Golden Age II

Type of visit: Required - 1 Year

On 08/28/2023 Licensing Program Analyst (LPA), Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua was greeted by House Manager, Venice Andrews, and explained the purpose of the visit. LPA Pascua asked that HM Andrews call the Facility Designated Representative, Kenroy Anderson to inform him that CCL was present. Shortly after, LPA met with FDR Anderson and Licensee, Marinela Placintar. There was one other staff member present, Donald Stewart. This facility is licensed to serve 6 residents who are 60 or older, all of which may be ambulatory. This facility has a dementia program on file and has a hospice waiver for 4. Current census was 5. A brief interview with Licensee Placintar was conducted. LPA reviewed 5 resident files. It was learned that there are 2 residents receiving hospice services. 5 out 5 resident files were current and complete. LPA reviewed 3 staff files. 3 out 3 staff files are complete and up to date. Administrator holds an active and current certificate #6000942740 and expires on 06/23/2024. A tour of the facility was conducted. The interior of the physical plant was in good condition and sanitary. Fire extinguishers appeared to have been annually inspected by Jorgenson Co on 02/27/2023. The kitchen area was toured. LPA observed a non-perishable and perishable foods in the cabinets and refrigerator. Additional perishable food supplies were identified in the garage. LPA observed a locked centralized stored medication cabinet located in the kitchen. Along with the administrator, the LPA observed, reviewed, and compared resident medication and medication dispensing logs. First Aid Kit was present and contained all of the required components. A tour of the bathrooms was conducted. Hot water temperature was measured and observed to be within the required range of 105-120 degrees. A linen closet was located in the hallway and presented a sufficient amount of linens to adequately supply and meet the needs of the residents at this time. A tour of the bedrooms was conducted. Resident furniture was observed to be sufficient to meet their needs at this time. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. A tour of the garage was conducted. Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time. A tour of the garage was conducted. Additional perishable food supplies were identified. Washer and dryer were identified. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time. The exterior of the physical plant was toured. Perimeter fence was observed to be stable and gates were in good repair. The following forms and documents were requested to be updated and submitted into CCL -LIC 308 -LIC 400 -LIC 500 -LIC 610 -Liability Insurance As a result of this visit, no deficiencies were observed or cited during this annual visit. An exit interview was conducted and copy of the 809 and 809-C was provided to Licensee, Marinela Placintar.the state’s words, verbatim · CDSS document, Aug 28, 2023

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA's) Sarah Hurt and Arielle Pascua conducted an unannounced visit today for the facility’s annual inspection. LPA met with facility staff Kenroy Anderson and explained the purpose for the visit. Continual Administrator's Certification for Marinela Placintar expires 06/23/2022. There are currently 6 residents who reside at this home and there is 2 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Fire extinguisher is within the safety regulation period. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA's confirmed staff present has vaccine cards or exemptions on file. LPA's confirmed staff present is background cleared. Facility Administrator Marinela Placintar's Administrator's Certificate expired on 06/23/2022. LPA's observed staff did not screen at entrance for COVID 19 symptoms or ask screening questions. LPA's observed mattresses stacked in a small room used for caregivers to sleep. LPA's reviewed facility sketch documenting the room should be a laundry room. Continued on 9099C... Continued from 809... LPA's observed several facility windows without screens. LPA's observed several stacked mattresses near a bedroom sliding glass door. Staff 1 stated the mattresses are used to prevent Resident 1 from wondering out of the facility during the night. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. The following deficiencies were cited during today's inspection per California Code of Regulations, Title 22. Exit interview conducted with Administrator Kenroy Anderson and a copy of this report was left at facilitythe state’s words, verbatim · CDSS document, Jul 6, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 20, 2022

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. The following requirement has not been met as evidenced by: LPA's observed several windows did not have screens which poses a potentiol health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 6, 2022

Plan of correction: Licensee will send proof all facility windows have screens to LPA's by 07/20/2022 POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87405(a) · Plan of correction due date: Jul 20, 2022

87468.1 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: The following requirement has not been met as evidenced by: Based on LPA's observation the laundry room is being used as a staff area, and there are several mattresses stacked in a residents bedroom to prevent Resident 1 from wandering, which poses a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 6, 2022

Plan of correction: Licensee wil send proof of mattress removal to LPA's by 07/20/2022 POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Jul 20, 2022

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. The following requirement has not been met as evidenced by: Based on records reviewed facility Administrator Marinela Placintar's certificate expired 06/23/2022 which poses a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 6, 2022

Plan of correction: Licensee will send proof of current Administrator's Certificate to LPA's by POC date 07/20/2022.

