Escondido Senior Living

Allegation investigated: Staff did not keep the facility free from bed bugs

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegation listed above. LPA met with Executive Director (ED) Amy Banaga and explained the purpose of the visit. During today's visit, LPA interviewed five (5) staff, two (2), and reviewed and obtained copies of pertinent documents. Regarding the allegation "Staff did not keep the facility free from bed bugs", it was alleged that the facility has an ongoing issue with bed bugs. Interview with ED Banaga and Maintenance Director Roy Hayes along with records reviewed revealed the facility has been battling bed bugs for the past few years and the treatment for it is ongoing. The facility has entered a new contract with extermination company Western for K9 bed bug inspection, chemical treatment and as well as heat treatments. Interview with Daniel Slaughter, Pacifica Senior Living Regional Director of Operations revealed Western Extermination will continue with maintenance services on an ongoing basis to help mitigate the bed bug issue. The facility owns their own heat treatment machine as well which is utilized on an as needed basis. Effected resident clothes and bedding are laundered separately with the highest temperatures. Community Care Licensing has been aware of this issue. (CONTINUED ON LIC9099-C) Unsubstantiated (CONTINUED FROM LIC9099) Although the facility has experienced bed bug issues, they are taking appropriate steps to help mitigate the problem. 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 allegation is unsubstantiated. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 16, 2023 · control 18-AS-20230815151027

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conduct a case management visit in conjunction with complaint control #18-AS-20230703125256. LPA met with Executive Director Amy Banaga and explained the purpose of the visit. On 07/13/2023, a facility visit was conducted with Shawna Emery, Resident Care Coordinator and LIC9099 dated 07/13/2023 was issued. The purpose of today's visit is to amend the findings of UNSUBSTANTIATED to UNFOUNDED on the LIC9099 issued on 07/13/2023. The amended LIC9099 was provided during today's visit. An exit interview was conducted and a copy of this report was also provided.the state’s words, verbatim · CDSS document, Jul 21, 2023

Allegation investigated: Resident's room is unsanitary

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility in initiate an investigation into the allegation listed above. LPA met with Resident Care Coordinator Shawna Emery and Marketing Director Carline Callaghan. Executive Director Amy Banaga was off duty at the time of the visit. During today's visit, LPA toured room #129, interviewed Resident #1 (R1), four (4) staff and reviewed pertinent documents related to R1. Upon tour of R1's room, #129, the room was observed to have an overwhelming odor of dog urine. Dog feces was observed scattered on the carpet of the room as well. Partially consumed drinks and plates of food were observed on the bed where R1 was laying as well as on the floor and desk next to the bed. A half eaten hamburger was on the floor at the foot of the bed. LPA also observed R1's dog eating from a bowl on the bed as well. The patio sliding door was observed open approximately 6 to 8 inches allowing flies to enter the room. The patio was covered in multiple piles of dog feces. A pile of feces soiled wet clothing was observed next to the trash can. LPA observed feces on the bedsheet next to and behind R1's head as they laid in bed. The seat on R1's wheelchair was also covered in dried feces. The tread on the wheels of R1's motorized wheelchair was impacted with dog feces as well. LPA observed R1's (CONTINUED ON LIC9099C) *This is an amended report. Unfounded (CONTINUED FROM LIC9099) the toilet to be full of feces, urine, and toilet paper and the back of the toilet seat was covered in either feces or vomit. Review of R1's Admission Agreement (AA) dated 9/22/2020 revealed R1 was to be provided weekly housekeeping of their assigned room and R1 agreed to keep their room in a clean an sanitary condition. The AA also indicated R1 agreed to be responsible for the care and maintenance of their pet. During an interview with R1, R1 stated they believed their assigned weekly housekeeping day was Friday. R1 reported their room is cleaned every week by Maintenance Director Roy Hayes. R1 also reported that there was nothing wrong with their room and did not smell any odor or see any dog feces on the floor. Review of R1's Resident Assessment dated 9/27/2022 revealed R1 was determined to be at care level 1, meaning they were to only receive assistance with medications however, R1 refused to sign the assessment and therefore does not currently receive medication assistance. The assessment also revealed R1 was independent with bathing, grooming, and toileting. The assessment does not indicate the facility is responsible for cleaning up after R1's dog. Review of R1's Physician's Report (PR) dated 4/18/2019 revealed R1 does not have dementia or MCI, is not confused, does not display inappropriate or aggressive behavior, is able to follow instructions and able to communicate their needs. The PR also revealed R1 maintains the capacity to provide self care and manage medications. Further review of R1's records revealed R1 was served with a 30 Day Termination and Notice to Quit on April 25, 2023 for failing to comply with the facility's pet policy regarding the care and maintenance of their pet. During R1's interview, R1 acknowledged receiving an eviction notice for failing to clean up after their pet but added that they did not think it was necessary because there was no issue with their room. Review of housekeeping checklists for R1's room dated Thursday, June 29, 2023 and Thursday, July 6, 2023 revealed R1 refused housekeeping services on those days. Additionally, after receiving complaints from other residents of odor emanating from R1's room, housekeeping was attempted on Tuesday, April 4, 2023, Wednesday, April 5, 2023, and Tuesday, April 25, 2023 and R1 refused each of these attempts. Four (4) of four (4) staff interviewed revealed R1's weekly housekeeping day is Thursday and R1 regularly declines the service or asks that it be completed at a later time however, when staff return at the requested time, R1 will decline. This agency has investigated the complaint alleging "Resident's room is unsanitary". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and copy of this report was provided along with LIC811- Confidential Names list. *This is an amended report.the state’s words, verbatim · CDSS document, Jul 12, 2023 · control 18-AS-20230703125256

