Maravilla

Allegation investigated: Facility staff handled resident roughly Facility staff verbally abused Resident(s) Facility did not accord Resident(s) with dignity Facility did not meet Resident's needs Facility failed to safeguard Resident(s) belongings

On 10/10/2023, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint visit to the facility above. LPA arrived at the facility, met with Christina Martinez, LVN, as the Administrator was not available, and announced the purpose of the visit. On the allegation: Facility Staff handled resident roughly. It is alleged by the Reporting Party (RP) that Facility Staff used forceful behavior towards residents who were clearly in physical pain. RP alleged Staff were overly aggressive with forcing resident(s) to sit down in specific places. Staff would forcefully take away items from residents. RP alleged that Staff members told RP they needed to use force with residents to get them to do what the Staff wants such as changing them, seating them, etc. Staff would allegedly stand in front of a seated resident so they couldn’t get up, grabbing the residents harshly allegedly causing bruising on 2 residents on their arms. RP additionally alleged that Staff would roll the residents over in bed, smacking their faces on the metal assisting bars. Continued on 9099-C Unsubstantiated RP stated that a resident once had a chipped front tooth and Staff explained that the resident “fell” but RP was not convinced since RP had seen how forcefully residents are turned over when being changed and felt like that was the reason why the resident had a chipped tooth. On 07/13/2021, the original LPA assigned to the complaint could find no evidence through interviews with Residents, Staff, Witnesses, LPA observation, and record review to confirm that Staff had handled resident(s) roughly while in care at the facility. On 09/19/2023, a second LPA conducted interviews with Staff members and residents of the facility while investigating a separate complaint at the facility. No interview divulged any evidence that a resident had sustained an injury while in care at the facility. No resident stated they had sustained a wound in care, or ever seen another resident sustain a wound in care due to rough handling on the part of the Staff of the facility. No Staff member stated that they had ever physically mishandled/handled roughly a resident. On 09/19/2023, Record review by the second LPA did not discover any evidence that a resident sustained a wound while in care. LPA received Physicians Orders/Audits from the primary care physician of certain residents dated from September of 2023 on a consistent basis (every day to every other day/occasionally every 3 days). LPA received copies of Medical Services provided to residents, regarding any wound a resident might have received while in care. LPA also received documentation of medical examinations for residents in September 2023. LPA received a copy of residents’ discharge summary from the hospital in August and September of 2023. LPA received detailed Doctor's Progress Notes from August 2023 and September 2023. LPA also received documentation of the facility 24 Hour Chart Check for the Resident for the months of August and September 2023. Interviews with facility staff members indicated that fragile or thin skin that tears easily is a concern with individuals at a certain age, but no resident had been moved by Facility Staff resulting in a wound opening on the resident that bled. From the record review of the medical documentation, 2nd LPA found no evidence of physical marking on any residents due to handling by Staff. On 09/19/2023, LPA interviewed residents about the allegation and no resident interviewed by the LPA stated that they had been mistreated and/or treated roughly by the staff of the facility at any time while in care. There is no evidence of Staff mishandling residents in a physically rough manner. All residents interviewed by the second LPA on 09/19/2023 stated Staff members were very good with bathing procedures and the changing of linens in the residents’ rooms, this included changing residents, seating residents, etc. Staff members interviewed stated that residents are checked up on regularly/periodically and there is no time a resident would be handled roughly after requesting or needing assistance. Continued on 9099-C This is corroborated by the record review documentation of the facility call button system usage. There is no evidence to corroborate/confirm the allegation that the facility staff handled resident(s) roughly. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Facility staff verbally abused Resident(s). It is alleged that Staff members referred to the residents as the following: “They’re fucken crazy” “They have no idea what the fuck is going on” “such a bitch” “They shit so much and all they do is complain.” RP alleges that there were multiple incidents where Staff referred to the residents as: “So annoying” “I’m surprised they haven’t died yet” “They always do this shit and think we’re going to immediately run to their room when they need something” “They paged like 4 times now, they better be dying or some shit like that hahaha” “They can wait, the soiled sheets aren’t going anywhere.” “…you’ll see they’re all fucking irritating and you’ll start to hate them too” “They can’t hear shit… what’s the saying for ‘blind as a bat’ but for hearing? Hahaha.” There is no evidence to corroborate the allegation that Facility Staff verbally abused resident(s). On 07/13/2021, the original LPA assigned to the complaint could find no evidence through interviews and record review to confirm that residents had been verbally abused by Staff. On 09/19/2023, the second LPA conducted interviews with Staff members and residents of the facility. No interview divulged any evidence that a resident had been verbally abused by a Staff member while in care at the facility. No resident stated they had been verbally abused while in care, or ever seen/heard another resident verbally abused while in care. On 09/19/2023, a second LPA received documented records of the facility call button system usage for each resident from September 2023. The facility Call History documentation lists the call type: Emergency calls, Area, Room, Floor, Call Time, Wait Time, and name of the resident calling. From the documented facility call history, all resident call button usage was responded to by staff members. Wait time for each call varied depending on the type of call, as Emergency calls were responded to immediately. On 09/19/2023, LPA interviewed residents about the allegation and no resident interviewed by the LPA stated that Staff ever said anything about not wanting to assist the resident when they pressed their call button. There is no evidence of neglect by Staff during the hours recorded on the call button documentation, and there were no long wait times by residents. This evidence contradicts the alleged verbal abuse by Staff members about making residents wait for assistance. The facility call button history documentation shows that the wait times for residents in the facility did not increase in length in proportion to the number of calls a resident made on the call button sequentially. Continued on 9099-C The Call Button History Documentation shows that all residents had a wait time from less than a minute to approximately under half an hour. All residents interviewed by the second LPA on 09/19/2023 stated Staff members were very good with bathing procedures and the changing of linens in the residents’ rooms. Staff members interviewed stated that residents are checked up on regularly/periodically and there is no time a resident would be left for hours or more after having pressed the call button for assistance. This is corroborated by the record review documentation of the facility call button system usage. Through interview & record review the LPA observed that Staff are meeting the incontinence needs, changing needs, bathing needs, etc. of the resident(s) in care. There is no evidence to corroborate/confirm the allegation that Staff members verbally abused residents in care at the facility. