Pacific Vista Senior Living 2

Allegation investigated: Staff are not properly trained to meet resident needs.

Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the aleegation noted above. LPA met with Administrator Jamie Teng and explained the purpose of the visit. The allegation was investigated. The investigation consisted of observations, interviews and records review. It was alleged that on or around 8/3/23, Resident #1 (R1) was “acting erratically” which prompted 9-11 being called out to the facility. It was also alleged that the facility staff was unable to provide any information about R1’s health conditions, and nor could any of the staff could provide any answers to the questions that were asked pertaining to R1. Per an interview with R1’s responsible party due to R1 and their current state exhibited over the past month agreed that the home was not appropriate and did not want R1 to stay at the facility. LPA conducted a complaint visit on 8/8/23 and there was no training information available as the facility was reportedly converting to electronic files. LPA requested the training documentation. The training checklist were received and reviewed and the checklist for Staff #1 is altered. Substantiated Their form has white out with their name typed over it. It was further observed that the hours and signatures are the exact same. Per interviews with facility staff, the training received was from a personal experience from a family member and from working at another residential care for the elderly facility, prior to working at the facility. In addition per the Administrator Jamie Teng “the training dates are unknown as the training was completed prior to both Staff #1 (S1) and Staff #2 (S2) being hired”. Based on interviews the allegation of Staff are not properly trained to meet resident needs is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted and copy of this report, 9099D, and appeal rights were reviewed and provided to Jamie Teng, Administrator. R1 did not have a profile with medications on file with them. During the initial complaint visit conducted on 8/8/23, LPA did not observe a facility file nor documents, to confirm which medications R1 was prescribed. However, it was confirmed that R1 was discharged from the SNF to the facility, but no confirmation that R1’s medication was sent over to the pharmacy. Additionally, there was no other explanation provided from the Administrator Jamie, other than “no R1 was not given any medication at the facility as they were not a resident". Therefore, the allegation of staff failed to administer residents medication as prescribed is 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(s) occurred. An exit interview was conducted and a copy of this report, and appeal rights were provided to Administrator Jamie Teng.the state’s words, verbatim · CDSS document, Oct 5, 2023 · control 18-AS-20230803125541

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Oct 20, 2023

87411 Personnel Requirements (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.... Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering and maintenance of buildings, equipment grounds... This requirement is not met as evidenced by: The licensee failed to ensure staff were properly trained to provide care and supervision to R1, 2 out of 2 times. This poses a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 5, 2023

Plan of correction: The licensee agrees to retrain both S1 and S2 with the training listed on the staff training checklist. Proof of completed POC is due by 5pm on 10/20/23.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Javina George made an unannounced case management deficiencies visit as LPA was delivering findings for complaint control # 18-AS-20230803125541 and observed the following deficiencies. The facility admitted (accepted responsibility) for Resident #1 (R1) on or around August 3, 2023. Per interviews with Administrator Jamie Teng, there is a contract or agreement with a local skilled nursing facility (SNF) to discharge residents from the SNF to the facility. Due to this contract or agreement, the facility is accepting residents without properly screening them, as well as not completing the evaluation of suitability for admission. The evaluation consist of: (1) Conduct an interview with the applicant and his responsible person. (2) Perform a pre-admission appraisal. (3) Obtain and evaluate a recent medical assessment). Per an interview with Administrator Jamie, the LIC 602 (Physician's report) was requested but was never sent over. As a result of the facility not properly screening new residents. R1 was admitted to the facility and began exhibiting erratic behaviors by trying to hurt thyself. As a result the facility had to contact 9-11 to assist, and have R1 removed without returning to the facility. Further interviews conducted with R1's responsible party who deemed the facility was not suitable for R1 and they should have not been sent there due to their current mental state that R1 had been exhibiting for the past a couple of months. Additionally, LPA observed that when LPA requested the staff files for review from the Administrator Jamie Teng. Jamie stated that the facility was in the process of converting to electronic files. Jamie verbally provided Staff #1 (S1) and Staff #2 (S2) hire dates. In addition to Administrator Jamie provided a copy of the staff training checklist that was the exact same, however S2’s name is written over S1’s name that had been covered with white out. The hours are off center and the exact same hand writing. Interviews with S1 and S2 stated that they both received training prior to working at the facility. Not only did the Administrator make false claims but provided false training documents and is being cited in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8) on the attached 809D. An exit interview was conducted and a copy of this report, and appeal rights were reviewed and provided to Administrator Jamie Teng.the state’s words, verbatim · CDSS document, Oct 5, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87456(a)(1-3) · Plan of correction due date: Oct 20, 2023

