Jocelyn's Loving Care

Allegation investigated: Facility staff did not inform family of residents death. Facility staff did not release body to authorized representative.

Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced subsequent complaint visit to deliver findings on 08/25/2023 at 1:45pm. Upon arrival LPA met the Administrator Jocelyn Espiritu and explained the purpose of this visit. #1. Facility staff did not inform family of residents death. It is alleged that R1 daughter in law was attempting to locate R1 and found out on 10/18/22, that R1 had been admitted to Jocelyn's Loving Care and had passed away on 10/17/22. To investigate the above allegation, on 10/20/2022 LPA Tuesday Cabiness conducted interviews with the administrator and requested copies of documents relevant to the investigation between 10:30am -11:30am. On 12/28/2023 at 1:00pm LPA Lacy requested additional documents relevant to the investigation and interviewed the administrator at 1:41pm. Continued on LIC9099C. Unsubstantiated During the investigation, interviews with the administrator revealed that R1 lived at home with their Power of Attorney (POA) prior to being admitted to the facility on 08/19/2022 and was receiving hospice care prior to being admitted. Upon record review on 12/28/2022 at 1:00pm of the facility Identification and Emergency Information and Courageous Care Hospice documentation shows the only family information or responsible party listed is R1s POA. Based on interviews, observations, and record review there is not enough corroborating evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time. issued. #2. Facility staff did not release body to authorized representative. It is alleged that the administrator refused to provide the attorneys or the daughter in law information on the funeral home or the current location of R1s body. To investigate the above allegation, LPA interviewed the administrator and it was revealed that she was contacted by a paralegal from an attorney’s office questioning her about the location of R1s body, she informed the caller that the POA was informed of R1s location, and requested documentation to release the requested information to them, the caller became angry and stated, “I will just report you to licensing”. R1s POA was notified immediately upon R1s death and arrived at the facility and was present along with Courageous Care Hospice agency until R1s body was retrieved by the mortuary. Upon record review, of R1s admission agreement they were admitted to the facility on 08/19/2022 and the only person listed as a responsible party is R1s POA. R1s hospice admission records are signed and list R1s POA for contact dated for 07/29/2023. Based on interviews, observations, and record review there is not enough corroborating evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time. No health and safety hazards are noted during this visit. No deficiencies cited, exit interview conducted, copy of report and appeal rights issued.the state’s words, verbatim · CDSS document, Aug 25, 2023 · control 31-AS-20221018132814

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility at 11:10am to conduct a One (01) year Required Infection Control visit. LPA meet with the administrator Jocelyn Espiritu and explained the purpose of this visit. A tour of the physical plant was conducted at 11:17am and the following was observed: The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) posted. The PPE screening station is located at the entrance of the facility and is equipped with sufficient PPE readily accessible thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit, the facility has six (06) bedrooms. A fire clearance and a hospice waiver for (06). Fire extinguisher located in the facility have a tag dated 11/23/2022. The facility maintains a comfortable temperature of 71 degrees. The facility has an approved mitigation plan on file. Kitchen: At 11:20am LPA observed the kitchen to be clean and an adequate supply of perishables and non-perishable food located in the refrigerator, freezer and second refrigerator located in the hallway near room five (05). Food was properly labeled and stored. Sharps were observed to be locked and stored in a small lock box on the kitchen counter. Toxins and cleaning supplies observed to be locked and stored under the kitchen sink. Food storage and preparation areas are clean and inaccessible to pests. The emergency food is stored in a cabinet located adjacent to the kitchen. Trash cans observed to be with tight fitting lids. Kitchen appliances observed to be operational and in good repair. Medication: At 11:37am the medication cart was observed to be locked and located in the hallway near room (01). At 11:46am LPA observed the First Aid Kit and Manual located in a cabinet cupboard in the hallway near room (01), also storing extra wash and bath towels. Continue on LIC 809C Laundry Room: At 11:44am LPA observed the laundry room to be locked located near room (01) observed to be clean and clear from obstruction and storing toxins, poisons, and laundry supplies. Storage Cabinets: LPA observed two (02) storage cabinets near room (06) at 11:48am. Storage (01) has PPE, incontinent supplies and personal care items, storage (02) has extra linens, mattress pads and comforters. Bedrooms: At 11:57am LPA observed (06) bedrooms, bedroom (06) is designated for staff. All bedrooms observed to be clean, properly furnished with appropriate bedding and linens and sufficient lighting. LPA observed auditory alarm on the door in bedroom (01). Bathrooms: LPA observed three (03) out of (04) bathrooms at 12:10pm. (02) out of (04) bathrooms are located in room (01) and (04), bedroom (04) is vacant and not being utilized. All bathrooms observed to be clean and in good repair and appropriate grab bars and non-slip skid mats. The hot water temperature measured at 108.4 between 110.7 degree Fahrenheit. LPA observed appropriate hand washing signs posted in each bathroom, with paper towels and hand soap, hand towels and washcloths are not shared. Living, dining room and common areas: At 12:17pm LPA observed all areas to have sufficient tables and chairs for seating with sufficient lighting. Living room sofa and love seats observed to be in good repair clean and clear from obstruction. Activities observed to be stored on a shelf in the living room. Surrounding grounds: LPA observed the outside and surrounding ground of the facility at 12:23pm observed to have a shaded area with tables and chairs for seating, observed to be clean and clear of debris. The facility has an attached garage observed to be locked and storing old bed furniture, wheelchairs, medical equipment and incontinent supplies. At 12:29pm LPA tested and observed the carbon monoxide detector located on a wall in the dining room to be operational and functioning properly. Smoke alarms are interconnected they were tested and observed to be operational and functioning properly. No bodies of water observed on the property. No deficiencies cited, Exit interview conducted, copy of report issued.the state’s words, verbatim · CDSS document, Dec 28, 2022

