Ladera Vista

Type of visit: Required - 1 Year

On 9/8/2023, Licensing Program Analyst (LPA) Alfonso Iniguez conducted an unannounced annual required visit using the CARE Inspection Tool. LPA met with Mark Cumming /Administrator. LPA explained the purpose of today’s visit. The facility is licensed to serve (6) residents ages 60 and above of which (4) may be non-ambulatory and (2) Bedridden in room #2 and #4. Facility has an approved hospice waiver for (6) residents. The facility is a single-story structure located in a residential neighborhood. It consists of (6) resident bedrooms, (4) resident bathrooms, (1) staff bathroom, living room, entertainment room, dining room, and kitchen gated pool. LPA Iniguez toured the physical plant with administrator. There were no obstructions on the premises. A locked gate around the pool was observed and to access the pool, a locked door needs to be open. A total of (3) rooms were inspected. Beds and bedding supplies were in good condition, adequate lighting was provided, and storage for the resident’s personal belongings was observed. Bathrooms were found to be within Title 22 regulations and were operational. LPA inspected rooms: #1, #2, and #3 and smoke and carbon monoxide combo are all operable conditions. The water temperature properly measured between 105°-120°F: Kitchen 105.6°F, Bathroom #1:106.9°F and Bathroom #2:107.8°F Evaluation Report Continues LIC 809-C LPA Iniguez observed the facility to be sanitary and appropriately furnished at the time of the visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps objects were stored and not accessible to residents. The kitchen was inspected and there is sufficient perishable and non-perishable food available maintained properly. All fire extinguishers were charged and were operable. A review of (3) residents' service files, (3) staff personnel files and (3) Medication Administration Records (MAR) were maintained in order. First AID kit was checked. Last facility disaster drill was on:8/16/2023. A copy of the liability insurance was provided to LPA during visit. LPA observed the facility's infection control practices. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Mark Cumming/Licensee.the state’s words, verbatim · CDSS document, Sep 8, 2023

Allegation investigated: Facility is allowing unqualified staff to provide care and supervision to residents in care.

On 05/17/23, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced complaint visit in order to acquire investigation findings for the above allegation. LPA confirmed there was no tranfer request submitted prior to S2 and S3 working at the above mentioned facility. During today’s visit LPA met with Anne Miranda, Administrator (S1) and the purpose of the visit was explained. The investigation consisted of the following: On 5/17/23 LPA met with staff #4 and toured the facility. LPA conducted interviews with Administrator and Staff Members #4-#6 and Residents #1-#6. LPA obtained and reviewed Staff and Residents roster, resident's medical assessments, their Needs and Services Plan (LIC625). LPA also obtained copies of the facilities' communication log . LIC 9099C is on the next page. Substantiated The investigation revealed the following: Allegation: Facility is allowing unqualified staff to provide care and supervision to residents in care. It was alleged that the Licensee, Mark Cummings, has been hiring underqualified staff without conducting background checks. On 5/17/23 LPA conducted interviews with the Administrator Anna Miranda, Staff #4-#6 (S4-S6) and Residents #1-6 (R1-R6). On 5/17/23 LPA conducted record reviews that confirmed that S2-S3 had not been associated with the above mentioned facility. During an interview conducted with Staff #1 (S1), it has been confirmed that S2 and S3 have been present at the facility and have been providing care to residents. According to the communication logs, there was additional proof of sufficient evidence to support that above mentioned allegation has taken place. Based on the Documents, interviews conducted with administrator and a review of the facility’s communication log, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22 Division (6) has been cited on the attached LIC9099-D. Exit interview was conducted and a copy of the report was provided to S1, administrator. The investigation revealed the following: Allegations: Residents sustained unexplained injuries while in care. Staff inappropriately touched residents in care. It has been alleged that a resident had experienced the above mentioned allegations. On 5/17/23 LPA conducted interviews with the Administrator Anna Miranda, Staff #4-#6 (S4-S6) and Residents #1-6 (R1-R6). On 5/17/23 LPA conducted record reviews of R1-R6 and interviews with S1, S4-S6 regarding the allegations listed above. Five out of Six residents (R2-R6) denied the allegations, while R1 was unresponsive. All staff members S1, S4-S6 have also denied the allegations. Therefore, there was not sufficient evidence to support that the above mentioned allegations had taken place. Based on documentation, record reviews and interviews conducted, LPA did not observe sufficient evidence to support the above allegations, therefore 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, therefore the allegations are unsubstantiated.the state’s words, verbatim · CDSS document, May 17, 2023 · control 11-AS-20230512153745

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87355(e)(2) · Plan of correction due date: May 19, 2023

(e) All individuals subject to a criminal record review..shall prior to working...in a licensed facility: (2)Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement was not met as evidenced by: Evidence obtained through LPA observation, record review and interview with staff #1 (S1). This poses a potential health and safety risk to all residents in care.the state’s words, verbatim · CDSS document, May 17, 2023

Plan of correction: LPA and Administrator have agreed that the transfer request for two staff members (S2-S3) will have been submitted on, or prior to, the POC due date to Mario.Leon@dss.ca.gov by means of either scanned documentation/photo evidence (via certified mail) or screenshot (via guardian).

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Mario Leon conducted an unannounced Annual required visit with a primary focus on infection control measures. LPA was met by Mark Cummings and the purpose of today’s visit was explained. The home consists of 6 resident bedrooms, 3 resident bathrooms, 1 staff bathroom, living room, entertainment room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place. LPA measured water temperature in bathroom #1 at 112.6 F, bathroom #2 at 113.1 F and kitchen at 116.0 F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. All doors have auditory alarms, unused (depending on census). Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. Outside grounds were toured. In ground pool was observed with gate around it. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. See LIC809C LPA advised the licensee to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. There was one (1) citation during this visit, see 809D. Technical Assistance was provided, see LIC9102. Exit interview conducted and a copy of this report was given to Mark Cummings, Licensee/Administrator.the state’s words, verbatim · CDSS document, Nov 2, 2022

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Annual/Random

On 11/24/2021, Licensing Program Analyst (LPA) Ngozi Nwaokoro conducted an unannounced visit to Ladera Vista and met with the Administrator Anna Miranda. The purpose of today’s visit was explained, to conduct the annual inspection with emphasis on Infection Control. Facility is licensed for six (6) residents, four ( 4) non- ambulatory residents and one (1) bedridden with approval for hospices waivers for six (6) residents. The facility currently has four (4) residents, some of the residents are receiving home health or hospice services. The facility does not handle any of the residents’ money. LPA Ngozi and Anna Miranda toured the physical plant, checked food service, medications, reviewed staff records and reviewed resident files for medical status and first Aid kit. The facility conducted last fire drill September 25, 2021. The home consists of 4 resident bedrooms, 1 staff bedroom, 2 resident bathrooms, 1 staff bathroom, living room, entertainment room, dining room, and kitchen. Resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid tile was in place. LPA measured water at 113.0 degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. All doors have auditory alarms. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. Outside grounds were toured. In ground pool observed with gate around it. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. No deficiencies cited during this visit. Exit interview conducted and a copy of this report was given to Anna Miranda.the state’s words, verbatim · CDSS document, Nov 24, 2021

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.