Merrill Gardens at Rockridge

Allegation investigated: Facility staff is handling residents in a rough manner. Facility staff smokes in the facility. Facility staff is under the influence.

On 09/05/23 around 10:00 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint finding for the above allegation. LPA met Anna Reddy, Administrator (ADM) and explained the purpose of the visit. During the investigation, LPA toured the facility with S2 and S5. LPA conducted resident, staff and witness interviews. LPA requested a current Resident Roster, Staff Roster, LIC 500, Training Records for four (4) Staff (S7, S8, S9, S10) and Emergency and Identification contact sheets for Residents (R1, R2). Continued on LIC9099C... Unsubstantiated ...continued from LIC9099 Allegations: Facility staff is handling residents in a rough manner. Facility staff smokes in the facility. Facility staff is under the influence. UNSUBSTANTIATED LPA conducted interviews with Staff (S1, S2, S3, S4, S5, S6, S10, S11), Residents (R1, R2, R3, R4, R5, R6) and Witness #1 (W1). S10 reported that S9 mishandled residents, was smoking, and drinking on the job while at the facility. S10 stated that the incidents had been reported to management but did not provide any dates. Interviews with Staff (S1, S2, S3, S4, S5, S6, S10, S11) revealed that they were not aware of any resident being mishandled, smoking, or under the influence. Interviews with R1, R2, R3, R4, R6 and W1 further revealed that they were not aware of any residents being mishandled by staff, staff smoking, or under the influence. S1 explained to LPA that the facility has been in contact with the principal and security of the local High School to prevent the high schooler’s from smoking in the facility’s parking garage that occasionally leaves an odor. LPA and S1 discussed scheduling meetings with Staff and Residents to mitigate the spread of rumors at the facility in an effort to maintain good morale within the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview and a copy of this report provided to ADM.the state’s words, verbatim · CDSS document, Sep 5, 2023 · control 15-AS-20230620090659

Allegation investigated: Staff engaging in inappropriate behavior while in the presence of residents.

On 09/05/23 around 10:00 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint finding for the above allegation. LPA met Anna Reddy, Administrator (ADM) and explained the purpose of the visit. During the investigation, LPA toured the facility with S2 and S5. LPA conducted resident, staff and witness interviews. LPA requested a current Resident Roster, Staff Roster, LIC 500, Training Records for four (4) Staff (S7, S8, S9, S10) and Emergency and Identification contact sheets for Residents (R1, R2). Continued on LIC9099C... Unsubstantiated ...continued from LIC9099 Allegation: Staff engaging in inappropriate behavior while in the presence of residents. UNSUBSTANTIATED LPA conducted interviews with Staff (S1, S2, S3, S4, S5, S6, S10, S11), Residents (R1, R2, R3, R4, R5, R6) and Witness #1 (W1). S10 stated that several residents and staff members have heard S4 and S5 engaging in inappropriate behavior in the office and in the presence of residents. Interviews with Staff (S1, S2, S3, S4, S5, S6, S10, S11) revealed that they had heard rumors about S4 and S5; no staff stated that they had heard or witnessed S4 and S5 engaging in inappropriate behavior in the presence of residents. R5 stated that he/she thinks there’s a strong possibility of the allegation but would not go into details. R1, R2, R3, R4, R6 and W1 were not aware of the allegation and never witnessed S4, S5 or other Staff engaging in inappropriate behavior in the presence of residents. LPA and S1 discussed scheduling meetings with Staff and Residents to mitigate the spread of rumors at the facility in an effort to maintain good morale within the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview and a copy of this report provided to ADM.the state’s words, verbatim · CDSS document, Sep 5, 2023 · control 15-AS-20230623145451

