Gardena Retirement Center

Allegation investigated: Staff are failing to meet residents' needs Resident wandered away while in care Staff speak to residents inappropriately Staff failed to provide adequate food service Staff failed to provide a safe and comfortable environment for residents Facility is disrepair

/21/2021, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Susana Fuentes, Administrator and explained the purpose of today's visit is to deliver findings for the allegations listed above. The investigation consisted of the following: On 9/15/2021 LPA Cifuentes conducted a tour of facility grounds. LPA spoke with administrator, reviewed facility files and requested and received the following documents: staff roster, client roster and other documents relevant to the investigation. On 12/8/2021 and 12/9/2021 LPA Cifuentes interviewed staff 1 -Staff 6 (S1-S6) and Residents 1-resident 8 (R1-R8) Continued on 9099-C Unsubstantiated Allegation: Staff failed to provide a safe and comfortable environment for residents The complainant alleges that facility does not provide a safe and comfortable environment for the residents. RP stated that second floor rooms have balconies which could be unsafe for Dementia Residents. LPA spoke to Administrator and several staff who stated that all residents with dementia or confusion reside on the first floor of the facility. More independent residents are housed on the second floor. LPA Cifuentes asked Administrator Susie Fuentes about the safety of the facility and providing a comfortable environment for residents. Per Ms. Fuentes, the facility is able to provide both a safe and comfortable environment for its residents. LPA interviewed residents (R1-R8) and asked if they felt safe at the facility. 7 out of 8 stated they felt the facility was safe. LPA interviewed staff (S1-S6) regarding resident safety and comfortability for residents at the facility. 4 out of 6 stated they felt the facility was safe. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Facility is disrepair The complainant alleges that facilities front door is broken. During visit on 9/15/2021 LPA Cifuentes noted that facility door was locked and had to be opened by staff to allow entry. No glass was broken, nor did it appear bent. LPA spoke to Administrator Susana Fuentes, regarding the facility door. Per Ms. Fuentes, the facility door is not broken, it was not closing on its own, it had to be pushed to close. She further added that the door has been repaired. LPA interviewed residents (R1-R8) regarding the facility door. 7 out of 8 residents stated the facility door is not broken.LPA interviewed staff (S1-S6) about the facility door being broken. Per all six staff interviewed, the facility door is not broken. A few added that it had been broken in the past but had been fixed. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, incident report, and interviews conducted and found no evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Susie Fuentes and a copy of the report was provided. INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff are failing to meet residents' needs The complainant alleges facility is failing to provide activities for the residents. Per Susie Fuentes, administrator, facility provides bingo, ball toss, dominoes. For those with dementia they have coloring and one on one time to stimulate them and they also go for walks in the park. LPA interviewed residents (R1-R8) regarding what activities the facility provides. Six of the eight interviewed residents stated facility provided bingo, ball toss, arts and crafts and outings. LPA interviewed staff (S1-S6) regarding activities provided to the residents. One staff stated they did not know, as they do are not present for activities. Of the others interviewed, 5 out of the 6 staff interviewed were able to state that the facility had activities. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Resident wandered away while in care The complainant alleges Resident 9 (R9) wandered away from the facility. LPA reviewed incident reports and did not have any reports of R9 wandering away or eloping while in care. LPA Cifuentes spoke with Administrator Susie Fuentes, who stated no residents had eloped in her time at the facility. LPA spoke with residents (R1-R8) regarding eloping/wandering. Of those interviewed, 8 out of 8 residents stated they have not wandered away from the facility. R9 was unavailable for interview. LPA interviewed staff (S1-S6) regarding residents wandering. Of those interviewed, 4 out of the 6 staff interviewed stated that residents had not wandered from the facility. Staff stated they constantly redirected residents so they would not try and wander. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Continued on 9099-C Allegation: Staff speak to residents inappropriately The complainant alleges the staff always talk to the residents inappropriately by saying that if they don’t like the facility, they will talk to their social workers and move them out to a different location. LPA spoke to administrator Susie Fuentes regarding allegation. Administrator Fuentes stated none of her staff had spoken inappropriately to residents. LPA interviewed residents (R1-R8) about staff speaking to them inappropriately or rudely to them. Of those interviewed, 8 out of 8 residents stated staff had not spoken inappropriately to them. LPA interviewed staff (S1-S6) about how they spoke to residents and was told by 6 out of 6 staff that they had not spoken rudely or inappropriately to resident. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Staff failed to provide adequate food service The complainant alleges that facilities food is creepy. LPA viewed facility food menu and food which contains a variety of meats, grains, fruits and vegetables. LPA interviewed residents (R1-R8) regarding allegation. 5 out of 8 residents interviewed stated the food was fine. One of the eight interviewed declined to comment. LPA interviewed staff (S1-S6) about the food and was told by 4 out of 6 staff that the facility food was fine and that the menu has variety. Based on information gathered through observation, the Department did not find sufficient evidence to support the allegation mentioned above. Continued on 9099-Cthe state’s words, verbatim · CDSS document, Dec 21, 2021 · control 11-AS-20210909155011