Allegation investigated: . Staff did not fill/reorder resident's medications for an extended period of time 2. Staff did not give resident medications according to physicians' orders 3. Resident is paying for services not received 4. Facility did not maintain a resident's medication list 5. Staff member made an inappropriate comment to resident 6. Staff member pushed resident resulting in resident falling 7. Resident is paying for services not received

Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit, to deliver the final findings of the allegations mentioned above. LPA met with Administrators Jocelyn and Christopher Espiritu, who was informed the reason of the visit. The following was determined: Allegation # 1: Staff member pushed resident resulting in resident falling. On July 26, 2021, from 930am to 1245pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews and reviewed facility and resident records. Based on information obtained, resident # 1 (R1) tried to hit staff # 1 (S1) with a shovel. S1 attempted to block R1 from being hit with the shovel, and in the process of blocking the shovel, S1 inadvertently bumped R1, causing R1 to fall on the ground. Both R1 and S1 are no longer at the facility, so that LPA was not unable to obtain interviews; and current residents and staff did not witness the incident. Therefore, based on interviews and documentation, the allegation is deemed UNSUBSTANTIATED. Unsubstantiated Allegation # 2: Facility does not provide a comfortable environment for resident. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records, and conducted a physical plant inspection. Based on today’s observations, and information obtained from staff and residents, the facility is always comfortable for residents, and the temperature met Licensing regulations. Therefore, based on today’s observations, and physical plant inspection, the allegation is deemed UNSUBSTANTIATED. Allegation # 3: Staff member made an inappropriate comment to resident. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. Through information obtained, LPA determined that resident # 1 (R1) caused tension and conflict with staff and other residents while living at the facility. LPA reviewed numerous incident reports, pertaining to the behavior of R1. Residents and staff who were present when R1 was at the facility, are gone, so LPA was not able to obtain further information. Current staff and residents did not witness the alleged inappropriate comment. Therefore, based on interviews and documentation, LPA determined the allegation is UNSUBSTANTIATED at this time. Allegation # 4: Facility did not maintain a resident's medication list. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. LPA observed the facility maintained resident # 1 (R1's) medication list and reviewed documentation from R1’s primary physician regarding the medication that was to be discontinued. LPA also obtained the medication administration record (MAR) obtained by the facility for R1. LPA observed no discrepancies, therefore, based on record review, LPA determined the allegation is UNSUBSTANTIATED at this time. Allegation # 7: Resident is paying for services not received. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. Information obtained and from interviews conducted, staff documented numerous incidents regarding the behavior and issues with resident #1 (R1) while in the care at the facility. It was also reported to LPA that R1 did not pay for rent for (4) months. LPA reviewed all documentation, and determined that the facility provided all services that was written in the admission agreement. LPA also determined there is insufficient evidence to prove the allegation, therefore, based on documentation and interviews, the allegation is UNSUBSTANTIATED at this time. Exit interview and copies of report provided. Allegation # 5: Staff did not fill/reorder resident's medications for an extended period of time. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. It was revealed to LPA by Administrators, that resident # 1 (R1) would drive to doctor visits alone without staff. R1 would not report or provide documentation such as any new physician or medication orders. Administrators attempted on several occasions to obtain medical information for R1. Administrators were denied any access to records and was instructed to obtain documentation from R1. R1 refused, therefore staff were not aware of current medical information for R1. It was also reported, that when staff cleaned R1’s private room, they found new medication RX’s and physician notes. Therefore, LPA determined, that R1 intentionally withheld medical information from staff, and medication stored by the facility was administered according to physician's orders. LPA was not able to interview R1, due to R1 no longer residing at the facility. Based on documentation and interviews, LPA determined there is insufficient evidence to prove the allegation, and it’s deemed UNSUBSTANTIATED at this time. Allegation # 6: Staff did not give resident medications according to physicians' orders. On July 26, 2021, from 930am to 1230pm, LPA Wendell Smith conducted interviews and obtain facility and resident records. During today’s visit, from 1130am to 315pm, LPA Tuesday Cabiness conducted additional interviews, reviewed facility, and resident records. It was revealed to LPA by staff, that resident # 1 (R1) would drive to doctor visits alone without staff. R1 would not report or provide documentation such as physician or new medication orders. Administrators attempted on several occasions to obtain medical information for R1. Administrators were denied any access to records and was instructed to obtain documentation from R1. R1 refused, therefore staff were not aware of current medical information. It was also reported, that when staff cleaned R1’s private room, they found new medication RX’s and physician notes. Therefore, R1 intentionally withheld medical information. LPA was not able to interview R1, due to R1 no longer residing at the facility. Based on documentation and interviews, LPA determined there is insufficient evidence to prove the allegation, therefore the allegation is deemed UNSUBSTANTIATED at this time.the state’s words, verbatim · CDSS document, Oct 20, 2022 · control 31-AS-20210714154341