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Facility did not accord Resident(s) with dignity. It is alleged that Staff members at the facility were pushing residents in wheelchairs when the resident clearly had their feet on the ground. It is also alleged that Staff members neglected specific residents because they were “annoying.” RP alleges to have heard the Staff members walking out behind the residents while laughing/mocking them. On 07/13/2021, the original LPA conducted an initial complaint investigation visit to the facility above. LPA found no evidence that the facility did not accord residents with dignity. On 09/19/2023, a separate LPA conducted interview, observation, and record review at the facility above. LPA found no evidence that corroborated the allegation the facility did not accord the residents with dignity while in care. There is documented evidence including interview, observation, and record review that the facility treats the residents with dignity and respect. During both complaint investigation visits by two (2) separate LPA’s, 07/13/2021 & 09/19/2023, all Staff members were observed to be treating each and every resident with dignity/respect. This included polite tone of speech & respectful manner of body language while speaking to residents, not speaking about a resident in a derogatory tone, privacy during treatment and personal care, the residents right to receive and make phone calls in private, send and receive mail unopened, and the right to associate privately with persons of resident’s choice. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Continued on 9099-C On the allegation: Facility did not meet Resident's needs. It is alleged by RP that the Staff members of the facility are rough, harsh, and neglectful with the residents. RP alleges that a resident with a history of falls requested help one day by screaming “help” when found lying on the ground. Once the Staff arrived, they stated that the resident was “faking it”. RP alleged that residents needed to be showered by Staff regardless of if they wanted to shower or not. Staff allegedly stated, “just sit them in the shower chair and shower them, it doesn’t matter if they want to shower or not.” RP alleged there were multiple occasions where residents were completely soiled in their own urine to the extent that it would go through to the sheets, therefore requiring RP to change the resident and the bed. Staff would then walk in and claim they “had just changed her and it hasn’t been that long” when that was clearly not the case. On 07/13/2021, the first LPA assigned to this complaint conducted an initial complaint investigation visit to the facility above. LPA interviewed staff members and residents in the facility. Neither staff members nor residents confirmed the allegation. Staff interviewed stated they had not observed any resident being forced into a situation they did not want to do. LPA did not observe any evidence of the allegation while at the facility. On 09/19/2023, a separate LPA conducted record review of the records/documentation for bathing for residents and the Staff logs from the facility on 09/19/2023. LPA requested & received the Call Button Logs from the facility and there is no evidence of neglect or ignoring residents by Staff during the hours recorded on the call button documentation. Additionally, there were no long wait times by residents. The facility call button history documentation shows that the wait times for residents in the facility did not increase in length in proportion to the number of calls a resident made on the call button sequentially. The Call Button History Documentation shows that all residents had a wait time from less than a minute to approximately under half an hour. All residents interviewed by the second LPA on 09/19/2023 stated Staff members were very good with bathing procedures and the changing of linens in the residents’ rooms. Staff members interviewed stated that residents are checked up on regularly/periodically and there is no time a resident would be left for 3 hours or more after having pressed the call button for assistance. This is corroborated by the record review documentation of the facility call button system usage. There is no evidence to corroborate/confirm the allegation that the facility staff are not meeting the needs of the resident(s) in care. On 09/19/2023, the second LPA interviewed residents who stated that they had never failed to have specific needs met by the Staff such as changing, bathing, cleaning linens, eating, medication management assistance, etc. On 09/19/2023, LPA obtained copies of resident medication records and physician order reports for residents, maintained in each resident’s record/file. Upon observation & record review, there were no unmet needs identified by a physician that were not being appropriately addressed by the facility Staff. Contd. 9099-C There is no documented evidence to corroborate the allegation that the facility did not meet the resident(s) needs. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Facility failed to safeguard Resident(s) belongings. It is alleged by RP that there was stealing going on in the facility. RP stated that allegedly an electric temperature checker had been stolen from the facility, and that previous thefts of resident belongings by Staff members had occurred. On 07/13/2021, the first LPA conducted an initial complaint investigation visit to the facility above. LPA conducted both Staff member & resident interviews, direct observations, and record review of pertinent information/documentation. LPA could find no evidence through interviews with Residents, Staff, Witnesses, LPA observation, and record review to confirm that facility failed to safeguard resident(s) belongings. On 09/19/2023, the 2nd LPA assigned to the complaint investigation obtained and reviewed the facility Residence and Care Agreement regarding Property Rights, Conduct & Respect of Accommodations, and the Personal Property/Theft and Loss Policy. The facility shall not be responsible for the loss of any personal property (including, without limitation, money, valuables, and other personal effects) belonging to residents, guests, or invitees, due to theft, fire, or any other cause, except to the extent the loss or damage was caused by facility negligence or intentional misconduct, including that of the Staff members. The facility strongly recommends that each resident obtain, at their own expense, insurance for the replacement value of their personal property, at adequate coverage and liability limits. This provision will survive termination of this Agreement. Residents are encouraged to carry personal property insurance to cover any loss due to fire, theft, or other casualty. A general inventory of personal belongings will be conducted at time of move-in, but the facility is not responsible for any loss of money, jewelry, or other valuables. Residents are encouraged to leave valuables/money with family members or in a bank. No witnesses interviewed indicated seeing staff take any resident property from any resident room at any time. The facility does not maintain LIC621 Client/Resident Personal Property and Valuables documentation. The facility does not maintain LIC405 Record of Client’s/Resident’s Safeguarded Cash Resources documentation. Theft of resident belongings/money will be documented and upon request by the resident, theft and loss records will be made available to governmental and law enforcement agencies. In this instance, the resident did not request any action taken on the part of the facility according to the Residence and Care Agreement. Contd. 9099-C LPA was unable to obtain any evidence of a resident missing or having any personal property stolen. No resident had any record of missing money from their bank account. The facility was unaware of any alleged missing money or missing personal property of any resident, and all Staff members interviewed stated that they had not seen or heard of any Staff member failing to safeguard residents’ belongings. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. Copy of the report provided to the facility.the state’s words, verbatim · CDSS document, Oct 10, 2023 · control 29-AS-20210709104343

Allegation investigated: Facility staff not meeting the incontinence needs of the resident(s) in care. Resident sustained injury while in care. Staff does not communicate with authorized representative. Staff failed to give medications as prescribed. Staff is insufficient in numbers/knowledge to meet the residents needs.

