Garden Silver Town

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Jose Villalobos, conducted a required annual inspection using the Inspection Tool. LPA met with Manager Jiyoung Kim and the purpose of the visit was discussed. Administrator Steve Kim arrived shortly after Structure/Physical Plant: The facility is a two story building located in a residential area and contains the following: 39 Bedrooms and 42 Bathrooms, dining room, living room, TV room, and activity room, locked storage cabinet for medications and sharps; bathrooms with shower, toilet and washbasin. A center courtyard with shaded area and seating for resident use. The residence is equipped with air conditioning in each room. Accommodations: Adequate accommodations observed throughout facility. Hallway and Doorways: Free and clean of obstruction and debris. Resident Rooms: All bedrooms are equipped with: overhead lighting, chair, night stand, lamp in addition to overhead lighting, large drawer, and closet space. Bathrooms: All bathrooms have a working toilet, wash basin, shower, grab bars and nonskid mats.Linens & Hygiene Supplies: Required linen/supplies observed. Emergency Phone Numbers, Exit Plan & Menu: Facility has a working phone landline. There are phones for residents use. Fire Extinguishers observed charged and up to date Food Service: All food and adequate utensils such as, dishes, cups, bowls and plates are stored at the other location until residents move in. Knives, cutlery and other sharps inaccessible to residents. Smoke Detectors & Fire Extinguishers: Detectors Electrical & connected to central panel recently inspected. Toxins: Locked/stored for staff use only. Hot Water Temperature: Measured between 110 -120 degrees all around the facility. Medications, First-Aid Kit & Book: Medications centrally stored and inaccessible to residents. First aid kit observed. Postings: Required wall postings observed.Residents & Staff Files: LPA reviewed (6) Resident medication records and files , as well as (5) Staff Files . Inspection tool was completed and no deficiencies were observed. Exit interview was conducted, and a Facility Evaluation Report was provided.the state’s words, verbatim · CDSS document, Jul 20, 2023

Allegation investigated: Resident sustained injuries while in care.

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced subsequent complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Steve Kim and explained the reason for the visit. The investigation consisted of: During the initial visit conducted on 5/17/22, LPA Gonzalez collected copies of Staff and Resident rosters. LPA also conducted a tour of entire facility inside and out with Caregiver Jung. LPA observed the residents to identify any signs of neglect, abuse or other immediate Health and Safety threats. LPA did not observe any immediate Health & Safety concerns during the visit. The investigation for this complaint was conducted by Investigator Robert Kujawa. (See LIC9099C for continuation) Unsubstantiated During the course of the investigation, Investigator Kujawa obtained copies of the following documents pertaining to Resident 1 (R1): Physician’s Report For Residential Care Facilities for the Elderly (RCFE) (LIC602A) dated 5/4/22, two (2) Unusual Incident/ Injury Reports (LIC624) dated 5/5/22 and 5/10/22, Death Report (LIC624A) dated 5/19/22, Urgent Care medical documents dated 5/5/22, and R1’s Advance Directives. Investigator Kujawa interviewed Facility Administrator Steve Kim, facility staff (S1-4), facility Resident 2 (R2), and R1 Family Member (R1 FM1). Investigator Kujawa additionally requested medical records from St Mary Medical Center for R1. The investigation revealed the following: Regarding allegation of, Resident sustained injuries while in care, during this investigation, the Department of Social Services Investigation Bureau, Investigator Kujawa, interviewed facility administrator and S1-4 and their statements revealed that R1 was provided proper care while living in the facility. Interview with R1 FM1 also revealed that the facility was providing proper care to R1 and they did not believe the facility neglected or abused R1. R1 FM1 also stated that they met with the facility administrator who showed R1 FM1 all the video footage the facility had. Investigator Kujawa interviewed R2 who did not recall the incident that occurred on 5/9/22. Interviews conducted with S1-4 revealed that R1 did not require any special care requirements for supervision or to harm themselves. Investigator Kujawa reviewed R1’s Physician’s Report which revealed that R1 did not require any special care requirements for supervision, or tendencies to harm thyself. Document also states that R1 was ambulatory, independent, not suicidal and did not pose any risk of self-harm. Investigator Kujawa reviewed video footage that was captured on 5/9/22 and observed that the footage showed R1 going into R2’s room and then R2 exit the room approximately 11 minutes later, R2 returned to their room a few minutes later but was not able to go in as the room was locked so R2 walked away. R2 attempts to go into their room again a few minutes after the first attempt but was still not able to open the door. Interview conducted with Administrator Kim revealed that the video camera that is located in the back of the facility was broken at the time of the incident and was not working properly. Per Investigator Kujawa, the facility had no way to know or prevent R1’s accident as the incident was unforeseen. Investigator Kujawa stated that there was insufficient evidence to support the allegation of Neglect/ Lack of Supervision led to R1 sustaining injuries while in care. Based on the investigation and supporting information obtained, this allegation is not corroborated. 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. Exit interview held. A copy of the report was provided to Administrator Steve Kim. The investigation revealed the following: In regard to the allegation, Facility did not follow resident’s Advance Directive resulting in resident’s hospitalization, it is alleged that 911 was called on 5/9/22. 911 instructed facility staff to perform CPR on Resident 1 (R1) although R1 was breathing on their own. R1 sustained three (3) broken ribs from the emergency procedure. It is alleged that R1 has an Advance Directive for R1 not to have CPR performed but CPR was performed anyway. Interviews conducted with Administrator Steve Kim and S4 revealed that staff follow all resident's Advance Directives at all times. Administrator and S4 stated that R1 has suffered an accident at the facility and had lost consciousness and that staff (S4) had to react very fast to the incident. S4 stated they immediately called 911 due R1 needing urgent emergency assistance. S4 stated that they did not have enough time to pull R1's file and review their Advance Directive and only followed all the instructions that they were getting from 911 emergency personnel. Administrator and S4 stated that Advance Directives are followed but in this particular incident everything happened so fast and S4 just did what was directed by 911 personnel. Based on interviews conducted with facility staff and review of documents, the preponderance of evidence standard has been met, therefore the above stated allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, are being cited on attached LIC9099D. Exit interview was conducted with Administrator Steve Kim. A copy of the report and appeal rights were provided to Administrator.the state’s words, verbatim · CDSS document, Jan 30, 2023 · control 28-AS-20220513175354