Allegation investigated: Staff handled resident in a rough manor Resident is being harassed by another resident

Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at the facility listed above. LPA spoke with Administrator Susie Fuentes via telephone prior to entering the facility to conduct risk assessment questionnaire and was informed that facility has no COVID cases nor do any of the clients have symptoms. LPA arrived at facility and was greeted by staff Christina Novoa. LPA explained the purposed of the visit was to deliver complaint findings and was allowed access to the facility. The investigation consisted of the following: On 10/7/2021 LPA conducted tour of facility grounds, reviewed facility files and spoke with administrator. On 10/7/2021, 12/8/2021 and 12/9/2021 LPA Cifuentes interviewed eight residents (8) residents (R1-R8), (6) staff (S1-S6) and re-interviewed administrator. LPA requested and received the following documents: staff and client rosters and other documents pertinent to the investigation Continued on 9099-C Unsubstantiated Allegation: Staff handled resident in a rough manor The complainant alleges that staff put their hands on R1 in an inappropriate manner. On 12/9/2021 LPA Cifuentes spoke with Administrator Susie Fuentes regarding the allegation. Administrator Fuentes stated she has not touched residents in a rough manner and had not seen any staff touch residents in a rough manner. LPA spoke with residents (R1-R8) regarding staff touching them/touching them aggressively and 7 out of 8 stated staff had not touched them in an aggressive or rough manner. LPA spoke with staff (S1-S6) regarding their handling of residents and 6 out of 6 staff stated they had not touched residents in a rough manner, while 5 out of 6 stated they had not seen other staff or volunteers touch residents in a rough manner. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Resident is being harassed by another resident This allegation was addressed previously on complaint 11-AS-20211004115959 and was found to be substantiated, as there was an altercation and residents in the facility had been harassing each other. LPA is unsubstantiating this allegation as it has been addressed previously and allegation referenced the same incident. The Department’s investigation consisted of an inspection of the facility, observation, analysis of residents records, incident report and interviews conducted and found no evidence to support the allegations: "Staff handled resident in a rough manor”, “Resident is being harassed by another resident”. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Susie Fuentes and a copy of the report was providedthe state’s words, verbatim · CDSS document, Dec 21, 2021 · control 11-AS-20211004122950

Allegation investigated: Illegal eviction

On 12/3/2021 at 12:03 p.m., Licensing Program Analyst (LPA)/ Susan Campos, initiated a 10-day complaint investigation visit for the allegation listed above. LPA was allowed entry into the facility by Administrator Susana Fuentes. LPA explained to Ms. Fuentes the purpose of the visit. The investigation consisted of the following: LPA and Ms. Fuentes conducted an inspection, for health and safety of the facilities’ physical plant, R1's resident room, and food supply, LPA conducted an interview with Administrator Susana Fuentes, and LPA was provided the following documents from Administrator Susana Fuentes: LIC 500-staff roster; Client roster; Incident Reports from November 2021 to present; R1 case notes; R1 physician report; and R1 service care plan. LPA was informed by Administrator Susana Fuentes that R1 was not evicted, from the facility, and that R1 can return to the Gardena Retirement Center upon discharge from medical facility. Based on information gathered, LPA did not find sufficient evidence to support allegation " Illegal Eviction”. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted with Susana Fuentes, Administrator, and a hard copy of a LIC 9099 was provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Dec 3, 2021 · control 11-AS-20211129153350

