Miracle Assisted Living Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with the administrator designee, Rima Araronyan and explained the reason for the visit. At approximately 11:45am, LPA Cava took a tour of the physical plant. Required postings were observed in the entry area. The LPA's temperature was taken at entry. Extra masks and hand sanitizer was observed with a sign in sheet. The smoke alarms are battery operated. The carbon monoxide detector functions properly. There is a fully charged fire extinguisher is located in the kitchen. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives are stored in a locked drawer. Bedrooms: There were four (4) bedrooms designated for residents' use. All four resident bedrooms were were properly furnished with appropriate beddings and linens with sufficient lighting. There is one (1) room designated for staff. Bathrooms: There are three (3) bathrooms designated for residents' use. All three bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 111 degrees Fahrenheit. No cleaning supplies were observed accessible to the residents in care. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit. Properly labeled medications were locked in staff's work station by the front entrance. Surrounding Grounds: Entry/exits were free of obstruction. The front and back yards were inspected and observed to be free of obstruction. The laundry area is located by the storage space, near the backyard exit of the home. Cleaning supplies and detergents were observed locked there. Resident Files: LPA conducted a file review of resident records to insure compliance of licensing forms. Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms. Medications: Medication and Medication Records were review for proper documentation. Pursuant to Title 22 Division 6 of the CA Code of Regulations, there were no deficiencies observed during the visit. Exit Interview Conducted and a copy of this report issued.the state’s words, verbatim · CDSS document, Oct 25, 2022

Allegation investigated: Resident 1 (R1) developed multiple pressure injuries while in the licensees’ care.

An unannounced subsequent complaint visit was conducted on this day by Licensing Program Analyst (LPA) Yelena Avetisyan. Upon arrival, the LPA met with staff. Rima Araronyan Administrator designee arrived 6:05pm Regarding the allegation listed above, it is being alleged that the R1 developed multiple pressure injuries while living at the facility. It is also being alleged that the pressure injuries worsened within weeks from last hospitalization. This investigation was conducted by Peter Zertuche, Investigator with Community Care Licensing Division’s Investigations Branch. On 11/17/2021, LPA Yelena Avetisyan conducted an initial 10-day visit to initiate the investigation. On that day, at 9:30 am., LPA Avetisyan reviewed and obtained copies of facility records for resident #1 (R1) and other 6 residents. Additionally, at 8:27 am., the LPA initiated staff interviews. At approximately 9:15 am., the LPA toured the facility. On 11/17/2021 and 11/18/2021, Investigator Zertuche subpoenaed Kaiser Medical and home health records for R1. Review of the records revealed the following: R1 was hospitalized on 11/1/2021. Substantiated Hospital records noted R1 presented with 4 pressure injuries. On 11/4/2021 the hospital completed a referral for home health care. Hospital records also documented that facility was instructed to reposition R1 every 2 hours. On 11/5/2021 a Initial Evaluation/Assessment was completed by Infinite Home Health. Upon completion of the evaluation/assessment R1 was diagnosed with a stage 2 pressure ulcer of right ankle, and a stage 4 pressure ulcer rt lateral malleolus. Home health records document that after every visit the facility home health staff “reinforced frequent change of position and diaper.” Staff verbalized an understanding to the home health nurse. R1 was again hospitalized on 11/13/2021 at which time R1’s pressure injuries were assessed and documented to have worsened and the following pressure injuries were noted: unstageable left heel, stage 4 right lateral malleolus and a healing Stage 2 right elbow. On 12/2/2021 from approximately 1:30 to 2:30 pm Investigator Zertuche conducted interviews with the assistant administrator Rima Araronyan, facility staff and residents. When interviewed Ms. Araronyan denied knowledge of the pressure injuries being over stage 2. Additionally, Ms. Araronyan admitted that staff did not reposition the resident because he was refusing and was able to turn himself, however facility and medical records document that R1 has no movement on his right side at baseline and was bed bound. Staff did not document the refusal, did not notify R1’s physician or home health agency. On 2/3/2022 LPA Avetisyan called Canyon Oaks Nursing and Rehabilitation and spoke with the Case Manager who confirmed that R1 did not have any pressure injuries when discharged from their facility. Information obtained during the course of the investigation confirmed that R1 developed pressure injuries while living at the facility. On 11/5/2021 the right lateral malleolus pressure injury was diagnosed as a stage 4 which is a prohibited health condition. Licensee/administrator and staff failed to follow hospital/home health instructions to reposition R1 which resulted in the pressure injuries worsening therefore the allegation is Substantiated. Per California Code of Regulations (CCR), Title 22, see LIC 9099-D for deficiencies cited. An immediate civil penalty of $500 is also assessed. The licensee was informed that a civil penalty might be assessed based on the Health and Safety Code 1569,49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f).the state’s words, verbatim · CDSS document, Mar 14, 2022 · control 31-AS-20211116143735

