Maryam RCFE

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with House Manager Maria Lerma. According to the facility’s license, the facility has a maximum capacity of six (6) clients, all of whom must be ambulatory. During today’s inspection, there were a total of six (6) clients in care, and per medical records, all were ambulatory. This facility does not feature a secured perimeter or delayed egress doors. LPA, accompanied by licensee’s staff, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 74 F. Hot water temperature at taps accessible to clients were all compliant: Kitchen sink was 103 F, Bathroom #1 sink was 103 F, and Bathroom #2 sink was 103 F. Refrigerator temperature was 35 F and freezer temperature was 0 F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. [CONTINUED ON LIC 809C] [CONTINUED FROM LIC 809] No pools or bodies of water were observed on the premises. Per the licensee's staff, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPAs interviewed multiple staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. The reviewed files contained required documents. Confidential records were stored in locked areas. Licensee's staff also presented proof of current/active business liability insurance and surety bond. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with House Manager Maria Lerma to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Oct 27, 2023

Allegation investigated: Staff did not seek medical attention for resident as requested

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced complaint investigation visit to deliver findings regarding the above-mentioned allegation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Caregiver Majida "Maggie" Houaoura. The Department’s investigation consisted of interviews, review of records, and a tour of the facility. It was alleged that the staff did not seek medical attention for a resident as requested. Interviews and review of Client 1’s (C1) medical records revealed that C1 has a history of physical aggression, yelling, cursing, slamming doors, and throwing and breaking items. San Diego Regional Center has advised staff to ask C1 to talk through C1’s frustrations and redirect C1 to participate in other activities. Review of C1’s medical documents revealed that C1 is able to communicate their needs. Interviews and record review revealed that around 12:30pm on 4/22/2020, C1 began becoming agitated. Staff attempted to redirect and deescalate C1 by asking C1 if C1 wanted to go on a walk, water plants, or watch television. Continued on LIC9099-C page... Unsubstantiated Interviews with the Licensee revealed that around 3pm, C1 became more agitated and began throwing things, made threats of self-harm, and made verbal threats against staff and clients. While C1 was agitated, C1 injured Staff 1’s (S1’s) finger. The facility staff called the La Mesa Police Department and Psychiatric Emergency Response Team (PERT). Interviews with the Licensee revealed that it did not take long for PERT to arrive and PERT took C1 to the hospital. C1 was not admitted and was discharged on the following day on 4/23/2020. The Department has investigated the above-mentioned allegation and based on observation, record review, interviews, the preponderance of the evidence has not been met, therefore, this allegation is deemed unsubstantiated. An exit interview was conducted with Caregiver Majida "Maggie" Houaoura, to whom a copy of this report and the Licensee Appeal Rights (LIC9058 01/16) were provided via hard copy.the state’s words, verbatim · CDSS document, Sep 30, 2022 · control 08-AS-20200428172657

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Required 1 - Year Visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with caregiver Majida "Maggie" Houaoura. House Manager Morena "Maria" Lerma arrived later during the visit. LPA conducted a brief tour of the facility and observed the staff and residents in care. In accordance with the Department’s Infection Control program, LPA provided technical assistance and observed and evaluated the facility's implementation of their COVID-19 Mitigation Plan, to include disinfection, screening protocols, and the use of personal protective equipment. No deficiencies were cited on this date. An exit interview was conducted with Lerma. A copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail to Lerma and administrator Leeda Dost.the state’s words, verbatim · CDSS document, Apr 12, 2022

Allegation investigated: Physical abuse by staff towards resident.

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 Caregiver Maria Lerma to whom was explained the purpose for the visit. The Department’s investigation consisted of staff and outside source interviews . The investigation also included facility, client, and outside source records reviews, observations and interactions with clients in care, and a facility tour. It was alleged that on March 17, 2020 Client1 (C1) (See Confidential Name List LIC 811) sustained bruising by a Staff (S1) member who grabbed C1 by the arm pulling them back into the facility from the facility balcony. An interview with facility staff revealed C1 was upset after an argument with another client and began hitting and scratching themselves out on the facility balcony. Facility staff redirected and coaxed C1 back into the facility. C1 continued to act out and make suicidal threats. Staff called 911 and C1 was transported to the hospital and placed on observation. Unsubstantiated A review of facility records review, as well as interviews with facility staff and outside sources revealed there was not a staff member (S1) working at the facility by the name identified as the alleged suspect. A review of outside source records revealed C1 had a chronic problem of fabricating stories, such as abuse by staff and/or clients, to deflect blame onto others, it was also noted in records that placement facilities should be aware of this behavior due to serious allegations C1 has made in the past, all determined to be unfounded or unsubstantiated. Records also revealed C1 displayed re-occurring self-harm behaviors and suicide threats. An interview with an outside source and facility staff corroborated C1’s tendency to fabricate stories and also corroborated C1 had several incidents of self-harm, including hitting and scratching themselves. An interview with another outside revealed they have recently, since discharge of C1, conducted visits to the facility on a regular basis. The Interview revealed never witnessing any issues or signs of abuse by staff, the clients in care always appeared well cared for and happy. The interview also revealed the clients are outspoken and have good relationships with the Licensee and Caregiver Lerma, and felt if there were any issues clients would not have any hesitation with reporting them. Due to lack of corroborating evidence, the findings regarding the above allegation was determined 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 Caregiver Lerma and Licensee Dost, who joined during the exit interview via telephone. A copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) will be provided to Caregiver Lerma and Licensee Dost via email at the conclusion of the visit. An electronic email read receipt confirms the documents were received.the state’s words, verbatim · CDSS document, Mar 22, 2022 · control 08-AS-20200317143554