Allegation investigated: Resident harassing another resident at facility

On 10/19/2021 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent investigation at the facility listed above. LPA spoke with staff Elizabeth via telephone call prior to entering the facility to conduct risk assessment questionnaire and was informed that facility had no COVID cases nor do any of the clients have symptoms. LPA arrived at facility and was greeted by staff. LPA explained the purposed of the visit was to investigate the allegations listed above and was granted access to the facility. The investigation consisted of the following: LPA interviewed Administrator Susie Fuentes, six (6) staff (S1-S6) and six (6) residents (R1-R6). LPA inspected the facility. LPA reviewed records for residents 1-6 (R1-R6) along with the current staff/resident roster and other documents in association with the allegation. Substantiated Allegation: Resident harassing another resident at facility The complainant alleges that R1 is being harassed by R2. On September 11, 2021 LPA Cifuentes received witness statements stating R2 was calling several residents names and making derogatory remarks towards them. On 10/4/2021 LPA Cifuentes received a faxed incident report documenting an incident of aggression between R1 and R2. LPA viewed video of incident between R1 and R2. LPA spoke with residents (R1-R6) regarding harassment and 4 out of 6 stated they had witnessed harassment between residents. LPA spoke with staff (S1-S6) regarding harassment between residents and 4 out of 6 staff stated the had witnessed harassment between residents. Based on information gathered, the department did find sufficient evidence to support allegation " Resident harassing another resident at facility” Based on interviews conducted and records reviewed the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of the LIC 9099 and appeal rights forms were provided to Administrator Susie Fuentes.the state’s words, verbatim · CDSS document, Oct 19, 2021 · control 11-AS-20211004115959

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Nov 2, 2021

Personal RIghts of Residents All Facilities To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by: Based on LPA's observations and interviews facility did not insure residents in facility were free from intimidation or abuse. This poses a potential Health and Safety risk to residents in carethe state’s words, verbatim · CDSS document, Oct 19, 2021

Plan of correction: Administrator will submit a plan to LPA on how they will prevent resident on resident harassment in the future and submit it to LPA by POC due date.

Allegation investigated: Residents meals are late Residents bed is in disrepair

Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent investigation at the facility listed above. LPA spoke with staff Elizabeth via telephone call prior to entering the facility to conduct risk assessment questionnaire and was informed that facility had no COVID cases nor do any of the clients have symptoms. LPA arrived at facility and was greeted by staff. LPA explained the purposed of the visit was to investigate the allegations listed above and was granted access to the facility. The investigation consisted of the following: LPA interviewed Administrator Susie Fuentes. Interviews were conducted with six (6) staff (S1-S6) and six (6) residents (R1-R6). LPA inspected the facility. LPA reviewed records for residents 1-6 (R1-R6) along with the current staff/resident roster and other documents in association with the allegations. Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Residents meals are late The complainant alleges that resident 1’s (R1’s) lunch has been late twice. LPA spoke with administrator Susie Fuentes, who stated that residents’ meals served in the dining room are not late. They might receive an item like water a little later, but they are served on time Per staff each meal has two seatings, one for those who need assistance with dinning and the second for those that are independent. Staff also agreed that food was not served late, but another item accompanying the meal could be served a little later, depending LPA interviewed residents (R1-R6) and of those interviewed, one stated they did not eat the food while 4 out of the 6 stated the meals at the facility are not late. LPA spoke to staff regarding resident meals and 5 out of 6 stated residents meals are not late. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Residents bed is in disrepair The complainant alleges R1’s bed is in disrepair and they can feel the springs. LPA spoke with Administrator, who stated she was not aware of any beds in disrepair. LPA toured facility grounds and checked the beds in several rooms. LPA Cifuentes did not feel any springs poking out of any of the beds. LPA spoke with residents (R1-R6) regarding their beds and 6 out of 6 residents stated their bed is not in disrepair. LPA spoke with staff (S1-S6) regarding residents’ beds and 5 out of 6 staff staff stated residents beds are not in disrepair Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, incident report, and interviews conducted and found no evidence to support the allegations: “Residents meals are late”, “Residents bed is in disrepair”. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Susie Fuentes and a copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 19, 2021 · control 11-AS-20211004141720

Allegation investigated: Resident is malnourished. Staff sexually abused resident. Resident is being physically abused while in care. Staff administered incorrect medication to resident. Resident's hygiene needs are not being met.

