La Casa Verde

Allegation investigated: Resident was over medicated while in care. Facility does not have awake staff at night. Facility did not fulfill reporting requirements. Facility did not seek resident timely medical attention. Facility did not ensure that resident received sufficient nourishment while in care. Resident's fee increase was not clearly specified. Facility failed to issue a proper refund.

On 8/10/2023 at 9:45 AM, Associate Governmental Program Analyst (AGPA) L. Francisco and Licensing Program Analyst (LPA) A. Gomez arrived unannounced to conduct complaint investigation and deliver findings for the above allegations. AGPA and LPA met with Administrator, Leonardo Alcantara and explained the purpose of the visit. During the complaint investigation, AGPA L. Francisco obtained information, reviewed records, collected documents, interviewed staff and attempted to interview residents. Allegation: Resident was over medicated while in care. However, AGPA observed medications listed on the centrally stored medication log and medication administration record (MAR) matched the medication order's provided by R1's physician. LPA observed staff initialled MAR according to the prescription instruction. ***REPORT CONTINUED ON 9099C*** Unsubstantiated Allegation: Facility does not have awake staff at night. Based on interviews with S1 and S2, they respond to residents when residents call for help. According to S2, S2 wakes up every hour and checks on the residents. AGPA and LPA attempted to interview two residents (2) but were unable to obtain additional information. Allegation: Facility did not fulfill reporting requirements. Based on information obtained from complainant, R1 fell out of her wheelchair. However, S1 and S2 denied of the incident. AGPA reviewed discharged notes from the hospital and it did not indicate that R1 fell out of her wheel chair. Due to conflicting information, AGPA was unable to prove or disprove allegation. Allegation: Facility did not seek resident timely medical attention. Based on record review of staff daily notes, on 3/14/23, S2 observed R1 had phlegm and was congested. S2 notified R1's responsible party and suggested R1 is to be seen by the doctor. According to the staff notes, R1 was not exhibiting shortness of breath. R1 was admitted to the hospital by R1's responsible party Allegation: Facility did not ensure that resident received sufficient nourishment while in care. Based on information obtained by complainant, due to R1 being over medicated from drugs, R1 was not eating. AGPA reviewed appraisal and physician's report and both records indicated R1 is able to feed herself. However, S1 and S2 stated R1 needed assistance. AGPA obtained a copy of an order from R1's speech therapist that puree diet with honey thick liquids to be initiated on 3/2/22. Resident's fee increase was not clearly specified. Based on record review, AGPA obtained a copy of the notification and observed that R1 was given a 60 day notice of the increase due to change in condition. However, R1 was not charged of the new rate because R1 had moved out of the facility. ***REPORT CONTINUES ON 9099C*** Facility failed to issue a proper refund. Based on record review of Admission Agreement, residents/responsible parties are to provide a 30-day notice or rates will continue. AGPA discovered when R1 was admitted to the hospital by R1's responsible party on 3/14/23, R1 never returned to the facility and facility was not provided a 30-day notice. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted with Administrator and a copy of report provided.the state’s words, verbatim · CDSS document, Aug 10, 2023 · control 15-AS-20220401154732

Type of visit: Required - 1 Year

On 02/01/23 at 4:03 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Licensee/Administrator, Leonardo Alcantara and explained the purpose of the visit. Co-Licensee/Administrator, Florida Alcantara, arrived shortly after. LPA toured facility with Leonardo including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of 6 total bedrooms which 3 bedrooms are occupied by the residents and 1 bedroom is occupied by staff. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 74 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 108 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of nonperishable and 2-day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 05/05/2022. Continued LIC 809 Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 02/08/2023: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan Liability Insurance Current Administrator’s Certificate Facility Sketch Covid-19 Mitigation Plan Monkey Pox Addendum No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 1, 2023

Allegation investigated: Personal right

On 11/14/22 at 1:25pm, Licensing Program Analyst (LPA) Catherine Lin conducted an unannounced initial 10-day complaint investigation visit regarding the above allegation and delivered investigation findings. LPA met with Administrator and explained the purpose of the visit. The Department has investigated this allegation and per record review, interviews, and observation found that R1 and R2 were laughing while talking to Administrators during investigation visit. R1 stated that facility was quiet, safe, comfortable, staff were kind, and food was good. R2 stated that facility was nice and clean, and staff was good. Staff member S1 and S2 couldn't think of any unusual things recently. No witness or other information indicated that staff member is violating personal right. Therefore, the allegation is unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. No deficiency cited, exit interview conducted with administrator, and a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Nov 14, 2022 · control 15-AS-20221108162537

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) James Sampair conducted an infection control annual inspection of the facility. Upon entry into the facility, The LPA explained the purpose of the visit with Licensee and designated Infection control leader Leonardo Alcantara, who toured the inside and outside with the LPA. The LPA observed that 1 of 2 staff members were wearing facial covering. Otherwise, they followed all of the required steps necessary for visitors to control infections including asking for vaccination status and the use of a screening station near the entrance. COVID-19 signs were posted in common areas to promote hand washing and physical distancing. Staff are documenting temperature and health status of staff and residents on a daily basis. Mr. Alcantara reported that all staff and residents were fully vaccinated, including their boosters. The LPA inspected the facility inside and outside. The Licensees were providing appropriate care for the residents in a well maintained and safe environment for the most part. The LPA observed that the temperature within the facility was maintained at a comfortable temperature. However, the hot water that was at 130 degrees Fahrenheit, for which the Licensees were cited Type A violation because it was outside of the 105 to 120 degree range in Title 22 Section 87303(e)(2). There were sufficient food and water supplies, which were appropriately labelled. However, in the back yard there was a great deal of junk that needed to be removed, for which the facility was cited a Type B violation according to Section 87303(a). The Smoke and Carbon monoxide detectors were fully operational. and the fire extinguisher was fully charged and last replaced February of 2021. The facility was cited for 1 Type A and 1 Type B deficiencies, the details of which are in the LIC809-D. An exit interview was conducted and a copy of this report and copies of the Appeal Rights were provided.the state’s words, verbatim · CDSS document, Nov 12, 2021