Allegation investigated: Staff does not ensure bed bug issue is being properly addressed Facility does not ensure food of good quality is served to residents in care Facility does not ensure that snacks are made available to residents in care

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Business Office Manager Jessica Playa and explained the purpose of the visit. Executive Director Amy Banaga was not available. Regarding the allegation "Staff does not ensure bed bug issue is being properly addressed", it was alleged that the facility is infested with bed bugs. Interview with ED Banaga and records reviewed revealed the facility has an ongoing fight with bed bugs over the past few years. The facility maintains a contract with Orkin extermination company for a K9 bed bug inspection which is done quarterly. The facility has purchased it's own bed bug heat treatment machine which is then utilized to apply treatments to those areas identified by the bed bug K9. Community Care Licensing has been aware of this issue. Although the facility has experienced bed bug issues, they are taking appropriate steps to help mitigate the problem. Regarding the allegation "Facility does not ensure food of good quality is served to residents in care", it was alleged that the food served at the facility is of poor quality, menu choices have been cut down to one, food is processed and not fresh, scrambled eggs come out of a box, bacon is always burnt, soups and meat are greasy, vegetables and fruit are frozen or canned, and the fruit is canned fruit cocktail. (CONTINUED ON LIC9099-C) Unsubstantiated (CONTINUED FROM LIC9099) Interviews were conducted with ten (10) residents and LPA toured the kitchen and inspected the facility's food supply. During LPA's tour of the kitchen, a multitude of fresh vegetables and fruits such as onions, lettuce, carrots, potatoes, mushrooms, zucchini, cabbage, apples, bananas, oranges, lemons, and limes were observed in the refrigerator as well as in the actual food prep area being prepared for residents. Meats such as chicken, pork, hamburger, and brisket were also observed in the refrigerator and freezer. Cartons of liquid scrambled eggs were observed in the refrigerator as well. LPA observed lunch service of soup, roasted turkey, yams, green beans, and a dessert of pumpkin cake which was in accordance with the planned menu. Interviews were conducted with ten (10) residents. Nine (9) of ten (10) residents interviewed reported the food served at the facility is of good quality. All ten (10) residents interviewed reported there are choices or alternatives available. Nine (9) of ten (10) residents interviewed reported the meat served at the facility was not greasy. All ten (10) residents interviewed reported the soup served was not greasy. All ten (10) residents interviewed reported the bacon served is cooked to a very crispy state and six (6) of ten (10) residents reported they prefer it that way. Regarding the allegation "Facility does not ensure that snacks are made available to residents in care", it was alleged that the facility does not provide snacks in between meals. All ten (10) residents interviewed revealed snacks are available in the dining room upon request. During facility tour, LPA observed snacks such as cake and fruit from the dining room in several resident rooms. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted and copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 22, 2023 · control 18-AS-20230309111059