On 9/15/21, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Susie Fuentes, Administrator, and explained the purpose of today's visit is to conduct interviews ans deliver findings for the allegations listed above. The investigation consisted of the following: On 8/10/2021 LPA Cifuentes inspected the facility. LPA reviewed records for residents 1-5 (R1-R5) along with the current staff/resident roster and other documents in association with the allegations. On 9/15/2021 LPA interviewed Administrator Susie Fuentes. Interviews were conducted with five (5) staff (S1-S5) and (6) residents (R1-R6). Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Resident is malnourished The complainant alleges that facility allowed for self-neglect of resident with food which led to malnutrition. LPA reviewed admissions agreement page 7 which states facility will provide residents with three nutritionally and well-balanced meals per day with snacks available and modified diets available if prescribed by physician as medically necessary. Administrator confirmed that residents are served three meals as well as snacks a in the morning, afternoon and evening. LPA interviewed residents (R1-R6) and of those interviewed, 6 out of 6 stated they are receiving enough food for their needs. LPA interviewed staff (S1-S5) who stated that residents are getting enough food. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Staff sexually abused resident The complainant alleges facility staff are sexually abusing resident. LPA Cifuentes spoke with Administrator Susie Fuentes, who stated that there have been no reports from staff or residents of inappropriate touching. Staff in-service was conducted regarding over the counter medications and the need for doctors’ notes. LPA spoke with residents (R1-R6) regarding inappropriate touch by staff or residents. 6 out of 6 residents stated they have not been touched inappropriately. LPA spoke with staff (S1-S5), all five staff stated they had not touched anyone inappropriately nor had they seen residents do so. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Resident is being physically abused while in care The complainant alleges resident was physically abused by staff and roommates. LPA spoke to administrator who stated she has not been told of staff or residents physically abusing residents. LPA Cifuentes has received no SIR’s regarding physical abuse between residents or staff on residents in the past months. LPA interviewed residents (R1-R6) about physical abuse and 6 out of 6 stated they had not been hit or pinched by residents or staff. LPA interviewed staff (S1-S5) about physical abuse and was told by 5 out of 5 staff that they had not physically abused residents nor had they seen anyone physically abuse residents. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Staff administered incorrect medication to resident The complainant alleges that resident was given wrong medication. On 9/15/2021 LPA reviewed facility MAR for several residents and did not find any discrepancies. Per Administrator Fuentes, facility is giving residents medications as prescribed by doctor and she has had no reports of issues with medication. LPA interviewed residents (R1-R6) about their medications and 6 out of 6 stated they had received their medications daily at the times it should be given . LPA interviewed staff (S1-S5) about medications and was told by 5 out of 5 staff that they had seen staff administer medications to clients daily and at the correct times. Based on information gathered through observation, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Resident’s hygiene needs are not being met. The complainant alleges that facility allowed resident to self neglect as she was not assisted with personal hygiene. On page 19 of admissions agreement for resident 7 (R7) it states that assistance with activities of daily living, which includes showering and toileting, is part of basic services that resident signed up for. LPA spoke to Administrator Susana Fuentes, who stated residents are on a shower schedule and those in need of assistance with incontinence are also on a schedule to be checked on regularly. If it is reported that a resident refused a shower, administrator, medtech or office manager verify the refusal of assistance with the resident. R7 was receiving assistance with bathing but not incontinence care. LPA Cifuentes confirmed that R7 is on the shower schedule. LPA interviewed residents (R1-R6) about their hygiene needs. 4 out of 6 stated they received assistance with bathing and that they are given showers twice a week. 1 resident stated they received assistance with incontinence needs and believed staff checked hourly, but that they also pushed the button to get assistance. LPA interviewed staff (S1-S5) about resident hygiene needs and and was told by 5 out of 5 staff that residents are showered twice weekly and that when it comes to incontinence care it depends on the resident, but they are checked several times a day. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, incident report, and interviews conducted and found no evidence to support the allegation: “Resident is malnourished”, “Staff sexually abused resident,” “Resident is being physically abused while in care,” “Staff administered incorrect medication to resident,” “Resident’s hygiene needs are not being met”. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Susie Fuentes and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 15, 2021 · control 11-AS-20210809161903

Allegation investigated: Staff is interfering with the residents hygiene needs Staff is not administering medications as needed Staff is not providing transportation services for the residents Staff is not providing comfortable accommodations for residents while in care Staff threatened a resident with eviction Staff are not properly providing care and supervision to the residents while in care