Allegation investigated: Personal Rights - Resident's care needs were not met resulting in hospitalization.

On 8/13/2021 at 10:30am, Licensing Program Analyst (LPA) L. Francisco arrived at the facility to deliver findings on the above allegation and met with Administrator. LPA explained to Administrator the purpose of visit. The Department has investigated the above allegation. On 3/9/2021 while R1 was on a Facetime call with sister, R1’s sister observed R1 experiencing slurring words. R1’s sister called her brother to transport R1 to Kaiser Walnut Creek. Hospital records show that R1 reported a “dead leg” feeling for the past few weeks and was under observation for a possible stroke when she went into shock for unspecified reason on 3/10/2021. R1 had low blood pressure and became hypothermic with a temperature of 94.6F. R1 was transferred to the intensive care unit (ICU) and found to have urinary tract retention and a foley catheter was placed on 3/12/2021. REPORT CONTINUES ON 9099C Substantiated Emergency Department Records indicate R1’s diagnoses are Transient Cerebral Ischemia (TIA) and Right Foot Contusion. During interview, Staff 1 (S1) denied hearing R1 slur her words and was only concerned about R1 falling more often. S1 stated that R1's family is responsible in taking R1 to the doctor. S1 also stated that R1 has not seen a doctor since moving to the facility on January 31, 2019. Based on the Department's observations, interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22 is being cited on the attached LIC 9099D. A $500.00 immediate civil penalty is assessed on this day. Civil penalty determination related to serious bodily injury is pending. Exit interview conducted. Appeal Rights and a copy of this report provided. 2. Resident's toileting needs were not met On May 19, 2021, LPA Luisa Fontanilla interviewed Staff 1. S1 is the primary caregiver for R1. S1 states that R1 had a schedule to address incontinence needs. S1 states R1 gets reminded and escorted to go to the bathroom every two hours or as needed during the day until 1am. After 1am, the next bathroom reminder/escort is at 7am. In one of the photos obtained during investigation, a sign indicating bathroom schedule was observed on R1’s door. Based on interviews and observations, the above allegations are unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 13, 2021 · control 15-AS-20210401092906

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Aug 16, 2021

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs....... the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and records review, staff failed to properly observe R1 resulting in R1's hospitalization( ICU) for possible stroke, low blood pressure, hypothermia, urinary retention which poses an immediate health and safety risks to resident in care.the state’s words, verbatim · CDSS document, Aug 13, 2021

Plan of correction: Administrator agrees to review regulation and register for training with outside vendor. Administrator will submit a copy of self-certication letter and registration confirmation for training to CCL by POC date A $500.00 civil penalty is assessed.

Type of visit: Case Management - Deficiencies

On this day, Licensing Program Analyst (LPA) L. Francisco conducted a case management visit and met with the Administrator. LPA explained to the Administrator purpose of the visit. During the investigation process conducted by the Department, S1 states R1 was falling on a regular basis. S1 did not obtain medical attention for R1, even though one fall resulted in a significant cut to the back of R1’s head. Another fall resulted in the mirror on a closet door shattering. S1 was unable to provide an explanation for how the falls occurred. S1 stated R1’s family is responsible in taking R1 to the doctor. S1 stated had not seen a doctor since January 31, 2019 because the family was not taking R1. Kaiser Walnut Creek medical records did not show any visits or calls regarding increased falls or injuries until R1’s brother called on 3/8/2021 to request an appointment to have R1 evaluated. During interview conducted by LPA Luisa Fontanilla on 5/19/2021, Administrator and S1 confirmed that no incident reports were submitted to CCL for the fall incidents.the state’s words, verbatim · CDSS document, Aug 13, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Aug 23, 2021

Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility. ........... (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on interviews and record reviews, facility failed to assist R1 in arranging for medical care appropriate to R1's needs and condition. S1 states R1 has not seen R1's doctor since 1/31/2019 because the family was not taking R1. And that taking R1 to the doctor is not S1's responsibility. This poses an immediate health risk to the clients under care.the state’s words, verbatim · CDSS document, Aug 13, 2021

Plan of correction: By POC date, Administrator states Sec 87465 will be reviewed with the staff and submit self-certification indicating completion of training.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(D) · Plan of correction due date: Aug 27, 2021

a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence… (D)Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident This requirement is not met as evidenced by: On 5/19/2021, Administrator confirmed with LPA that no incident reports were submitted to CCL for the fall incidents which poses a potential risk to health and safety of clients under care.the state’s words, verbatim · CDSS document, Aug 13, 2021

Plan of correction: By POC date, Administrator states that he will review Sec 87211 and submit self-certification stating understanding of Reporting Requirements by POC date.