Mayflower Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Maria (Mita) Partoza conducted an unannounced required 1 year inspection visit, met with Administrator Isabel Eslava and stated the purpose of the visit. The facility is licensed to serve adults 60 and over, 5 non-ambulatory and 1 bedridden. The facility has 2 hospice waiver. LPA toured the facility with ADM, inside and outside including but not limited to the kitchen, dining, 4 resident bedrooms, 2 staff room, 2 bathrooms used by the resident and staff and laundry area. Bathroom are equipped with grab bars and anti slip mats. LPA observed 6 bedrooms, 4 Out of 6 bedrooms are used by resident and 2 Out of 6 bedroom are used by staff. 6 Out of 6 bedrooms have functioning lights, a chair, clean bedding, storage space for personal belongings of residents. 1 Out of 6 resident is under hospice care, 3 out of 5 are non-ambulatory and 2 Out of 6 are ambulatory. 2 Out of 6 bedroom are shared and 4 out of 6 are not shared. LPA observed the laundry area and chemicals are locked and inaccessible to persons in care. LPA observed that the dining room and kitchen are organized and sanitary. LPA observed 2 days of perishable food and 7 days of non-perishable food. LPA observed the sharps and chemicals are stored in a locked cabinet under the sink. The medication cabinet is locked and inaccessible to residents. page 1 of 2 LPA observed 2 double door refrigerators/freezer combination and temperature measured at 32 degree F and 0 degree F. The facility temperature measured at 71 degree F, the water temperature measured at 112.1 degree F. LPA observed that interior hallways, and exterior walkways are not obstructed and free from debris. However, LPA observed that facility has excessive incontinent supply stored in different places of the facility such as the shed, garage, and near the emergency exit area. LPA observed unused wheelchairs, more incontinent supplies and construction materials piled on one side by the fence of the backyard. LPA observed 2 locked storage shed in the exterior of the facility. LPA observed that the ramps and railings around the facility are sturdy and maintained. LPA observed emergency exit doors/sliding doors are working and free from obstruction. The facility is equipped with carbon monoxide and smoke alarm system, in good working condition when tested. The facility is equipped with a fire extinguisher last inspected on 05/08/25. The facility conducted their fire/earthquake and disaster training drill was on 01/12/25, 03/02/25, 07/06/25 and 09/03/25. LPA reviewed 3 out of 4 staff record. LPA verified that 3 Out of 4 staff are fingerprint and criminal background cleared. Training are updated and health screening are cleared. LPA reviewed 3 out of 6 resident and verified them to be complete and up to date. No deficiencies were cited during today's inspection based on California Code of Regulations (CCR) Title 22. An exit interview was conducted with Administrator Isabel Eslava and a copy of the report was provided. end of report page 2 of 2the state’s words, verbatim · CDSS document, Oct 13, 2025

Allegation investigated: Facility issued an unlawful eviction notice due to change of resident condition.

