deliver final findings for the above allegations. During today’s visit, LPA Yolanda Delgado met with Adulfa Garcia, Caregiver and explained the reason for the visit. On 10/04/2023, the Riverside Adult and Senior Regional Office (RO) received a complaint regarding allegations of Neglect/Lack of Care to Resident #1 (R1). It was reported that when R1 was admitted to the hospital, R1 was observed to have a Stage 4 pressure injury to the coccyx and multiple bruises throughout R1’s body. Medical personnel suspected possible abuse/neglect of R1. According to R1’s facility file review, R1 was admitted to the facility on 05/04/2023. According to R1’s physician’s report, dated 05/03/2023, R1’s diagnosis included antiphospholipid syndrome. (Continued on Page 2 Unsubstantiated (Continued from Page 1) Other conditions noted were mild cognitive impairment (MCI), pressure sores on heel and sacrum, required continuous bed care due to unable to sit/stand, motor impairment/paralysis, and deconditioning. R1 needed assistance with all activities of daily living (ADLs), was considered bedridden, and required assistance with turning or repositioning in bed. A review of medical records revealed that R1 was hospitalized from 04/01/2023 until 05/04/2023. The discharge summary stated R1 was readmitted on 04/01/2023. The discharge summary also documented that R1 had been admitted previously from 02/24/2023 to 03/02/2023 and discharged to a skilled nursing facility. The initial wound care consultation on 04/02/2023 noted the presence of suspected pressure injuries on the left buttock, sacrum, and the left heel (DTI) deep tissue injury. The wound care consultation on 05/04/2023 documented that the pressure injury on the coccyx was at a Stage 3 and the DTI on the left heel was still present. The medical records also revealed R1 was admitted to the hospital on 06/07/2023 and the diagnosis included a pressure injury on the sacrum that was at Stage 4 (muscle, tendon or bone). R1 was discharged on 06/10/2023 with instructions to continue wound care. The medical records further revealed that R1 was seen again at hospital on 08/10/2023 with diagnosis of pressure ulcer of coccyx Stage 4 and admitted from 08/25/2023 to 09/11/2023 with diagnosis of buttock cellulitis. On 10/02/2023, R1 was seen by plastic surgery to evaluate the Stage 4 pressure injury. The wound was cleaned and debrided. Plastic surgery was not done. It was recommended for R1 to be seen at the wound clinic in November 2023 to discuss the possibility of a flap. On 10/03/2023, R1 was admitted to the hospital with an altered level of consciousness. The diagnoses made at the emergency room included gastrointestinal hemorrhage, anemia due to acute blood loss, coagulopathy (a condition in which the ability of blood to coagulate is impaired), UTI, and severe sepsis with organ dysfunction due to UTI. It was also documented that R1 had a Stage 4 sacral pressure injury with no surrounding redness. The nursing note upon admission documented that R1 had multiple bruising throughout R1’s body. (Continued on Page 3 (Continued from Page 2) The hospital personnel reported that it was possible that the bruising was a result of neglect. The Nutrition Initial Assessment conducted on 10/04/2023 documented multiple wounds at varying stages throughout her body. There was no mention of bruising. A review of the Home Health Care medical records revealed the start of care assessment was conducted on 05/05/2023 and it documented a small sacral pressure injury. The initial LVN visit, made on 05/09/2023, does not mention the stage of the pressure injury. On 05/27/2023, the LVN documented the sacral pressure injury to be at a Stage 2. By 05/31/2023, the pressure injury was at a Stage 4, measuring 2.6 cm long by 1.6 cm wide and 1.5 cm deep. Instructions were given to caregivers on how to turn R1 every two hours. According to the documentation, the pressure injury stayed at Stage 4 ever since and only grew in size to 6 cm by 08/07/2023. The records also show that R1 was getting daily wound treatment by Home Health nurses September 2023 until 09/20/2023. R1 was then seen every five days until the last treatment on 09/30/2023. On the allegation: Neglect/lack of supervision resulting in pressure injury. The evidence collected during the Department’s investigation was not sufficient to substantiate that neglect or lack of care led R1 to develop a Stage 4 pressure injury on R1’s coccyx. R1 was admitted to the facility with orders for home health services to treat the wounds. The facility staff also received instructions on pressure injury prevention that included repositioning R1 to relieve pressure off the coccyx. Facility staff stated that they followed these instructions. Even though wound treatment was provided by skilled nurses from the home health agency and the facility staff repositioned R1 every two hours, the pressure injury on the coccyx progressed to a Stage 4 by 05/31/2023 and stayed at Stage 4 until R1 left the facility on 10/03/2023. During the time R1 was placed at the facility, R1 was sent to the hospital on four separate occasions to evaluate the pressure injury. R1 was discharged back to the facility each time with orders for home health treatment. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Neglect/lack of supervision resulting in multiple bruises. (Continued on Page 4) (Continued from Page 3) Although the medical records mention the presence of multiple bruises on R1 upon admission at the hospital on 10/03/2023, the evidence was not sufficient to substantiate that the bruises on R1 seen at the hospital were a result of neglect or lack of care by facility staff. R1 had a diagnosis of “antiphospholipid syndrome”, the Mayo Clinic defines this syndrome as a condition in which the immune system creates antibodies attacking tissues in the body. These antibodies can cause clots to form in the arteries, leading to heart attacks and strokes. R1 was treated with blood thinning medications. The Home Health nurse did not document any bruising on R1 on the visits prior to 10/03/2023. The hospital records mention the bruising, but there is no follow-up or explanation for its cause. The Administrator stated that she was aware of the bruise and spoke to the home health nurse about it and was told that it could be due to the blood thinner medications that R1 was taking. The Administrator denied any type of abuse or accidental falls. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted with Adulfa Garcia, copy of this report, LIC811 was issued.the state’s words, verbatim · CDSS document, Aug 19, 2025 · control 18-AS-20231004162605