On 08/25/21, Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Susie Fuentes, Administrator, and explained the purpose of today's visit is to deliver findings for the allegations listed above. The investigation consisted of the following: LPA interviewed Administrator Susie Fuentes. Interviews were conducted with seven (7) staff (S1-S7) and (7) residents (R1-R7). LPA inspected the facility. LPA reviewed records for residents 1-5 (R1-R5) along with the current staff/resident roster and other documents in association with the allegations. Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff is interfering with the resident’s hygiene needs The complainant alleges that administrator stopped house hygiene supplies for residents and told them that they had to purchase it on their own. Similar allegation addressed on complaint# 11-AS-20210706130137. LPA reviewed admissions agreement page 4, which states the facility will assist with the ordering of supplies and assist with personal hygiene. Administrator stated that facility provides supplies for those on the Healthy Families program but for everyone else the resident or the family is responsible to provide hygiene supplies. The facility does have a stock of donated care packages which are given to those who don’t have supplies. LPA interviewed residents (R1-R7) and of those interviewed, 7 out of 7 stated the facility did not provide hygiene supplies and 5 of those 7 indicated they could purchase it on their own. LPA spoke to staff regarding hygiene supplies and 6 out of 7 stated facility does not provide hygiene supplies. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Staff is not administering medications as needed The complainant alleges facility staff have stopped given residents over the counter medications. LPA Cifuentes spoke with Administrator Susie Fuentes, who stated that there is a house supply of over the counter medications but for those residents who requested over the counter medication a doctors ordered was needed. Staff in-service was conducted regarding over the counter medications and the need for doctors’ notes. LPA spoke with residents (R1-R6) regarding over the counter medications and 5 out of 6 residents stated facility had not been providing overt the counter medications. LPA spoke with staff (S1-S7) all seven staff stated facility was not currently giving out over the counter medications, with three of those questioned stating that a doctors order was needed. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Continued on 9099-C Allegation: Staff is not providing transportation services for the residents The complainant alleges administrator stopped Uber as transportation for residents’ medical appointments. Similar allegation addressed on complaint# 11-AS-20210706130137. LPA spoke to administrator who stated facility has Lyft account for resident’s medical transportation if they cannot use other services. Ms. Fuentes stated she has used Uber for one residents’ appointments and other residents have set-up Access transportation services, use medical transportation or Gardena transit. LPA was given copies of Uber receipts. LPA interviewed residents (R1-R7) about transportation and was told they use a variety of the following: the facility helps set up transport, Access transportation, they drive, or use public or medical transport. When asked if the facility assisted with transportation 5 out of 7 state the facility helps. LPA also asked if facility had ever refused to assist them with transportation and 4 of the 7 said no. LPA interviewed staff (S1-S7) about transportation and was told by 5 out of 7 that facility assists with transportation. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Staff is not providing comfortable accommodations for residents while in care LPA noted on 7/6/2021, 8/5/2021 and 8/25/2021 that facility is clean, free of odors and in good repair. Resident rooms had appropriate amount of beds for those in residence. LPA observed enough bedding, soap and toilet paper in rooms. Of the rooms surveyed on multiple visits, all had working toilets and sinks in attached bathrooms. Facility was at a comfortable temperature, with individual rooms adjusted to resident’s preference. Facility provides a dining room, lounge, outdoor shaded area and an outdoor smoking area for all residents in care. Facilities accommodations are within title 22 regulations. Based on information gathered through observation, the Department did not find sufficient evidence to support the allegation mentioned above. Continued on 9099-C Allegation: Staff threatened a resident with eviction The complainant alleges that administrator told resident R2 they had to stop smoking or they would be evicted. LPA spoke to Administrator Susana Fuentes, who stated she had a discussion with R3 regarding their smoking inside of their room. Facility allows residents to smoke in smoking area, which is outside in back of the facility but does not allow smoking in doors. LPA Cifuentes spoke to R2, who stated they did smoke in the smoking area and had not been threatened with eviction. LPA spoke with six other residents, who all stated they were allowed to smoke in facilities smoking area. LPA also spoke to staff regarding residents smoking and 7 out of 7 staff stated residents are allowed to smoke outdoors. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Staff are not properly providing care and supervision to the residents while in care The complainant alleges that the facility is short on staff. LPA Cifuentes addressed a similar allegation on Complaint# 11-AS-20210706130137. LPA Cifuentes substantiated that allegation but noted that today 8/25/2021 during walkthrough facility had three caregivers attending residents as well as a medtech and the activities director who can assist with care giving if needed. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, incident report, and interviews conducted and found no evidence to support the allegation: “Staff is interfering with the residents hygiene needs”, “Staff is not administering medications as needed”, “Staff is not providing transportation services for the residents”, “Staff is not providing comfortable accommodations for residents while in care”, “Staff threatened a resident with eviction”, “Staff are not properly providing care and supervision to the residents while in care”. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Susie Fuentes and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2021 · control 11-AS-20210629115913