Type of visit: Case Management - Other

On 05/31/23 at 11:00 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a case management inspection. LPA met with Abby Reddy, General Manager (S1) and explained the purpose of the visit. On 05/29/23 at approximately 05:27 PM, Community Care Licensing Department (CCLD) received an Unusual Incident Report (UIR)via fax from S1 regarding a fire that took place on 5/28/23 at the facility. Around 11:30 AM, LPA conducted interviews, captured photos and toured the facility with S1. The UIR and S1 stated that the fire started in Resident’s #1 (R1) room (RM) 507 on 5/28/23. What appeared to be cat food, was left on R1’s stove top and R1 was unaware that the stove-top burner was on. The rooms are individual apartments and multiple rooms had damage. R1 has relocated to 222, R2 was in RM 407 and has relocated to RM 310, R3 was in RM 307 and has relocated to RM 302, R4 remains in RM 207 where there appeared to be minimal water damage except in the bathroom where there is vertical perforations along the middle of the wall that’s located near the washer and dryer; the dimensions appear to be about 2 feet long and 3 inches wide. RM 507 appears to have fire damage to the stove, walls, and refrigerator. The entire apartment has a strong smell of smoke. Per S1, RM 407 has the most water damage since it is located directly under RM 507. At first glance, RM 307 appears to not have much damage, but there is a strong damp smell throughout the apartment. ...continued on LIC809C ...continued from LIC809 S1 has been in contact with a water restoration company, fans are placed throughout the facility and rooms on the 1st, 2nd, 3rd, 4th and 5th floors. W1 stated that he/she cleaned about an inch and a half of excess water that was in the bathroom and has placed additional humidifiers in the apartment; S1 will assess if additional fans are needed for RM 207. R4 receives oxygen and hospice services. Being that the incident occurred over the Memorial holiday weekend, S1 and residents remain in contact with their insurance companies to investigate their personal and property damages. LPA requested documentation from insurance and/or water restoration company when they become available. LPA requested Resident’s (R1. R2, R3, R4) Identification/Emergency contact sheets be submitted to CCLD by 06/02/23. Fire Safety Training was performed with the Staff on 05/25/23 and one will be conducted with residents on 06/01/23.the state’s words, verbatim · CDSS document, May 31, 2023

Allegation investigated: Staff did not administer medication as needed in a timely manner. Staff didn't reappraise resident when resident health condition changed.

On 2/1/2023 at 12:00PM, Licensing Program Analyst (LPA) C. Lin arrived unannounced to conduct an initial 10-day complaint investigation in regard to the allegations above, and deliver investigation findings. LPA met with Administrator and informed her the reason for the visit. Allegation: Staff did not administer medication as needed in a timely manner - Substantiated The Department has investigated this allegation and per records review and interviews, found that staff S3 has admitted not to administer medication to resident R1 a timely manner on 2/4/23. S3 stated that she was running around for other things until got a call from R1’s private caregiver, then S3 realized it was late. S3 went to R1’s room and gave medication to R1 afterwards. Continue on LIC9099-C Substantiated Allegation: Staff didn't reappraise resident when resident health condition changed – Substantiated The Department has investigated this allegation and per records review and interviews, found that staff did not update R1’s needs and services plan when R1 was admitted to hospice in May 2022. The previous needs & services plan was dated on 7/16/2018. Based on information obtained, the preponderance of evidence is met, therefore the allegations are SUBSTANTIATED. Deficiencies are cited from Title 22 California Code of Regulations (see 9099D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof of correction were discussed with Administrator. Exit interview conducted. Appeal Rights, LIC9099D, and copy this report provided. Allegation: Staff did not communicate with family member (POA) – Unsubstantiated The Department has investigated this allegation and per record reviews and interviews, found that a note indicated that staff did call resident’s POA on 1/2/23 then follow by an email on 1/3/23. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did occur, therefore the allegations are UNSUBSTANTIATED. No deficiency cited. Exit interview conducted with staff and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 1, 2023 · control 15-AS-20230124092737

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Feb 8, 2023

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by… Based on observation the licensee did not comply with the section cited above. LPA observed staff didn't administer medication to resident timely poses an potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 1, 2023

Plan of correction: Deficiency Cleared, Administrator had trained staff on medication on 1/31/23, no repeating training is needed within 24 hours..

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Feb 8, 2023

87463 Reappraisals (a)The pre-admission appraisal shall be updated, in writing as frequently as necessary…. This requirement is not met as evidenced by… Based on observation the licensee did not comply with the section cited above. LPA observed that staff didn't update care plan for resident who was admitted to hospice in May 2022 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 1, 2023

Plan of correction: Deficiency Cleared. No POC is needed as the deficiency was cited from previous complaint allegation in July 2022, and it was corrected. This alleged violation was for May 2022 which was before that. the new management team has updated residents' care plan up to day.