On 09/29/2023, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced subsequent complaint visit to the facility above. LPA arrived at the facility, met with Licensed Vocational Nurse Jessica Hernandez as the Administrator was not available, and announced the purpose of the visit. On the allegation: Facility staff not meeting the incontinence needs of the resident(s) in care. It is alleged by the Reporting Party (RP) that a resident pressed the call button for incontinence assistance but was left for three hours in a soiled diaper as no Staff member responded. RP reported that they have observed old, soiled linens in the laundry basket of the resident. On 09/21/2022, Licensing Program Analyst (LPA) conducted an initial complaint investigation visit to the facility above. Through interview of Staff members and residents, LPA observation, and record review the LPA found no evidence of the allegation that the facility Staff were not meeting the incontinence needs of the residents in care. Continued on 9099-C Unsubstantiated On 09/19/2023, a second LPA received documented records of the facility call button system usage for each resident from September 2023. The facility Call History documentation lists the call type: Emergency calls, Area, Room, Floor, Call Time, Wait Time, and name of the resident calling. From the documented facility call history, all resident call button usage was responded to by staff members. Wait time for each call varied depending on the type of call, as Emergency calls were responded to immediately. On 09/19/2023, LPA interviewed residents about the allegation and no resident interviewed by the LPA stated that they had been ignored by the staff of the facility when they pressed their call button. There is no evidence of inadequate staffing during the hours recorded on the call button documentation, and there were no long wait times by residents. The facility call button history documentation shows that the wait times for residents in the facility did not increase in length in proportion to the number of calls a resident made on the call button sequentially. The Call Button History Documentation shows that all residents had a wait time from less than a minute to approximately under half an hour. All residents interviewed by the second LPA on 09/19/2023 stated Staff members were very good with bathing procedures and the changing of linens in the residents’ rooms. Staff members interviewed stated that residents are checked up on regularly/periodically and there is no time a resident would be left for 3 hours or more after having pressed the call button for assistance. This is corroborated by the record review documentation of the facility call button system usage. There is no evidence to corroborate/confirm the allegation that the facility staff are not meeting the incontinence needs of the resident(s) in care. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Resident sustained injury while in care. It is alleged that a resident had a wound on their hand that staff re-opened when they grabbed the resident by their hand to help the resident. RP stated that the wound bled from the incident. There is no evidence to corroborate the allegation that a resident sustained injury while in care. On 09/21/2022, the original LPA assigned to the complaint could find no evidence through interviews and record review to confirm that the resident had received the wound while in care at the facility. On 09/19/2023, the second LPA conducted interviews with Staff members and residents of the facility. No interview divulged any evidence that a resident had sustained an injury while in care at the facility. No resident stated they had sustained a wound in care, or ever seen another resident sustain a wound in care. Continued on 9099-C No Staff member stated that they had ever re-opened a wound in care on a resident. Record review by the second LPA did not discover any evidence that a resident sustained a wound while in care. LPA received Physicians Orders/Audits from the primary care physician of certain residents dated from September of 2023 on a consistent basis (every day to every other day/occasionally every 3 days). LPA received copies of Medical Services provided to residents, regarding any wound a resident might have received while in care. LPA also received documentation of medical examinations for residents in September 2023. LPA received a copy of residents’ discharge summary from the hospital in August and September of 2023. LPA received detailed Doctor's Progress Notes from August 2023 and September 2023. LPA also received documentation of the facility 24 Hour Chart Check for the Resident for the months of August and September 2023. Interviews with facility staff members indicated that fragile or thin skin that tears easily is a concern with individuals at a certain age, but no resident had been moved by Facility Staff resulting in a wound opening up on the resident that bled. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Staff does not communicate with authorized representative. It is alleged that the Staff members of the facility did not let the authorized representative of a resident know about the wound on the resident’s hand that had been re-opened due to the Staff grabbing the hand of the resident. The allegation also states that there is currently no management person that a resident or family member can contact for any reason. The facility does not contact family members in cases of medical or residential emergencies. RP alleges that the facility does not know what medications they are giving to their residents who are under medication management. On 09/21/2022, LPA conducted an initial complaint investigation visit to the facility above. LPA found no evidence that the facility had no management individual that a resident or family member could contact. The Administrator was listed on the LIC 500 Personnel Report, including the hours that the Administrator would be in the facility. At the time of the LPA visit, the Administrator was present in the facility and spoken with. According to interviews with Staff members and residents, the Administrator was in contact with Authorized Representatives on a continuing basis. On 09/19/2023, a separate LPA conducted interview, observation, and record review at the facility above. LPA found no evidence that corroborated the allegation of the facility not contacting family members of residents in cases of medical emergencies. Continued on 9099-C There is documented evidence including interview and record review that the Administrator of the facility does contact relatives/representatives in cases of resident medical emergencies, and the Administrator of the facility is very open about contact with family members. This includes having signs in the facility which detail contact information the family members/representatives can use to communicate with the facility. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Staff failed to give medications as prescribed. It is alleged by RP that medications were not given to residents due to being out and were not refilled timely. RP requested if staff could let them know if the resident’s medications are current, but staff did not have knowledge of the medication. RP alleges that the facility cannot provide a record, over the course of 5 days of what medications they have provided to certain residents. On 09/21/2022, the first LPA assigned to this complaint conducted an initial complaint investigation visit to the facility above. LPA interviewed staff members and residents in the facility. Neither staff members nor residents confirmed the allegation. Staff interviewed stated they had not observed any resident being given incorrect medications. LPA did not observe any evidence of the allegation while at the facility. On 09/21/2022, LPA received documentation of daily medications given to residents, as well as the Centrally Stored Medication & Destruction Record. On 09/19/2023, a separate LPA conducted record review of the records/documentation of medication for residents and the Centrally Stored Medication and Destruction Record received by separate LPA from the facility on 09/19/2023. No errors or questionable staff marking were found in any of the resident medication documentation. LPA saw no incidents between 09/06/2022 through 09/22/2022 in which wrong medications had been documented being given to any resident. On 09/19/2023, the second LPA interviewed residents who stated that they had never been given any wrong medication at the facility or heard of any other resident receiving any incorrect medication. On 09/21/2022, LPA interviewed staff members and obtained records/documentation of medication for residents and the Centrally Stored Medication and Destruction Record. Medication records for September 2022 are documented appropriately with no inconsistencies or absence of documentation. There is no documented evidence to corroborate the allegation. No witnesses interviewed stated seeing or receiving any incorrect medications. On 09/19/2023, separate LPA reviewed the Centrally Stored Medication and Destruction Record for the assisted living portion of the facility. LPA also obtained copies of resident medication records and physician order reports for residents, maintained in each resident’s record/file. Continued on 9099-C LPA observed that all the correct/proper medications were logged as having been given to each resident, and an audit of the actual medications stored in the assisted living portion of the facility matched the records maintained by the facility. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. On the allegation: Staff are insufficient in numbers/knowledge to meet the residents’ needs. It is alleged that there are no facility staff on in the evenings or weekends that are employed by the facility. There are no caregivers that work for the facility that assist residents from Friday nights through Monday mornings. Outside agencies are trying to provide care but are minimal in their numbers. On 09/21/2022, the first LPA observed the Staff of the facility while at the facility for the initial complaint investigation visit. The LPA observed all staff members answering radio calls and attending to residents on a consistent basis. On 09/19/2023, the second LPA interviewed witnesses who indicated that staff members are attentive to the needs of residents in a timely manner at the facility. LPA did not observe any received radio call by facility staff members go unanswered or ignored. On 09/19/2023, LPA observed staff members answering all calls for assistance in a timely manner and attending to residents when/if needed. LPA did not observe any staff refusing or neglecting residents at the facility. LPA received documentation from the facility regarding employed Staff members including an LIC 500 Personnel Report and Staff schedule. LPA found no evidence to corroborate the allegation that there are not enough Staff members to meet the needs of residents in the facility. Based on the information obtained, there was insufficient evidence to prove the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted. Copy of the report provided to the facility.the state’s words, verbatim · CDSS document, Sep 29, 2023 · control 29-AS-20220913135747