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility at 10:30am to conduct a One (1) year Required Infection Control visit. LPA meet with the administrator Jocelyn Espiritu and explained the purpose of this visit. A tour of the physical plant was conducted at 10:38am and the following was observed: The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) posted. The PPE screening station is located at the entrance of the facility and is equipped with sufficient PPE readily accessible thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit, visitors are allowed in the facility in common areas or outside patio shaded area with tables and chairs for seating. The facility has six (6) bedrooms, one (1) is designated for staff and four (4) bathrooms. Fire Extinguisher located in the hallway near room 1 has a purchased receipt from Tashman Home Center dated 11/18/21. The facility maintains a comfortable temperature of 73 degrees. The facility has an approved mitigation plan on file. Kitchen: At 10:45am LPA observed the kitchen to be clean and an adequate supply of perishables and non-perishable food located in the refrigerator, freezer and second refrigerator located in the hallway near room five (5). Food was properly labeled and stored. Sharps were observed to be locked in a small box on the kitchen counter. Toxins and cleaning supplies observed to be locked and stored under the kitchen sink. Continue on LIC 809C Food storage and preparation areas are clean and inaccessible to pests. The emergency food is stored in a cabinet located adjacent to the kitchen. Garbage cans observed to be with tight fitting lids. Laundry Room: At 11:03am LPA observed the laundry room to be locked located near room (1)observed to be clean and clear from obstruction and storing toxins, poisons, and laundry supplies. Medication: At 11:09am the medication cart was observed to be locked and located in the hallway near room (1). At 11:12am LPA observed the First Aid Kit and Manual located in a cabinet cupboard in the hallway near room (1), also storing extra wash and bath towels. Storage Cabinets: LPA observed two (2) storage cabinets near room (6) at 11:27am. Storage (1) has PPE, incontinent supplies and personal care items, storage (2) has extra linens, mattress pads and comforters. Client Rooms: At 11:39am LPA observed (6) bedrooms (1) is designated for staff. All bedrooms observed to be clean, properly furnished with appropriate bedding and linens and sufficient lighting. Bathrooms: LPA observed three (3) out of (4) bathrooms at 11:52am. (2) out of (4) bathrooms are located in rooms (4) which is not being utilized, and room (1), The remaining (2) are for resident use, observed to be clean and in good repair and appropriate grab bars and non-slip skid mats. The hot water temperature measured at 107.6 between 111.9 degree fahrenheit. LPA observed appropriate hand washing signs posted in each bathroom, with paper towels and hand soap, hand towels and washcloths are not shared. Living, dining room and common areas: At 12:05pm LPA observed all areas to have sufficient tablesand chairs for seating with sufficient lighting. Living room sofa and love seats observed to be in good repair clean and clear from obstruction. Surrounding grounds: LPA observed the outside and surrounding ground of the facility at 12:08pm observed to have a shaded area with tables and chairs for seating, observed to be clean and clear of debris. The facility has an attached garage observed to be locked and storing old bed furniture, wheelchairs, medical equipment and incontinent supplies. No bodies of water observed on the property. At 12:15pm LPA tested and observed the carbon monoxide detector all smoke alarms in the living room, bedrooms, and hallways are operational and functioning properly. No deficiencies issued, Exit Interview conducted, and copy of report issued.the state’s words, verbatim · CDSS document, Nov 18, 2021

