Oceanside Elderly Care Home 448

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ramin Hashemi conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by and discussed the purpose of the visit to Licensee Muhammad "Zebi" . The facility's license shows a maximum capacity of six (6) non-ambulatory residents, ages 60 and over, 3 of which may be bedridden. The facility has an approved waiver for 4 hospice residents. LPA and Licensee toured the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility contained at least 2 days of perishable food, and at least 7 days non-perishable food, all safely stored. Cooking, dining equipment, and utensils were present. No toxic chemicals or poisons were accessible to clients. Medications were labeled, as required, and stored in locked areas. No pools or bodies of water exist on the premises. Per Licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all in working order. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA interviewed staff and reviewed facility records. The files reviewed by LPA contained required documents. Confidential records were stored in locked areas. No deficiencies were cited during the inspection. An exit interview was conducted with Licensee Muhammad "Zebi" to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Apr 8, 2026

Allegation investigated: Resident developed pressure injuries while in care. Staff left resident in soiled diapers for an extended period of time. Staff did not dispense resident’s medication as prescribed.

Licensing Program Analyst (LPA) Becky Kennedy conducted an unannounced complaint investigation visit to the facility to deliver findings on the above allegations. LPA was granted entry to the facility, after identifying herself and met with Chedly Benattia, Assistant Administrator explaining the reason for the visit. The Department’s investigation consisted of review of facility records, outside source records, and interviews with facility staff and outside sources. The investigation revealed that no resident by the name or with a date of birth identified in the complaint allegations ever resided at this facility. Based on the evidence obtained during the complaint investigation, the allegations above are UNFOUNDED, meaning the allegations against a facility are false, could not have happened, or lacks a reasonable basis. An exit interview was conducted with Chedly Benattia, Assistant Administrator, a copy of this report and Licensee's Rights (LIC9058) were provided. Unfoundedthe state’s words, verbatim · CDSS document, Feb 13, 2026 · control 08-AS-20240304090728

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Jean May Marquez. LPA spoke with Licensee Muhammad "Zebi" Alvi via telephone during the visit. During today's visit, LPA reviewed facility records, and observed residents in care. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. No deficiencies were cited on today's date. An exit interview was conducted with Caregiver Marquez, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, May 30, 2025

Allegation investigated: -Licensee did not notify physician of resident’s skin tear. -Licensee did not meet other reporting requirements. -Licensee involuntary transferred a resident.