Unannounced complaint visit made out to this facility on 03/09/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated Administrator, Isabel Eslava, who was briefly interviewed at this time. Current census was (6) residents. The purpose of this visit was to deliver the findings of this investigation to this facility, and it's designated Administrator, at this time. Based on interviews and a review of the forms and documents that were retrieved during this investigation, it was learned that resident, R1, initially moved into this facility back in June 2024. It was learned that shortly after admission this facility, and it's representative, served R1 with an eviction notice. This eviction notice was issued due to the alleged need for a higher level of care with concerns for maintaining skin integrity and requiring a 2-person assist at all times. This initial eviction notice was given to R1 and R1's responsible family and friends on 07/12/2024 merely a few weeks after admission. Based on a review of the forms and documents, it was learned that a second eviction notice was issued on Substantiated 09/02/2024 which cited the following issues and reasons for this eviction notice: Thin skin and easily bruising with concerns for maintaining skin integrity Need to be on the toilet requiring assistance to get to the restroom Assistance with transferring requiring use of a Hoyer lift Issues with staying up late due to being on the toilet for long periods of time Requiring 2 staff members for assistance with Activities of Daily Living (ADLs) It was learned that a third eviction notice was also issued on 10/29/2024 to R1 and R1's responsible family and friends citing the following issues and reasons for this eviction notice: R1's inability to independently transfer Pressure injuries and issues with maintaining skin integrity Based on a review of the facility forms and documents submitted into CCL, it was learned that an Appraisal/Needs and Services Plan (LIC 625) was completed for R1 by this facility designated Administrator on 06/24/2024 which was at the time of R1's admission into this facility. It was learned that the issue of needing assistance with transferring was duly noted and deemed that a Hoyer lift would be employed in order to provide adequate care and supervision to R1. It was also noted on this LIC 625 that R1 had a history of bruising easily and sustaining skin tears was also a constant risk. It was learned that this facility designated Administrator planned to involve the licensed medical professional and the Home Health agency to assist in this matter and noted it as such on this form. Based on a review of the facility forms and documents for R1, it was learned that from a completed Physician's Report (LIC 602) dated on 04/12/2024 stated that R1 was diagnosed with dementia and deemed to be Bedridden at that time. It was learned that this LIC 602 was completed two months prior to R1 being admitted to this facility. It was learned that the facility designated Administrator was made aware of this information and was provided a copy of this LIC 602. Based on interviews and a review of the facility forms and documents, it was learned that shortly after being admitted to this facility R1 was then served with an eviction notice to vacate the premises within 30 days since this facility, and its staff, were no longer able to provided the appropriate level of care and supervision to R1 at that time. Based on interviews and a review of the facility forms and documents, this facility designated Administrator was well aware of the health conditions and issues that afflicted R1 upon admission to this facility. An LIC 625 was completed along with updated information from the LIC 602 that was completed two months prior to the admission of R1 into this facility. It was learned that this facility already had a resident under the care of hospice who was deemed to also be bedridden at that time. This facility was already deploying the use of a Hoyer lift in helping to transfer this hospice resident in/out of bed, in/out of their wheelchair, and assistance with toileting as well. It was learned that this eviction notice was served to R1 and R1's responsible family and friends once R1 was admitted and presented additional issues and workload for this facility to take on at that time. This facility already was approved to be able to accept and retain up to (2) residents under the care of hospice at any given time. In addition, this facility was approved and fire cleared to be able to accept and retain up to (1) bedridden resident at any given time. This facility already had the approved programs needed in order to provide the adequate care and supervision to a resident diagnosed with dementia, resident on hospice, and a resident who needed assistance with transferring and toileting needs due to being bedridden. As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met. The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes. Appeal rights were printed and a copy was given to the facility designated Administrator at this time. Exit Interviewthe state’s words, verbatim · CDSS document, Mar 9, 2025 · control 26-AS-20241007153228

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(d) · Plan of correction due date: Mar 10, 2025

A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-Admission Appraisal and providing the other basic services specified below, either directly or through outside resources. This facility was found to be deficient as evidenced by the issuance of (3) eviction notices to a resident, and their responsible family and friends, citing issues with a higher level of care and care needs that were already made aware to this facility upon admission which poses an immediate threat to the Health, Safety, and Personal Rights to residents in care.the state’s words, verbatim · CDSS document, Mar 9, 2025

Plan of correction: The facility designated Administrator stated that she will undergo training, for no less than one hour in duration, on the subject matter of facility residents rights and proper eviction procedures and how to properly maintain them at all times. A statement of correction, along with copies of the updated training, will will be completed and submitted into CCL by the due date. Proof of completed training will involve the topic of training, name of the vendorized trainer, and list of attendee(s).

Allegation investigated: Licensee refusing to allow resident to return to facility after hospitalization.

