Helping Hands

Type of visit: POC

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to the fire clearance for non-ambulatory residents. LPA met with Rosanna Mead, Administrator, and explained purpose of the inspection. Caregiver, Jomelyn Lovena, was also present. LPA and Administrator toured the facility to ensure that resident (R1) had moved to a room approved for a non-ambulatory resident. LPA observed R1's belongings to have been moved to a room that is in compliance with the fire clearance, and only the required furniture to be in room #1. Administrator confirmed that R1 moved to another room on Friday, June 30 and provided photo documentation by email on 7/3/2023 also when LPA reached out. LPA observed (3) residents to be present. Administrator stated that currently (1) resident is with family and (1) resident is at a medical appointment with a staff member. LPA did not observe any health and safety risks to residents or personal rights violations during today's inspection. LPA cleared the deficiencies issued on 5/10/2023 and on 6/1/2023. There are no deficiencies issued on this report. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, Jul 6, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a follow up case management inspection related to the fire clearance for non-ambulatory residents. LPA met with Rowena Tirasol, caregiver, and Rosana Mead, Administrator, and explained purpose of the inspection. LPA observed (1) resident to be enjoying television in the common area and a second resident to be sitting on the front porch. LPA observed (5) residents present and a hospice nurse also present with one resident. LPA stated she spoke with local fire inspector today who confirmed an inspection was made on 5/30/23 and room #1, in front, can only be approved for a non-ambulatory resident if an exit door is installed in the room as a primary exit. Fire inspector explained that the front door cannot be considered a primary exit. LPA and Administrator toured the facility and observed a glass sliding exit door in rooms #4, 5 and 6 and an exit door from Room #3. License is currently approved for (5) non-ambulatory residents, (1) of whom can be bedridden. LPA reached out to fire inspector during today's inspection to confirm if room #3 is approved for (2) non-ambulatory residents. The facility was issued a citation on 5/10/23 for a violation of the fire clearance due to resident (R1) who is non-ambulatory residing in room #1. Resident did not agree to move to another room by the POC date of 5/12/23, so a second citation is issued today. Resident agrees now that she cannot stay in a room that is not approved for a non-ambulatory resident and agrees to move to another room if approved for a second resident. Administrator to issue a 30-day eviction today should another room not be available for R1 to move into. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency is issued on the 809D page. Exit interview. Copy of report and appeal rights provided to Administrator.the state’s words, verbatim · CDSS document, Jun 1, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87202(a)(1) · Plan of correction due date: Jun 2, 2023

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.(1) Nonambulatory persons. This requirement is not met as evidenced by: Based on documentation reviewed, the Licensee did not ensure that resident (R1) who has a non-ambulatory status was placed in a resident room that was approved for a non-ambulatory resident, which poses a potential health and safety risk to residents in care. R1 did not agree to move to another room by 5/12/23, following the first citation.the state’s words, verbatim · CDSS document, Jun 1, 2023

Plan of correction: Licensee/Administrator agree to issue an immediate 30-day eviction notice to R1 in the event there is not an open vacancy at the facility in a room approved for non-ambualtory status. R1 also agreed to temporarily stay in room #3, pending confirmation from fire it is approved for (2) non-ambulatory residents. Licensee/Administrator agrees to provide a copy of the eviction notice issued to R1 to the Department by tomorrow, 6/2/23, and also provide an update if R1 moves to another room or moves from the facility.