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent visit to deliver findings regarding the above prior complaint allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Christopher Diaz. LPA also spoke via phone with Licensee Dr. Mohammed Rahman, during the visit. The Complainant alleged that after Resident #1 (R1) sustained a skin tear on their lower left leg, Licensee did not notify R1’s doctor, as required. They also alleged that Licensee also did not notify R1’s responsible person (RP) and CCLD, as required. They also alleged that Licensee involuntary moved R1 and Resident #2 (R2) out of the facility. [See LIC811 Confidential Names List for a description of select person identifiers used in this report.] CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of pertinent staff and outside sources. The Department also reviewed relevant care records. LPA attempted to interview R1 and R2 about the above allegations, but due to their baseline memory loss, each was unable to be qualified as a reliable historian for this case. [CONTINUED ON LIC 9099-C, 1 of 2] Substantiated [CONTINUED FROM LIC 9099] At the time of the complaint allegation, R1 was being followed by a visiting nurse practitioner (NP), who operated as an extension of R1’s primary care physician (PCP), to help address R1’s health issues as they developed. Care records and interviews aligned to show that R1 was memory-impaired, wheelchair-bound, took blood-thinner medication, had very fragile skin, had a history of being prone to bruising and skin tears, and required staff assistance with bathing, among other tasks. Interviews of multiple staff and outside sources corroborated that during mid-July 2024, R1 sustained a skin tear on their lower left leg. CCLD obtained a photograph of the skin tear, showing that at one point, the open area of skin was around 3 inches long by 2 inches wide. In their interview, Staff #1 (S1) confirmed that while cleaning R1’s lower left leg with a loofah during a shower, they scrubbed too hard and accidentally caused the skin tear. S1 admitted that they did not inform either R1’s NP or PCP, or facility management. S1 also admitted they did not inform the RP until eight (8) days after it had occurred, and only after the RP had visited the facility and confronted S1 with questions about the skin tear. Interviews of the PCP and NP confirmed that facility staff did not notify them of R1’s injury. Interviews of Staff #2, Staff #3, and outside sources confirmed S1’s account, and that Licensee’s staff did not notify RP of the injury until over a week later. LPA reviewed the CCLD San Diego Regional Office’s files, finding that Licensee did not submit a written incident report regarding R1 sustaining a skin tear on their lower left leg (which was required to be done within seven days of incident occurrence). By the start of CCLD’s investigation, the skin in the affected had already scabbed over and healed, yet 2 of 2 facility Licensees/managers and 2 of 5 caregivers (who directly cared for R1) interviewed were still unaware of said earlier skin tear on R1’s leg. There was also no written documentation of this skin tear on R1’s lower left leg in the facility’s records, as was required. Interviews of facility Licensees/managers, caregivers, and outside sources aligned to show: During the time frame of the complaint, R1 and R2 were the only two residents in care at Oceanside Elderly Care Home 448. On a day in late July 2024, Licensee moved R1 and R2 to new bedrooms at Oceanside Elderly Care Home 452 (a separate CCLD-licensed care facility), to consolidate operations and reduce operating costs. Licensee did not prior notify CCLD of these transfers, or the fact that Oceanside Elderly Care Home 448 would become dormant. [CONTINUED ON LIC 9099-C, 2 of 2] [CONTINUED FROM LIC 9099-C, 1 of 2] R1 and R2, per their latest physician’s reports and care records, both suffered from memory loss. LPA interviewed each and found neither could provide informed consent to transferring facilities. Manager and outside source interviews further showed that Licensee did not notify R1’s responsible person about R1’s moving, either before, during, or after the transfer. R1’s responsible person did not consent to the transfer. Per manager interviews, Licensee did contact and receive permission from R2’s responsible person to transfer R2. LPA attempted multiple times to interview R2’s responsible person to confirm this but was unsuccessful in reaching them. Based on records and interviews, a preponderance of evidence exists to show: After R1 sustained a skin tear on their lower left leg, Licensee did not notify R1’s healthcare providers of the injury, Licensee did not meet other reporting requirements, and Licensee involuntary transferred R1. These three (3) allegations were therefore Substantiated. Deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D pages). Plans of Correction were jointly developed with the Licensee. An exit interview was conducted with Dr. Rahman, to whom a copy of this report, the LIC 9099-D pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided. [CONTINUED FROM LIC 9099] Per review of CCLD’s Guardian and Licensing Information System (LIS) databases, during the time frame of the complaint allegation, both S4 and S5, as well as all other current facility staff, were each fingerprinted and possessed active background clearances to work. Interviews of Licensees/managers and facility staff reiterated the same. Based on record review and interviews, the allegation that Licensee’s staff did not have current background / criminal-record clearances is Unfounded, meaning it was false, could not have happened, and/or is without a reasonable basis. The Department has therefore dismissed the allegation, and no deficiency was issued for it. An exit interview was conducted with Dr. Rahman, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Oct 11, 2024 · control 08-AS-20240821121132

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Nov 11, 2024

87466 Observation of the Resident: “The licensee shall ensure that residents are regularly observed for changes in physical…functioning... When changes such as…deterioration of…a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident’s physician and the resident’s responsible person, if any.” This requirement was not met, as evidenced by: Based on records and interviews, 1 of 2 residents (R1) had a deterioration of a physical health condition which staff observed, but Licensee did not ensure that this change was documented and brought to the attention of the resident’s physician (or their staff) and responsible person. This posed a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Oct 11, 2024