Allegation investigated: Staff are not answering call buttons timely Staff are not meeting residents needs Staff are not providing the quantity of food to meet residents needs

On 2/1/23 at 9:20am, Licensing Program Analyst (LPA) C. Lin arrived unannounced to deliver findings on the above allegations and met with Administrator Anna Reddy. LPA explained the purpose of the visit. On 10/05/2021, LPA Leslie Ibo initiated 10-day initial visit and obtained resident records. On 01/19/2023, LPA L. Fontanilla obtained additional records including but not limited to Resident 1 (R1) Physician’s Report, hospice notes, pendant call logs for September 2021, staff roster, Admission Agreement and Needs and Services Plan and conducted interviews. Conitnue LIC9099-C Unsubstantiated Allegation: Staff are not answering call buttons timely LPA L. Fontanilla interviewed 4 out of 7 caregivers on January 19 and 20, 2023. Staff interviewed state that each time a staff responds to R1’s pendant call, R1 would not let the staff leave the room to attend to other residents until R1 is finished. Staff state that R1 would use the toilet from 45 minutes to an hour. And during those times, staff stayed with R1 and never left the room. In cases wherein the staff gets a call from other residents, staff would ask another caregiver to attend to the other residents. On January 20, 2023, LPA L. Fontanilla reviewed pendant call log. Based on the log, R1 pressed pendant 4x on 9/26/2021 as follows: Initiation Date Time Response Date Time Response Time 9/26/2021 8:42:18AM 9/26/2021 8:47:51 5 m 9/26/2021 10:02:00AM 9/26/2021 10:07:05 5 m 9/26/2021 1:12:42PM 9/26/2021 1:24:00 12 m 9/26/2021 3:03:35PM 9/26/2021 3:06:11 3 m Caregivers interviewed state that average response time to pendant calls is 10 minutes. Allegation: Staff are not meeting residents needs On January 19 and 20, 2023, LPA L. Fontanilla interviewed 4 out of 7 caregivers. Staff interviewed state they are aware of R1’s needs as indicated in the Needs and Services Plan. And that all the care indicated in the care plan were provided to R1. Caregivers interviewed state there were times R1 would ask staff to do tasks which are not indicated in the care plan. Staff would explain to R1 the reason why staff cannot do the tasks for R1. All staff interviewed state that R1 was alert, able to communicate and did not have Dementia diagnosis Staff added R1 would complain if the caregivers do not attend to meet the needs of R1. Continue on LIC9099-C Allegation: Staff are not providing the quantity of food to meet residents needs Based on interview conducted by LPA L. Fontanilla with 4 out of 7 caregivers, R1 was alert and did not have Dementia diagnosis. Caregivers provided R1 with the menu. R1 would call Front Desk to place order for food. Caregiver will pick up food from the kitchen and deliver to R1’s room. Caregivers interviewed state that R1 never complained about the quantity of food served. A review of hospice notes indicate that R1 was diagnosed with “Dysphagia, worsening with patient generally eating 3 small to medium sized meals 3x daily that take more than 60 minutes to eat. Patient sometimes fatigues before finishing or misses meals with appetite….” Based on interviews and records reviewed, the above allegations are unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. There is no deficiency noted. Exit interview was conducted with XXX and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 1, 2023 · control 15-AS-20210927154001

Type of visit: Case Management - Other

On 2/1/23 at 10:20 am, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving self-reported incident dated 12/20/22 submitted to CCLD regarding resident was being physical abused. LPA explained the purpose of the visit with administrator (ADM). ADM stated a neighbor recorded a video that the caregiver hit resident's lower body while providing care. ADM showed the video to LPA. A SOC341 was submitted to CCL and Ombudsman. The police was called and involved. The subject staff was removed from schedule immediately then terminated. ADM had trained all staff on 12/20/22. and provided training record to LPA during visit. A deficiency was cited from the California Code of Regulations, indicated on LIC809D. Failure to correct deficiencies by POC date and/or any repeat deficiencies within a 12-month period may result in additional Civil Penalties. Exit interview conducted with Administrator. LIC809D, Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 1, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87413(a)(2) · Plan of correction due date: Feb 2, 2023

87413 Personnel - Operations (a) In each facility: (2) Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice. This requirement is not met as evidenced by… Based on record review and interview, the licensee did not comply with the section cited above. The caregiver hit resident's lower body was witnessed by a neighbor and video recorded as evidence which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Feb 1, 2023

Plan of correction: Deficiency Cleared. Administrator had trained all staff on 12/20/22 and provided training record to CCL during visit.

