Oasis for Seniors at Heaven's Garden

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct an annual inspection. LPA met with administrator Adela Toderean during today's inspection. LPA ensured they applied hand sanitizer before entering the facility. LPA toured facility with administrator to ensure health and safety of residents in care. LPA toured 5 resident rooms, 1 staff room, 2 bathrooms, kitchen, common living spaces, backyard and the garage area. LPA toured the backyard area and observed emergency exit was locked. There is a locked storage for medications and toxins. Food supply is adequate for 2-day perishable and 7-day nonperishable. LPA observed an adequate amount of linens and found the first aid kit to be complete. LPA reviewed 2 of 6 resident files and 2 staff files. LPA reviewed medications of one resident comparing with Centrally Stored Medication Record and physician orders. A review of staff records indicates that all facility staff has received criminal record clearances and/or are associated to this facility.LPA observed a copy of current liability insurance. There are deficiencies being cited as a result of todays inspection. Deficiencies cited on 809-D. Exit interview conducted and appeal rights provided.the state’s words, verbatim · CDSS document, Aug 16, 2023

Type of visit: POC

Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to conduct a POC visit. LPA met with Administrator Adela Toderean during today's inspection. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks. LPA was following up on plan of correction from deficiency cited in October 2022. Administrator stated refund was mailed out to responsible party on Friday February 10, 2023. Administrator is expected to receive a receipt of responsible party receiving the refund in the next few days. Administrator agrees to send receipt of refund by 2/17/23. No deficiencies cited during today's visit. Exit interview conducted.the state’s words, verbatim · CDSS document, Feb 14, 2023

Allegation investigated: The licensee did not use an approved addmission agreement. Licensee failed to refund resident representative as required. Licensee increased fees without proper notice to resident/ representative.

On 10/12/22, Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced to open this complaint onvestigation. The investigation was also concluded based on evidence collected, delivered complaint findings. LPA met with the Licensee and explained the purpose of the visit. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA completed a facility risk assessment upon arrival. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by facility staff upon entering the facility. LPA advised more thorough screening of visitors be documented. The department reviewed client/resident records provided by the reporting party and verifed information with the licensee during an interview. The department finds that the allegations cited above are substantiated. Continued on LIC 9099-C Substantiated R1 was admitted on or about 3/1/22. At the time of the admission, the agreed upon fee was $6500, plus a one time fee of $650. During the month of March, R1 was hospitalized, had a change of condition and returned to the facility on Hospice. R1's monthly fees were increased to $7000 due to what the licensee determined were increase level of care. LPA reviewed licensee's admission agreement and found: The admission agreement used by the licensee is not the same as the approved admission agreement on file with the Department; The admission agreement in use at the home and used with R1 has a sliding scale for the first month of residents admitted on hospice; LPA and licensee reviewed a copy of another resident's admission agreement (R1's file is not present- LPA to receive a copy), the admission agreement also contains a one time admission fee of $650 without a written general statement describing all costs associated with the preadmission fee charges and stating that the preadmission fee is refundable, and describing conditions for the refund. Licensee will submit copies of R1's LIC 602, appraisal, hospice assessment and admission agreement. In the interview with the licensee and in review or the admission agreement in use, it was found that the licensee does not have a level of care fee schedule as part of the admission agreement. From a review of the evidence it is found that R1 was wrongly charged an additional $500 for April- June 2022, or $1500. Additionally, R1 passed away and belongings were removed by 6/24/22. That amounts to $233 x 6 day= $1398. Therefore, the total reimbursement owed R1 is $2,898. It should be known that it was evident during discussions with the licensee that they did not appear to be acting in bad faith. There errors in assessment of fees appears to have been on the advice of others than Community Care Licensing. The licensee does not contest the error and is very cooperative toward resolving the issue and re-establishing regulation compliance. As a result of this investigation, LPA finds allegation to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies were cited on 9099-D, per Title 22 Regulations, Division 6. (A)This poses an immediate Health and Safety risk to clients/residents in care. (B) This poses a potential Health and Safety risk, or personal rights violation, to clients/residents in care. Report reviewed with licensee . Copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Oct 12, 2022 · control 25-AS-20221010152111

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Nov 9, 2022

Plan of Operation. Each facility shall have and maintain a current..plan of operation. ... Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requiremtn was not met based on records review and interview finding a admission agreement in use not approved by CCL. This posed a potential risk to personal rightsthe state’s words, verbatim · CDSS document, Oct 12, 2022

Plan of correction: Licensee will submit the admission agreement that they wish to use, if different than on file, to CCL by the POC date of 11/9/22.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(c) · Plan of correction due date: Oct 27, 2022