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Mar 16, 2022

Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement was not met as evidenced by: Based on information obtained during the investigation the licensee did not comply with the cited section by retaining R1 at the facility with a stage 4 pressure injury which posed an immediate health and safety and personal rights risk to R1.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: Licensee, Administrators will schedule 4 hours vendorized training for themselves and all staff. 1) Verification of the scheduled training with the credentials of the trainer will need to be emailed to the LPA by 3/16/2022 2) Verification of completed training will need to be submitted to the LPA by 3/28/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87616(a) · Plan of correction due date: Mar 16, 2022

As specified in Section 87209, Program Flexibility, the licensee may submit a written exception request if he/she agrees that the resident has a prohibited and/or restrictive health condition but believes that the intent of the law can be met through alternative means. This requirement was not met as evidenced by: Based on information obtained during the investigation, the licensee did not comply with the cited section by not submitting an exception request to retain R1 at the facility with a prohibited health condition, which posed an immediate health and safety and personal rights risk to R1.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: Licensee, Administrators and assistant administrators will schedule and attend 1 hours vendorized training related to the cited section.. 1) Verification of the scheduled training with the credentials of the trainer will need to be emailed to the LPA by 3/16/2022 2) Verification of completed training will need to be submitted to the LPA by 3/28/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(f)(1) · Plan of correction due date: Mar 16, 2022

Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on the information obtained during the course of the investigation the licensee failed to comply with the cited section by not following instructions provided by physician/skilled medical professional related to the care of R1 which resulted in R1 developing prohibited health conditions and posing an immediate health and safety and person rights risk to R1.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: Licensee, Administrators will schedule 2 hours vendorized training for themselves and all staff related to the cited section. 1) Verification of the scheduled training with the credentials of the trainer will need to be emailed to the LPA by 3/16/2022 2) Verification of completed training will need to be submitted to the LPA by 3/28/2022. Because this violation resulted in resident developing prohibited health conditions as a result of improper care an immediate civil penalty in the amount of $500 is issued.