Type of visit: Required - 1 Year

On 1/10/2022 starting at 12:05 p.m., Licensing Program Analyst (LPA) Catherine Lin arrived unannounced to conduct Infection Control Inspection. LPA met with the Administrator and Resident Care Director, and disclosed the purpose of the visit. Upon entry, LPA’s temperature was checked and fill out Covid-19 questionnaire by the machine. LPA toured facility including but not limited to screening station, hand washing stations, bedrooms, bathrooms, kitchen, common areas, and outdoor areas. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy and hand sanitizer were observed at screening station. Cough/sneeze etiquette and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has Infection Control Plan, Emergency Disaster Plan, and maintains record of routine screening for residents, staff, and visitors. No deficiency cited during visit. Exit interview conducted with Administrator, and a copy of this report provided.the state’s words, verbatim · CDSS document, Jan 10, 2023

Allegation investigated: Facility did not follow COVID-19 protocols. Facility did not have a current care plan for resident. Facility did not have sufficient staff to meet residents' needs.

On 12/13/2022 at 12:00 PM, Licensing Program Analyst (LPA) C. Lin arrived unannounced to conduct a subsequence complaint investigation visit in regard to the above allegations and delivered investigation findings. LPA met with Administrator and informed the reason for visit. Allegation: Facility did not follow COVID-19 protocols – Substantiated The Department has investigated this allegation and per records review and interviews found that staff S1, S2, S3, and S6 stated that facility didn’t designate staff to only take care of Covid-19 positive residents during Covid outbreak started in July 2022. Staff stated that the former resident care director S5 didn’t correct staff due to staff shortage in subject time period. Continue on LIC9099-C Substantiated Allegation: Facility did not have a current care plan for resident – Substantiated The Department has investigated this allegation and per records review and interviews found that facility didn’t have current care plan for 3 residents who were randomly reviewed. The latest care plans for these 3 residents were observed dated in year 2019. Resident R1 has been requesting an updated care plan since the beginning of 2022, it has not been discussed and provided until the new management came on aboard in September 2022. Allegation: Facility did not have sufficient staff to meet residents' needs – Substantiated The Department has investigated this allegation and per records review and interviews found that only one care staff worked at PM shift 8 days in July staff work schedule, they were from 7/22/22 to 7/26/22, and from 7/29/22 to 7/31/22, and no care staff was scheduled to work at NOC shift on 7/31/22. Work schedule indicated that 2 care staff were scheduled at PM shift and 1 care staff was scheduled at NOC shift daily, however, staff was no show on above dates, facility was unable to provide information to proof additional care staff was added on schedule. Based on information obtained, the preponderance of evidence is met, therefore the allegations are substantiated. Deficiencies are cited from Title 22 California Code of Regulations (see 9099D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Deficiencies and plan and proof of correction were discussed with the Administrator. Exit interview conducted. Appeal Rights, LIC9099D, and copy this report provided. Allegation: Facility food is not adequate (lacks nutrition, freshness, unappetizing, poor quality, timeliness) – Unsubstantiated The Department has investigated this allegation and per records review and interviews found that facility menus were designed and monitored by Crandall Corporate Dietitians. Administrator stated that the corporation didn't allow facility to create separate menus. Administrator provided copies of dietitians quarterly audit report to CCL for review, it was the 4th quarter report of year 2022 dated on 11/8/2022. 7 residents were interviewed, 5 of them stated that food was adequate and service was met. Due to the communal dinning room was closed in Covid outbreak, meals were delivered to each resident's room. Some residents received meals later than normal meal time, residents stated that the delay was not bad and acceptable. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Dec 13, 2022 · control 15-AS-20220712070126

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Dec 20, 2022

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful... This requirement is not met as evidenced by… Based on observation the licensee did not comply with the section cited above. LPA observed staff crossover working between Covid-19 positive and negative residents which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 13, 2022

Plan of correction: Administrator agrees to retrain staff for infection control, and submit proof of training to CCL by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Dec 20, 2022

