Healthy Life Service Facility

Type of visit: Case Management - Other

On 07/06/2023 Licensing Program Analyst (LPA) Evelin Rios made an unannounced visit to the facility mentioned above to have amended LIC 9099 and LIC9099-C signed for complaint control #31-AS-20221014100314. LPA met with Licensee Arusyak Ohanyan and explained the purpose of the visit. Licensee opted to sign the amended report originally signed by her administrator Armine Dishoyan. Armine Dishoyan is still the current administrator for the facility. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jul 6, 2023

Type of visit: Required - 1 Year

At 8:50 am Licensing Program Analyst (LPA), Tihesha Smith conducted an unannounced Required 1-year inspection at this facility. LPA was greeted by facility staff and disclosed the purpose of the visit. The administrator was contacted, and the Licensee and Administrator arrived later. LPA conducted a tour of the physical plant at approximately 9:30 am to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Common areas were observed for the ability to safely serve the needs residents. These included the living room and kitchen/dining combination. The common areas were checked for cleanliness and furniture was checked for functionality. Common areas observed to be furnished appropriately with adequate seating for residents. LPA reviewed the food service areas, food storage and supply (perishable and nonperishable foods). The kitchen food supply was observed and sufficient for the five (5) residents currently residing there. Two (2) days of perishable food 7 days non-perishable food observed. The freezer is stocked with meats and frozen vegetables. Sharps stored and locked in kitchen drawer and medications are stored in locked hall closet next to main entry door. Sharps and medications observed to be inaccessible to residents. There is one (1) fire extinguisher: attached to wall in kitchen. Laundry room is located through the kitchen in separate alcove area. The appliances observed to be functional. Toxins stored in cabinets across from washer and dryer and observed to be locked and inaccessible to residents. The facility has a total of five (5) bedrooms and three (3) bathrooms. The resident bedrooms were properly (Cont from 809) furnished with at least one chair, nightstand, and sufficient lighting for each resident. The bedrooms had appropriate and adequate bedding and linens such as sheets, pillowcases, mattress pads, and blankets. LPA observed a supply of linens in hall closet with a supply of hygiene products on bottom section of closet. Each bathroom has posted “wash your hands” signs and the following items available: hand soap, paper towels, and trash cans. The hot water temperature was measured for the three (3) bathrooms to ensure it is within the required range for residents’ comfort and safety. The water temperature range was between 125 -128.8 degrees Fahrenheit with hot water caution signs present. Backyard has the following: Large Gazebo with table with chairs and three (3) separate patio areas. Patio furniture observed to be in good repair No garage at facility Smoke detectors/carbon monoxide detector were tested and operable at time of visit. Facility grounds were free of hazards. There were no immediate health and safety hazard observed during the day of inspection. At approximately 11:30 pm,LPA reviewed files for the five (5) residing residents. Resident files included physicians’ assessment, needs and services appraisals. Staff files reviewed for four (4) staff. Staff files had medication training's, dementia training's, certificate including current First aid/CPR certificates. No Deficiencies cited. Exit interview conducted and reported giventhe state’s words, verbatim · CDSS document, May 21, 2023

Allegation investigated: Facility did not provide assistance to resident. Facility did not provide incontinent care to resident. Facility forced resident to sign up for hospice.

