Hope Home Care for Elderly

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Cynthia Chan conducted a case management visit to interview staff. LPA met with Staff, Peter Kim, and explained the purpose for the visit. LPA obtained a copy of the personnel record and interviewed Staff #1 who was on duty. No deficiency was issued. A copy of this report was given to the staff.the state’s words, verbatim · CDSS document, Oct 10, 2023

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management Visit on 6/30/23, regarding an incident that occurred at Happy Home Care for Elderly and is owned by Licensee Jung Kim. LPA Ramirez gained entry into the facility at 10:25 am. LPA Ramirez was greeted by Licensee/Administrator Jung Kim and LPA explained the purpose of the visit. The facility is licensed to serve residents 60 years old and older and has a fire clearance for four (4) ambulatory and two (2) non-ambulatory. The facility is currently approved for six (6) hospice residents. LPA Ramirez and Licensee Kim conducted physical plant tour at 10:33 am Case Management Findings: · Minimum of two (2) day supply of perishable food was not observed on the premises. · Resident Room #1 was observed to be shared. LPA Ramirez observed a 7ft x 14ft beige room divider and a white door that led into a makeshift spare bedroom. LPA Ramirez observed a twin sized framed bed with one (1) mattress, one (1) pillow and five (5) drawers attached to the bottom of the frame, and two standing dressers. No linen was observed on the mattress. LPA Ramirez observed an empty, clear, three (3) drawer plastic cubby located next to bed. LPA Ramirez observed a sliding door that leads to the backyard from this makeshift spare room. Entry into this makeshift spare room can be accessed through resident room#1 door entry and sliding door entry from backyard. Per Licensee Kim, former staff would stay in this area but, the area is now being utilized by the residents currently occupying bedroom#1 as an extra area to rest. LPA Ramirez observed facility sketch plan posed in dining room area. Facility sketch does not reflect observations made by LPA Ramirez in resident bedroom #1. Facility sketch also states “two (2) non-ambulatory” and does not reflect room would be utilized for staff or as a spare room for residents. This licensing agency did not receive prior request or notification of construction or alteration to facility. SEE 809-C for continuation · LPA Ramirez observed auditory devices in “OFF” mode and not operable during visit. LPA Ramirez advised staff and licensee to keep auditory devices in “ON” mode. LPA Ramirez observed auditory device on outside of dining room sliding door to be secured with clear tape. Staff later secured auditory device according to it’s original design. · Copy of Certificate of liability insurance provided to LPA Ramirez on 6/30/23 does not meet liability limits. Exit interview is being conducted with Licensee Jung Kim and a copy of this report, 809-D, and appeals rights was provided.the state’s words, verbatim · CDSS document, Jun 30, 2023

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.605 · Plan of correction due date: Jul 1, 2023

1569.605 Liability insurance; coverage requirements On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidence by: Copy of Certificate of liability insurance provided to LPA Ramirez on 6/30/23 does not meet liability limits.the state’s words, verbatim · CDSS document, Jun 30, 2023

Plan of correction: Licensee agreed to submit plan by 7/01/23 to address liability insurance. Proof of liability insurance that meets liability limits per HSC 1569.605 must be submitted to LPA by 7/10/23.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87555(26) · Plan of correction due date: Jul 1, 2023

87555 General Food Service Requirements (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidence by: Minimum of two (2) day supply of perishable food was not observed on the premises.the state’s words, verbatim · CDSS document, Jun 30, 2023

Plan of correction: Licensee will maintain nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. Licensee will provide LPA Ramirez receipt of perishable food supply for a minimum of two days for six residents. Must be submitted via email to LPA by 7/1/23.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(j) · Plan of correction due date: Jul 1, 2023

87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement is not met as evidence by: • LPA Ramirez observed auditory devices in “OFF” mode and not operable during visit. LPA Ramirez advised staff and licensee to keep auditory devices in “ON” mode. LPA Ramirez observed auditory device on outside of dining room sliding door to be secured with clear tape. Staff later secured auditory device according to it’s original design.the state’s words, verbatim · CDSS document, Jun 30, 2023

Plan of correction: Licensee will develop a plan to re-train staff on the importance of keeping auditory devices to "ON" mode. Proof of staff receiving training must be submitted to LPA Ramirez by 7/7/23 via email.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87305(a)(b) · Plan of correction due date: Jul 14, 2023