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87469(c)(1) · Plan of correction due date: Feb 3, 2023

Advanced Directives and Requests Regarding Resuscitative Measures (c) If a resident who has an advance directive and/or request regarding resuscitative measures form on file experiences a medical emergency, facility staff shall do one of the following:: (1) Immediately telephone 9-1-1, present the advance directive and/or request regarding resuscitative measures form to the responding emergency medical personnel and identify the resident as the person to whom the order refers. This requirement is not met as evidenced by: LPA interviews with facility staff revealed tha Advance Directive was not followed on 5/9/22. This poses an potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 30, 2023

Plan of correction: Administrator will conduct in-service training regarding Advance Health Directives and/or other similar forms that need to be reviewed/ provided to emergency personnel at the time of an emergency. POC to be submitted to MP RO CCLD by POC due date. ***Administrator provided LPA with proof of in service training regarding Advance Health Directives dated 1/30/23. ***Citation was cleared at the time of the visit.

Allegation investigated: Facility did not provide adequate supervision to resident.

Licensing Program Analyst (LPA) Jose Villalobos conducted an initial complaint investigation for the allegation listed above. LPA met with Administrator Steve Kim and the purpose of the visit was discussed. On todays visit LPA conducted the following: Interviewed Staff#1-#4 (S1-S4), interviewed Residents #1-#5 (R1-R5), toured the physical plant, observed the food supply, collected documents from resident #1's file and collected a copy of the staff and resident roster. The investigation revealed the following: In regards to the allegation "facility did not provide adequate supervision to resident" it was alleged that a resident had an unwitnessed fall when attempting to leave the facility. (4) of (4) Staff interviewed denied the allegation. (5) of (5) Residents interviewed could not collaborate the allegation.... Continued on LIC 9099-C Unsubstantiated Interviews do not show that any residents had unwitnessed falls. File review did not show documentation of resident falls in the last month. LPA was not provided the name of the alleged resident who fell or of staff who assisted resident. Based on LPA's interviews, observations, and documents reviewed; 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. Exit interview conducted with Steve Kim and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 3, 2023 · control 28-AS-20221228154942

Allegation investigated: Facility is in disrepair Staff are not provided their prescriptions as prescribed Staff do not adequately supervise residents to prevent falls

