Kamstra Care Home

Allegation investigated: Resident developed a pressure injury while in care Facility did not notify resident's family of change in resident's medical condition

Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced subsequent complaint visit to deliver the findings of the investigation into the above allegations. LPA Velazquez was allowed entry into the facility and met with Administrator (ADMIN) Runette Catibog and explained the purpose of the visit. On today's visit LPA Velazquez along with ADMIN Catibog looked in on the 6 residents in care. The residents appeared well-groomed and well-cared for. One resident was watching TV in the living room, the other 5 residents were either sleeping or resting in their rooms. During the course of the investigation the following was revealed: Regarding the allegation: Resident developed a pressure injury while in care, LPA Velazquez conducted interviews with the complainant, Resident (R) #2’s family, residents, and staff. LPA Velazquez also reviewed and obtained copies of pertinent documents. The records reviewed included medical records from Los Alamitos Medical Center including photographs taken in the Emergency Department of R2’s pressure injuries, PIH Hospice of Presbyterian hospice records, Physician’s Reports, Advanced Health Care Directive, Substantiated Resident Appraisals, Preplacement Appraisal Information forms, and Admission Agreements. R2 was sent out to the hospital on September 22, 2022 due to difficulty breathing. At Los Alamitos Medical Center R2 was diagnosed with Acute Cystitis, Acute Hyperglycemia, Severe Anemia, Severe Sepsis among other conditions. While at Los Alamitos Medical Center additional consultation by a Social Worker was requested due to the presence of a pressure injury on R2’s sacral region as well as redness on one of R2’s heels. Four of four individuals interviewed were able to corroborate the allegation: Resident developed a pressure injury while in care. Regarding the allegation: Facility did not notify resident's family of change in resident's medical condition the following was revealed: LPA Velazquez conducted interviews with the complainant, Resident (R) #2’s family, residents, and staff. LPA Velazquez also reviewed and obtained copies of pertinent documents. The records reviewed included medical records from Los Alamitos Medical Center including photographs taken in the Emergency Department of R2’s pressure injuries, PIH Hospice of Presbyterian hospice records, Physician’s Reports, Advanced Health Care Directive, Resident Appraisals, Preplacement Appraisal Information forms, and Admission Agreements. When interviewed two of two facility staff stated R2 had no pressure injuries prior to being sent out to the hospital. R2's facility documentation indicated R2 "no bed sores" which Administrator Catibog confirmed. R2's family first became aware of R2's pressure injuries in the Emergency Department when R2 was transported via ambulance to Los Alamitos Medical Center on September 22, 2022. Per Administrator Catibog an Unusual Incident/Injury Report (LIC 624) was not submitted to Community Care Licensing Division pursuant to statute and regulation regarding R2's hospitalization. Based on the observations of LPA Patricia Velazquez, interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegations: Resident developed a pressure injury while in care and Facility did not notify resident's family of change in resident's medical condition are deemed SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D. An exit interview was conducted with Administrator Runette Catibog and a copy of this report along with the appeal rights, LIC 811, and LIC 9098 were provided at the time of this visit.the state’s words, verbatim · CDSS document, Jan 24, 2023 · control 22-AS-20220923152100

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Jan 25, 2023

Basic Services. 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). This requirement is not met as evidenced by: based on record review and interviews the licensee did not observe R2's change in condition with R2's pressure injuries. This poses an immediate risk to the health & safety of residents in care.the state’s words, verbatim · CDSS document, Jan 24, 2023

Plan of correction: The Licensee will provide staff an in-service training regarding this regulation by 01/25/23. Licensee to provide the name of the instructor, their qualifications, and submit written proof of the staff training to LPA by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Jan 25, 2023

Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional...and that appropriate assistance...when such observation reveals unmet needs...licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person (RP). This requirement is not met as evidenced by: based on record review and interview the licensee did not observe R2's pressure injuries and did not notify R2's RP. This poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jan 24, 2023