Allegation investigated: Facility has insufficient staffing Staff failed to treat resident with dignity and respect

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint received on 4/3/2023. LPA met with Rosana Mead, Administrator, and Rowena Tirasol, caregiver, and explained purpose of inspection. LPA observed (1) resident to be watching television in the common area and (3) residents to be resting in their private rooms. Currently, there are (2) residents under hospice care. During the course of the investigation LPA interviewed, Administrator, (2) caregivers, Ombudsman, (2) individuals who know resident (R1), and resident (R1). LPA reviewed documentation including, but not limited to, R1’s physician’s report and care plans. The results of the investigation are as follows: Resident (R1) moved to the facility on/around August 2021. Resident’s physician’s report, dated 8/24/21, notes resident has a diagnosis of: Hypertension, Arthritis and chronic pain and is wheelchair bound and is able to follow instructions, communicate and does not have any memory issues or inappropriate behavior. The results of the investigation are as follows: ...cont on 9099C(1).. Unsubstantiated Allegation: Facility has insufficient staffing. Complaint alleges that resident requires (2) staff persons present at all times to assist resident. in transferring due to a diagnosis of spinal bifidus Interviews with (2) individuals who know resident (R1) well indicated they felt staffing levels were adequate for the residents at the facility, there were “always 1-2 staff” present and resident primarily needed assistance with getting to the toilet on a regular basis during the day. Care plans document that resident is wheelchair bound and needs assistance in being wheeled from point to point but can transfer from chair to bed or bed to chair on her own. Care plans also state that resident needs assistance from staff with ADL’s and handing hygiene supplies to her and assistance with showering. Staff (S2) who works full time, stated on 44/23, there are usually two staff working at the facility and in March 2023, another staff was hired to assist residents. In addition, the Administrator helps, as well as a part-time staff (S3) and (S1) is on call. Administrator and S2 stated on 5/19/23 that they are currently both working full-time at the facility with S2 is on-call during the night hours. There are no residents that wander during the night but hospice residents are checked on regularly during the night. Resident (R1) stated on 5/19/23 that there are usually at least 2 caregivers, Administrator and S2 and she always receives the help she needs when she requests it. LPA observed (2-3) staff present in February and April during prior inspections. LPA observed R1 to be wearing a pendant necklace today. Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Allegation: Staff failed to treat resident with dignity and respect. Complaint alleges that resident (R1) stated to an outside agency that she is being verbally abused and neglected.. **cont on 9099C(2).. 9099(C)(2)... A friend of R1 stated he would receive phone calls from resident on a regular basis where resident complained about one particular staff (S1) and “nit-picky” things, not directly related to care. S2 stated R1 told her she did not like caregiver,(S1), who would talk in a loud voice. S2 stated that R1 complained to her about S1 asking R1 "what's wrong with your arms". S2 stated "My understanding is that S1 told R1 "be careful with your arms" instead on one occasion, and commented "maybe R1 was very sensitive". LPA reviewed Ombudsman’s report noting that R1 stated on 4/4/23 that she moved from the facility due to a staff being “rough and abrasive”. The report states that after a few days in the new care home, resident decided to move back since she missed caregiver S2, who had taken some time off. Resident stated on 5/19/23 that S1 pulled her pants up too high and was "rough" R1 stated staff (S1) didn't get along the best but she is sure S1 is a "nice person and has her positive qualities", and she observed S1 to "be fine with other residents". R1 stated S1 never yelled but made a couple of comments she took offense to and gave the example that S1 stated her "6 year old son could do those word searches" and commented that there was nothing "wrong with R1's left arm" in a common setting, in front of other residents and staff.. R1 stated staff (S3) was very sweet and gentle and she liked her. S1 stated there was one time when resident was rude to her about when she was trying to help her put a sweater on, asserting, “Yes, I could never treat her rudely- she would scream and yell and I still never treated her rudely". A second person who knows resident stated "No, I never observed anyone to disrespect her". Based on information obtained, LPA finds the allegation to be UNSUBSTANTIATED- A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview. Copy of report provided to Administrator. cont on 9099A-C(1).. S1 stated "I was in charge of cleaning and R2 did all of the cooking- I also did dishes, floors, rooms and every time R1 used the toilet, I would clean always, using bleach, wipes, 409 and Lysol- there were no issues with sanitizing the facility". LPA toured facility several times during the investigation and observed the floors to be clean, trash to be emptied in the bathroom, and no foul odors to be present. LPA observed significantly less items to be in the common space on 5/19/23 than on previous occasions. Based on information obtained, LPA finds this allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Allegation: Staff neglected resident while in care. Complaint alleges that resident reported to an outside agency that she is neglected at the facility. Resident's friend stated he felt resident got “above and beyond care- that's the reason why we're going back". The same friend said "I saw no abuse, no neglect, the residents seemed happy and I would visit at non-scheduled times". R1 stated on 5/19/23 her care needs are always met and staff provides assistance when needed. S1 stated to LPA that R1 received a lot of attention from staff, including special food she requested, and resident was very particular and wouldn’t allow her to touch her skin, even though she always wore gloves. S1 stated that resident was polite to her but she always preferred another caregiver help her. Administrator and S2 confirmed that R1 would receive regular showers and would ask if she wanted additional showers. Administrator indicated that she would take R1 to regular scheduled appointments, hair stylist would style her hair at the facility and resident would receive assistance in ambulating to the restroom or to the outside patio area. Based on information obtained, LPA finds this allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. cont on 9099A-C(2)... 9099A-C(2).. Allegation: Staff isolated resident while in care. Complaint alleges that resident was isolated from socializing with other residents Resident's (R1) friend said he didn't believe it bothered R1 at all that other residents were bedridden and that resident would occupy her time watching tv, doing crossword puzzles, talking on the phone and smoking.Care plans dated 8/20/21 and 12/30/22 note that resident prefers to stay outside on the front porch so she can smoke, do puzzles, exercises, make phone calls, and have visitors over. Both care plans state that resident will come inside to be with other residents, during meals if desired, but also indicates that resident has her own schedule of meals at times. When asked if R1 was isolated from socializing with other residents, S1 stated "No, during lunch R1 would talk to other residents in the dining area- she wanted to be on the porch 24/7 as she liked to be outside, until about 9:00 pm, and preferred not to participate in activities with other residents. LPA observed a note entered on the care plan, on 9/30/21, that resident did not want to participate in activities. R1 stated she never felt isolated in her room and would visit with other residents during meals and other times of the day. R1 stated she likes to do word searches to pass the time. Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. On 4/19/23, an additional allegation was received about Administrator and S2 reaching out to R1 over the phone and in person, manipulating her emotionally to convince her to move back to the car home. Resident's friend stated "I guarantee that (R1) was the instigator in calling (Administrator and S1) back". A second person who knows R1 well said she visited resident approximately 2 weeks ago and resident stated she was not happy at the new facility and wanted to return to Helping Hands facility. This same person indicated that resident is currently capable of making her own decisions. Based on information obtained, LPA finds the allegation to be UNFOUNDED- meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Exit interview. Copy of report provided to Administrator.the state’s words, verbatim · CDSS document, May 19, 2023 · control 59-AS-20230403102610