Allegation investigated: Facility is in disrepair.

Licensing Program Analyst (LPAs) Mark Jeffries and Kristin Kontilis conducted an unannounced initial 10-day complaint investigation based on the above stated allegation. LPA met with Ruth Grande, Administrator and Luis Martinez, Maintenance Director and explained the purpose of the visit. Entrance interview conducted: LPAs conducted a physical tour of the facility to ensure health and safety precautions were met. At approximately 11:17 am, LPAs observed a sign posted on Elevator #1, located near the facility lobby in Assisted Living, stating the facility elevator is presently inoperable. During the visit, LPAs obtained various documents pertinent to the investigation. From 11:25 am to 2:30 pm, LPAs conducted interviews with staff and residents in care. Interviews conducted revealed that Administrator and Maintenance Director are working closely with the elevator vendor to rectify the issue of the in-operable elevators. Please continue to 9099-C, Pg 2. Substantiated Interviews conducted revealed on 2/13/2023 Resident 1 (R1) was unable to return to R1’s room after a visit within the facility on a different floor. Interviews conducted revealed R1 was detained on the separate floor for approximately 2 hours. Interviews conducted revealed on 2/11/2023 the two elevators in Assisted Living were not working properly. During LPAs' visit, Administrator stated Elevator #1 was currently out of order and Elevator #2 was out of order on 2/11/2023, 2/13/2023, 2/14/2023, and is out of order on this day. At the end of today's visit, Elevators #1 and #2 were repaired and working. However, through interviews conducted, it was discovered that the elevators were in need of modernization to avoid further repairs. Pursuant to Title 22, Division 6, Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D): Exit interview conducted. Copy of report issued and Appeal Rights issued at the time of the visit.the state’s words, verbatim · CDSS document, Feb 15, 2023 · control 29-AS-20230210144006

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Feb 22, 2023

87303(a) Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of Residents, employees and visitors. This requirement is not met as evidenced by: Based on interviews conducted, the licensee did not comply with the section cited above by Elevator 1 and Elevator 2 were not in working condition on 1/18/2023 and 2/10/2023; Elevator #2 was not working on 2/11/2023, 2/13/2023, and 2/14/2023. This posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 15, 2023