Termination of admission agreement upon death of resident...- (c) A refund of any fees paid in advance... shall be issued to the individual... within 15 days after the personal property is removed. This requirement was not met based on documents and statements that fees were insufficient and exceeded 15 days. This posed a risk to personal rights.the state’s words, verbatim · CDSS document, Oct 12, 2022

Plan of correction: Licensee will submit proof of reimbursement agreed to with R1's spouse, not to exceed $2,898, by rhe POC date of 10/27/22

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(4)(B) · Plan of correction due date: Oct 27, 2022

Admission Agreements.(g)(4)(B)The conditions under which a licensee may increase or change rates shall be specified in the admission agreement. Records found that level of care increases are not identified in the admission agreement yet were charged to R1. This posed a potential risk to personal rights.the state’s words, verbatim · CDSS document, Oct 12, 2022

Plan of correction: Licensee will submit a statement of understanding of this requirement. The statement will contain that no other residents are currently charge level of care fees and that should the licensee develop level of care fees, it will be submitted for approval to CCL POC due 10/27/22

Type of visit: Required - 1 Year

On 9/19/2022, Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility and conducted a Required 1-Year inspection. LPA met with Licensee, Adela Toderean, and explained the purpose of the inspection. Prior to today's inspection, LPA completed required COVID-19 testing protocols and completed daily assessment and confirmed the facility does not currently have any positive Covid-19 diagnoses. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask. Upon entrance, LPA observed staff to not be masked. LPA informed Licensee all staff are to wear mask at all times in the facility. The facility currently has (6) residents and (0) resident on hospice services. LPA and Licensee toured the interior of the facility including bathroom, (5) resident bedrooms, laundry room, kitchen and common area. LPA observed (3) residents to be in the common area, (1) resident in the dining area, and (2) residents to be in their private rooms. LPA observed paper towels, soap and hand washing signs in bathroom. LPA advised Licensee that all trash can are to have lids. LPA observed sharps, toxics and medication to be locked and secured. LPA observed the facility to have 2+ days of perishables and 7+ days of non-perishables. Fire extinguishers last serviced 9/2/2022. LPA discussed vaccination status with Licensee. LPA observed Administrator Certificate #6045732740 to be up to date. LPA reviewed 1 of 6 resident's file. LPA requested a copy of current liability insurance, LIC 308, and LIC 500 during today's inspection by 9/30/2022. As a result of today's inspection, deficiency was observed. Please see attached LIC 809-D. Exit interview was conducted. Copy of report and appeal rights was left at facility.the state’s words, verbatim · CDSS document, Sep 19, 2022

From the deficiency page — Deficiency type: Type B · Plan of correction due date: Sep 30, 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 and comfortable accommodations... This requirement is not met as evidenced by: Based on observation of (2) staff not wearing mask in the facility, Licensee did not comply with the section cited above that all staff are to wear maks regardless of vaccination status which poses/posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Sep 19, 2022

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On September 16, 2021, at 9:30am, Licensing Program Analyst (LPA) DeAnna Williams-Lyons arrived unannounced to conduct a required 1 year inspection. LPA met with Administrator Adela Toderean and explained purpose of inspection. Prior to initiating the inspection LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: mask. Additionally, LPA was screened by personnel upon arrival. Adela and LPA completed the inspection tool questionnaire with no issues or advisories to report. The Administrator Certificate expires 12/19/2021 . Currently, the facility has 5 residents residing in the home. The home was 75 degrees F. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, and kitchen. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food. Hot water temperatures were taken and measured at 109 degrees F. There’s appropriate lighting throughout the facility. To continue see 809-C... Living room, dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident bedrooms and bathrooms were toured. There are Bedrooms 5 and 2 bathrooms for residents. All rooms had the required items of furniture. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mat. Bathrooms were clean, sanitary. The sink, toilet, bathtub and shower operate properly. The facility has a sufficient supply of linens, towels, bedding, etc. for residents in care. Washer and dryer was present and operating properly. Toxic substances, laundry and cleaning supplies are inaccessible. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguisher is maintained and ready for emergency use. LPA inspected the exterior grounds of this facility. There are no bodies of water on the premises. The perimeter fence, side gates, and latches were in good repair. Passageways are free of obstruction and potential hazards. There’s a centralized storage area for resident’s medication. LPA reviewed 2 resident files and 2 staff file. Resident records reviewed had all the required documents and signatures. Staff records reviewed indicated current First Aid & CPR certificates. Facility is conducting staff training as required. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no violations were observed during this visit. The administrator shall submit updated copies of the LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610D the Emergency Disaster Plan, and copy of current Liability Insurance to update the facility file in our Regional Office. Administrator shall submit the listed documents to Licensing later than October 16, 2021.the state’s words, verbatim · CDSS document, Sep 16, 2021