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to the fire clearance for non-ambulatory residents. LPA met with Rowena Tirasol, caregiver, and Rosanna Mead, Administrator, and explained purpose of the inspection. LPA recently received an exception request for a non-ambulatory resident (R1) to be allowed to reside in a room approved for an ambulatory resident. During today's inspection, LPA reviewed the prior physician's report (LIC602) dated 8/24/21 which notes R1 is wheelchair bound and non-ambulatory. LPA also reviewed the updated LIC602, dated 3/7/23 where it also denotes R1 as wheelchair bound and non-ambulatory. LPA observed R1 to be awake and ambulating on her own in a wheelchair. Administrator and LPA contacted Sac Metro Fire Department to inquire when they could visit the facility and evaluate if the room R1 currently resides in can be approved for a non-ambulatory resident. Administrator stated to LPA that in years past, the room where R1 is staying was approved for a non-ambulatory resident and then later approved for staff use in March 2009. LPA reviewed documentation supporting this. The Department will follow up and send an STD850 to Sac Metro requesting R1's room be inspected for possible approval for non-ambulatory, as it is near an exit door. R1 moved to the facility on/around August 2021, moved out in March 2023 and returned in May 2023, and has resided in the same room the entire time. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency is issued on the 809D page. Exit interview. Copy of report and appeal rights provided to Administrator.the state’s words, verbatim · CDSS document, May 10, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87202(a)(1) · Plan of correction due date: May 12, 2023