87463 Reappraisals (a)The pre-admission appraisal shall be updated, in writing as frequently as necessary…. This requirement is not met as evidenced by… Based on observation the licensee did not comply with the section cited above. LPA observed that care plan has not been updated for residents who change in health condition since 2019 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 13, 2022

Plan of correction: Administrator agrees to review regulations, submit a self-certification to CCL by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Dec 20, 2022

87411 Personnel Requirements-General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...facilities licensed for sixteen or more, sufficient support staff shall be employed….. This requirement is not met as evidenced by… Based on observation the licensee did not comply with the section cited above. Insufficient staff was observed on work schedule in July 2022 which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 13, 2022

Plan of correction: Administrator agrees to provide a planning of maintaining sufficient staff to meet residents' needs at facility, and submit to CCL by POC due date.

Type of visit: Case Management - Deficiencies

On this day 12/13/22, Licensing Program Analyst (LPA) C. Lin conducted a case management visit and met with Administrator. LPA explained the purpose of the visit. During an investigation conducted by the Department, records obtained indicated that staff training records on and before September 2022 was not available for CCL to review. A deficiency is cited from Title 22 California Code of Regulations (see 9099D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty. Exit interview conducted with Administrator. A copy of this report and Appeal Rights was provided.the state’s words, verbatim · CDSS document, Dec 13, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87412(c) · Plan of correction due date: Dec 20, 2022

87412 Personnel Records (c)Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by… Based on observation the licensee did not comply with the section cited above. LPA observed staff training records on and before September 2022 was not available for CCL to review which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 13, 2022

Plan of correction: Administrator agrees to provide a planning of maintaining staff records at facility, and submit to CCL by POC due date.

Type of visit: Case Management - Other

On 12/13/22 at 12:00PM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving residents from Grand Lake Gardens (GLG) and check on residents, and a self-reporting incident regarding a resident's suicidal ideation. LPA met with Resident Care Director and explained the purpose of the visit. During visit, LPA obtained GLG roster. A total of 14 residents from GLG are currently residing at MGR, 3 of them new moved-in since the last visit, and 1 resident was discharged on 12/12/22. LPA met with 2 residents who stated that they were safe and comfortable living in facility. Supplies were adequate and staffing is stable. There was no imminent health/safety concerns on today's date. Exit interview conducted with Resident Care Director and copy of this report provided.the state’s words, verbatim · CDSS document, Dec 13, 2022

Type of visit: Case Management - Other

On 12/6/22 at 12:45PM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving residents from Grand Lake Gardens (GLG) and check on residents, and a self-reporting incident regarding a resident's suicidal ideation. LPA met with Resident Care Director and explained the purpose of the visit. During visit, LPA obtained GLG roster. A total of 12 residents from GLG are currently residing at MGR, 2 of them were new move-in since the last visit. LPA met with 2 residents who stated that they were safe comfortable living in facility. Regarding the self-reporting incident, LPA obtained resident's physician's report and care plan for review. The resident is still hospitalized and has no definitive discharge date. Exit interview conducted with Resident Care Director and copy of this report provided.the state’s words, verbatim · CDSS document, Dec 6, 2022

Type of visit: Case Management - Other

On 11/23/22 at 1:10PM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving residents from Grand Lake Gardens (GLG) and check on residents. LPA met with Resident Care Director and explained the purpose of the visit. During visit, LPA obtained staff schedule. A total of 10 residents from GLG are currently residing at MGR, 2 of them were new move-in after the last visit. LPA met with 3 residents who stated that they were safe comfortable living in facility. Supplies were adequate and staffing is stable. There was no imminent health/safety concerns on today's date. Exit interview conducted with Resident Care Director and copy of this report provided.the state’s words, verbatim · CDSS document, Nov 23, 2022

Type of visit: Case Management - Other

On 11/17/22 at 10:15AM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving residents from Grand Lake Gardens (GLG) and check on residents. LPA met with Resident Care Director and explained the purpose of the visit. During visit, LPA obtained resident roaster from GLG. A total of 8 residents from GLG are currently residing at MGR, 6 of them were new move-in after the last visit. LPA met with 5 residents who stated that they were feeling safe in the facility. Supplies were adequate and staffing is stable. There was no imminent health/safety concerns on today's date. Exit interview conducted with Resident Care Director and copy of this report provided.the state’s words, verbatim · CDSS document, Nov 17, 2022