Allegation investigated: Staff are not wearing masks Resident has bed bugs Staff did not properly administer resident's medications

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Executive Director Amy Banaga and explained the purpose of the visit. During today's visit, LPA reviewed and obtained copies of facility maintenence records and interviewed five(5) staff. Regarding the allegation "Staff are not wearing masks", it was alleged that on June 30, 2022, four(4) staff were observed to not be wearing a mask as required and that their director was aware of this issue and did not address it. Four(4) of four(4) staff and one(1) of one(1) residents interviewed did not corroborate the allegation and records reviewed indicated that one of the staff accused was not working on that day. Regarding the allegation "Resident has bed bugs", it was alleged that Resident #1(R1) has bed bugs. Interviews conducted and records reviewed revealed the facility has had incidents of bed bugs occassionally in recent years. The facility has maintained a contract with an extermination company to assist them when incidents do occur and Community Care Licensing has been made aware of this issue. During today's visit, LPA observed heat treatments being applied to various areas of concern in the facility. Although the facility is experiencing a bed bug incident, they are taking appropriate steps to help mitigate the issue. (CONTINUED ON LIC9099C) Unsubstantiated (CONTINUED FROM LIC9099) Regarding the allegation "Staff did not properly administer resident's medication", it was alleged that Staff #1(S1) administered medication and water to R1 while R1 was lying completely flat. Interview with S1 did not corroborate this allegation nor did interview with R1. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names List.the state’s words, verbatim · CDSS document, Sep 21, 2022 · control 18-AS-20220705163733

Allegation investigated: Resident not allowed visitors. Staff not responding in timely manner.

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegations listed above. LPA met with Executive Director Amy Banaga and explained the purpose of the visit. During today's visit, LPA interviewed two(2) staff, one(1) resident, and reviewed facility records. Regarding the allegation "Resident not allowed visitors", it was alleged that on September 11, 2022, a visitor visiting Resident #1(R1) was escorted from the premises at the culmination of their visit and was told they could not return. Records reviewed indicated that the visitor was given entry to the facility for a visit and did visit with R1. Interview with Staff #1(S1) revealed the visitor was in fact escorted from the premises following their visit and informed them they could not return. Facility staff have since learned that they were erronuous in their understanding the reason of preventing the visitor from visiting again however, the visitor has not made any attempts to visit since September 11, 2022. Regarding the allegation "Staff not responding in timely manner", it was alleged that staff often do not assist with providing R1's water cup when it is out of reach. Interview with R1 revealed R1 has not had an instance when their water cup was out of reach requiring staff assistance. Additionally, (CONTINUED ON LIC9099C) Unsubstantiated (CONTINUED FROM LIC9099) LPA observed R1 traversing in a wheelchair from the dining room to their room via the hallway without assistance. Upon arrival to their room, LPA observed R1 rise from the wheelchair and climb into their bed unassisted. LPA also observed R1's bottle of water on their side table next to their wheelchair. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names List.the state’s words, verbatim · CDSS document, Sep 21, 2022 · control 18-AS-20220919152048

Allegation investigated: Staff refused to accept resident back into the facility

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegation listed above. LPA met with Executive Director (ED) Amy Banaga and explained the purpose of the visit. During today's visit, LPA interviewed ED Banaga and discussed the events surrounding Resident #1 (R1) and their recent hospitalization. Regarding the allegation "Staff refused to accept resident back into the facility", it was alleged that R1 was not permitted to return to the facility upon their discharge from the hospital on July 21, 2022 due to safety reasons. Interview with ED Banaga revealed she had received a phone call from R1's hospice agency to discuss R1's return to the facility and did inform the hospice agency that the facility would not accept R1 back due to the safety risk involved in accepting R1 back. Based on LPA interview which was conducted, the preponderance of evidence standard has been met, therefore the allegation "Staff refused to accept resident back into the facility" is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview as conducted with ED Banaga and a copy of this report was provided along with Appeal Rights and LIC811- Confidential Names List. Substantiatedthe state’s words, verbatim · CDSS document, Aug 2, 2022 · control 18-AS-20220725094743