87456 Evaluation of Suitability for Admission (a)(1-3) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (1) Conduct an interview with the applicant and his responsible person. (2) Perform a pre- admission appraisal. (3) Obtain and evaluate a recent medical assessment. This requirement is not met as evidenced by: The licensee failed to conduct an evaluation for R1, 1 time. This posed a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 5, 2023

Plan of correction: The licensee agrees to submit a personal statement self certifying that any new residents moving forward the facility will conduct an evaulation of suitability.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87207 · Plan of correction due date: Oct 20, 2023

87207 False Claims No licensee, officer or employee of a license shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: 2 out of 2 times the licensee stated that their staff received training upon hire. This poses a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 5, 2023

Plan of correction: The licensee agrees to make a personal statement of understanding about the importance of providing true and accurate information to the department, The statement is to include the potential risks and consequences of providing misleading/false claims, or statements. Proof is to be submitted to the department by 5pm on the due date indicated.

Type of visit: Office

Licensing Program Analyst (LPA) Janira Arreola and Licensing Program Manager (LPM) Joel Esquivel conducted an informal office meeting with the administrator and licensee Jaime Teng, Corporate Board Member of RIVERSIDE ELITE ADVANTAGE CARE HOME LLC. The following items were discussed: The administrator failed to provide plan of correction for deficiency cited on 8/4/2023 for Eviction Procedures. The licensee was provided with a copy of eviction procedures in California Code of Regulations under Title 22. During this meeting, the licensee stated they would informed on eviction procedures to ensure that resident receive a proper eviction when it is required. Licensee unprofessional behavior during 8/4/2023 visit. The licensee agreed during today's meeting to act in a professional manner with CCL staff. In regards to staff competency the licensee to provide training to improve staff competency. They agreed they would be at the facility 20 hours a week at the facility Monday to Sunday from 12pm to 6pm and agreed to amend the staff roster to reflect this. In regards to prior complaint allegations, Licensee agreed to provide more training to staff and be more receptive to facility residents to prevent future complaints. In regards to facility Intake process the licensee agreed to have all required paperwork at the facility prior to accepting a new resident. Reporting requirements. The licensee was provided with the public inbox for reporting incidents at the facility in a timely manner: CCLASCPRO@dss.ca.gov. The licensee agreed to send in death report to inbox for Resident #1 (R1). In regards to facility records, the licensee agreed to have the records available at the facility and ready for LPA's inspection. In regards to unassociated staff, the licensee agreed to check the facility roster and make sure all staff are associated prior to working at the facility. An exit interview was conduced where this report was reviewed and provided to the Licensee, Jaime Teng.the state’s words, verbatim · CDSS document, Aug 15, 2023

Allegation investigated: Staff refusing to accept resident back after hospital discharge

Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with staff Dominga Altoba and licensee Jaime Teng over the phone who was informed of the purpose of the visit. During the visit, LPA conducted interviews, documented observations, and conducted records reviews. It was alleged that the facility was not allowing Resident #1 (R1) to return to the facility. It was found through records review that R1 had been diagnosed with MRSA infection upon admittance to Riverside Community hospital on 6/30/23. Licensee reported that around 1 week after the resident fell they had been informed of the MRSA infection and stated they could not accept the resident back due to this being a prohibited condition and facility not having an exception for the resident. Unsubstantiated During today's visit 8/4/23 LPA observed... Therefore, the allegation that the facility refused to accept the resident back to the facility is unsubstantiated. Findings that are unsubstantiated mean that although the allegation is valid, the preponderance of the evidence standard has not been met. An exit interview was conducted where this report was reviewed and provided to…the state’s words, verbatim · CDSS document, Aug 4, 2023 · control 18-AS-20230710095114

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Janira Arreola conducted a visit to the facility for an unrelated matter and found deficiencies in the process. This report is to document those deficiencies. LPA met with staff, Dominga Altoba who was informed of the purpose of the visit. It was found through interview with Licensee that Resident #1 (R1) had been diagnosed with an infectious disease under the Title 22 Prohibited Conditions. R1's responsible party was contacted who stated they were informed by licensee that they could not return to the facility. Licensee confirmed this and stated they had provided a list of placement's for R1 and had gone on to accept another resident in R1's place. Licensee stated they had not issued the family with an eviction notice as the family had agreed to move R1. Licensee also stated they could get Resident #2 (R2) to move within a couple days from the facility as they seemed to be a "reasonable" person. Licensee was unaware of the fact that they needed an eviction notice. During today's visit PA was informed by staff that R3 had been discharged after living at the facility for (2) days. LPA also observed R1 was still not back at the facility. Therefore, based on the above the facility failed to provide R1 and R3 with an eviction notice when warranted. Deficiency was cited under California Code of Regulations Title 22 on an LIC809-D. Plan of correction was unable to be made with licensee over the phone as licensee acted in unprofessional manner. Licensee will be contacted for an office meeting. An exit interview was conducted with Staff Dominga Altoba where this report along with LIC809-D page and appeal rights were reviewed and provided to them. Staff refused to sign the report.the state’s words, verbatim · CDSS document, Aug 4, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(4) · Plan of correction due date: Aug 18, 2023