Type of visit: Case Management - Other

On 11/10/22 at 3:05PM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving residents from Grand Lake Gardens (GLG) and check on residents. LPA met with Resident Care Director and explained the purpose of the visit. During visit, LPA obtained resident roaster from GLG and Merrill Gardens at Rockridge's (MGR) staff schedules. A total of 10 residents from GLG have moved in to MGR. LPA met with 2 residents who stated that they were feeling safe in facility. Supplies were adequate and staffing is stable. There was no imminent health/safety concerns on today's date. Exit interview conducted with Resident Care Director and copy of this report provided.the state’s words, verbatim · CDSS document, Nov 10, 2022

Type of visit: Case Management - Incident

On 08/29/22 at 11:30AM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving two self-reported incidents submitted to CCLD. LPA met with Administrator (ADM) and explained the purpose of the visit. The incident dated 8/18/22 regarding to R1's elopement, LPA observed that R1 has hired 24/7 private caregiver with her. ADM had educated the private caregiver must accompany with R1 at all time. ADM also discussed with R1's family member that R1 should be moved to memory care unit or moved out to other facility for proper care needs. The incident dated 8/19/22 regarding to R2's body injury, LPA observed that facility has the same setup of a stackable washer and drier installed in a closing door closet in each apartment, the machine was observed heavy and steady but not attached to the wall . R2 stated that she lost balance while doing laundry that day, she grabbed the opening of washing machine on the top and both washer and drier fell forward, lucky R2's walker blocked the way in between so the machine didn't fell on R2's body directly. R2 pressed call button, staff went to her room immediately and assisted her in time manor. R2 got injuries on her head and index finger. LPA discussed with ADM that facility might consider to secure washer and drier from now on due to the population they serve. No deficiency cited during visit. Exit interview conducted with ADM, and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 29, 2022

Type of visit: Case Management - Incident

On 08/10/22 at 1:25PM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving self-reported incident dated 08/02/2022 submitted to CCLD regarding medication error. LPA explained the purpose of the visit with general manager. Based on the record review and interviewed, LPA observed that resident R1 was given wrong medication Levothyroxine 100mg x1 tablet which belonged to resident R2. LPA spoke with R1, R1 stated that she didn't feel sick, however, staff still wanted her to be checked by doctor so 911 call was activated. R1's son-in-law arrived at facility before ambulance came then took R1 to hospital. LPA observed that the hospital discharge paper indicated "Hypotension due to drugs". Resident stated that she has not been having symptoms due to wrong medication since then. Due to no injury or medical issue was resulted to R1 as of today, no civil penalty is assessed. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809-D. Failure to submit proofs of correction (POC) by plan of correction due date and/or any repeat deficiency within a 12-month period may result in civil penalties. Exit interview conducted with general manager, appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Aug 10, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5)(A) · Plan of correction due date: Aug 11, 2022

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility,,, (5) Facility staff, except those authorized by law...Assistance with self administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician. This requirement is not met as evidenced by… Based on observation, interview, and record review, the licensee did not comply with the section cited above. Wrong medication was given to R1 which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 10, 2022

Plan of correction: General manager agreed to retrain staff on medication, and provide a detail planing how to prevent same incident happen in the future, and submit to CCL by the POC due date.

Allegation investigated: Resident made to wait an excessive period of time for assistance on more than one occasion. Resident's emergency call button malfunctioned.

On 7/11/22, at 1:50pm, Licensing Program Analyst (LPA) C. Lin arrived unannounced to deliver findings on the above allegations. LPA met with Business Office Director, Lisa Read and explained the purpose of visit. On 3/5/2021, LPA Allison O’Hollaren initiated initial 10-day investigation, obtained records and interviewed reporting Party (RP). On 10/14/2021, this complaint was reassigned to LPA Luisa Fontanilla. LPA Fontanilla interviewed staff and reviewed the following records for Resident 1 (R1): call log, Physician’s Report, Service Plan and Monthly Task Log. Based on the call logs reviewed for the period February 4 – 17, 2021, response time recorded ranges from 1 minute to 11 hours and 29 minutes. Continue on LIC9099-C Substantiated Staff interviewed state that due to the pandemic, the facility was experiencing shortage of staff. The facility contracted with an agency for additional staff. However, since the agency staff are new and not familiar with the resident, it took longer for the agency staff to respond to the residents. Staff interviewed confirmed with LPA that there were technical issues with the call button around the time the complaint was filed. Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, are being cited on the attached LIC 9099D. Exit interview was conducted with Business Office Director, Appeal Rights and copy of this report provided.the state’s words, verbatim · CDSS document, Jul 11, 2022 · control 15-AS-20210223101041