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(20) · Plan of correction due date: Aug 12, 2022

Additional Personal Rights of Residents in Privately Operated Facilities- (a) In addition to the rights listed in Section 87468.1... residents in privately operated care...facilities for the elderly shall have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions. A license shall comply with all eviction and relocation protections for residents. This requirement was not met as evicdenced by: the licensee did not refrain from involuntarily evicting R1. Based on LPA interview conducted, the licensee refused to accept R1 upon their discharge from the hospital. This poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 2, 2022

Plan of correction: Licensee states they will submit a written statement of understanding on the regulation cited by POC due date of 8/12/2022.

Allegation investigated: Staff hit resident in care. Staff yelling at resident.

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegations listed above. LPA met with Executive Director Amy Banaga and explained the purpose of the visit. During today's visit, LPA toured the memory unit of the facility, interviewed seven (7) residents, six (6) staff and reviewed pertinent records. Regarding the allegations "Staff hit residents in care" and "Staff yelling at resident", it was alleged that a resident was overheard to be screaming while being assisted by staff during an adult brief changing and that a slap noise was also overheard. It was further alleged that staff have been overheard to yell at residents to be quiet and get out of the hallway. Seven (7) of seven (7) residents interviewed denied ever experiencing a staff hit them or yell at them in anyway nor did they report any complaints regarding their residency at the facility. Records reviewed indicated identified residents who experience difficulties during bathing and/or brief changing activities and these difficulties are being addressed on an ongoing basis. This agency has investigated the complaint alleging "Staff hit resident in care" and "Staff yelling at resident". We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. An exit interview was conducted and a copy of this report was provided. Unfoundedthe state’s words, verbatim · CDSS document, Jun 22, 2022 · control 18-AS-20220613104637

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff not following infection control masking guidance.

Licensing Program Analyst (LPA) Iby Strong and Interim Assistant Program Administrator (IAPA) Icela Estrada conducted an unannounced subsequent visit, to deliver a finding regarding the above complaint allegation. LPA and IAPA themselves to the receptionist and met with and discussed the purpose of the visit with Executive Director Amy Banaga. During the investigation, the Department toured the facility, reviewed facility records, outside source records and conducted interviews with staff and the executive director. On January 18, 2022, LPA and Licensing Program Manager (LPM), John Rante conducted a tour of the facility and observed Staff 1 (S1) wearing a face mask only covering his mouth and Staff 2 (S2) not wearing a face mask. During the visit, LPM discussed the importance of employees wearing face masks while in the facility with the Executive Director. On January 25, 2022, LPA conducted a subsequent visit to the facility and observed S2 without a face mask once again. Substantiated On February 9, 2022, LPA conducted a subsequent visit to the facility and while touring the facility with the Executive Director, they observed S2 wearing a face mask on her chin. LPA asked S2 why she was not wearing the face mask properly while providing grooming services to residents, S2 advised it was uncomfortable. LPA offered alternatives but S2 declined. LPA asked that she position the face mask properly and S2 complied. During the period of December 27, 2021 and February 8, 2022, the facility had one or more residents in the facility with active COVID-19 diagnoses. Interviews with outside sources revealed that on multiple occasions staff have been observed without face masks. The outside source stated that the staff exposed residents in care. During the period the outside sources observed staff without face masks, the facility had COVID-19 positive residents. During today’s visit, LPA and IAPA observed S1 not wearing a mask but minutes later he put one on. A review of staff records revealed S1 was verbally counseled for not wearing face masks properly on July 6, 2020 and received Personal Protective Equipment (PPE) training on August 27, 2020. Based on staff interviews, review of records, and observations, a preponderance of evidence exists to support the allegation that facility staff are not following infection control masking guidance. The allegation is therefore substantiated. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Executive Director Amy Banaga, to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 01/16) were provided via E-mail.the state’s words, verbatim · CDSS document, Apr 8, 2022 · control 08-AS-20220214130037