Allegation investigated: Facility is in disrepair

On 08/25/21, Licensing Program Analyst (LPA) Stephanie CIfuentes conducted an unannounced initial complaint visit at this facility. LPA met with Susie Fuentes, Administrator, and explained the purpose of today's visit is to investigate the allegation listed above. The investigation consisted of the following: On 8/25/2021 LPA Cifuentes spoke with administrator, reviewed facility records, was given a tour of facility grounds and interviewed residents 1-resident 6 (R1-R6) as well as staff 1-staff 5 (S1-S5). LPA also requested and received the following: admissions agreement , staff roster and resident roster Continued on 9099-C Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Facility is in disrepair The complainant alleges toilets on first floor have been out of order for three weeks and that elevator is faulty. LPA spoke with administrator, who stated that some toilets have been clogged with diapers or wipes, but that they have been immediately unclogged by facility staff or a plumber has been called. LPA inspected facility grounds and found working toilets in all 10 of the resident’s rooms checked. LPA also found the elevator to be in good repair. LPA spoke to residents (R1-R6) regarding their bathrooms. 6 out of 6 residents interviewed stated their bathroom was currently working and that there had been no issues with their toilets in the past month. LPA also asked residents about elevator and was told it was working correctly. LPA also interviewed staff (S1-S5) and 4 out of the 5 stated residents had working bathrooms and that there had been no issue with the resident’s toilets. When asked about the elevators, all 5 staff interviewed stated the elevators were working correctly. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of records and interviews conducted and found no evidence to support the allegation: " Facility is in disrepair ". Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Susie Fuentes and a copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 25, 2021 · control 11-AS-20210819151014

Allegation investigated: Resident sustained multiple falls while in care

On 08/5/21, Licensing Program Analyst (LPA) Stephanie CIfuentes conducted an unannounced complaint visit at this facility. LPA met with Susie Fuentes, Administrator, and explained the purpose of today's visit is to conduct interviews and to deliver findings. The investigation consisted of the following: LPA interviewed Administrator Susie Fuentes. Interviews were conducted with seven (7) staff (S1-S7) and (7) residents (R1-R7). LPA inspected the facility. LPA reviewed records for residents 1-5 (R1-R5) along with the current staff/resident roster and other documents in association with the allegations. Continued on 9099-C Substantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Resident sustained multiple falls while in care The complainant reports (R1) fell several times in one day but the falls were unwitnessed. Staff #1 (S1) reports that she found R1 sitting on the floor in front of their wheelchair. S1 assessed R1’s range of motion and assisted them to their bed. At 9:30 PM S1 received a call from caregivers on shift and arrived at the room to find that R1 had fallen again and their wheelchair was on top of them. Another range of motion check was completed and R1 was checked for any bumps, bruises or bleeding, none were found and R1 stated they were in no pain. R1’s movement was a bit off, so the decision was made to call an ambulance to take R1 for evaluation to insure no unseen injuries. Interviews with (S1 to S7) show that 4 out of 7 staff state R1 has a history of falling. Per R1’s records, resident is unable to transfer without aid, but there is no fall care plan in place. Based on LPA’s observation and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation of "Resident sustained multiple falls while in care" is found to be: Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099-D. An exit interview was conducted with Susie Fuentes. The Rights were discussed and a copy of Appeals Procedures for Licensees was provided, as well as a copy of this report to the Administrator. Allegation: Facility staff did not seek medical attention in a timely manner The complainant reported (R1) did not arrive to the hospital in a timely manner after multiple falls. Interview with (S1) disputes this allegation and states that a non-emergency ambulance was called immediately as (R1) stated they were in no pain and no blood or bruises were found, however there was a several hour wait for pick-up. Administrator states she was informed by (S1) that several ambulance services were called, all stated that there were long waits that evening and it would be several hours before a pick-up could happen. In addition, the transport was delayed and the facility had no other method of transporting the resident. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of records, incident report, and interviews conducted and found no evidence to support the allegation:"Facility staff did not seek medical attention in a timely manner". Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegation is Unsubstantiated.the state’s words, verbatim · CDSS document, Aug 5, 2021 · control 11-AS-20210803145611

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Aug 19, 2021

Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights...To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interviews, observation, and record review, on 8/5/2021, LPA observed that R1, a fall risk, did not have a fall prevention plan which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Aug 5, 2021

Plan of correction: Administrator will provide CCL with fall risk plan by POC due date.

Allegation investigated: Facility not adhering to Admissions Agreement. Resident is not being allowed to smoke.