Plan of correction: The Licensee will provide staff an in-service training regarding this regulation by 01/25/23. Licensee to provide the name of the instructor, their qualifications, and submit written proof of the staff training to LPA by POC due date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced Case Management visit to Kamstra Care Home. LPA Velazquez met with Administrator Runette Catibog. During the complaint investigation visit with Complaint Number: 22-AS-20220923152100, LPA Velazquez questioned ADMIN Catibog regarding the facility's lack of submission of an LIC 624 Unusual Incident/Injury Report for R2's hospitalization on September 22, 2022. ADMIN Catibog confirmed that an LIC 624 was not submitted to Licensing pursuant to statute and regulation. LPA Velazquez printed Title 22 Regulation Section 87211 Reporting Requirements and provided Administrator Catibog with consultation regarding adherence to this regulation. LPA Velazquez also advised ADMIN Catibog to participate in the Provider Informational Calls as well as staying abreast with the Provider Information Notices (PINs) which can be found on the CCLD website. Deficiencies cited under California Code of Regulations Title 22 Division 6 Chapter 8. An exit interview was conducted with Administrator Runette Catibog and a copy of this report along with the appeal rights, LIC 811, LIC 9098 and were provided at the time of this visit.the state’s words, verbatim · CDSS document, Jan 24, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(A-D) · Plan of correction due date: Jan 31, 2023

Reporting Requirements. Each Licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident seven days of the occurrence of any of the events specified in (A) through (D) below. This requirement is not met as evidenced by: based on record review and interview the Licensee did not submit an LIC 624 for R2's hospitalization.the state’s words, verbatim · CDSS document, Jan 24, 2023

Plan of correction: The Licensee to ensure written reports are submitted to the Department pursuant to this regulation. The Licensee to provide LPA a written statement indicating they have read this section of Title 22 regulation and how exactly they intend to adhere to it by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) conducted an unannounced visit for the purpose of conducting a Required 1 Year inspection. LPA was greeted and granted entry by Care staff Jamil Razon and reason for visit was explained. LPA Frank toured the facility. There are 5 residents residing in the facility and no active COVID-19 cases. LPA observed 5 residents on site appeared clean and well taken care and 1 resident is receiving hospices care. LPA observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed had ample soap/ sanitizer and appeared clean. Resident bedrooms appeared clean and sanitary. LPA observed 2 day supply of perishables and 7 day supply of non-perishable food is available for the number of residents present. Hygiene supplies and supply of linen were observed in quantities for the number of residents in care. LPA observed locked areas for toxins and hazardous items. Medication were observed locked in cabinet. LPA observed Facility’s physical plant, hallways appears to be clean and free of debris, free of odor. Sufficient lighting observed throughout the facility. No bodies of water, weapons or ammunition on premises. In addition, LPA Frank tested the hot water temperature, which measured 107.1 degrees F in resident bathroom. Resident areas were noted to be a comfortable temperature. Smoke detectors and carbon monoxide detector were tested and are operational. Fire extinguishers were fully charged. Fire drill was conducted on 5/18/22. Facility stove, oven, microwave, refrigerator, washer and dryer are clean and operational. LPA observe the facility to be clean and in good repair. LPA Frank reviewed Emergency Disaster Plan (LIC610E); LIC 9020A Client Roster; LIC 808) Mitigation Plan and Current Liability Insurance; Designation of Administrative Responsibility (LIC308) and Personnel Report (LIC500). Based on the observations made during today’s visit, no deficiencies are being cited in area inspected. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Aug 2, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Shobhana Frank made an unannounced visit to the facility today to conduct required 1 year inspection. During today’s visit, LPA met with Administrator Runette Catibog and explain the purpose of today's visit. LPA Frank toured the facility, inspected resident rooms and bathrooms, reviewed resident and staff records. LPA Frank reviewed centrally stored medications and records, reviewed food services, and inspected the kitchen. In addition, LPA Frank tested the hot water temperature, which measured 108.8 degrees F in resident bathroom. Resident areas were noted to be a comfortable temperature. Smoke detectors and carbon monoxide detectors were tested and found to be operational. The facility also has fire extinguisher that was mounted and charged. LPA Frank confirmed food supply: 2 day supply of perishables and 7 day supply of non-perishable food is available for the number of residents present. Hygiene supplies and supply of linen were observed in quantities for the number of residents in care. LPA observed locked areas for toxins and hazardous items. Medication were observed locked in cabinet. LPA observed COVID - visitation station equipped with hand sanitizer, thermometer, Gloves, visitors log, COVID posters throughout the facility. Every week the facility conduct COVID testing for residents and staff. LPA observe the facility to be clean and in good repair. Physical Plant and Safety of Environment/Operational Requirements. LPA Frank reviewed : 1.) Designation of Administrative Responsibility (LIC308) 2.) Personnel Report (LIC500); 3.) Emergency Disaster Plan (LIC610E); 4.) LIC 9020A Client Roster; LIC 808) Mitigation Plan; Current Liability Insurance. Based on the observations made during today’s visit, no deficiencies are being cited in area inspected. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Sep 2, 2021