Liwag's Residential Care Home

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Marisela Garcia-Centeno made a Case Management visit to follow-up on a resident's death. LPA was granted entry into the facility by Administrator, Nora Liwag, to whom she disclosed the purpose of the visit. A Incident Report was received by Community Care Licensing (CCL) on August 15, 2023, informing that Resident #1 (R1) [staff was provided an LIC 811 that identifies the Resident] passed away at the facility on August 14, 2023. During today's visit, LPA conducted a health and safety check, no violations were noted during today's visit. LPA collected R1's records. An exit interview was conducted with Administrator, Liwag, to whom a copy of this report and the appeal rights (LIC9058 01/16), was provided at the end of the visit.the state’s words, verbatim · CDSS document, Aug 16, 2023

Allegation investigated: Staff did not administered medication as ordered

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint investigation visit to open an investigation and deliver findings on the above allegation. LPA was granted entry by Administrator, Nora Liwag to whom she discussed the purpose of the visit. During the investigation, the facility was briefly toured, records reviewed, and interviews conducted with staff. It was reported staff did not administer medication for one resident (R1) [an LIC 811 Confidential Names List was provided to staff to identify the resident], as prescribed. It was specifically alleged that staff crushed and disguised medication in R1’s food. Review of R1’s medication records indicated the medication was to be administered three (3) times per day. A detailed audit of the medication records for the period between February 2, 2023, to May 2, 2023, indicated the psychiatric medication in question was administered three (3) times per day. (continue LIC9099C) Substantiated (continue from LIC9099) However, during interviews the staff stated they crushed and mixed the medicine in R1’s food because the resident did not want to take it. Staff reported they tried to encourage R1 to take the medication but that R1 still did not want to take it. In addition, staff stated they had consulted with R1’s medical provider regarding R1 refusing to take medication, however, there was no physician’s order to crush medication. The Department has investigated the above-mentioned allegation and has found that there was sufficient evidence to show facility staff were not administering medication as prescribed. Therefore, this allegation is deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on LIC 9099D. A plan of corrections was developed with Administrator, Liwag. An exit interview was conducted with Administrator, Liwag and a copy of this report, Confidential Name List (LIC 811), the LIC9099D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided at the conclusion of the visit. An exit interview was conducted with Administrator, Nora Liwag, to whom a copy of this report, LIC9099D, and LIC811 Confidential list form and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, May 10, 2023 · control 08-AS-20230503121308

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(C)(2) · Plan of correction due date: May 31, 2023

87465(C)(2) Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidence by: Based on observations, interviews and records review, facility staff did not administer medications in accordance with physician’s orders for R1, which posed a potential health and personal rights risk to 1 of 4 persons in care.the state’s words, verbatim · CDSS document, May 10, 2023

Plan of correction: Licensee agreed to conduct in service training on medication management. In addition, licensee will obtain a doctor’s order to crush medication or stop crushing medication if a physician’s order is not obtained. Documentation of physician’s order and of completion of training should be submitted to CCL by POC date of 5/31/2023.

Type of visit: Required - 1 Year

Licensing Program Analyst, Amy Domingo, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA met with Nora Liwag (Licensee) and we discussed the purpose of the visit. All staff present have a current criminal record clearance. LPA conducted a tour of the facility, both inside and outside and observed the residents in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. No deficiencies were cited or observed on this date. The Licensee was provided a copy of her appeal rights (LIC9058 01/16), and her signature on this form, acknowledges receipt of these rights. An exit interview was conducted, and a copy of this report was provided to Nora Liwag.the state’s words, verbatim · CDSS document, Jul 14, 2022

Allegation investigated: Staff locks resident's inside and outside the facility.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegation. LPA was met and granted entry into the facility by Licensee Liwag to whom was explained the purposes for the visit. The Department’s investigation consisted of staff and outside source interviews, a facility tour, and a facility record review. It was alleged that the facility staff lock residents inside and/or outside the facility. An interview with an outside source (OS1) revealed a staff member (S1) was outside the facility on the front patio with a resident and could not gain access back into the facility because the door providing entrance into the facility was locked. OS1 revealed that the facility residents only had access to the living room due to a gate that blocked the residents from entering the facility kitchen, and the only access to enter and exit the facility is through the kitchen. Unsubstantiated Interviews with the Licensee revealed they were at the facility with the other residents in care when S1 was out on the patio supervising a resident, S1 did not have their keys so the Licensee allowed S1 and the resident back in. The Licensee also revealed the kitchen gate was installed temporarily. The Licensee revealed the gate was not locked, there was a latch to open and close it, and it was used to delay a resident from entering the kitchen because they touched all the food with their bare hands, and the gate had since been removed. A facility record review and facility tour revealed there were approximately 9 doors providing entrances and/or exits at the facility, and a facility tour corroborated there was no gate that blocked the kitchen. Interviews with outside sources revealed no issues with the facility entry and exit points nor had any complaints regarding the facility or staff. Based on interviews, a facility record review, and facility tour the above allegation was established to be unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted with Licensee Liwag and a copy of the Complaint Investigation Report (LIC 9099) and Licensee Rights (LIC 9058 01-2016) was provided to Licensee Liwag and signature on this report acknowledges receipt of the reports.the state’s words, verbatim · CDSS document, May 25, 2022 · control 08-AS-20201014122643

Allegation investigated: Lack of supervision resulting in client on client altercation.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegation. LPA was met and granted entry into the facility by Licensee Nora Liwag to whom was explained the purposes for the visit. The Department’s investigation consisted of staff and outside source interviews, and a facility and resident record review. It was alleged that the above mentioned incident occurred due to lack of supervision. An interview with an outside source and a record review revealed the incident was observed and addressed by facility staff. On June 30, 2020 facility staff observed R1 begin to yell at another resident (R2) and swiftly punched and kicked them one time. R1 then proceeded to their bedroom. Facility staff called R1’s Case Manager who instructed staff to call 911. The police arrived at the facility and placed R1 on a 72 hour hold. An interview with an outside source (OS1) revealed alternative placement is being pursued that can provide a higher level of care due to R1’s aggressive behavior. The facility is fully staffed and there have been no other incidents or substantiated complaints regarding lack of supervision. Unsubstantiated With no other corroborating evidence, the finding regarding the above allegation was established to be unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred. An exit interview was conducted with Licensee Liwag and a copy of the Complaint Investigation Report (LIC 9099) and Licensee Rights (LIC 9058 01-2016) was provided to Licensee Liwag and signature on this report acknowledges receipt of the reports. Based on a facility record review the above allegation is determined to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint allegation. An exit interview was conducted with Licensee Liwag and a copy of the Complaint Investigation Report (LIC 9099) and Licensee Rights (LIC 9058 01-2016) was provided to Licensee Liwag and signature on this report acknowledges receipt of the reportsthe state’s words, verbatim · CDSS document, May 20, 2022 · control 08-AS-20200706140423

The state marks this report as 4 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.