Type of visit: Case Management - Deficiencies

An unannounced Case Management Deficiencies visit in conjunction with a subsequent complaint visit was conducted on this day by Licensing Program Analyst (LPA) Yelena Avetisyan. The purpose of this visit is to address deficiencies that were identified during the initial 10 day complaint investigation visit and during the course of the investigation that is not related to the complaint control 31-AS-20211116143735. Upon arrival at approximately 5:50 pm LPM met with Staff who identified herself as Varduhi, however when LPA again asked the staff for her name staff responded that her name was Susan. LPA requested and reviewed photo id for staff and confirmed her name was Susan Nelly Sahakyan. LPA conducted review of the Licensing information system and confirmed that staff's criminal record clearance has not been transferred to this facility. While conducting a tour of the facility LPA observed that resident 2 (R2) is residing in a room that was designated as a staff room and according to the administrator designee later changed to an ambulatory resident room. At 6:18 pm LPA conducted review of R5's physicians report which documented that resident is non ambulatory. The administrator designee Rima Araronyan arrived to the facility approximately 6:05 pm. A discussion was held with Ms. Araronyan regarding staff working at the facility. Ms. Araronyan insisted that the staff member is currently in training and has been working at the facility for only 2 days. Ms. Araronyan also stated that the staff member is not left alone with the resident and that she only stepped away from the facility briefly. Approximately 6:32 pm LPA conducted interview with 2 of the residents who confirmed that the staff has been working at the facility for about a week or two and is usually the only staff in the evenings and on weekends. At approximately 6:40 pm a discussion was held with Ms. Araronyan regarding resident 3 (R3). Per Ms. Araronyan resident is not bedridden and is put in her wheelchair at time., however according to the residents physicians report upon admission to the facility R3 was bedridden. At approximately 6:43 pm LPA spoke with R3's roommate who confirmed that the staff repositions R3 and cannot recall the last time that R3 was taken out of bed if ever. R3 is currently residing in a room that has non-ambulatory fire clearance. During the initial 10 day complaint visit from approximately 9:15 am to 9:25 am LPA conducted a tour of the facility. From 9:30 am to 9:45 am LPA conducted review of the resident files and request copies of pertinent documents. From 9:45 am to 10:10 am LPA spoke with Rima Araronyan Administrator designee. During the visit LPA noted and discussed the following with Ms. Araronyan. Licensee/Administrator retained 7 residents at the facility from 10/29/2021 to 11/15/2021 Licensee did not transfer criminal record clearance for Staff 1 (S1). During the 11/17/2021 visit LPA was informed by Ms. Araronyan that she emailed the transfer form to the regional office email. LPA requested for the email to be forwarded to her attention. As of today's visit the email has not been forwarded.. Administrator designee Rima Araronyan requested for resident 2 (R2) to provide false/misleading statement to the LPA regarding his status at the facility by telling the resident in Armenian to say he is the husband of the female staff. Ms. Araronyan also asked R2 to provide false/misleading statement to the LPA regarding the room he resides in. The licensee did not obtain/complete an agreement in writing related to the care of R1's pressure injuries. The licensee did not ensure staff receive training from the home health agency for R1's care needs Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiencies were observed and cited: (Refer to LIC 809-D). Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.the state’s words, verbatim · CDSS document, Mar 14, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87204(a) · Plan of correction due date: Mar 16, 2022

(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. This requirement was not met as evidenced by: Based on information obtained on 11/17/2021 and interviews the licensee/administrator did not comply with the cited section by operating over capacity. Admitting and retaining 7 residents when their licensed capacity is for 6 residents which posed an immediate health and safety and personal rights risk to clients in care.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: Licensee, Administrators and assistant administrators will schedule and attend 1 hour vendorized training related to the cited section. 1) Verification of the scheduled training with the credentials of the trainer by 3/16/2022 2) Verification of completed training will need to be submitted to the LPA by 3/28/2022. This is a zero tolerance violation therefore a civil penalty in the amount of $500.00 has been issued. Civil penalties will continue to accrue until plan of correction is submitted.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87355(e)(2) · Plan of correction due date: Mar 15, 2022

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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is not met as evidenced by Based on interviews, and record review, the licensee & administrator did not comply with the section cited by allowing S1 to work at the facility prior to transferring her criminal record clearance to this facility. which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: Licensee/Administrator will submit transfer of the Criminal Record Clearance, photo ID and criminal record statement for S1 and S2. This is a zero tolerance violation therefore a civil penalty in the amount of $500.00 has been issued. Civil penalties will continue to accrue until plan of correction is submitted.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87207 · Plan of correction due date: Mar 16, 2022