The purpose of this report is to correct the regulation cited. LPA indvertently cited under wrong regulation #. Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Manager Jiyoung Kim Manager and explained the reason for the visit. The purpose of the visit is to investigate the above allegations. At today's visit at 10:30 AM tour of the facility was conducted which included resident rooms 103, 107, 108, 110, 203, 204, 205, and 209, resident restrooms, dining room, television room, library, kitchen area, activity room and elevator. Interview was conducted with Resident's R 1- R 5 from 11:00 AM to 11:45 AM. Interview was conducted telephonically with Administrator Steve Kim at 9:50 AM. Interview was conducted with Manager Jiyoung Kim Manager at 11:45 AM. Resident and Staff Roster were submitted. In regards to the allegation Facility is in disrepair, LPA toured the facility and observed the facility in good repair. Client rooms inspected had the necessary furniture and beddings and hot water temperature measured between 105F. and 120 F. The elevator was operable and all utilities were operable. Unsubstantiated Resident's R1-R5 all stated that the facility was in good repair and their room had nothing broken or in need of repair. Staff interviewed stated that any minor repairs are handled right away by maintenance and that facility has been in good repair with no major issues. 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. In regards to the allegation Staff are not provided their prescriptions as prescribed, based on interviews conducted, review of medication and information gathered all residents interviewed stated that they get all their medication daily and have not missed any doses. Staff interviewed stated that all residents get their prescribed medication and have not missed any doses. Review of medication was done for Resident's R1-R5 at today's visit and all medication was given as prescribed with no doses being missed. 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. In regards to the allegation Staff do not adequately supervise residents to prevent falls, based on interviews conducted and information gathered Resident's R1-R5 stated that they have not fallen and not observed anyone falling. Stated that staff do a good job supervising and that there are enough staff. Staff interviewed stated that there are 5 to 7 staff on shift from 6:30 AM to 7:30 PM and that staff check every 2 hours on residents in rooms and will always be watching residents and supervising. 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.the state’s words, verbatim · CDSS document, Dec 7, 2022 · control 28-AS-20221025164239

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Nov 3, 2022

Personal Rights Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by: Based on interviews conducted and observation licensee failed to enable residents to leave or depart the facility at any time with having the outside door locked when coming back into the facility which causes an Immediate Health and Safety Risk to residents in Care.the state’s words, verbatim · CDSS document, Dec 7, 2022

Plan of correction: Administrator will ensure that residents have the right to leave the facility at any time and not have doors locked when regaining entry. Administrator will submit a plan of action that will ensure that residents are not locked out from reentry and at the same time ensure their safety,

Allegation investigated: Facility is in disrepair Staff are not provided their prescriptions as prescribed Staff do not adequately supervise residents to prevent falls

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit to the facility and was greeted by Manager Jiyoung Kim Manager and explained the reason for the visit. The purpose of the visit is to investigate the above allegations. At today's visit at 10:30 AM tour of the facility was conducted which included resident rooms 103, 107, 108, 110, 203, 204, 205, and 209, resident restrooms, dining room, television room, library, kitchen area, activity room and elevator. Interview was conducted with Resident's R 1- R 5 from 11:00 AM to 11:45 AM. Interview was conducted telephonically with Administrator Steve Kim at 9:50 AM. Interview was conducted with Manager Jiyoung Kim Manager at 11:45 AM. Resident and Staff Roster were submitted. In regards to the allegation Facility is in disrepair, LPA toured the facility and observed the facility in good repair. Client rooms inspected had the necessary furniture and beddings and hot water temperature measured between 105F. and 120 F. The elevator was operable and all utilities were operable. Unsubstantiated Resident's R1-R5 all stated that the facility was in good repair and their room had nothing broken or in need of repair. Staff interviewed stated that any minor repairs are handled right away by maintenance and that facility has been in good repair with no major issues. 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. In regards to the allegation Staff are not provided their prescriptions as prescribed, based on interviews conducted, review of medication and information gathered all residents interviewed stated that they get all their medication daily and have not missed any doses. Staff interviewed stated that all residents get their prescribed medication and have not missed any doses. Review of medication was done for Resident's R1-R5 at today's visit and all medication was given as prescribed with no doses being missed. 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. In regards to the allegation Staff do not adequately supervise residents to prevent falls, based on interviews conducted and information gathered Resident's R1-R5 stated that they have not fallen and not observed anyone falling. Stated that staff do a good job supervising and that there are enough staff. Staff interviewed stated that there are 5 to 7 staff on shift from 6:30 AM to 7:30 PM and that staff check every 2 hours on residents in rooms and will always be watching residents and supervising. 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.the state’s words, verbatim · CDSS document, Nov 2, 2022 · control 28-AS-20221025164239

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468(a)(6) · Plan of correction due date: Nov 3, 2022