Plan of correction: Licensee agreed to contact a third-party, CCLD-approved education Vendor to arrange a retraining class. The retraining will cover Skin Care for the Elderly, 87625 Managed Incontinence, 87465 Incidental Medical and Dental Care, 87466 Observation of the Resident, 87211 Reporting Requirements, and Resident’s Personal Rights (as articulated in CCLD form LIC613C-2), and will include both Licensee principals and current facility caregivers. Licensee agreed to E-mail the certificates of training completion (or similar proof) to LPA, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Nov 11, 2024

87211 Reporting Requirements: "(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified...(D) Any incident which threatens the welfare, safety or health of any resident." This requirement was not met, as evidenced by: Based on records and interviews, 1 of 2 residents (R1) had an incident which threatened their welfare/health, and Licensee did not submit a written report of the incident to the licensing agency and the person responsible for the resident within seven days of incident occurrence. This posed a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Oct 11, 2024

Plan of correction: Licensee agreed to contact a third-party, CCLD-approved education Vendor to arrange a retraining class. The retraining will cover Skin Care for the Elderly, 87625 Managed Incontinence, 87465 Incidental Medical and Dental Care, 87466 Observation of the Resident, 87211 Reporting Requirements, and Resident’s Personal Rights (as articulated in CCLD form LIC613C-2), and will include both Licensee principals and current facility caregivers. Licensee agreed to E-mail the certificates of training completion (or similar proof) to LPA, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(20) · Plan of correction due date: Nov 11, 2024

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: “(a)…residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions…‘involuntary’ means a transfer, discharge, or eviction that is initiated by the licensee, not by the resident.” This requirement was not met, as evidenced by: Based on records and interviews, Licensee did not ensure that 1 of 2 residents (R1) was protected from involuntary transfer. The transfer was initiated by the licensee, not by the resident. This posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 11, 2024

Plan of correction: As of the date of deficiency issuance, the responsible person (RP) for R1 has agreed with Licensee’s decision to keep R1 in their current bedroom at Oceanside Elderly Care Home 452, for the time being. Licensee agreed that if at a future point they desire for R1 to move back to Oceanside Elderly Care Home 448, they will first communicate with R1’s RP, receive their consent, and meet all regulatory requirements.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite deficiencies identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Christopher Diaz. LPA also spoke via phone with Licensee Dr. Mohammed Rahman, during the visit. During records review, LPA observed: Licensee did not maintain in Resident #1 (R1)’s care records the name and contact information for R1’s current primary care physician (PCP), dentist, and nurse practitioner (NP), as required. The physician that was listed on R1's Face Sheet was obsolete. Interviews showed that the NP had come to the facility in person on prior occasions to provide care to R1 and had identified themselves to and interacted with facility staff. Licensee also did not maintain in Resident #2’s (R2) care records the name and contact information for R2’s current dentist, as required. [See LIC811 Confidential Names List for a description of R1 and R2]. Licensee also did not have file an LIC625 Appraisal/Needs and Services Plan (or equivalent “written record of care the resident will receive”) for R1 or R2. There was also no evidence that Licensee held a care-conference meeting with R1 and R2's responsible persons within the last twelve (12) months, as was required. Although R2’s responsible person could not be reached for interview, interview of R1’s responsible person confirmed they had not participated in a care conference with Licensee within the last year. Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). Plans of Correction were jointly developed with the Licensee. An exit interview was conducted with Dr. Rahman, to whom a copy of this report, the LIC 809-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.the state’s words, verbatim · CDSS document, Oct 11, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(b)(9) · Plan of correction due date: Nov 11, 2024

87506 Resident Records: “(b) Each resident’s record shall contain at least the following information: (9) Name, address, and telephone number of physician and dentist.” This requirement was not met, as evidenced by: Based on records and interviews, for 2 of 2 residents (R1 and R2), Licensee did not ensure that their record of care contained the name, address, and telephone number for both their respective current dentist and physician. This posed a potential health risk to persons in care.the state’s words, verbatim · CDSS document, Oct 11, 2024