On March 7, 2025, at 8:50 AM, Licensing Program Analysts (LPA), Kenneth Madrigal and Manuel Monter, conducted an unannounced visit to conclude the complaint investigation. LPAs met with Isabel Eslava, Administrator (ADM)/Licensee (LIC). On December 20, 2024, the California Department of Social Services (Department) received a complaint regarding the above allegation. It has been alleged that the licensee refused R1 to return to the facility on December 20, 2024. On December 17, 2024, the Deparment received an Incident Report for R1’s hospitalization on December 15, 2024. Incident Report stated R1 was not at baseline and 911 was contacted. R1’s family member informed the facility R1 will be admitted to the hospital for more observations. Page 1 of 3. Unfounded On December 20, 2024, LPA Tarin interviewed witness (W1) stated that the ADM is using R1’s hospitalization to refuse R1 to return to the facility. W1 stated that R1 was hospitalized on December 15, 2024, R1 is at their baseline, ADM must take R1 back to the facility, and there is no change in level of care. On December 20, 2024, LPA Tarin interviewed Kaiser Social Service Manager (SSM) stated that R1 has anticipated discharge of December 20, 2024. SSM spoke with the Doctor and R1 will be staying overnight. Also, SSM stated that he/she spoke to ADM who stated he/she feels that R1 requires a higher level of care and R1 exceeds the level of care the facility can provide. On December 21, 2024, LPM Manzano communicated with ADM. ADM stated that Kaiser nurses were initially not able to provide a medical assessment for R1 at the hospital. ADM stated she wanted more medical information regarding R1’s condition. ADM stated on December 21, 2024, she was informed about R1’s conditions. ADM stated R1 will be discharged to the care home and requested an updated Physician’s Assessment by R1's Primary Care Physician. On December 26, 2024, LPA Rai conducted an initial complaint investigation. The Department received, obtained, and reviewed the following documents for resident 1 (R1): Physician’s Report and Appraisal Needs & Services Plan (ANS). LPA Rai interviewed ADM. ADM stated R1 went to the hospital on December 15, 2024, after R1 expressed numbness on the right side of his/her body. ADM stated she assessed R1 on December 17 and 19, 2024, at the hospital. ADM stated that she was waiting to receive an update from the nurses before accepting the resident back to the facility. ADM stated on December 20, 2024, the hospital called to inform R1’s discharge and ADM stated that she wanted to conduct her assessment, but Patient Care Coordinator did not tell ADM R1’s updated diagnosis. ADM stated that she did not refuse R1 and wanted additional assessment regarding his/her conditions. On December 21, 2024, ADM conducted her assessment and nurses informed ADM about R1’s condition. ADM stated that R1 returned to the facility on December 21, 2024. Page 2 of 3. Therefore, based on interviews conducted, on-site observations, and facility records review, the above allegations are false, could not have happened, and/or are without a reasonable basis, therefore the allegations are UNFOUNDED. During today’s visit, no deficiencies were cited from CCR, Title 22, Division 6. An exit interview was conducted with ADM, Isabel Eslava and a copy of this report was provided to her. End of Report. Page 3 of 3.the state’s words, verbatim · CDSS document, Mar 7, 2025 · control 26-AS-20241220135831

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Marcella Tarin, Manuel Monter and Steve Chang conducted an unannounced annual inspection visit, and met with Administrator Isabel Eslava. ADM informed LPAs that the facility has 2 staff and 6 clients. LPAs toured the facility inside and outside which included: kitchen, office area, 6 resident rooms and 3 restrooms. 6 out of 6 resident bedrooms had functioning lights, a chair, clean bedding, dresser and storage space for residents personal belongings. LPAs observed a perishable food supply of at least two days and a non-perishable food supply of at least seven days. LPAs observed the sharps and chemicals storage area locked underneath the kitchen sink. The staff area of the facility was also inspected. The front yard and backyard of the facility was also inspected. While touring the backyard, LPAs observed a trash can and recycling can obstructing the walkway, directly next to room #1. The path the trash can and recycling bin were obstructing are on the emergency evacuation path. (Photograph was taken). LPAs also observed a container of dish soap and fabric softener near the garage door on the side of the home. (Photograph was taken). ADM removed the chemicals and locked them away during visit. LPAs observed two sheds in the backyard that are being used for storage. While touring bathroom #3, LPAs observed a bottle of Oxiclean stain remover in the shower and a Clorox toilet cleaner, near the toilet (Photograph was taken). ADM removed chemicals/cleaning products during visit. While touring hallway next to bedroom #3, LPAs observed Ortho flea & tick killer in hallway linen closet (photograph was taken). ADM removed Ortho flea & tick killer to a locked storage area. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to clients in care. The hot water temperature in 3 out of 3 hallway resident restrooms was measured at 105.4 and 105 degrees F. Page 1 Out of 2. The facility was equipped with smoke and carbon monoxide detectors. All smoke detectors functioned properly when tested. Fire extinguishers were last serviced on 05/08/2024. LPAs observed the facility first aid kit and it was observed to be complete. LPAs requested to review the facility fire drill log. ADM stated she does conducts drills but does not have any documentation. LPAs reviewed facility records for 3 staff and 3 clients, which were all found to be complete during review. LPAs reviewed 5 clients medications and centrally stored medication records and found the centrally stored medication records to be complete. LPA interviewed 2 staff. Deficiencies are being cited during today's visit as per California Code of Regulations Title 22. See LIC809-D This report was reviewed with ADM Isabel Eslava and a copy of the signed report was provided. Appeal Rights were provided. Page 2 Out of 2. END OF REPORT.the state’s words, verbatim · CDSS document, Oct 10, 2024