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jul 18, 2022

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, facility staff failed to respond to R1’s pendant call for assistance in a timely manner which poses a potential risk to the health and safety of resident under care.the state’s words, verbatim · CDSS document, Jul 11, 2022

Plan of correction: Administrator states staff training will be conducted about the facility’s protocol on pendant call response and submit proof of training to CCL by POC date,

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Jul 18, 2022

87303 Maintenance and Operation (a) 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 and records reviewed, the facility’s emergency call button had technical issues which poses a potential risk to the health and safety of clients under care.the state’s words, verbatim · CDSS document, Jul 11, 2022

Plan of correction: On 4/18/2022, LPA Fontanilla spoke with Dillon Cagulada, Manager who confirmed with LPA Fontanilla that the pendant call system had a lot of issues few months before he started working at the facility. Cagulada added that there were changes and upgrades done to the system and has been working fine. By POC date, Manager will submit 1.self-certification stating the pendant call system has been fixed and currently functional 2.plan on how to address resident calls if pendant call system is broken

Allegation investigated: Neglect/Lack of Supervision

On 7/11/22 at approximately 2:30pm, Licensing Program Analyst (LPA) C. Lin arrived unannounced to deliver findings for the above allegation and met with Business Office Director Lisa Read and explained the purpose of visit. On 8/30/2021, LPA Allison O’Hollaren initiated 10-day investigation. On 10/14/2021, this complaint was reassigned to LPA Luisa Fontanilla. During the course of investigation, the Department conducted interviews and reviewed records such as incident reports, staff schedule for the month of June 2021, Resident 1 (R1) Emergency Information, Physician’s Report, Admission Agreement and Task Log for June 2021. Continue on LIC9099-C Unsubstantiated When interviewed, R1 denied anyone kissed R1 at the facility. All staff interviewed state that S1 did not work with R1 and had minimal interactions and would only see R1 in the common areas such as dining room and living room. S1 denied kissing R1 and explained that S1 had minimal interactions with S1 and would only speak with S1 in the dining room. In addition, Former Resident Care Coordinator states that S1 could not tell who kissed S1. Staff denied ever seeing S1 act inappropriately with other staff or any of the residents including R1. Based on interviews conducted, the allegation that R1 was sexually abused – kissed and hugged by a facility male staff (S1) is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. There is no deficiency noted. Exit interview conducted with Business Office Director and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 11, 2022 · control 15-AS-20210827145908

Type of visit: Case Management - Other

On 7/11/22, at approximately 2:38pm, Licensing Program Analyst (LPA) C. Lin conducted case management while delivering complaint investigation findings (15-AS-20210827145908). LPA met with Business Office Director Lisa Read and explained the purpose of visit. During the course of investigation on a complaint, the Department observed one staff working at the facility was not cleared or associated to the facility. Deficiency is cited per Title 22 California Code of Regulations. Please refer to Lic 809D. Civil Penalty of $500 is accessed today. Exit interview was conducted with Business Office Director, Appeal Rights and a copy of this report provided.the state’s words, verbatim · CDSS document, Jul 11, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Jul 12, 2022

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 or (2) This requirement is not met as evidenced by: Based on the Department’s investigation, a staff working at the facility was not cleared or associated to the facility which poses an immediate threat to the health and safety of clients under care. This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, one staff working at the facility was not cleared or associated to the facility.which poses a immediate risk to the health and safety of resident under care.the state’s words, verbatim · CDSS document, Jul 11, 2022

Plan of correction: By POC date, General Manager will review and submit certification of understanding of Sec 87355. Civil Penalty of $500 is accessed.