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. (b) The licensing agency may require the facility to acquire a local building inspection where the agency determines that a suspected hazard to health and safety exists. This requirement is not met as evidence by: Resident Room #1 was observed to be shared. LPA Ramirez observed a 7ft x 14ft beige room divider and a white door that led into a makeshift spare bedroom. Facility sketch also states “ two (2) non-ambulatory” and does not reflect room would be utilized for staff or as a spare room for residents.the state’s words, verbatim · CDSS document, Jun 30, 2023

Plan of correction: Licensee agreed to contact local code enforcement to obtain permit or inspection to ensure divider wall is safe and does not pose a potential risk to residents in care, staff or visitors. Licensee agreed to take down divider wall if permit or inspection could not be obatined by 7/14/23. Proof must be submitted to LPA Ramirez by 7/14/23 via email. Licensee agreed to refrain from using this makeshift room until code enforcement or this licensing agency grants approval.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(C) · Plan of correction due date: Jul 7, 2023

87307 Personal Accommodations and Services (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidence by: LPA Ramirez observed a sliding door that leads to the backyard from this makeshift spare room. Entry into this makeshift spare room can be accessed through resident room#1 door entry and sliding door entry from backyard. Per Licensee Kim, former staff would stay in this area but, the area is now being utilized by the residents currently occupying bedroom#1 as an extra area to rest.the state’s words, verbatim · CDSS document, Jun 30, 2023

Plan of correction: Liensee will certify in writing to this licensing agency, that residnet bedroom #1 will not be used as a passageway to another room. Proof must be submitted to LPA Ramirez by 7/7/23 via email.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced annual inspection focusing on the Infection Control Domain. LPA Pena was greeted by the caregiver Deuk Kong and was covid screened upon entry. At 1:51pm, Administrator, Jung Hyun Kim arrived and LPA discussed the purpose of today's visit. The facility is licensed to serve elderly residents, age range 60 and over. It is approved for capacity of four (4) ambulatory and two (2) non ambulatory and hospice waiver for six (6) residents. There are currently five (5) residents who are livin gin the facility, two (2) of which are non ambulatory. This single-story home contains four (4) bedrooms, three (3) bathrooms, a small office next to the dining room, a living room/activity area, dining room, kitchen, backyard, and attached garage. Annual fees are current. LPA and the Administrator toured the facility and the following was observed/inspected: The facility had a universal entrance screening area including a sign-in sheet, thermometer, and hand sanitizer. COVID-19 signage was placed in several areas including entrance and common areas. Facility maintain a 30-day supply of PPE including N-95, surgical masks, hand sanitizers, gloves, gowns, and face shields. Staff wore face masks throughout their shift and furniture was spaced for physical distancing. Facility currently has at least a 30-day supply of PPEs. At 2:15pm, kitchen was inspected and LPA observed that there was a sufficient supply of 2-day perishable foods and 7-day non-perishable foods. All kitchen appliances are clean and in working order. Cleaning solutions and sharps were locked in the cabinets and inaccessible to the residents. Hot water temperature was measured and were within the required 105-120 degrees F. At 2pm, bathroom #1's hot water temperature read at 113.2 deg. F, bathroom # 2 read at 105.2 deg. F and bathroom #3 read at 106.5 deg. F and kitchen was measured at 112.2 deg. F. All resident bedrooms contained required furniture including bed, dresser, night stand, trash bins with lid, lamp, and chair. Attached garage was inspected and used for storage and laundry area. Medications were locked and centrally stored. Medications were given as prescribed. Smoke detectors/carbon monoxide detectors were present and operable. Backyard was inspected and Indoor/outdoor passageways were free from obstruction. The backyard has a shaded area and sitting area. The activity area and backyard have been designated as the visitor area during the COVID-19 pandemic. Exit doors have auditory devices that were operating at the time of the visit. There is a fire extinguisher located in the dining room/kitchen and observed to be fully charged and recently purchased on 7/09/2022. There are no firearms being stored at this location. There are no cameras or bodies of water in the facility. Resident files were inspected, and emergency contact information and health screenings were up to date for all residents. Staff files were inspected and contained the required health screenings, criminal record clearances, and training. Administrator certificate expires on 5/15/2024. Facility has a specific plan to ensure proper cleaning and disinfection of environmental surfaces and laundry; commonly touched surfaces are cleaned and disinfected at least once every shift . Plan when to notify medical provider if symptoms develop or COVID-19 exposure or when to call 911 for severe respiratory distress. Infection Control Plan was submitted to CCLD in May 2022. No deficiencies were cited. An exit interview was conducted and a copy of this report and appeal rights were provided to the Administrator, Jung Hun Kim.the state’s words, verbatim · CDSS document, Nov 30, 2022

Allegation investigated: Staff abandoned resident at hospital.