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry by Lidia Popa. LPA began inspection with introduction, visit purpose and provided a business card. Resident record review began- Three (3) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements. Employee records review began- Two (2) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification. CPR and requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the clients in care. Administrator certification is present and current; expires 05/15/2026. Physical Plant and Safety of Environment/Operational Requirements- LPA toured the facility inside and outside. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured 106.0 degrees F. Laundry facilities and a locked cabinet is present for storing laundry soap and other chemicals in the garage. All outdoor and indoor passageways are free of obstruction. A locked area is provided for medications and sharp objects. LPA verified there is a telephone working at this location. (Continued on Page 2) (Continued from LIC809, Page 1) Food Service- Food supply meets the of one week supply of nonperishable and 2-day supply of perishables food on hand. A menu is posted, foods are dated to assure safety. Food prep areas are clean and organized. LPA observed Clorox cleaner under the kitchen sink accessible to clients in care at 10:45. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. The facility has not exceeded its capacity limitation, and the structure has changed according to the approved floor plan. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers are tested or replaced annually and were last done so on 02/13/2025. The facility is conducting emergency disaster drills. The last disaster drill was conducted on 07/2/2025. Based on the information received during this visit today, there are two deficiencies, an immediate $500 Civil Penalties is being assessed that are being cited per Title 22, Division 6 of The California Code of Regulations. This report, LIC809D, LIC 421IM and Appeal Rights was reviewed with Lidia Popa, and a copy provided at the time of the exit interview.the state’s words, verbatim · CDSS document, Aug 11, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Stephanie Martinez, conducted a required annual inspection at the facility. The LPA was allowed entrance into the facility and met with staff, Jac Anda. The Administrator, Lidia Popa, was notified of the purpose for the visit via telephone. The inspection included the following: Physical Plant: The facility consists of four (4) resident bedrooms, four (4) staff/private rooms, three (3) bathrooms, storage areas, a kitchen and dinning areas, one (1) living space, two laundry rooms, and a patio and yard with sufficient seating and space for activities. There are no bodies of water located on the property. According to staff Anda, no weapons are stored in the home. The facility is being maintained at a comfortable temperature. All outdoor and indoor passageways are kept free of obstruction and are free of debris and other trash. There are grab bars for each toilet, bathtub and shower used by residents. The smoke and carbon monoxide devices were tested by staff Anda and were observed to be in operating condition. The home was kept clean and organized. LPA was notified by staff there is no facility telephone at this time, after the LPA was unable to reach the facility at the number listed, on 08/14/2024. On 08/11/2023 the facility was also unable to be contacted by LPA, Sara Martinez, during a visit. A citation will be issued. Food Service: There is a minimum of 2 days supply of perishable foods and 1 week's supply of non-perishable foods available. Sufficient dinning supplies were available for residents in care. A variety of food was available and stored in a safe and healthful manner. Record Review: All staff were observed to have appropriate fingerprint clearances. LPA did not observe any excluded individuals on the premises at time of visit. Staff responsible for direct care and supervision have current first aid and CPR training. Completed training included dementia related training, hospice related training, postural support related training, and emergency training. The facility currently has an approved Hospice Waiver for two (2) residents and there is currently one resident in care receiving hospice services. Proof of emergency drills were observed on file. All records were observed to be well organized. LPA observed during a review of resident records there is a bedridden resident in care, Resident Two (R2). The Physician's Report for Residential Care Facilities for the Elderly (RCFE) indicated the resident is bedridden. According to Administrator Popa, R2 is not bedridden; however, one staff interview reported R2 is unable to rotate on their own. A citation will be issued and civil penalty will be issued. A review of the hospice file for Resident Two (R2) was completed. No hospice care plan was observed on file. A citation will be issued. The LPA reviewed the facility's liability insurance. The liability insurance on file indicated the general aggregate is $2,000,000.00 rather than a total annual aggregate of $3,000,000.00. A citation will be issued. Medication Review: The LPA inspected resident medications. Medications were observed to be well organized, appropriately labeled and inaccessible to unauthorized individuals. An exit interview was conducted with Administrator Popa, in which this report was discussed and a copy was provided, along with the LIC 811, LIC 9098, and instructions on appeal rights. This report was also reviewed with staff Anda.the state’s words, verbatim · CDSS document, Aug 14, 2024