Plan of correction: Administrator agrees to develop a mobility plan for Residents on Floors 2 & 3 in the event the elevators are malfunctioning or broken. Administrator agrees to submit plan in place to LPA via email no later than POC due date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Mark Jeffries and Kristin Kontilis conducted an unannounced on-site one-year Infection Control Inspection visit to the above-named facility. LPAs arrived at 10:35 am and was greeted by Staff 1 (S1). LPAs explained the purpose of the visit. Ruth Grande, Administrator participated in the inspection at approximately 11:10 am. Also participating in the inspection visit were Luis Martinez, Maintenance Director and Mariana Pelayo, Regional Nurse. Entrance interview conducted. The facility is a three-story Residential Care Facility for the Elderly (RCFE) with a hospice waiver for 20. Currently, there are 15 residents with a dementia diagnosis, 17 residents on hospice, and 7 bedridden residents. A tour of the physical environment and accommodations were assessed, and the following was noted: LPAs observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPAs inspected the facility for fire safety, personal accommodations, and food service. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. There are two kitchens where food is prepared. Each kitchen is equipped with industrial kitchen equipment and is kept neat and clean. The facility maintains a comfortable temperature. Medications, First Aid kit, and additional first aid supplies are kept in the locked Nurse’s station. In a separate locked room within the Nurse’s station, multiple rolling medication carts are also secured. Additionally, residents’ records are kept in the locked Nurse’s station. Additional First Aid kits are stored in various areas throughout the facility including but not limited to the kitchen areas, Memory Care medication room, Administration area, Maintenance Department, and the Housekeeping Department. Residents participate independently in live entertainment and music, worship support, exercise activities, card games, lectures, Resident Council Townhall meetings, Bingo, art, reading club, pet therapy, arts and crafts, and outings to parks, restaurants, shopping excursions, and other local attractions. Please continue to 809-C, Pg 2. If any suspected or confirmed cases of COVID-19 are found in the facility a staff will be assigned to only work with those quarantined/isolated individuals and will not work with other COVID-19 negative individuals until cleared by Health Department. Staff will use full PPE with N95 masks and face shields when dealing with any pending or confirmed cases of COVID-19. Precautionary Droplet signs will be posted on any room with quarantine or isolated individuals. PPE supplies will be located immediately outside those rooms when required. Facility has a 30-day supply of PPE on hand. Facility has plans for delivering medications and meals to any quarantined/isolation resident room. The facility has proper cleaning and disinfectant sprays. Facility Administrator has a plan in place for when and whom to notify in an outbreak or other emergencies. Administrator will keep a line list of all vaccinated and tested staff/residents in care with dates/results. Facility has conducted training on infection prevention, symptoms, transmission and PPE use. Facility has non-punitive sick leave polices for staff. Staff who have a respiratory illness are requested to stay home and not report to work. Activities have been modified to individuals or small groups with social distancing. Residents' medication is delivered in 30-day supplies to the facility. The facility ensures proper cleaning is done on frequently touched surfaces and between any individuals sharing of space or items. Sinks were well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in the locked staff office. Facility observes guidance changes and the most up-to-date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. The most stringent orders should be followed by any of these agencies. Exit interview conducted. Facility is following Infection Control protocols. Copy of report issued at the time of the visit.the state’s words, verbatim · CDSS document, Feb 15, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPA's) Mark Jeffries and Kristin Kontilis, conducted a Case Management - Deficiencies visit to issue final findings and citations related to the Case Management visit conducted on 11/30/2021. LPA Jeffries and Kontilis met with Administrator, Ruth Grande. On 11/30/2021, from 9:40am to 3:20pm, Licensing Program Analysts (LPAs) Rachael De Leon and Kristin Kontilis conducted a case management visit to the facility regarding an email from the Administrator reporting the death of Resident #1 (R1) on 11/26/2021. LPAs De Leon and Kontilis met with Staff Christina Martinez, Director of Enliven Memory Care and explained the purpose of the visit. Administrator Ruth Grande arrived at approximately 12:30 pm to meet with the LPAs. The LPAs conducted staff interviews and obtained copies of documents pertinent to the investigation. The LPAs determined further investigation was needed. The case was referred to the CCL Investigations Branch (IB) and assigned to Investigator Robert Kujawa. Investigator Kujawa conducted interviews on 12/03/2021, at approximately 10:12am, with the Administrator; on 12/27/2021, from approximately 3:38pm to 4:58pm, with staff; on 06/23/2022, at approximately 1:58pm, with Staff #1 (S1); and on 07/14/2022, at approximately 1:00pm, with the Memory Care Director. In addition, Investigator Kujawa reviewed facility file documents related to R1, video footage of the facility dated 11/24/2021, and the Santa Barbara County Coroner’s Report. On 10/26/2021, R1 was admitted to the Enliven Memory Care portion of the facility. The admission assessment noted R1 had a diagnosis of dementia, hypertension, confusion, depression, no cognitive disease, and no suicidal/self-abuse behaviors. CONTINUED on LIC809-C On 11/24/2021, R1 went on an outing with a private caregiver (S1). R1 asked S1 to buy R1 some antifreeze, and S1 purchased the antifreeze. The video footage of the facility’s lobby dated 11/24/2021 at 11:55am showed R1 and S1 walking into the lobby together, with S1 holding the bottle of antifreeze. At 01:33 of the video, it shows S1 holding the antifreeze in his right hand and looking toward a facility staff member’s direction. At 01:34 of the video, it shows S1 motioning his left hand and tapping the bottle of antifreeze. On 11/26/2021, R1 was found deceased in R1’s bedroom and a bottle of open antifreeze was found under R1’s pillow. When interviewed, S1 admitted to working in the memory care field for many years. S1 stated they bought the antifreeze because R1 would not stop asking for something from the auto parts store, and then requested antifreeze once they arrived at the store. S1 stated they took the antifreeze into the facility to appease R1. S1 stated they notified two staff in the facility about the antifreeze so they would immediately remove it. However, one of the staff mentioned was later interviewed and refuted this claim, denying that they were ever told about the antifreeze; the other staff was unable to be interviewed. Interviews conducted with facility staff revealed that at least one staff observed the bottle of antifreeze in R1’s closet, and the staff tried to remove it from R1’s room but R1 yelled at the staff to get out of R1’s room. The staff stated they did not inform management about the bottle but did tell a couple of coworkers. One other staff stated they searched for the bottle in R1’s room, after the other staff informed them of the bottle, but they did not see it. Multiple facility staff members had knowledge R1 had the antifreeze bottle in R1’s room and did not notify facility management or remove the antifreeze before R1 ingested it. R1 had no vehicle to have a need for antifreeze in their possession, nor any viable reason, and had a diagnosis of dementia and should not have had access to the antifreeze. The Santa Barbara County Coroner ‘s office determined R1’s cause of death was a result of Ethylene Glycol Ingestion with the manner of death being suicide. CONTINUED on LIC809-C Based on the information obtained throughout the course of the investigation, there is sufficient evidence to support the allegation of Questionable Death, therefore the allegation is deemed Substantiated at this time. A $500 immediate civil penalty is assessed today. The Administrator, Ruth Grande was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e). Pursuant to Title 22, California Code of Regulations, the following deficiency is cited (refer to LIC 809-D). Exit interview conducted, appeal rights provided, a copy of this report issued.the state’s words, verbatim · CDSS document, Feb 15, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(2) · Plan of correction due date: Feb 16, 2023

Care of Persons with Dementia (f)The following shall be stored inaccessible to residents with dementia: (2)Over-the-counter medication,..., and toxic substances ...,cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the above section by failing to remove and secure R1’s antifreeze, thus allowing R1 to ingest the antifreeze causing death, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 15, 2023

Plan of correction: Licensee to submit plan how you will ensure all toxics will be stored inaccessible to residents in care. Submit to CCL by 2/16/2023.