Plan of correction: During today’s site visit, LPA provided Licensee with the names and phone numbers for R1’s PCP and RP. Licensee agreed to update the Face Sheet for R1 to include the name, address, and telephone number for R1’s current PCP, NP, and dentist. Licensee agreed to update the Face Sheet for R2 to include the name, address, and telephone number for R2’s current dentist. Licensee agreed to E-mail the updated Face Sheets for R1 and R2 to LPA, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87467(a) · Plan of correction due date: Nov 11, 2024

87467 Resident Participation in Decisionmaking: “(a) Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, and any other appropriate parties, to prepare a written record of care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility.” This requirement was not met, as evidenced by: Based on records reviewed and manager interview, Licensee did not have on file for 2 of 2 residents (R1 and R2) a completed LIC625 Appraisal/Needs and Services Plan (or equivalent “written record of care the resident will receive”), and the resident’s preferences regarding the services provided at the facility. This posed a potential health and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Oct 11, 2024

Plan of correction: Licensee agreed to complete an LIC625 Appraisal/Needs and Services Plan form on both R1 and R2, and to have both signed by their respective responsible person and a facility representative after a joint-review during a care-conference meeting. Licensee agreed to E-mail the completed and signed LIC625s for R1 and R2 to LPA, by the POC due date. Going forward, Licensee agreed to update the LIC625 and hold a care conference, for all residents, whenever there is a significant change in their condition, but also at least once every twelve (12) months, whichever occurs first.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Case Management - Annual Continuation visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Arnel Reclusado. Administrator Muhammed Alvi arrived during the visit. The facility is licensed for a maximum capacity of 6 non-ambulatory residents, 3 of which may be bedridden. The facility has a waiver for 4 hospice residents. During today’s visit, the facility had a census of 2 non-ambulatory residents. The Administrator for the facility is Muhammed Alvi and their certificate was valid and current. During visits on 5/31/2024 and 6/19/2024, LPA toured the facility and inspected each room of the facility, including resident rooms, bathrooms for resident and staff use, kitchen, garage, common areas, and outside space. No bodies of water were observed on the premises. LPA did not observe any aspects of delayed egress or secured perimeter. The facility was found to be clean, safe, and in good repair with no pathway obstructions. The facility’s water temperature was measured at 141.5 degrees Fahrenheit in a common bathroom and 143.2 degrees Fahrenheit in a shared resident bathroom. Facility staff adjusted the water heater during the visit. The facility’s internal temperature was measured at 74 degrees Fahrenheit. LPA observed locked storage for all hazardous and/or toxic chemicals and were stored separately from food supplies. According to Muhammed Alvi, no firearms or weapons are stored on the premises. LPA also observed locked storage for resident medications and resident and staff files. Resident medications are stored in their original container and label. LPA observed a minimum of a 2-day supply of perishable food and a 7-day supply of non-perishable food present at the facility. The facility refrigerator was kept at 45 degrees Fahrenheit, and the facility freezer was kept at 0 degrees Fahrenheit. LPA observed linens and hygiene products provided to the residents that are in good repair and sufficient to meet their needs. Continued on LIC809-C page… Staff present at the facility during the time of the inspection had a criminal background clearance, were associated to the facility, and had a first aid certificate. LPA reviewed multiple resident and staff records. Each resident record was complete and contained a signed admission agreement, updated physician’s report and medical assessment, documents regarding safeguarding personal property, and personal rights. Each staff file was complete and contained a personnel record, first aid certificate, fingerprint clearance and association, and a health screening. LPA spoke with staff and residents present at the facility during the time of the inspection and those interviews did not reveal any licensing or regulatory concerns. The Administrator will submit copies of the LIC500 Personnel Report, LIC610E Disaster Plan, and current liability insurance to the Department within 15 business days. The following deficiency was cited for hot water temperature and noted on the attached LIC809-D page. An exit interview was conducted with Administrator Muhammed Alvi, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, Jun 19, 2024