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.50(a)(3) · Plan of correction due date: Jul 7, 2022

Health and Safety code 1569.50 (a)(3) Conduct Inimical: Conuduct which inimical to health, common morals, common welfare, or safety of either an individual in, or receving services from the facility or the people of the state of California. The following requirement has not been met as evidenced by: Based on observation the facility did not implement COVID pre screening measures at entrance to facility this poses an immediate health, and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 6, 2022

Plan of correction: Facility staff agrees to train all staff on COVID 19 precautionary measures by POC date of 07/07/2022.

Type of visit: Office

An office meeting was conducted today in the Sacramento Regional Office via Microsoft Teams. The purpose of this meeting was to discuss the 3rd quarter 2021 audit findings. Present at the meeting was Regional Manager (RM) Krystall Moore, Licensing Program Manager (LPM) Stephenie Doub, Licensing Program Analyst (LPA) Sarah Hurt, Jacqueline Juarez, Xiao Ni, DSS Auditors, Marinela Placintar, Licensee, and Licensee Attorney Michael Levin. Since 11/5/2020, the Department has been conducting quarterly financial monitoring due to the findings of a solvency audit. The Licensee furnished documents for the 3rd quarter of 2021 which showed despite there being funds available there is still non-sufficient fund payments, water bills not paid timely and food costs below the required food requirements. The Licensee agreed that payments may have been late in 2021, but that she is working on correcting this by hiring a new bookkeeper and incorporating each facility independently to avoid having to pay each facility bills one by one. The licensee further explained that all food receipts may not have been provided, which may be the reason for the low food costs. It was agreed that financial monitoring will continue six months from now with a smaller one-month audit. The licensee would provide all requested documents for only the month of September of 2022 to DSS Audits section by October 20,2022. The Licensee will submit applications to Licensing by next week to incorporate her facilities. The Licensee will also submit letters to Licensing and facility clients regarding the incorporation of the facilities by close of business on Tuesday 4/5/2022. The Licensee was encouraged to reach out to the Department should there be any questions regarding receipts to submit. An exit interview was conducted with Licensee Marinela Placintar and copy of this report was provided via email.the state’s words, verbatim · CDSS document, Mar 30, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Jason Lund made an unannounced visit on this day for the purpose of conducting a Case Management visit. LPA Jason Lund met with Administrator Bianca Placintar and explained the reason for the visit. On 6/9/2021 an Office meeting was held with the Licensee Marinela Placintar, the RO and DSS Auditors. During the meeting, the RO explained audit finding and expectation of financial monitoring for one year. Licensee Placintar was advised of documents needing to be provided to the Audits Department along with the dates expected to submit to the Department. The Audits Department also sent emails to Licensee Placintar reminding of the deadlines. The documents required for the solvency monitoring are as follows: 1. LIC 401-Monthly operating statement for Golden Age 5 & 6 & 10; 2. The food receipts showed the food delivered to Golden Age 10. How many residents reside at Golden Age 10 located at 3213 Inverness St, Modesto, CA; 3. Electricity Bill dated in August 2021; 4. Water Bills for the period July – September /2021 for all the facilities; 5. Bank statement account ending 3545 for July 1 – July 31/2021; 6. Xfinity Cable bills for the period July – September /2021 for all the facilities; 7. Water bills for the period July – September /2021 for all the facilities; 8. Food receipt for Golden Age 1 _ September 2021. These documents were to be submitted quarterly and were due for the third quarter on October 15, 2021. As of this date, these documents have not been received. The following deficiencies were cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted with Administrator Bianca Marinela and a copy of this report along with appeal rights was provided.the state’s words, verbatim · CDSS document, Jan 26, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87755(c) · Plan of correction due date: Feb 4, 2022

The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). This requirement is not met as evidenced by: The Department requested paperwork from the license by 10/15/21 and did not receive paperwork . This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 26, 2022