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced follow up visit to this facility to deliver findings on the above mentioned allegation of "Staff abandoned resident at hospital". Upon arriving at the facility, LPA met with Staff / Jay Choi and was later joined by the Administrator / Jung Hyun "Eunice" Kim who assisted with the visit. LPA Katrdzhyan conducted a prior visit to this facility (telephonically) on 7/16/20, in reference to the allegation listed above. The investigation consisted of interviews of various persons to include the Administrator, Staff 1 (S1) and Social Worker from Kaiser Baldwin Park. LPA was unable to interview Resident 1 (R1) as R1 expired on 7/5/20. Also, copies of the following documents were obtained and reviewed in reference to R1; • Physician's Report • Unusual Incident/Injury Report / LIC 624 • Death Report • Prior Hospital Records from Kaiser Baldwin Park dated 6/10/2020 (Please see LIC 9099C for additional information) Unsubstantiated The investigation revealed the following; Allegation: Staff abandoned resident at hospital. The details of this allegation states that R1 was dropped off on the curb at the hospital in her wheelchair in an "altered state and confusion". No one signed R1 into the hospital and no one was with the resident. Based on interviews conducted, LPA learned that on 7/3/2020, R1 was having abdominal pain and requested to be transported to the hospital for an evaluation. The Administrator contacted the Social Worker at Kaiser, and was provided a list of transportation companies to contact and schedule a pick up for R1. Arrangements were made by the Administrator to have R1 transported to Kaiser Baldwin Park (KBP) around 4pm, using a third party transportation company authorized by Kaiser. According to the Administrator, the transportation company (name unknown) transported R1 to KBP and the Administrator along with S1 went separately using the Administrator's personal vehicle. The Administrator was unable to ride with R1 due to the situation surrounding the Coronavirus Disease 2019. The Administrator provided R1's information to the driver so that the driver could have R1 checked in upon arriving at KBP. The Administrator also contacted the Social worker at Kaiser and notified them that R1 was on her way to the ER. The Administrator along with S1 arrived at KBP approximately 10 minutes after R1 and R1 had already been checked in and being assisted inside the ER. LPA conducted an interview with the Social Worker at Kaiser and was unable to obtain details regarding R1's drop off and admission to the ER. Based on interviews conducted, the statements obtained were inconsistent and did not corroborate with the allegation of Staff abandoned resident at hospital. There is insufficient evidence to support this allegation to be true. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Jun 6, 2022 · control 28-AS-20200708105822

Allegation investigated: Facility did not refund resident Facility did not assist resident with self administered medication

Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial 10-day complaint visit to investigate the above allegations. LPA met with S-1/Facility Administrator and discussed the purpose of today's visit. During this investigation, the following occured: LPA obtained a copy of the Staff schedule, list of Resident(s), reviewed Resident #1 (R-1) and Resident #2 (R-2) files and obtained relevant documentation, interviewed Staff#1/Facility Administrator (S-1) and Staff #2 (S-2). LPA attempted to interview R-1 via telephone and was unable as R-1 did not understand LPA's interview questions. LPA also interviewed R-1's family member via telephone. LPA attempted to interview Resident #2 (R-2) and was unable as R-2 has Dementia. R-1 is unconserved and does not a Power of Attorney, therefore Staff did not release any confidential information on R-1 to family members. Staff and R-1's family member interviews revealed that R-1 independently moved into this facility and resided at this facility from 12/28/2021 through 01/03/2022. Per Staff interviews, R-1 decided to move out of this facility on 01/03/2022 and took belongings and medication and moved back with R-1's family member. R-1's family member also confirmed this information. Per S-1/Facility Administrator, copies of the signed documents were provided to R-1. Refer to LIC 9099C for the continuation of this report. Refer to LIC 9099C for the continution of this report. Unsubstantiated Allegation: Facility did not refund resident. During this investigation, LPA reviewed Resident #1 (R-1) and Resident #2 (R-2) files and obtained relevant documentation, interviewed Staff#1/Facility Administrator (S-1) and Staff #2 (S-2). LPA attempted to interview R-1 via telephone and was unable as R-1 did not understand LPA's interview questions. LPA also interviewed R-1's family member via telephone. LPA attempted to interview Resident #2 (R-2) and was unable as R-2 has Dementia. Per S-1/Facility Administrator interview R-1 paid $2,000.00 out of the $3,000.00 monthly rate in cash upon admission. Per S-1/Facility Administrator interview, refunds (also noted on R-1's signed Admission Agreement) apply as follows: "1) There is no condition for refund contained in this contract other than the death of the resident. Other than this, regardless of condition, the monthly fee paid in any given month will not be refunded". Additionally, per R-1's file review, R-1 is able to handle their own cash resources. Interviews revealed that R-1 resided at this facility from 12/18/2021 through 01/03/2022. Per Staff interviews, R-1 decided to move out of the this facility on 01/03/2022 and took belongings and medication. Interviews conducted do not corroborate this allegation. Allegation: Facility did not assist resident with self administered medication. During this investigation, LPA reviewed Resident #1 (R-1) and Resident #2 (R-2) files and obtained relevant documentation, interviewed Staff#1/Facility Administrator (S-1) and Staff #2 (S-2). Staff interviews revealed Staff administered R-1's medication as prescribed and did not provide R-1 with another Resident's medication. Copies of the Medication Administration Record (MAR's) for R-1 and R-2 were provided for December 2021 through January 2022. LPA attempted to interview R-1 via telephone and was unable as R-1 did not understand LPA's interview questions. LPA also interviewed R-1's family member via telephone. LPA was unable to interview Resident #2 (R-2) as R-2 has Dementia. Interviews conducted and file review do not corroborate this allegation. Based on LPA's interviews conducted the preponderance of evidence standard has been met, therefore the allegation(s) are UNSUBSTANTIATED. Exit interview was conducted, a copy of this report and Appeal Rights were provided to S-1/Facility Administrator.the state’s words, verbatim · CDSS document, Jan 12, 2022 · control 28-AS-20220105111938

Allegation investigated: Resident fell while in care. Staff did not administer resident's medication.

Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial 10-day complaint visit to investigate the above allegations. LPA met with S-1/Facility Administrator and discussed the purpose of today's visit. During this investigation, the following occured: LPA obtained a copy of the Staff schedule, list of Resident(s), reviewed Resident #1 (R-1) and Resident #2 (R-2) files and obtained relevant documentation, interviewed Staff#1/Facility Administrator (S-1) and Staff #2 (S-2). LPA attempted to interview R-1 via telephone and was unable as R-1 did not understand LPA's interview questions. LPA also interviewed R-1's family member via telephone. LPA attempted to interview Resident #2 (R-2) and was unable as R-2 has Dementia. R-1 is unconserved and does not a Power of Attorney, therefore Staff did not release any confidential information on R-1 to family members. Staff and R-1's family member interviews revealed that R-1 independently moved into this facility and resided at this facility from 12/28/2021 through 01/03/2022. Per Staff interviews, R-1 decided to move out of this facility on 01/03/2022 and took belongings and medication and moved back with R-1's family member. R-1's family member also confirmed this information. Per S-1/Facility Administrator, copies of the signed documents were provided to R-1. Refer to LIC 9099C for the continuation of this report. Unsubstantiated Allegation: Resident fell while in care. During this investigation, LPA reviewed Resident #1 (R-1) and Resident #2 (R-2) files and obtained relevant documentation, interviewed Staff#1/Facility Administrator (S-1) and Staff #2 (S-2). LPA attempted to interview R-1 via telephone and was unable as R-1 did not understand LPA's interview questions. LPA also interviewed R-1's family member via telephone. LPA attempted to interview Resident #2 (R-2) and was unable as R-2 has Dementia. Staff interviews revealed R-1 did not fall while in care at this facility. Staff interviews revealed that R-1 resided at this facility from 12/18/2021 through 01/03/2022. Per Staff interviews, R-1 decided to move out of the this facility on 01/03/2022 and took belongings and medication. Interviews conducted do not corroborate this allegation. Allegation: Staff did not administer resident's medication. During this investigation, LPA reviewed Resident #1 (R-1) and Resident #2 (R-2) files and obtained relevant documentation, interviewed Staff#1/Facility Administrator (S-1) and Staff #2 (S-2). Staff interviews revealed Staff administered R-1's medication as prescribed and did not provide R-1 with another Resident's medication. Copies of the Medication Administration Record (MAR's) for R-1 and R-2 were provided for December 2021 through January 2022. LPA attempted to interview R-1 via telephone and was unable as R-1 did not understand LPA's interview questions. LPA also interviewed R-1's family member via telephone. LPA was unable to interview Resident #2 (R-2) as R-2 has Dementia. Interviews conducted and file review do not corroborate this allegation. Based on LPA's interviews conducted the preponderance of evidence standard has been met, therefore the allegation(s) are UNSUBSTANTIATED. Exit interview was conducted, a copy of this report and Appeal Rights were provided to S-1/Facility Administrator.the state’s words, verbatim · CDSS document, Jan 12, 2022 · control 28-AS-20220105154340