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Rebecca Ruiz and Ryan Fulton conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPAs were greeted by, identified herself to, and explained the purpose of the visit with Caregiver Christopher Diaz. Administrator Muhammed Alvi arrived during the visit. During today's visit, LPAs toured the facility, reviewed facility records, and observed residents in care. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. No deficiencies were cited on today's date. An exit interview was conducted with Administrator Muhammed Alvi, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).the state’s words, verbatim · CDSS document, May 31, 2024

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Debbie Correia conducted a case management visit to deliver an amended complaint investigation report (LIC 9099). LPA's visit consisted of delivering the amended report. The original version of the complaint report (LIC 9099) is dated 2/28/2024. A copy of this report was provided to Licensee Alvi confirms receiptthe state’s words, verbatim · CDSS document, Mar 12, 2024

Allegation investigated: Staff did not allow resident to have visitors during reasonable hours. Staff did not ensure records of centrally stored medication were complete. Staff did not ensure medication was available for resident.

Licensing Program Analyst (LPA) Correia conducted an unannounced visit to deliver findings regarding the above-mentioned allegations. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Caregiver Diaz. The Department’s investigation included staff, resident, and outside source interviews. The investigation also included facility and outside source records reviews, and a facility tour. It was alleged facility staff did not ensure medication was available for a resident in care. Interviews and record reviews revealed on February 22, 2023, Resident 1 (R1) sustained a fall at the facility that resulted in a head injury. An interview conducted with an Outside Source 1 (OS1) revealed they saw R1 approximately one hour after the fall and observed a large lump on the left side of R1’s forehead. Subsequently, OS1 called 911, and asked facility staff to ensure R1’s medication records were provided to medical personnel when they arrived to transport R1 to the hospital. Additionally, OS1 revealed they received a phone call at 9:17 p.m. from staff at the hospital where R1 was transported, requesting R1’s medication information and confirmed the facility staff did not provide R1’s complete medication list. At that time OS1 was also informed R1 could return to the facility the next day. A review of facility and outside source records corroborated the allegation. This is an amended version of the report dated 02/28/2024. Substantiated It was also alleged that staff did not ensure R1’s records of centrally stored medication was complete. R1 returned to the facility upon discharge from the hospital the following day, February 23, 2023, at approximately 8:00 a.m., from being admitted for the treatment of a head injury after sustaining a fall at the facility. An interview conducted with OS1 revealed they arrived at the facility on February 23, 2023, at approximately 9:00 a.m., one hour after R1’s return, and requested Staff 1 (S1) to see R1’s Medical Administration Record (MAR), which is used to document dates and times staff administer medication to residents in care. The interview with OS1 also revealed looking through R1’s MAR and saw it was not complete and secured a photo. An outside source interview and facility record reviews confirmed R1’s MAR was not complete. Lastly, it was alleged that facility staff did not allow residents to have visitors during reasonable hours. An Outside Source 1 (OS1) Interview, LPA observation, and facility records reviews revealed the facility changed their visitation hours to 9:00 a.m. through 5:00 p.m. without any notice. An interview with OS1 revealed they had previously visited the facility outside the newly imposed visitation hours without any issue. OS1 also revealed coming to the facility at approximately 6:30 p.m. and was denied visitation. On March 2, 2023, the Department conducted an unannounced visit to the facility and observed a sign with visitation hours of 9:00 a.m. to 5:00 p.m. had been posted on the front door to the facility confirming the allegation. [See LIC 811 for Confidential Names] Based on evidence obtained, the allegations are substantiated because the preponderance of the evidence standard has been met. Deficiencies are being cited in accordance with the California Code of Regulations, Title 22, Division 6 Chapter 8, and listed on the 9099D. An exit interview was conducted with Caregiver Diaz who was notified a copy of this report along with the LIC 9099D and Licensee/Appeals Rights (LIC 9058 01/16) will be provided at the conclusion of the visit. Signature below confirms receipt of the documents. This is an amended version of the report dated 02/28/2024. An interview with Outside Source 1 (OS1) revealed R1 was in their wheelchair and reached for something causing them to fall out of their wheelchair. Based on facility staff and outside source interviews the allegation was determined to be unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with and a copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) will be provided to the Licensee. Licensee's signature below confirms receipt of the reports.the state’s words, verbatim · CDSS document, Feb 28, 2024 · control 08-AS-20230224152348