Allegation investigated: Facility staff failed to seek timely medical attention for resident Resident care needs are not being met Staff mismanaged resident's medication

On 6/29/2022 at 1:35pm, Licensing Program Analyst (LPA) C. Lin conducted an unannounced subsequent complaint investigation visit of the allegations listed above. LPA met with Resident Care Director Parinda Kleinberg and explained the purpose of the visit. Allegation: Facility staff failed to seek timely medical attention for resident - Unsubstantiated The Department has investigated this allegation and per record review and interviews found that R1 is fully alert, R1’s wound was not developed in facility, R1’s physician was aware of it, and prescription was prescribed to R1. R1 stated that proper care was received by staff members timely. When R1 asked for assistance by using call button, staff member arrived in approximately 15 minutes during daytime and 10 minutes at night. S1 stated that caregivers would not provide wound care to resident based on the California Regulation Code of Title 22. However, Med-Tech S2 and S4 were trained to provide basic care consistently on R1’s wound based on physician’s order. Continue on LIC9099-C Unsubstantiated Allegation: Resident care needs are not being met - Unsubstantiated The Department has investigated this allegation and per records review and interviews found that staff R2, R3, R4, R5, and R6 have been providing same care to R1 based on what R1 needs. R1 confirmed that the care needs including but not limited to ADL, dressing, mediations were met. Allegation: Staff mismanaged resident's medication - Unsubstantiated The Department has investigated this allegation and per records review and interviews found that facility has made afford to communicate with physician for the order (Bacitracin). W1 also confirmed that multiple requests were received from facility and responded to facility multiple times between 1/10/21 and 1/19/22. Facility received the physician's order on 1/20/22 and assisted R1 to administer medication as soon as receiving it on the same day which was documented on R1's MAR. Although the allegations may have happened or are valid, there is not a preponderance of evidence to provide the alleged violation did occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted with Director and a copy of this report provided.the state’s words, verbatim · CDSS document, Jun 29, 2022 · control 15-AS-20220124150642

Allegation investigated: Staff do not safeguard resident's personal items.

On 3/3/2022, Licensing Program Analyst (LPA) C. Lin conducted an unannounced subsequent complaint investigation visit of the allegation listed above. LPA met with Administrator and explained the purpose of the visit. LPA interviewed R1 who denied jewelry was missing. R1 missed a wallet but didn't report it to facility. LPA interviewed other 6 residents and 1 visitor, none of them claimed that their belongs were missing. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with Administrator and a copy of this report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 3, 2022 · control 15-AS-20211201102127

Type of visit: Case Management - Other

On 3/3/2022 at 9:10am, Licensing Program Analyst (LPA) C. Lin conducted a Case Management visiting of health and safety check. LPA met with Administrator and explained the purpose of the visit. LPA toured facility including but not limited to common area, dinning room, bedrooms, and bathrooms. and also interviewed residents and visitor. Based on the observation, record review, and interview, LPA observed food supplies was sufficient, daily menu was prepared weekly, and posted both in kitchen for staff and on dinning tables for residents. Dinning room opens from 7am to 7pm which was agreed upon on Admission Agreement. Facility did adjust staff's schedule based on business needs, but the impact of Assisted living residents' needs and service was not observed. Staffing is adequate. No deficiency cite during visit. Exit interview conducted with Administrator and a copy of this report provided.the state’s words, verbatim · CDSS document, Mar 3, 2022

Type of visit: Required - 1 Year

On 2/2/2022 starting at 3:40 p.m., Licensing Program Analyst (LPA) Catherine Lin arrived unannounced to conduct Infection Control Inspection. LPA met with Administrator Dillon Cagulada and disclosed the purpose of the visit. Upon entry, LPA’s temperature was checked by the staff, asked to fill out Covid-19 questionnaire, and requested to wash hands. LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, bathrooms, kitchen, and common areas. There is one central entry point for universal screening for staff, residents, and visitors. A sign-in policy, thermometer and hand sanitizer were observed at screening station. Cough/sneeze etiquette and hand washing posters were observed. Facility staff were observed to be wearing proper PPE. Facility has a sufficient 2-day perishable and one-week non-perishable food supply. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. Facility has Mitigation Plan, Emergency Disaster Plan, and maintains record of routine screening for residents, staff, and visitors. No deficiency cited during visit. Exit interview conducted with Administrator, and a copy of this report provided.the state’s words, verbatim · CDSS document, Feb 2, 2022