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.(1) Nonambulatory persons. This requirement is not met as evidenced by: Based on documentation reviewed, the Licensee did not ensure that resident (R1) who has a non-ambulatory status was placed in a resident room that was approved for a non-ambulatory resident, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 10, 2023

Plan of correction: Licensee/Administrator agree to move R1 to another room that is approved for a non-ambulatory resident and place a resident who is ambulatory in R1's room. Licensee/Administrator to send a photo that resident's belongings have moved to another room by 5/12/23. Licensee reached out to Fire Dept today regarding an inspection. The Department will follow up and send an inspection request by email.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual. LPA met Rose Mead, Administrator, and staff, Rowena Tirasol. LPA explained purpose of inspection. LPA observed (1) resident sitting outside on the front patio and (3) residents to be in their rooms at the start of the inspection. The facility is licensed for (5) non-ambulatory residents, (1) ambulatory and has a hospice waiver for (3). Currently, there are (3) residents on hospice. Prior to initiating today's inspection, LPA completed required COVID-19 Department protocols, wore a surgical mask and was screened per Covid-19 precautionary measures upon entering the facility. LPA and Administrator toured the interior and exterior of the facility including the common areas, (4) private resident bedrooms (1) vacant shared resident bedroom, (2) resident bathrooms, (1) staff room, kitchen and laundry area, and office area. LPA observed the facility to be clean, in good repair and odor-free. LPA observed the bathrooms to have the necessary grab bars, non-skid flooring, paper towels and hand-washing posters. LPA observed sufficient 2+day perishable and 7+day non-perishable supply of food, and locked sharps, medications and toxins in the kitchen/laundry area. LPA observed the inside temperature to be 71*F. LPA observed games/activities on site. The fire extinguisher was last serviced on 11/14/22. Facility conducts quarterly fire drills. All staff are cleared and associated to the facility. Discussed vaccination status of residents/staff. Booster flyer was provided. LPA observed multiple Covid posters throughout as well as other required postings. LPA observed (2) unlocked gates from the outside patio and also covered seating. Administrator to ensure any donations being stored outside are picked up timely. LPA observed sufficient incontinent and PPE products on hand. Discussed PIN 23-02 issued 2/9/23. LPA observed RCFE Administrator certificate #6014576740-exp 3/18/24. LPA reviewed (2) resident files and (1) staff file and found them to be complete with current documentation, including training, completed through out approved outside vendor. LPA observed a completed Infection Control Plan and Monkey Pox Plan, also obtained through an approved outside vendor, on file. Updated copy of license printed to reflect hospice waiver for (3). LPA requested an updated copy of the LIC308, LIC500 and current liability insurance be provided by 2/17. There are no deficiencies issued during today's inspection. Exit interview. Copy of report provided.the state’s words, verbatim · CDSS document, Feb 10, 2023

Type of visit: Annual/Random

Licensing Program Analyst (LPA) Sarena Keosavang arrived at the facility unannounced on 1/19/2022 to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Administrator, Rosana Mead, and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and contacted licensee and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 Mask. Additionally, LPA were screened by facility staff upon entering the facility. LPA toured the interior and exterior of the facility together with Administrator to ensure health and safety of residents in care. LPA observed three (3) residents at the facility. Areas toured include but are not limited to: common areas, three (3) resident bedrooms, two (2) bathrooms, kitchen, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA and Administrator completed the infection control domain and facility was found to be in substantial compliance at this time. LPA requested for facility's documents such as Administrator's Certificate and LIC 308 Designation of Administrative Responsibility. LPA received copies of the documents at the facility. No deficiencies are being cited as a result of todays inspection. Exit interview conducted and copy of report left at the facility.the state’s words, verbatim · CDSS document, Jan 19, 2022

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.