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Elizabeth Irra completed this Case Management-Deficiencies report during (2) complaint investigations. File review revealed that R-1 independently moved into this facility and resided at this facility from 12/28/2021 through 01/03/2022. During this visit, LPA observed R-1 did not have a Physician's Report on file. Per Administrator, R-1 was in the process of obtaining a Physical exam. Deficiency cited under California Code of Regulations Title 22. Refer to LIC 809D. Exit interview conducted, a copy of this report and Appeals Rights provided to S-1/Facility Administrator.the state’s words, verbatim · CDSS document, Jan 12, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a)(1) · Plan of correction due date: Jan 13, 2022

87458 Medical Assessment: (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. This standard is not met as evidency by: File review revealed that R-1 independently moved into this facility and resided at this facility from 12/28/2021 through 01/03/2022. During this visit, LPA observed R-1 did not have a Physician's Report on file. Per Administrator, R-1 was in the process of obtaining a Physical exam.the state’s words, verbatim · CDSS document, Jan 12, 2022

Plan of correction: Facility Administrator to provide a written statement as to how the facility will be in complaince with this regulation to LPA Irra by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Spencer conducted an unannounced annual inspection focusing on the Infection Control Domain. LPA Spencer met with administrator Jung Hyun Kim and discussed the purpose of today's visit. This single-story home contains four (4) bedrooms, three (3) bathrooms, a living room, kitchen, dining area, office, backyard, and attached garage. The following was observed/inspected: The facility had a universal entrance screening area; sign-in and temperature logs were maintained. COVID-19 signage was placed in several areas of the facility, except for the front entrance. There was a sufficient supply of 2-day perishables and 7-day supply of non-perishable foods. All areas were found to be clean and in good repair. Cleaning solutions and sharps were locked. Each room contained required furniture including bed, dresser, night stand, lamp, chair, and closet. All beds contained the required linens including mattress cover, fitted sheet, flat sheet, blanket, and comforter. Bathrooms contained supplies including liquid soap and toilet paper. Administrator placed paper towels in each bathroom prior to the end of visit. Facility did not maintain a 30-day supply of PPE to include masks, gowns, and face shields. Medications were locked, centrally stored, and given as prescribed. Staff wore face masks consistently throughout the shift and group activities were spaced to encourage physical distancing. Smoke detectors/carbon monoxide detectors were present and operable. A fire extinguisher was observed to be fully charged and purchased in July 2021. Client files were inspected and emergency contact information and physician's reports were up-to-date. All staff files were inspected and contained required health screenings, criminal record clearances, and first-aid/training certificates. Administrator certificate expired on 5/15/2020; however, administrator provided proof that renewal was already submitted and is awaiting certificate in the mail. Technical advisories were issued on separate LIC9102. There were no deficiencies cited. An exit interview was conducted and a copy of this report and Appeal Rights were provided to the administrator.the state’s words, verbatim · CDSS document, Nov 24, 2021

The state marks this report as 5 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.