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Apr 22, 2022

Personal Rights of Residents in All Facilities To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on observations, records reviewed, and interviews, he licensee did not protect the personal rights of residents in care to receive safe and healthful accommodations in that S1 and S2 did not wear face masks while in the facility during a COVID-19 outbreak. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Apr 8, 2022

Plan of correction: The Executive Director (ED) indicated that S1 was couseled recently for not wearing a face mask and most likely will be terminated for not following guidance. ED agrees to request PPE training for all staff.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced case management visit regarding an incident report that was received by CCL on 2/23/22 for Resident 1 (R1). LPA identified herself and discussed the purpose of the visit with Amy Banaga. The purpose of this visit was to follow up on the incident reports regarding Resident 1. (See LIC 811 Confidential Names) LPA conducted a tour of the facility and observed residents in care. No immediate health or safety issues were observed on this date. LPA obtained additional information regarding the incident for R1 on this date. No deficiencies cited on this date. An exit interview was conducted with Amy Banaga. A copy of this report was provided to the administrator via email. An electronic response confirms the documents were received. Licensee Rights (LIC9058 01/2016) were left at the facility.the state’s words, verbatim · CDSS document, Feb 25, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Iby Strong conducted an unannounced Case Management Visit. LPA met with Executive Director Amy Banaga, and discussed the purpose of the visit. Today's visit is in response to the self-reported death of Resident 1 (R1 - see LIC811 Confidential Names List). R1 passed away at a hospice house, date of death: 12/31/21. LPA conducted a wellness check at the facility, and no health or safety issues were identified. All staff present have a current criminal record clearance. Residents observed appeared appropriate for the facility. Additional information was obtained on this date regarding R1's death. No deficiencies were cited or observed on this date. The Licensee was provided a copy of their appeal rights (LIC9058 01/16), and his signature on this form, acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided to Amy Banaga. An email receipt confirms the acknowledgement of these documents.the state’s words, verbatim · CDSS document, Jan 25, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced annual required licensing inspection. LPA was granted entry by Carline Callaghan, Sales Director. LPA was granted entry after identifying themselves and disclosing the purpose of their visit. An overall tour of the facility was conducted inside and out. The inspection included, but was not limited to, verifying compliance with statutes, regulations and other written requirements that are most relevant to protecting the health of residents in care and staff, including in the area of infection control practices. LPA reviewed the facility’s Plan for Epidemic Outbreak Specific to COVID-19 Mitigation Plan Report (LIC 808) with Carline and Jessica Lane, Resident Service Director, including the following sections: Persons in Care, Staff, Visitors, Facilities without COVID-19, Residents, Plans for Infection Control and Physical Distancing. LPA assessed the strategies that the facility is employing for the prevention, containment and mitigation of COVID-19, implementation of infection control guidance, staff retention and essential health and safety. LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, residents and visitors; a sign-in policy enacted for all visitors; signs posted at facility entrance with the facility’s visitor policy and signs throughout the facility to promote hand hygiene, cough/sneeze etiquette and physical distancing; face coverings worn by staff and face coverings recommended to residents; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of PPE. The facility is in compliance with and has implemented infection control practices as outlined in its LIC 808. No deficiencies were observed during today's visit. An exit interview was conducted with Carline Callaghan and a copy of this report along with the Licensee Rights (LIC 9058 FAS 01/16) was provided to Carline and Executive Director Amy Banaga via email; an email read receipt confirms receipt of these rights.the state’s words, verbatim · CDSS document, Nov 30, 2021

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced case management visit. LPA identified herself and stated the purpose of the visit to Executive Director Amy Banaga. The facility self-reported an incident regarding Resident 1 (R1) to Community Care Licensing on October 16, 2021. The facility reported that on October 16, 2021, R1 left the facility (AWOL) and was returned to the facility by police. On today’s date, LPA toured the facility and conducted a health and safety check. LPA briefly interviewed the Executive Director Amy Banaga and requested copies of additional facility records. No deficiencies were cited at this time. An exit interview was conducted with Amy Banaga, to whom a copy of this report and the LIC9058 Licensee/Appeal Rights were provided via E-mail. An electronic read receipt verifies receipt of these documents.the state’s words, verbatim · CDSS document, Oct 28, 2021