Personal Rights Residents in all residential care facilities for the elderly shall have all of the following personal rights: To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by: Based on interviews conducted and observation licensee failed to enable residents to leave or depart the facility at any time with having the outside door locked when coming back into the facility which causes an Immediate Health and Safety Risk to residents in Care.the state’s words, verbatim · CDSS document, Nov 2, 2022

Plan of correction: Administrator will ensure that residents have the right to leave the facility at any time and not have doors locked when regaining entry. Administrator will submit a plan of action that will ensure that residents are not locked out from reentry and at the same time ensure their safety,

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Glenn Trueman made an unannounced visit and was greeted by Staff Kye Hang Shin and explained the reason for the visit. The purpose of the visit is to complete the required inspection. LPA Trueman toured the facility along with Staff Kye Hang Shin today 6/07/22 @ 12:45 PM and the following was observed: Facility contains 39 Bedrooms and 42 Bathrooms, dining room, living room, TV room, and activity room. Required Annual inspection included Infection Control Domain and check of the food supply, medications and criminal clearance check. LPA observed sufficient supply of 2 day perishables and 7 day non perishables. All staff were cleared and associated. Medication for clients were verified as being administered and a 30 day supply on hand. Visitation signage was posted along with signage for hand washing and proper sanitizing. Temperature checks are conducted 2x a day and logged. Staff have been trained in hand washing. Staff are sufficient with no shortages and there is a plan to replace workers if ill. There are rooms available if isolation is needed. Staff wear masks, gloves and face shields. Bathrooms have proper signage for hand washing. There are multiple stations for hand sanitizing. Social distancing is implemented. Meal times are sanitized after each meal. Facility has sufficient supply of PPE. Facility has a specific plan to ensure proper cleaning and disinfection of environmental surfaces and laundry; commonly touched surfaces are cleaned and disinfected at least once every shift . Plan when to notify medical provider if symptoms develop or COVID-19 exposure or when to call 911 for severe respiratory distress. No deficiencies. Exit interview conducted.the state’s words, verbatim · CDSS document, Jun 7, 2022

Allegation investigated: Resident has missed multiple of her medical appointments Facility is not allowing the residents to leave the facility Facility is not allowing visitors

Licensing Program Analyst (LPA) Glenn Trueman conducted a subsequent complaint investigation for the allegations listed above. LPA met with Administrator Steve Kim. Today’s complaint investigation consisted of the following: Interview was conducted with Administrator Steve Kim at 10:00 AM. Resident R1 was interviewed at 10:20 AM. Staff Jinho Ha was interviewed at 10:30 AM. R2 was interviewed at 10:45 AM telephonically. R3 was interviewed at 10:55 AM. Family member of R1 was interviewed telephonically at 11:05 AM. In regards to the allegation Resident has missed multiple of her medical appointments, based on interviews conducted and information gathered all residents and family member of R 1 stated they were allowed to leave facility and go to medical appointments. R 1 stated his daughter would pick him up and take him on medical Unsubstantiated appointments. R 2 stated that he did leave on doctor's appointment's with his daughters. Family member of R 1 stated that R 1 needed to see a specialist and she was allowed to get R 1 and leave the facility to go on medical appointments. All staff interviewed stated that doctor will come here at least 1x a month and all residents can leave freely to go to medical appointments. It should be noted that LPA observed an e-mail to a residents family member dated 4/13/2021 which states family member can leave the facility freely at any time. Visitors sign in and out sheet was observed for 4/21-5/21 with numerous entries for visitation and leaving facility. Although the allegation may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED. In regards to the allegation Facility is not allowing the residents to leave the facility, based on interviews conducted and information gathered all residents, staff and family member of Resident 1 stated that facility allowed residents to leave the facility and would fill out sign in and out sheet .LPA observed an e-mail to a residents family member dated 4/13/2021 which states family member can leave the facility freely at any time. Visitors sign in and out sheet was observed for 4/21-5/21 with numerous entries for visitation and leaving facility. Although the allegation may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED. In regards to the allegation Facility is not allowing visitors, based on interviews conducted and information gathered all residents, family member of Resident 1 and staff stated that facility was allowing visitors. Resident 1 stated that his son and daughter would visit and bring food. Resident 2 stated that his daughter would visit him quite often. Visitors sign in and out sheet was observed for 4/21-5/21 with numerous entries for visitation and leaving facility. Although the allegation may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Jul 20, 2021 · control 28-AS-20210504131343