This report serves as an amendment to clarify finding. It does not supersedes the complaint investigation findings reflected on report created 8/5/2021. On 08/5/21, Licensing Program Analyst (LPA) Stephanie CIfuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Susie Fuentes, Administrator, and explained the purpose of today's visit is to deliver findings. The investigation consisted of the following: On 7/8/2021 LPA Cifuentes spoke with administrator, reviewed facility records, was given a tour of facility grounds and interviewed residents 1-resident 5 (R1-R5) as well as staff 1-staff 4 (S1-S4). On 7/20/2021 LPA interviewed residents 6-resident 7 (R6-R7) as well as staff 5-staff 6 (S5-S6). LPA also requested and received the following: admissions agreement for R1, staff roster and resident roster. Continued on 9099-C Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Facility not adhering to Admissions Agreement. The complainant reports (R1)’s admissions agreement states they were paying to receive a private room and that administrator then moved someone into the room with (R1). LPA reviewed admissions agreement, which did not indicate whether (R1) was paying for a private room or a shared room. LPA found that admissions agreements do not indicate whether client has a single or double room. Per administrator, (R2) was put into the room with (R1) as there was no indication in the records that (R1) had a private room. Resident is on the ALW program(Assisted Living Waiver) and the program is paying for a shared room. Administrator informed LPA that due to Covid-19 precautions, residents had not been sharing rooms previously, which led (R1) to think they had a private room. When R1 informed Administrator they believed they had a private room, R1 and Administrator reviewed admissions agreement with ALW Social worker and (R1) was informed they had a shared room. LPA also interviewed residents (R1-R7) and found that 6 out of 7 were paying for the type of accommodation they currently have. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Resident is not being allowed to smoke. The complainant reported (R1) is not being allowed to smoke. LPA spoke to administrator who stated all residents are allowed to smoke, they just have to do so in the facilities designated smoking area. LPA interviewed (R1-R7) about whether or not they were allowed to smoke in smoking area, all residents stated facility allows smoking in the smoking area. LPA interviewed (S1-S6) about whether or not residents were allowed to smoke, and all stated residents are allowed to smoke in designated smoking area. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R-1)'s service records, incident report, and interviews conducted and found no evidence to support the allegations: "Facility not adhering to admissions agreement" and "Resident not being allowed to smoke" Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Susie Fuentes and a copy of the report was provided by email.the state’s words, verbatim · CDSS document, Aug 5, 2021 · control 11-AS-20210701084959

Allegation investigated: Resident missed her medical appointment Staff refused to provide transportation for resident's medical appointments Staff failed to meet residents' hygiene needs

This report serves as an amendment to clarify finding. It does not supersedes the complaint investigation findings reflected on report created 8/5/2021. On 08/5/21, Licensing Program Analyst (LPA) Stephanie CIfuentes conducted an unannounced subsequent complaint visit at this facility. LPA met with Administrator Susie Fuentes and explained the purpose of today's visit is to deliver findings. The investigation consisted of the following: On 7/8/2021 LPA Cifuentes spoke with administrator, reviewed facility records, was given a tour of facility grounds and interviewed residents 1-resident 5 (R1-R5) as well as staff 1-staff 4 (S1-S4). On 7/20/2021 LPA interviewed residents 6-resident 7 (R6-R7) as well as staff 5-staff 6 (S5-S6). LPA also requested and received the following: staff roster, resident roster and other documents relevant to the allegations. Continued on 9099-C Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Resident missed her medical appointment The complainant alleges resident was notified two days before a medical appointment that facility would no longer be providing transportation to and from their medical appointments, causing resident to miss their appointment. LPA reviewed facility admissions agreement page 3, which states facility will assist with necessary medical or dental transportation at cost listed, which depends on the amount of time needed for the trip. LPA spoke with administrator Susie Fuentes regarding missed medical appointments for residents. Per Administrator Fuentes the facility does not have its own vehicle to use for resident transportation. The facility was using Uber to get residents to their appointments and had not been charging them. Ms. Fuentes stated she informed residents that Uber was still available, but facility would be charging for its use. As a result, some residents used Uber to get to their medical appointments while others used a transportation service like Access or contacted their families for transport. Per Ms. Fuentes, no residents missed their medical appointments, nor did they need to reschedule. LPA spoke to residents (R1-R7) regarding missed medical appointments. Resident mentioned in allegation was not available for interview. Out of those interviewed, 5 out of the 7 stated they have not missed medical appointments. LPA also interviewed staff (S1-S6) and 4 out of the 6 stated residents had not missed medical appointments. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Allegation: Staff refused to provide transportation for resident's medical appointments The complainant reported staff have refused to provide transportation for resident’s medical appointments. LPA spoke to administrator who stated facility has Lyft account, she has used uber for one residents appointments and other residents have set-up Access services, use medical transportation or Gardena transit. LPA was given copies of Uber receipts. LPA interviewed residents (R1-R7) about transportation and was told they use a variety of the following: the facility helps set it up, they use Access, drive, public transport or medical transport. When asked if the facility assisted with transportation 5 out of 7 state the facility helps. LPA also asked if facility had ever refused to assist them with transportation, and 4 of the 7 said no. LPA interviewed staff (S1-S6) about transportation, and was told by 5 out of 6 that facility assists with transportation. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. Continued on 9099-C Allegation: Staff failed to meet residents' hygiene needs The complainant reports resident’s family buys hygiene products for the resident because facility does not provide them. LPA reviewed admissions agreement page 4, which states the facility will assist with the ordering of supplies and assist with personal hygiene. Administrator stated that facility provides supplies for those on the Healthy Families program but for everyone else the resident or the family is responsible to provide hygiene supplies. The facility does have a stock of donated care packages which are given to those who don’t have supplies. LPA interviewed residents (R1-R7) and of those interviewed, 7 out of 7 stated the facility did not provide hygiene supplies and 5 of those 7 indicated they could purchase it on their own. LPA spoke to staff regarding hygiene supplies and 5 out of 7 stated facility does not provide hygiene supplies. Based on information gathered, the Department did not find sufficient evidence to support the allegation mentioned above. The Department’s investigation consisted of an inspection of the facility, observation, analysis of (R1)'s service records, incident report, and interviews conducted and found no evidence to support the allegations: "Resident missed her medical appointment, Staff refused to provide transportation for resident's medical appointments, Staff failed to meet residents' hygiene needs Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Susie Fuentes and a copy of the report was provided by email. Allegation: Insufficient staffing to meet the residents' needs The complainant reported that whenever residents need help the staff does not assist them in a timely manner due to lack of staffing. LPA spoke to administrator who stated that she believed the facility could use a few more staff and that she was in the process of hiring more. LPA interviewed residents regarding the lack of staffing and of the 7 interviewed, 6 stated that there was not enough staff. Interviews with staff showed that 2 out of 6 staff believe there is not enough staff. Based on LPA’s observation and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation of "Insufficient staffing to meet the residents' needs" is found to be: Substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099-D. An exit interview was conducted with Susie Fuentes. The Rights were discussed and a copy of Appeals Procedures for Licensees was provided, as well as a copy of this report to the Administrator.the state’s words, verbatim · CDSS document, Aug 5, 2021 · control 11-AS-20210706130137