Allegation investigated: Staff member records residents

Licensing Program Analyst (LPA)Tiffany Holmes arrived at the facility to deliver findings for a complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Janet Acosta, Caregiver. LPA previously conducted interviews, made observations, and obtained and reviewed pertinent records. LPA conducted the initial visit on August 26, 2020, and conducted a tour of the facility. It was alleged that the staff member records residents. Interviews revealed that Staff #1 (S1) did record C1 while at the facility. Interviews revealed it was mentioned to mangement and management asked S1 why they recorded the client. Interviews revealed there was an incident when S1 recorded C1 because they were sitting on the balcony talking about the buildings and S1 asked C1 if anyone had touched their stuff. C1 responded to S1 that another staff went into their room and touched their stuff. Management wrote S1 up for recording C1. Interviews revealed S1 thought that they could show management the recording of C1 so management could see what C1 was saying. **Amended report from 06/23/2021** Substantiated It was alleged staff member neglects residents' basic care needs. Interviews revealed that residents needs are met and anytime they need assistance they receive it. Interviews revealed staff check on residents frequently. Staff provides meals and assistance to the residents several times on a daily basis. The residents receive assistance with bathing and dressing. Interviews with outside sources states the staff provides quality care to the clients in care. Clients needs are met according to their care plans There were no witnesses to prove staff neglects residents basic care needs. It was alleged that staff member fails to treat residents with dignity and respect. Interviews revealed that staff talk and treat the residents kindly. Interviews revealed staff respect the residents needs and their wants. Interviews revealed there haven't been any instances when staff have been rude or disrespectful at any time. Interviews with clients revealed that staff are nice and clients have a good rapport with them. Interviews with outside sources states that there have been no complaints of staff not treating clients with dignity and respect. There were no witnesses to prove staff member fails to treat residents with dignity and respect. This agency has investigated the complaint allegations of staff member abuses residents, staff member neglects residents' basic care needs and staff member fails to treat residents with dignity and respect. Based on interviews conducted, the allegations are unsubstantiated. An exit interview was conducted with Janet Acosta, Caregiver, and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Licensee, Leeda Dost via email. An electronic email read receipt confirms the documents were received. Interviews revealed that staff are not supposed to use their phones when working with the residents. There were witnesses to prove staff records residents. Based on interviews conducted, the allegation is substantiated. This agency has investigated the complaint alleging staff member records residents. We have found the allegation happened and the preponderance of evidence has been met. An exit interview was conducted with Janet Acosta, Caregiver and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Licensee, Leeda Dost via email. An electronic email read receipt confirms the documents were received.the state’s words, verbatim · CDSS document, Sep 14, 2021 · control 08-AS-20200821103147

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Sep 24, 2021

Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement has not been met as evidenced by: Interviews revealed 1 out of 4 clients were being recorded while in care at the facility by staff. This poses a potential safety risk to clients in care,the state’s words, verbatim · CDSS document, Sep 14, 2021

Plan of correction: Licensee will provide training on personal rights of clients to all staff from Medicine Camp Pharmacy. Documents/materials and sign in sheet will be provided to CCL by POC date of 09/24/2021

Allegation investigated: Staff member abuses residents and staff Staff member neglects residents' basic care needs Staff member fails to treat residents with dignity and respect

Licensing Program Analyst (LPA)Tiffany Holmes arrived at the facility to deliver findings for a complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Sahym Meza, Caregiver. LPA previously conducted interviews, made observations, and obtained and reviewed pertinent records. LPA conducted the initial visit on August 26, 2020, and conducted a tour of the facility. It was alleged staff member abuses residents and staff. Interviews did not reveal any physical or emotional abuse by staff. Staff 1 (S1) (see LIC811 Confidential Names List) in question denies abusing any residents or staff. S1 does not speak rudely or mean to the other staff or residents. S1 admits to doing the best they can on their job. There were no witnesses to prove staff member abuses residents and staff. Continued... * This is an amended report from 06/23/2021 Unsubstantiated It was alleged staff member neglects residents' basic care needs. Interviews revealed that residents needs are met and anytime they need assistance they receive it. Interviews revealed staff check on residents frequently. Staff provides meals and assistance to the residents several times on a daily basis. The residents receive assistance with bathing and dressing. There were no witnesses to prove staff neglects residents basic care needs. It was alleged staff member fails to treat residents with dignity and respect. Interviews revealed that staff talk and treat the residents kindly. Interviews revealed staff respect the residents needs and their wants. Interviews revealed there haven't been any instances when staff have been rude or disrespectful at any time. There were no witnesses to prove staff member fails to treat residents with dignity and respect. Based on interviews conducted, the allegations are unsubstantiated. This agency has investigated the complaint alleging staff member abuses residents and staff, staff member neglects residents' basic care needs and staff member fails to treat residents with dignity and respect We have found the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation occurred. An exit interview was conducted with Licensee, Sahym Meza, Caregiver and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Licensee, Leeda Dost via email. An electronic email read receipt confirms the documents were received. ** This is an amended report from 06/23/2021**the state’s words, verbatim · CDSS document, Jun 23, 2021 · control 08-AS-20200821103147