Plan of correction: Licesnsee will turn requested paperwork by 2/2/2022

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Arlene Garcia arrived at this facility unannounced to conduct a case management visit. LPA met with Colin Falconer, Caregiver (S!) and explained the purpose of the visit. LPA Garcia toured the facility with S1. COVID wellness check conducted. Sufficient PPE supplies. LPA observed comfortable living accommodations. LPA observed 2-day perishable and 7-day non-perishables. LPA observed lights functional. During this visit, it appeared that staff was sufficient. S1 reported there was a sufficient number of staff. S1 reported S1 gets paid on time. S1 reported S1 had no issues or concerns. LPA advised Ken Roy Anderson, House Manager S2 that the Department is performing Golden Age facilities 3rd quarter, 2021 financial monitoring review. LPA requested the Administrator provide the following documents for period July - September / 2021. Administrator AD to submit to the Department no later than the close of business day on Monday January 3rd, 2022. 1. LIC 401/401A Form for the month of September 2021. 2. LIC 403/403 A Form for the month of September 2021. 3. All utility monthly billing statements including cable, water, garbage, electricity and gas for the period from July 2021 to September 2021. 4. Monthly Bank Statements for period from July 2021 to September 2021. 5. All food receipts for all the facilities for period from July 2021 to September 2021 6. Rental Roll including resident name and rental payment for the period from July 2021 to September 2021. Exit interview conducted with Ken Roy Anderson, House Manager S2. . Copy of report provided.the state’s words, verbatim · CDSS document, Dec 30, 2021

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Arlene Garcia conducted an unannounced annual / Infection Control visit on this date. LPAs were greeted by Thurmeta Smith, Caregiver. LPAs met with Administrator, Marinela Placintar and Caregiver (S1), Jevonnie Smith LPA and S1 inspected physical plant including but not limited to the main kitchen, residents bedrooms and bathrooms, laundry room, and dining room area. LPA observed sufficient seven days non-perishable and two days perishable food supplies in the main kitchen. LPA and S1 observed centrally stored medications. Hot water temperature was measured in residents' bathroom with the Administrator and measured at 117.1 degrees which is in the required range of 105 to 120 degrees. LPA observed there was a Carbon Monoxide monitor in facility. LPA observed cabinet under sink in kitchen locked. LPA observed sharps locked in pantry closet. LPAs verified the last FireDrill was conducted July 2021. Fire extinguisher maintained on 5/5/21. Cont on 809-C >>>>>>>>>>>>>>>>>>>>>>> LPA observed hospital bed in R1 room. S1 confirmed R1 is not on hospice. LPA reviewed R1 file and found no doctors note issuing the use of a hospital bed. Staff and visitors enter the facility through ringing the locked front door, sanitizer and thermometer were observed. COVID signs posted in front entry way. Sign in sheets were observed to document date, visitors name, and temperature. Sign in sheets did not include symptom screening for reporting requirements to public health officer and contact tracing. LPA was greeted by both S2 and S3. Routine symptom screening (+/- temperature and symptom check) was not initiated at entry until prompt by the LPA. LPA reviewed 3 staff files and 4 resident files. While reviewing files, LPA observed two staff file missing Health Screen. All 3 staff have their TB completed. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited today in violation of California Code of Regulations. Exit interview held with Marinela Placintar and a copy of report given at the conclusion of the visit.the state’s words, verbatim · CDSS document, Aug 5, 2021

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Aug 5, 2021

87468.1 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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This regulation was not met by evidence by: Caregiver that allowed the LPA to enter did not complete routine symptom check This poses an immediate risk to the residents.the state’s words, verbatim · CDSS document, Aug 5, 2021

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Aug 5, 2021

87411(f) (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This regulation was not met by evidence by: LPA reviewed the staff files. Two staff dod not have a completed Health Screen. This poses an immediate risk to the residents in care.the state’s words, verbatim · CDSS document, Aug 5, 2021

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Aug 5, 2021

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). (As identified in 87101: (E) Maintenance of house rules for the protection of residents) This regulation was not met by evidence by: A sign-in policy was not enacted with all visitors to ensure compliance with central entry point for symptom screening and to record contact information (for reporting requirements to public health officer and contact tracing).the state’s words, verbatim · CDSS document, Aug 5, 2021

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Aug 5, 2021

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. (A) Physician-prescribed orthopedic devices such as braces or casts, used for support of a weakened body part or correction of body parts, are considered postural supports. This regulation was not met by evidence by: LPA observed a hospital bed in R1 Room. LPA reviewed R1 file and no documentation in staff file.the state’s words, verbatim · CDSS document, Aug 5, 2021