Type of visit: Case Management - Incident

Licensing Program Analysts (LPAs) Mark Jeffries and Kristin Kontilis conducted an unannounced Case Management – Incident visit to the facility today. LPA met with Ruth Grande, Administrator and explained the purpose of the visit. The purpose of today’s visit is to address a self-reported incident reported to CCL on 1/19/2023. Staff 1 (S1) reported Resident 1 (R1) is prescribed Seroquel (25 mg) each morning at 9:00 am. Incident report states S1 was contacted by R1’s POA to let S1 know that R1 had not been administered the medication on 1/13/2023 due to the “medication not being on hand”. S1 reviewed R1's MAR and discovered the medication had not been administered on 1/13/2023, 1/14/2023, and 1/15/2023 and discovered the medication was in the overflow cart. Incident report states a retraining will be done with Staff 2 (S2) and Staff 3 (S3) to follow medication protocol to conduct a thorough search of medication cart rather than assume medications are not available along with re-training licensed nurses and care directors to monitor electronic MAR dashboard for missed medications. Incident report further states Administrator will submit training information to CCL/LPA no later than 1/25/2023. Records reviewed revealed CCL/LPA did not and has not received training information regarding incident. Pursuant to Title 22, Division 6, Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D):the state’s words, verbatim · CDSS document, Feb 15, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(c)(2) · Plan of correction due date: Feb 17, 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 is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above when staff did not follow physician’s orders for medications, which posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 15, 2023

Plan of correction: Administrator agrees to conduct medication training with all staff and provide training records with full name, signatures, dates, and description of training to CCL by 2/17/2023.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Mark Jeffries and Kristin Kontilis conducted a Case Management visit to address deficiencies noted during Complaint Control #29-AS-20230210144006 investigation visit conducted on 2/15/2023. LPAs met with Ruth Grande, Administrator and explained the purpose of the visit. On 2/14/2023, CCL received notification that Resident 1 (R1) was placed on hospice on 2/4/2023. Hospice notification states, “I apologize this is late”. On 2/14/2023, CCL received notification that on 2/3/2023, 9-1-1 was called for Resident 2 (R2) when Staff 1 (S1) observed R1 had a cough, congestion, and with white foam at the mouth. Pursuant to Title 22, Division 6, Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D)the state’s words, verbatim · CDSS document, Feb 15, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87632(d)(2) · Plan of correction due date: Feb 22, 2023

87632(d)(2) Hospice Waiver: The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. Based on records review, the licensee did not comply with the section cited above when staff did not notify R1’s hospice placement within five working days from date of placement which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 15, 2023

Plan of correction: Administrator agrees to conduct training with all directors and nurses of timing required for hospice notification. Training records will show full names of attendees, date of training, and person conducting training.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1) · Plan of correction due date: Feb 22, 2023

87211(a)(1) Reporting Requirements: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below… Based on records review, the licensee did not comply with the section cited above when staff did not submit a Serious Illness/Serious Injury report for R2’s change of condition within seven days of the occurrence which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 15, 2023

Plan of correction: Administrator agrees to conduct training with all directors, nurses of reporting requirements. Training records will show full names of attendees, date of training, and person conducting training.

Allegation investigated: Staff did not respond timely to a resident's call button. Staff did not seek timely medical attention to a resident.

Licensing Program Analyst (LPA) Kristin Kontilis conducted an initial 10-day complaint visit to address the allegations as stated above. LPA met with Ruth Grande, Administrator and explained the purpose of the visit. On 7/11/2022 and 7/12/2022, LPA interviewed the reporting party, who noted issues with Person 1 (P1)’s call button and staff not seeking timely medical attention. During the call, it was determined P1 does not live in the licensed/Assisted Living portion of the facility; rather P1 lives in the Independent Living section on the same property which is not licensed by Community Care Licensing Division (CCLD) and does not provide care and supervision to residents in Independent Living. During the visit, LPA viewed a resident roster and confirmed P1 does not reside in Assisted Living or Memory Care. Based off the information obtained, the allegation is deemed Unfounded at this time because P1 does not reside in a facility licensed by CCLD. A finding of “Unfounded” means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Exit interview conducted, report issued via email. Unfoundedthe state’s words, verbatim · CDSS document, Jul 13, 2022 · control 29-AS-20220707163011

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.

Allegation investigated: Staff did not communicate changes in resident's functionality to the resident's authorized representative and physician. Staff do not follow resident's care plan properly. Staff do not respond to resident's call button in a timely manner. Staff is unable to communicate to resident due to a language barrier. Residents' needs are not being met due to facility being understaffed.