(a) The licensee may evict a resident for one or more of the reasons listed...(30) days written notice to the resident is required...(4)...it is determined that the resident has a need not previously identified... This requirment is not met as evidenced by: The licensee failed to serve an eviction notice to R1. This poses a potential health, saftey or personal rights risk.the state’s words, verbatim · CDSS document, Aug 4, 2023

Plan of correction: LPA was unable to get a plan of correction as the licensee acted in an unprofessional manner over the phone.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Janira Arreola conducted a visit to the facility for an unrelated matter and found deficiencies in the process. This report is to document those deficiencies. LPA met with staff, Dominga Altoba and spoke with licensee Jaime Teng over the phone and informed of the purpose of the visit. LPA received notification from Riverside Community Hospital that Resident #1 (R1) had tested positive for MRSA infection. LPA spoke with licensee Jaime Teng who confirmed they had spoken verbally with a nurse at the hospital and been informed of the diagnosis around a week ago. LPA conducted a brief tour of the facility with PPE equipment and met with staff and explained the purpose of the visit and PPE. Staff stated they were unaware of R1's diagnosis. LPA spoke with licensee who stated they had not tested the remaining residents for MRSA for taken any action concerning the diagnosis. They stated they were waiting for paper work confirming the diagnosis from the hospital and had not received any. Additionally LPA observed the staff was not wear protective equipment during the visit. Based on the above information, the facility failed to take the proper precautions to ensure the residents safety against communicable disease after being informed of a positive diagnosis for R1. Deficiencies were cited according to California Code of Regulations Title 22 Division 6 Chapter 8. Plan of correction was documented and created with licensee over the phone. An exit interview was conducted over the phone for this report, along with deficiency pages and appeal rights.the state’s words, verbatim · CDSS document, Jul 18, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87470(b)(1) · Plan of correction due date: Jul 19, 2023

(b)...when one or more residents in the facility are diagnosed with a contagious disease...(1)... maintain a safe and sanitary environment and to ...contain,...mitigate the transmission...This requirment was not met as evidenced by: Based on interviews and observation it was found that the facility has not taken any measures to migate or contain MSRA after R1 was diagnosed. This poses an immediate, health saftey or personal rights risk.the state’s words, verbatim · CDSS document, Jul 18, 2023

Plan of correction: The licensee agreed to report the infectious disease to department of public health, implemented saftey precautions, and send LPA an SIR for the incident by POC due date. The licensee will also send the LPA self certified statement of the above and precautions licensee will taken when they are informed of infectiouse in their facility.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Janira Arreola made an unannounced visit to the facility on 11/9/2022 at 1:20 p.m. to conduct an annual inspection focused on infection control. LPA was granted entry and met with Licensee/ Administrator, Jaime Teng, who was informed of the purpose of the visit. At the time of visit there was (3) staff and (5) residents present. The facility currently has zero positive or suspected Covid-19 cases. During today's visit, LPA toured the facility interior and exterior. LPA observed Covid-19 postings and a single entry point was designated where symptoms screenings and temperature checks occur daily for all visitors, residents, and staff. The facility had a plan in place to clean and disinfect the high touch surfaces. LPA observed the resident restrooms which had the adequate amount of hand hygiene supplies (soap, hand sanitizer, paper towels). LPA observed the resident bedrooms where the residents would be isolating. There is a plan in place to monitor and attend to those in the isolation rooms. LPA observed the facility did not have a 30-day supply of PPE equipment. This will be documented on a technical advisory note, and Administrator was able to place more PPE equipment at the facility by the end of the visit. The facility also has a designated infection control lead and a plan in place report covid positive cases. LPA reviewed the facilities infection control plan for COVID. LPA will document technical advisory note for facility to make infection control plan for Monkey Pox and submit to LPA by the end of the day 11/9/2022. LAP noticed the kitchen drawer where the knifes are being kept had a broken safety latch. The administrator was able to place the knifes in a different drawer immediately, while this is repaired. This will be documented on a technical advisory note. LPA will document technical advisory note for updated LIC9020 to ensure all contact information for residents has been updated. The administrator was able to update this by the end of the visit. No deficiencies were issued at the time of the visit. An exit interview was conducted where this report was reviewed and provided to Administrator Jaime Teng.the state’s words, verbatim · CDSS document, Nov 9, 2022

The state marks this report as 5 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.