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(A)(1) · Plan of correction due date: Mar 28, 2024

Incidental Medical and Dental Care. A plan for...medical...care shall be developed by each facility. The plan shall ... provide...obtaining such care, compliance with...the Licensee shall arrange...medical...care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on interviews and records reviews the Licensee did not arrange medical care for Resident 1 (R1) that was appropriate to their condition. This posed a potential health risk to 1 out of 6 residents in care.the state’s words, verbatim · CDSS document, Feb 28, 2024

Plan of correction: Facility staff will attend a CCL approved training on when to obtain or arrange medical care for residents in care based on their health, physical, or mental conditions. Licensee will provide proof of completion by POC due date. This is amended version of the report dated 02/28/2024.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(e)(1-4) · Plan of correction due date: Mar 28, 2024

Incidental Medical and Dental Care. For every prescription and... PRN medication for which the licensee provides...shall be a signed... order....and label shall contain...The specific symptoms... hours between doses... maximum...doses allowed in...24-hour. This requirement was not met as evidenced by: Based on interviews and records reviews the Licensee did not maintain a signed written order for Resident 1 [R1] in care. This posed a potential health risk to 1 out of 6 residents in carethe state’s words, verbatim · CDSS document, Feb 28, 2024

Plan of correction: Facility staff will attend a CCL approved training on medication management and implement a tracking system to ensure all resident's MAR are complete at the end of each shift. Licensee will provide proof of completion by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Mar 28, 2024

Residents in all residential care facilities for the elderly shall have all of the following personal rights:(11)To have their visitors, in...permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This regulation was not met as evidenced by: Based on interviews and observations Resident 1 [R1] in care was not afforded a reasonable level of visits at the facility. This posed a potential personal rights risk to [R1] 1 out of # in care.the state’s words, verbatim · CDSS document, Feb 28, 2024

Plan of correction: At the time of the initial visit LPA consulted with Licensee and at the time of visit Licensee removed visitation signs from facility door. Visitation is allowed per plan of operation protocol. Deficiency is cleared. This is amended version of the report dated 02/28/2024.

Type of visit: Case Management - Deficiencies

LPA Correia conducted an unannounced Case Management visit to cite deficiencies. LPA was greeted by Caregiver Diaz identified herself and discussed the purpose of the visit with Caregiver Diaz.Today’s visit was in response to information obtained while conducting a complaint investigation. The Department received a complaint on February 22, 2022, alleging neglect by staff neglect resulting in a serious injury. Over the course of the investigation interviews and records reviews revealed Resident 1 (R1) sustained a head injury as a result from a fall. Facility staff notified the Licensee who directed staff to notify R1's Responsible Party (RP). Facility staff interviews and outside source interviews and records reviews revealed 911 was not initiated for nearly an hour after R1 sustained a head injury. Per Title 22 mandate, 911 shall be initiated immediately after residents in care sustain a head injury. An exit interview was conducted with Caregiver Christopher Diaz to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Feb 28, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465 · Plan of correction due date: Mar 28, 2024

The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis... This requirement was not met as evidenced by: Based on staff and outside source interviews and records reviews revealed the Licensee did not immediately telephone 911 after Resident 1 (R1) sustained an injury deemed an imminent threat to their health. This posed an immediate safety risk to [R1] 1 out of 6 residents in care.the state’s words, verbatim · CDSS document, Feb 28, 2024

Plan of correction: An all staff will attend CCL approved training regarding incidents that occur that require immediate medical intervention including activating a 911 call. Proof of POC will be provided by POC due date.