On 3/4/22 at 12:25 p.m., Licensing Program Analyst (LPA) Toan Luong conducted a subsequent complaint visit to deliver findings for the above allegations. LPA met with Administrator Ruth Grande and explained the reason for the visit. On 03/19/2020, at 1:43pm, Licensing Program Analyst (LPA) Kristin Kontilis initiated a complaint investigation for the allegations listed above. At approximately 2:09pm, LPA Kontilis conducted a telephone interview with the Administrator and requested copies of documents pertaining to the investigation. On 12/22/2021, from 3:30pm to 4:30pm, and on 02/11/2022, from 11:00am to 5:20pm, LPA Kontilis conducted subsequent complaint visits to the facility to continue the investigation and obtain additional pertinent documents. LPA Kontilis interviewed Administrator, staff and residents on 02/11/2022 from 11:35am to 3:45pm. On 02/24/2022, from 1:35pm to 4:21pm, LPA Toan Luong, conducted additional resident and staff interviews. On 03/01/2022, from 2:17pm to 2:36pm, LPA Lyndia Sager interviewed former Assisted Living Director, Christine Cortez. (Continued on 9099C) Unsubstantiated Resident #1 (R1) physician report, dated 09/16/2019, lists the primary diagnosis as stroke, Bradycardia, and Dementia. On 09/17/2019, (R1) was admitted to the memory care portion of the facility. After three (3) weeks, R1’s condition improved and R1 was transferred to a private apartment in the Assisted Living portion of the facility at the request of R1’s Representative. Based on the 10/04/2019 Health and Service Evaluation, R1 did not have any wandering, disruptive, aggressive or inappropriate behavior and R1 required minimal to no assistance with transferring, showering, grooming, dressing, toileting, and meal consumption. R1 required status checks four (4) times per shift, required a one (1) person total assist or wheelchair escort to and from activities and meals, and required stand-by assistance three (3) times per week with bathing. R1 also used a wander guard alert device. On the allegation: Staff did not communicate changes in resident's functionality to the resident's authorized representative and physician. Health and Services Evaluations and Service Plans, dated 10/04/2019, 11/01/2019 and 01/23/2020 were reviewed for (R1). Each of the plans were signed and dated by the facility LVN and R1’s Representative. LPA Sager reviewed Nursing Progress Notes dated 09/17/2019 through 03/13/2020. The notes reflect that R1’s Representative was notified in person and by phone with updates on a frequent basis regarding R1. R1’s physician was also notified by phone when R1 had a change of condition. Based on the information obtained, the allegation is deemed unsubstantiated at this time. On the allegation: Staff do not follow resident's care plan properly. R1’s care plan (service plan) reflected that R1 required status checks four (4) times each shift when family or private caregiver was not present. Based on information obtained through interviews, staff performed status checks as noted in service plan; however, during the overnight shift, R1 did not like staff coming into the apartment when R1 was sleeping. R1 did not like to be awakened in the middle of the night. R1’s Representative requested that R1 not be checked on during the night as R1 was a light sleeper. R1’s Representative was advised that R1’s service plan needed to be followed with staff performing the status checks for the health and safety of R1. R1’s service plan also indicated R1 required standby assistance with showers three (3) times per week. R1 needed to be prompted to take showers and sometimes would refuse. Per the Administrator, R1’s Representative was made aware that R1 sometimes refused showers. Staff interviews revealed that they are made aware of resident service plans. Staff stated they document in the summary log if they observe changes and notify the nurse. The nurse will give updates at the beginning of each shift if there are any resident change of condition or a new resident service plan to follow. Based on the information obtained, the allegation is deemed unsubstantiated at this time. (Continued 9099C) On the allegation: Staff do not respond to resident's call button in a timely manner. LPA Sager was unable to obtain a copy of the call button response time logs for the time period of November 2019 through March 2020 as the facility does not keep records of call logs for more than the current year. Information obtained through resident interviews revealed that more often than not, the call button response time is adequate. Per the Administrator, the expectation is that staff respond within 10 minutes or less. If no response after 10 minutes, then another alert will notify upper management. Staff interviewed stated the response time to the call button was 7 to 10 minutes. Based on the information obtained, the allegation is deemed unsubstantiated at this time. On the allegation. Staff is unable to communicate to resident due to a language barrier. Resident interviews revealed that they are able to communicate with staff and that all of the direct care staff speak English. Per the Administrator, one of the requirements upon being hired as a direct care staff is that you must be able to speak English. Other facility staff (cooks, dishwashers, housekeepers) are not required to speak fluent English. Based on the information obtained, the allegation is deemed unsubstantiated at this time. On the allegation: Residents' needs are not being met due to facility being understaffed. LPA Sager reviewed staff schedules for December 2019 through March 2020. There are five (5) to six (6) direct care staff, two (2) med aides, and one (1) nurse on the A.M. shift; four (4) to five (5) direct care staff, two (2) med aides, one (1) nurse on the P.M. shift; and two (2) direct care staff, one (1) med aide on the NOC (overnight) shift. Based on information obtained through Administrator and former Assisted Living Director interviews, there was a sufficient amount of staff to meet the residents’ needs as majority of the residents in assisted living required minimal care and assistance. R1 had a private duty caregiver (companion) during the day four (4) days per week. Staff interviewed stated they believed the staffing was sufficient for the residents’ needs. Based on the information obtained, the allegation is deemed unsubstantiated at this time. Exit interview conducted and a copy of this report and appeal rights emailed to administrator.the state’s words, verbatim · CDSS document, Mar 4, 2022 · control 29-AS-20200309125214

Type of visit: Required - 1 Year

On 02/24/22 at 10:30 a.m., Licensing Program Analyst (LPA) Toan Luong conducted an unannounced One Year Infection Control Annual visit to the facility. LPA met with Administrator Ruth Grande and Regional Nurse Mariana Pelayo and explained the purpose of the visit. LPA was screened at the entrance, and LPA toured the residential care facility for the elderly. At 12:00 p.m., LPA discussed items in the Infection Control Module and noted that facility answered yes to all questions in the Infection Control. Infection Control module was addressed with administrator to satisfaction. Between 12:30 p.m. and 2:00 p.m., LPA reviewed facility schedule and found 2 individual working at the facility without a Criminal Record Clearance. Individuals were not present at the facility during the inspection. Administrator removed staff from the schedule until they receive clearance. LPA issued citation under Title 22, Division 6 Chapter 8 Article 06. Background Check 87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. At 10:47 a.m., LPA and administrator entered the Memory Care Unit and found a unlocked cabinet in room near the memory care entrance. Caregivers were not present in the area and one resident was observed in the room. Cabinet contained 3 cleaning spray bottles with the label Peroxide Multi Surface Cleaner and 1 bottle of Joy dishwasher soap. Staff locked the cabinet. LPA issued citation under Title 22, Division 6 Chapter 8 Article 12. Dementia 87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. Deficiency issued on LIC 809D. A civil penalty was issued. LPA conducted exit interview with administrator and emailed a copy of today's report and appeal rights to the administrator.the state’s words, verbatim · CDSS document, Feb 24, 2022

Allegation investigated: Facility illegally evicted resident Staff did not provide adequate care and supervision to a Resident in care