Allegation investigated: Facility staff neglected resident resulting in pressure injury. Staff did not provide proper care for resident.

It was alleged that resident #1 (R1) developed pressure injury on the left heel, due to staff not following physician order. During course of investigation on 05/08/2020 between 8:00am and 8:30am LPA Margaryan spoke with two facility staff. At 8:45am LPA spoke with the Administrator. Staff indicated that they were not involved in R1’s wound care. R1 developed a pressure injury on their right heel sometime in February 2019 and started to receive a wound treatment by the home health care staff. Although, staff was following nurses order and elevating R1’s foot, the wound became unstageable and was debrided by the wound care doctor. On 05/27/2019 LPA Margaryan spoke with the home health care supervisor, who verified the information received from the staff. On 06/09/2020 at 2:30pm, LPA Margaryan reviewed R1’s home health care records previously requested and received from the home health care agency. A review of medical records verified the information received from the staff. Based on interviews and record review, there is no sufficient information to support the allegation, Therefore, the allegation is UNSUBSTANTIATED at this time. Unsubstantiated -Staff did not provide proper care for resident: The complainant was alleging that staff did not provide proper care to R1 which resulting in an infection. During course of investigation on 05/08/2020 between 8:00am and 8:30am LPA Margaryan spoke with two facility staff, who was assisting R1 at the facility. Staff indicated that R1 had edema on their left leg and was receiving home health care services. Staff was trying to ensure that R1’s feet were elevated as much as possible. However, at time R1 was not cooperating and not letting staff put pillows under R1’s legs to keep their feet elevated. Sometime in November 2019, due to an accident, R1 hit their left foot on the stool and had a small laceration on left shin. R1‘s responsible party took R1 to the doctor assuming that the wound was infected. The wound was never infected. To avoid possible infection the doctor prescribed triple antibiotic treatment which was provided by the home health care providers. On 05/27/2019 LPA Margaryan spoke with the home health care supervisor, who verified the information received from the staff, a review of home health care records conducted on 06/09/2020 at 2:30pm, verified the information received from the staff. Based on interviews and record review, there is no sufficient information to support the allegation, Therefore, the allegation is UNSUBSTANTIATED at this time.the state’s words, verbatim · CDSS document, Oct 7, 2021 · control 31-AS-20200506102811

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87307(a) · Plan of correction due date: Oct 7, 2021

Personal Accommodations and Services. A facility’s buildings and grounds shall have no other purpose than those related to the care, comfort and privacy of the residents, staff, and others who may reside in the facility. This requirement is not met as evidenced by; Based on inspection, observation and interview, the licensee did not comply with the section cited above. The two live in staff are sleeping in the large closet space and on the sofa located in the common area. This poses a potential health and safety and personal rights risk to residents in care:the state’s words, verbatim · CDSS document, Oct 7, 2021

Plan of correction: Licensee has submitted a new facility sketch identifying that room number three (3) is designated as a staff room. This citation is cleared during this visit.