No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This Requirement was not met as evidenced by: Based on the information obtained by LPA during the 11/17/2021 visit the Administrator designee Rima Araronyan did not comply with he cited section by asking Resident 2 (R2) to provide false/misleading statements to LPA regarding his identity and the room he resides in which posed an immediate personal rights violation to residents in care.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: Administrator designee Rima Araronyan will submit a written explanation regarding her actions to the Department. Ms. Araronyan, Licensee Representative, administrator and all other corporate members will also attend 10 hours vendotized training for the following title 22 regulations. 87405: Administrator Qualifications and Duties. 87408: Denial or Revocation of a Certificate 87777: Exclusions Personal Rights. Written statement and verification of scheduled training with the trainers credentials will need to be submitted by 3/16/2022 and completed by 4/1/2022.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87609(b)(4)(A)(B)(C) · Plan of correction due date: Mar 16, 2022

(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met:(4) (A)(B)(C) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s)........ This requirement was not met as evidenced by: Record Review and Interview conducted. The licensee did not comply with the cited section by not completing a written agreement with the home health agency related to the condition and care of the pressure injuries which posed a potential health and safety and personal rights risk to R1.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: Licensee, Administrator and administrator designee will review all of section 87609 and 87631. A written statement will be submitted by each individual indicating that they have reviewed and understand the regulation and that it will be followed at all times.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202 · Plan of correction due date: Mar 15, 2022

All facilities shall maintain a fire clearance. Prior to accepting persons over 60 years of age none ambulatory and/or bedridden the licensee shall notify the licensing agency and obtain an appropriate fire clearance. 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 by retaining 1 bedriddent resident in room with non ambulatory fire clearance and 1 non ambulatory resident in room with ambulatory fire clearance which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: Ms. Araronyan informed the LPA that she will speak with the families of residents and relocate the 2 residents to rooms that have appropriate fire clearances. Mr. Araronyan will inform the LPA in writing when the moves have been completed and indicate which room the residents were relocated to.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87613(2)(A)(B) · Plan of correction due date: Mar 16, 2022

(a) Prior to admission of a resident with a restricted health condition, the licensee shall: (2) (A)(B) Ensure that facility staff who will participate in meeting the resident’s specialized care needs complete training provided by a licensed professional sufficient to meet those needs.... This requirement was not met as evidenced by: Based on interview and record review the licensee did not comply with the cited section by not ensuring staff providing care to R1 received training related to R1's specialized care needs which posed an immediate health and safety and personal rights risk to R1.the state’s words, verbatim · CDSS document, Mar 14, 2022

Plan of correction: Licensee, Administrator and Administrator Desginee will schedule 6 hours vendorized training for themselves and all staff for the following title 22 regulations. 87609, 87611, 87612, 87613, 1) Verification of the scheduled training with the credentials of the trainer will need to be emailed to the LPA by 3/16/2022 2) Verification of completed training will need to be submitted to the LPA by 3/28/2022.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Wendell Smith made an unannounced required annual visit. LPA met with administrator designee and explained the reason for this visit. he physical plant was toured inside and out. Property consist of five (5) bedrooms of which four (4) are designated for residents use and three (3) bathrooms designated for residents use; facility has a kitchen, dining/living room and designated office area. The facility has been fire cleared for five (5) non-ambulatory and one (1) bedridden. There are two (2) shared rooms and two (2) private rooms designated for residents. LPA observed all resident bedrooms to be appropriately furnished. LPA observed bathrooms to have grab bars and non skid material. Hot water temperature was tested and found to be at 116 degrees F. LPA toured facility common areas and found them to be appropriately furnished. The facility smoke alarms/carbon monoxide were tested and found to be in working order. LPA checked the kitchen area for the ability to prepare and store food. LPA observed there to be a sufficient amount of perishable and non perishable food. LPA observed there to be a sufficient amount of emergency supply food also. LPA observed a washer and dryer . The supply of extra bed and bath linen is adequate. All required postings observed on the wall near the office area. Alarms on all exterior doors were engaged at the time of visit. The outside was toured and observed free of visible hazards. There is a pool on the premises which was observed fenced/locked. Backyard is set-up with patio furniture for residents use. Facility currently has four residents on hospice at the time of the visit. Exit interview conducted.the state’s words, verbatim · CDSS document, Aug 3, 2021