On 12/30/2021 at 4:48pm, Licensing Program Analyst (LPA) Diaz, conducted an unannounced complaint visit to issue final findings for the above allegations. LPA met with administrator Ruth Grande. On 12/31/20 at 10:10 a.m., Licensing Program Analyst (LPA) Kristin Kontilis initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint investigation was conducted telephonically with Ruth Grande, Administrator. LPA Kontilis conducted a telephone interview with the Administrator and requested copies of documents pertaining to the investigation. On 12/28/20 and 12/30/20, LPA Kontilis interviewed the complainant. On 07/21/21, LPA Lyndia Sager requested additional documents from the Administrator and at 3:40 p.m., conducted an interview with Witness #1 (W1). Unsubstantiated On 08/02/21 at 4:35 p.m., LPA Sager conducted an interview with Administrator; on 08/03/21 from 1:22 p.m. to 4:45 pm., conducted interviews with Memory Care Director, Witness #2 (W2), and Witness #3 (W3); on 08/04/21 at 11:40 a.m., conducted an interview with Memory Care Charge Nurse. On 12/01/20, Memory Care Resident #1 (R1) and Resident #2 (R2) were involved in a physical altercation where R1 bit the hand of R2. Paramedics were called and R1 and R2 were taken to the Goleta Valley Cottage Hospital Emergency Room for evaluation. R2 was treated for human bite wounds to both hands. The hospital refused to place R1 on a Psychiatric hold. R1’s Power of Attorney (POA) was called to pick up R1. Upon arrival back to the facility, the POA was informed he would need to provide a one-on-one caregiver for R1. The POA agreed that he would be the one-on-one caregiver for R1 and took R1 to the Independent Living apartment at Maravilla. The POA contacted the Primary Care Physician who recommended hospice placement. On 12/02/20, R1 was assessed and admitted to hospice with a recommendation for a 5-day respite for medication management of R1’s aggressive behavior. POA agreed as he was not able to continue to be a one-on-one caregiver for R1 as was needed due to the aggressive behaviors. Per the Administrator, the POA was informed of the need for a one-on-one caregiver, initially agreed to be the one-on-one caregiver, then refused and said he could not afford to pay for a one-on-one caregiver. R1 continued to stay with the POA until 12/04/20 when the POA moved R1 out of the facility. R1 had previously lived in an Independent Living apartment at Maravilla with the POA. On 11/17/20, a pre-appraisal for R1 was completed by the POA and Memory Care Director, which did not indicate any aggression or behavioral issues. R1 transferred to the Memory Care unit of Maravilla on 11/17/20. Progress notes reviewed found that from 11/19/20 to 12/01/20, R1 had numerous incidents of increased confusion, wandering, agitation, yelling, medication refusal and aggressive behaviors. A Care Plan was completed on 11/17/20 noted that the resident had a current or history of behavior issues and needed hourly checks. Information obtained through interviews found that the POA was notified that R1 would need a one-on-one caregiver and that the POA agreed and wanted to oversee R1. Other interviews found that the POA was under the impression they would be the one-on-one caregiver only overnight. W3 stated that the POA informed W3 that “R1 was asked to exit the memory care”. W3 stated R1 was initially placed on hospice on 12/02/20 for a 5-day respite for medication management in order to give the POA respite from the one-on-one caregiving. The respite was extended and R1 remains on hospice. Information obtained from the Administrator found that R1’s behavior could not be managed in the memory care without a one on one caregiver while medications were being adjusted. Administrator states R1 was not evicted, she did not issue an eviction notice due to on 12/03/20 the POA informed her that R1 would be moving out of the facility. LPA Sager reviewed pertinent documents relevant to the allegations. LPA verified the one-on-one care clause in the Residence and Care Agreement which states: …”if it is determined that it is necessary to provide you with one-on-one care in order to protect your health and safety or the health and safety of others, we may provide or arrange for such care at our discretion and the charge for such one-on-one care, as set forth on Part C, Number 1, will apply immediately.” Based on the information obtained during the course of the investigation, LPA Sager determined there is not a sufficient amount of evidence to support the above allegations. The above allegations are deemed Unsubstantiated. Exit interview conducted and a copy of report given to Administrator.the state’s words, verbatim · CDSS document, Dec 30, 2021 · control 29-AS-20201223114835

Type of visit: Case Management - Incident

Licensing Program Analyst's (LPA's) De Leon and Kontilas conducted a case management visit to the facility above regarding an email from the administrator reporting the death of a resident in care on 11/26/2021. LPA's met with Staff Christina Martinez, director of Enliven Memory Care at Maravilla and explained the purpose of the visit. Administrator Ruth Grande arrived around 12:30 pm to talk with LPA's. LPA Kontilas interviewed two staff at the facility regarding the death of the resident. LPA De Leon requested the following records for Resident 1 (R1): LIC. 602A Physicians Report, Appraisal Needs and Services Plan, Pre-Appraisal, Hospital /or Doctors records for visits or discharge, Staff notes, Centrally Stored Medication and Destruct Records, Medication Administration Records, Police Contact Information Case#/ Name/phone number, Enliven Sign in and out sheets for November, POA/Conservator records, Emergency Contact form, Enliven Resident Roster, Enliven Staff Roster with phone numbers, Enliven Staff Schedule for the week of November 21st-27th, Copy of Contract with Agency for staffing, Agency Contract Staff Schedule at Enliven for the week of November 21st-27th, List of Agency Contract staff names and phone numbers, Transfer associations for Agency Contract Staff. The facility has a contract with an agency to provide additional care givers for residents at the facility. The same agency also has contracts with residents and their responsible parties for companionship. Staff 1 (S1) has a contract for care giving with the facility and also has contracts with residents at the facility for companionship. S1 does provide help with feeding for some residents and therefore must be associated to work at the facility due to the fact that S1 provides some type of care and is alone with residents in care at the facility. LPA De Leon referred the death of the resident to Community Care Licensing Investigation Branch (IB) for further investigation. Exit interview conducted, deficiency cited, civil penalty assessed, copy of report and appeal rights emailed to Administrator.the state’s words, verbatim · CDSS document, Nov 30, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Nov 30, 2021

(e) All individuals subject to a... (1)...or (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or Based on record review the licensee did not comply with regualtion above and was working without a tranfer assocaition which poses an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Nov 30, 2021

Plan of correction: Administrator told contracted staff that they can no longer work at the facility any longer. Administrator will make sure all contracted care staff is associated to the facility before working at the facility. Administrator will sign a statement that no staff will provide any care giving duties until associated to work at the facility. Facility will provide an up to date LIC 500 to LPA.