On 02/10/2023 Licensing Program Analysts (LPAs) Evelin Rios and Mariana Agban arrived at the facility to conduct a subsequent unannounced complaint investigation. Upon arrival, LPAs were greeted by administrator Armine Dishoyan. At 9:38 a.m., LPAs conducted a tour of the facility to ensure no immediate health and safety issues were present. No issues on todays visit were observed. Allegation 1: Facility did not provide assistance to resident. It is alleged staff did not assist resident #1 (R1) out of bed causing R1 to be bedbound while staying at the facility. On 10/18/2022 the LPA was able to tour the facility, interview the administrator regarding the allegation, and obtain and review pertinent information for the investigation. Administrator's interview revealed the facility confirmed staff did not assist R1 out of bed due to R1's weight and instead, staff relied on diapering R1. LPA’s review of R1’s physician report revealed R1’s nonambulatory status as based on their physical condition. Based on this information the allegation is deemed Substantiated. (9099 Continued) Substantiated Allegation 2: Facility did not provide incontinent care to resident. It is alleged R1 was only allowed 3 diapers per day. On 11/22/2022 LPA interviewed Licensee and Administrator regarding this allegation. Licensee stated that their policy is to check the residents’ diapers, in the morning, noon, night, and when needed not just 3 times a day. The administrator stated they do not change diapers and have been left alone in the facility to provide care for the residents, but no resident had needed a diaper change while she was at the facility alone. On 10/18/2022 LPA review of facilities Program states nonverbatim facility may retain a resident with manageable incontinence and the condition will be managed by the following, ensuring that the appropriately skilled professional develops the bowel and/or bladder program, if necessary, provides training to facility staff responsible for implementation of the program. R1’s records revealed an initial appraisal was not completed before R1’s admission to the facility and an incontinent care plan was not created for R1. The administrator stated there was no professionally developed incontinence care plan on file for R1. Based on the information obtained this allegation is deemed Substantiated. Allegation 4: Facility forced resident to sign up for hospice. Regarding the allegation the facility made the patient enroll in hospice. On 10/18/2022 an interview with the administrator regarding the allegation, revealed administrator and R1’s responsible party discussed acquiring "diapers" for R1. Administrator provided copies of text messages sent to R1's responsible party where the administrator states they called a hospice provider and later provided responsible party with two Hospice provider options. R1 was requesting an agency that provided physical therapy as per resident's Skilled Nursing Facility(SNF) Post Discharge Plan of Care. Review of SNF Discharge records revealed verbatim, patient will be referred to home-based palliative care. Interview with R1 revealed R1 did not believe themselves to be terminally ill and primary physician was not consulted when Hospice certification was made. Records of physician's certification for hospice benefits and physician's report revealed to have been completed by a physician other than R1's primary doctor four days after admission to the facility on 09/19/2023. R1 was admitted to facility on 09/15/2023. Based on the information obtained this allegation is deemed Substantiated. Deficiencies issued per CA code of Regulations Title 22. Appeal rights issued. Report signed and delivered. Exit interview conducted. Allegation #2: Insufficient staff to meet resident’s needs. Regarding the allegation it is alleged there was only one caregiver to assist 6 residents including R1. On 10/18/2022 the LPA was able to tour the facility and speak with three (3) out of the four (4) residents in care. LPA was also able to interview the administrator regarding the allegation. According to the Administrator, she has found it difficult to hire staff or retain staff. There are days when she has to be a caregiver or the Licensee has to stay all night as a caregiver. According to the Administrator there is usually two staff in the facility. Administrator has three full-time staff and one is on call. Residents stated that they receive immediate assistance when they call staff and they are happy with the care they receive at the facility. Based on the information obtained this allegation is deemed Unsubstantiated. No deficiencies issued, this report was signed and delivered. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 10, 2023 · control 31-AS-20221014100314

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87459(a)(4) · Plan of correction due date: Feb 24, 2023

87459(a) The facility shall assess the person's need...Such activities shall include, but not be limited to: (4)Transferring, including the need for assistance in moving in and out of a bed or chair. This requirement is not met as evidenced by: Based on an interview with the Administrator, the administrator did not comply with the section cited above by not assisting R1 out of bed during the time the resident was in the facility. Which posed a potential Health and Safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 10, 2023

Plan of correction: Resident is no longer in the facility. The regulation was addressed on todays visit. No POC required.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(4) · Plan of correction due date: Feb 24, 2023

(b) the licensee shall be responsible for the following:(4)Ensuring that bowel and/or bladder programs are designed by an appropriately skilled professional... This requirement is not met as evidenced by: Based on interview and record review, the administrator did not comply with the section cited above by not ensuring an incontinent care plan or a needs and services plan for R1 was created which posed a potential Health and Safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 10, 2023

Plan of correction: Licensee/ Administrator will identify residents in care that require a incontinent care plan and have a skilled professional develop a plan and administrator will keep plan in residents' file.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87633(a)(3) · Plan of correction due date: Feb 24, 2023

(a)...to reside in the facility and receive hospice services from a hospice agency in the facility when all of the following conditions are met: (3)Hospice agency services are contracted for by each terminally ill resident or prospective resident individually, not by the licensee on behalf of a resident or prospective resident. This requirement is not met as evidenced by: Based on an interview with the Administrator and records review, administrator did not comply with the section cited above by offering assistance in finding a Hospice agency for R1 which posed a potential Health and Safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 10, 2023

Plan of correction: Resident is no longer in the facility. The regulation was addressed on todays visit. No POC required.

Allegation investigated: Facility overmedicating residents. Facility does not offer planned activities.