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Aug 19, 2021

Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement was not met as evidenced by: Based on interviews, observation, and record review, on 8/5/2021, LPA that facility does not have sufficient staff which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Aug 5, 2021

Plan of correction: Administrator will provide plan to LPA to insure sufficient staff are available for each shift to cover residents needs. Will submit to CCL by POC due date.

Allegation investigated: Staff interfered with resident's daily living functions Residents not accorded dignity in their relationships with staff

Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced complaint investigation at above facility. LPA arrived at facility at 10:23am and was greeted by staff Carlos Aguirre. LPA explained the purposed of the visit was to investigate the allegations listed above and was granted access to the facility. The investigation consisted of the following: On 7/20/2021 LPA Cifuentes spoke with administrator, reviewed facility records, was given a tour of facility grounds and interviewed residents 1-resident 7 as well as staff 1-staff 5. LPA also requested and received the following: staff and client rosters, admissions agreement for R1. Regarding the allegation: Staff interfered with resident's daily living functions The investigation revealed the following: Continued on 9099-C Unsubstantiated On 7/20/2021 LPA Cifuentes toured facility grounds with administrator and reviewed facility files. On 7/20/2021 LPA Cifuentes interviewed residents 1 through resident 7. Of the residents interviewed 7 out of 7 stated the facility staff was not interfering with their daily living function. On 7/20/2021 LPA Cifuentes interviewed staff 1 through staff 5. 5 out of 5 staff stated they are not interfering with residents daily living functions. Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation: Residents not accorded dignity in their relationships with staff The investigation revealed the following: On 7/20/2021 LPA Cifuentes toured facility grounds with administrator and reviewed facility files. On 7/20/2021 LPA Cifuentes interviewed residents 1 through resident 7. Of the residents interviewed 7 out of 7 stated that most of the staff treated them with politeness and dignity. On 7/20/2021 LPA Cifuentes interviewed staff 1 through staff 5. 5 out of 5 staff stated they treat residents with dignity and respect. Based on LPA’s observation, interviews conducted, and records reviewed, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted, and a copy of the report was given to Susana Fuentes, Administrator.the state’s words, verbatim · CDSS document, Jul 20, 2021 · control 11-AS-20210716163947