On 1/19/2023, Licensing Program Analyst (LPA) arrived at the facility to conduct an unannounced subsequent complaint visit. Upon arrival, LPA was greeted by the Administrator and Licensee. LPA conducted an entrance interview, and the purpose of the visit was explained. It was alleged that the facility are overmedication residents. To investigate this allegation, LPA collected documents relevant to this investigation, such as Centrally Stored Medication and Destruction Record (LIC622) for four (4) residents, and PRN (as needed) medication log for one (1) resident. On 12/20/2022, LPA conducted a random medication count of Lorazepam, a PRN medication filled on 7/19/22 for one (1) resident. Medication count and PRN log showed that as of 12/20/22’s visit, Lorazepam had been issued seven (7) times since the fill date. Additionally, LPA conducted interviews with three (3) out of five (5) residents who were able to communicate, and all residents deny being overmedicated or issued wrong medication. Unsubstantiated An interview with the Licensee, the Administrator, one (1) staff also revealed that there have been no known issues with any resident being over medicated. Based on record review, LPA observation, and interviews, the allegation mentioned above is Unsubstantiated at this time. It was alleged that the facility does not offer planned activities. To investigate this allegation, LPA conducted an interview with the Administrator. The Administrator stated that they do offer activities to the residents, however the residents in care enjoy their privacy and are not very active. The Administrator stated that for the most part, residents deny certain activities, but they do engage in conversations, games, and TV watching in the common rooms with staff. On 12/20/22, LPA conducted an interview with three (3) out of five (5) residents who were able to communicate, and they stated that they do not care much for games or activities. They enjoy watching TV, talking to family, and enjoy their privacy and for the most part, keep to themselves. Based on interviews conducted, the allegation mentioned above is Unsubstantiated at this time. During today's visit, LPA collected an activities list/schedule. No deficiencies issued, this report was signed and delivered. Exit interview conducted.the state’s words, verbatim · CDSS document, Jan 19, 2023 · control 31-AS-20221216093123

Type of visit: Required - 1 Year

At 11:05 a.m. on 03/28/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced annual inspection. LPA met with staff and later Administrator and disclosed the reason for the visit. LPA and Administrator toured the facility inside and out. The facility was last visited on 03/08/2021 for a prelicensing inspection. The facility has an approved fire clearance for 6 non-ambulatory residents of which 1 may be bedridden in room #3 or room #4. Hospice waivers for 5 residents. The facility is a single-story building with 4 bedrooms, 2 bathrooms, living room, dining room, kitchen, laundry area, staff office, back yard, and garage. The facility serves residents with Dementia. Safety: The facility has ramps at the front door and outside of Bedroom #3 and Bedroom #4. All ramps were stable with sturdy handrails. Emergency exit paths, located on the west and east sides of the facility, were free from hazards. Emergency exit doors used inward facing, self-closing latches which were unlocked. Emergency disaster plan and emergency evacuation routes posted and clearly labeled. Auditory alarms on 4 out of 4 doors were on and functioning. A fully charged fire extinguisher hung in the kitchen. LPA observed its receipt from 03/04/2022. At approximately 11:40 a.m. LPA tested smoke and carbon monoxide detector in the living room. The detector was hardwired to others in the building, and all functioned appropriately. The facility uses a call system which signals to the kitchen. Entry: LPA entered the one main entrance. Upon entry, LPA observed a sign labeled “No Smoking - Oxygen in use”. LPA also observed a sign regarding the updated visitation policy. Screening: LPA was screened for symptoms of infectious disease upon entry. LPA observed a sign instructing visitors to wash hands upon entry. The screening station contained a digital thermometer, surgical masks, and a visitor log. Bedrooms: The facility has 4 bedrooms for resident use. Bedroom #2 and Bedroom #3 are shared. Bedroom #1 and Bedroom #4 are private. All bedrooms contained a chair, night stand, storage, and beds with adequate bedding. All bedrooms were clean and in good repair. Bedroom #1 is a private bedroom. Resident was observed resting. Bed had a half bed rail. Bedroom #2 is a shared bedroom. 2 residents were observed resting. Both beds had full bed rails. Bedroom #3 is a shared bedroom. 2 residents were in bed. Both beds had full bed rails. Bedroom #4 is a private bedroom. The bedroom was vacant. Bathrooms: The facility has 2 bathrooms. One bathroom was private to Bedroom #3. The other bathroom is located near the main entrance. Both bathrooms contained liquid soap, paper towels, handwashing instruction signs, grab bars by the toilet and shower, non-skid mats, and trash cans with tight-fitting lids. Linen closet: LPA observed a linen closet near Bedroom #1. The closet contained an adequate supply of clean towels and bedsheets. Below the linen closet, LPA observed a locked cabinet which contained hygiene supplies and razors. Laundry: LPA observed a washer and dryer in good condition. Detergents were locked in a cabinet. Staff had the keys with them. Kitchen: The facility contained adequate supplies of perishable and non-perishable food. Food was labeled with expiration dates. Stove burners were functioning properly. LPA observed a temperature log for refrigerator and freezer temperatures from the past week. Common Areas: Facility walls, floors, ceilings, windows, blinds, and window screens were all clean and in good repair. LPA observed a locked office near the dining area. The office was free from hazards. Outdoors: LPA observed patio furniture in good condition under a shaded canopy. Back yard and front yard lawns were maintained. During today's visit, the facility is in compliance with Title 22 regulations, no citations issued. Exit interview conducted. Copy of report issued.the state’s words, verbatim · CDSS document, Mar 28, 2022