Park Visalia Assisted Living

Allegation investigated: Resident sustained severe injury due to staff neglect Staff did not administer resident's medication Staff did not assist resident with eating Staff did not provide adequate food service to resident Staff did not meet resident's laundry needs Facility is malodorous

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Amanda Kelsey and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on interviews and record review no incidents were documented that resulted in resident abuse or injury. Medication audit was conducted but was inclusive due to resident relocation. Resident weight records were reviewed which indicated although resident weight was at an incline recently at the time of resident admission the resident had put on weight. Facility tour was conducted and did not reveal any facility physical plant issues. . Based on observation and interview of staff and residents, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 26, 2023 · control 24-AS-20230619145953

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 10/26/2023, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct a case management inspection regarding incident report that was received in the CCL office. Incident Report occurred on 7/30/2023 regarding medication errors. LPA explained the reason for inspection and met with Executive Director/ Administrator, Amanda Kelsey LPA conducted a medication audit and reviewed R1’s records and observed residents PRN medication was not documented when given. Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. An exit interview was conducted with the Administrator. Report signed on-site and printed copy provided with appeal rights.the state’s words, verbatim · CDSS document, Oct 26, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(b)(3) · Plan of correction due date: Oct 27, 2023

87465 Incidental Medical and Dental Care (b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. Review of residents medication and MARs revealed PRN medication was given without proper documentation.the state’s words, verbatim · CDSS document, Oct 26, 2023

Plan of correction: Licnesee to ensure a record of each PRN dose is maintained in the resident's record.

Type of visit: Case Management - Annual Continuation

On 10/26/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Continuation Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Executive Director, Amanda Kelsey. LPA reviewed staff training records and discussed with Activities coordinator the activities calendar. LPA checked residents’ locked medications and completed a medication audit of a sample pull. Fire drill conducted on 10/25/2023. Service records reviewed for annual Sprinkler Service and Fire alarm system. Carbon monoxide tested and operational. No deficiencies were issued during this inspection. An exit interview was conducted with the Administrator. Report signed on-site and printed copy provided.the state’s words, verbatim · CDSS document, Oct 26, 2023

The state marks this report as 4 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 10/24/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff. LPA met with Executive Director, Amanda Kelsey. LPA toured Front Lounge/seating area and Theater while waiting for Administrator. LPA conducted the rest of the facility tour with Administrator. All pathways, entrances and exits were clear from obstructions. The tour started in the facility common areas which were furnished with sufficient seating. The tour continued to the facility dinning and kitchen. The kitchen was observed clean, in good repair with necessary items and appliances. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Ice Machine was clean and serviced on 8/2023. At 12:02 PM LPA observed unlocked chemicals in the resident laundry room. LPA toured several resident rooms which were observed to be furnished with required furniture and adequate lighting. Bathrooms were properly equipped with non-slip tile and grab bars. Hot water temperature was tested between 112.5 degrees F and 120 degrees F in several resident bathrooms. Medications are kept locked in the Med Carts in the Medication room. Facility grounds were toured. Memory care toured; delayed egress doors observed. At 1:25 PM LPA observed an odor in Memory Care room 120. LPA questioned Memory Care Director who informed LPA resident was recently changed after a bowel movement. LPA removed resident’s comforter and observed brown stains on the inside of the comforter. Doors and passageways are unobstructed throughout the facility and to the outside. LPA toured an enclosed patio area with sufficient seating and shade for recreational purposes. Resident's records contained signed Admission Agreement, Personal Rights, and current Physician's Report. Staff files were reviewed for good health. It was verified that there are at least two staff on duty who are CPR certified. Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Continued to next page. LPA is requesting the following documents be submitted to the Fresno CCL office by 10/31/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020. Due to time constraints, LPA will return at a later date for an annual continuation. An exit interview was conducted with Administrator. Report signed on-site; a copy of this report, 809D with appeal rights was provided.the state’s words, verbatim · CDSS document, Oct 24, 2023

Allegation investigated: Staff do not provide a comfortable temperature for the residents in care.

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Mandy Rancour and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Although the facilities kitchen and dining room air conditioning was not working properly; the facility applied alternative methods until necessary repairs were made. Based on observation and interview of staff and residents, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 7, 2023 · control 24-AS-20230705120145

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff do not respond to call signal system in a timely manner

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit and reviewed records. LPA met with Administrator Mandy Rancour and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on observations, interviews and record review the Staff did not respond to call signal system in a timely manner. The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC9099D. Exit interview was conducted with Administrator and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Sep 7, 2023 · control 24-AS-20230728084541

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(d)(3) · Plan of correction due date: Sep 8, 2023

87411 Personnel Requirements - General (d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall… (3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met as evidenced by: Based on interviews and record review the Staff did not respond to call signal system in a timely manner.the state’s words, verbatim · CDSS document, Sep 7, 2023

Plan of correction: Administrator to provide in service training to staff to ensure staff are responding timely. Facility to implement backup check system to ensure call lights are addressed if staff do not respond timely.

Allegation investigated: Staff failed to provide adequate food service Insufficient staffing to meet residents’ needs Facility is in disrepair

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Mandy Rancour and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. LPA conducted a kitchen tour and observed sufficient food supplies, review of menu records divulged sufficient food service. LPA observed during Lunch Meal a complete nutritional meal. Based on LPA observations common areas and resident rooms were clean and with adequate furnishings. Based on observations and record review facility has sufficient staff to provide care and supervision. Based on observation and interview of staff and residents, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Sep 1, 2023 · control 24-AS-20230607155704

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Licensee does not ensure there is an Administrator or designated substitute present at all times Staff failed to administer resident's medication as prescribed

Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit and reviewed records. LPA met with Administrator Mandy Rancour and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings. The Department investigated the allegations listed above. Based on observations, interviews and record review a designated substitute was not present at all times while Administrator was on leave. LPA reviewed Residents (R1) medication records and observed medication that was logged in the Centrally stored medication and destruction record (CSMDR) was not sufficient to meet the administration of medication as directed by the physician. The preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. See citations on the attached LIC9099D. Exit interview was conducted with Administrator and appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Sep 1, 2023 · control 24-AS-20230626083044

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Sep 16, 2023

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall ... (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Medication that was logged in the Centrally stored medication and destruction record (CSMDR) was not sufficient to meet the administration of medication as directed by the physician. LPA observed CSMDR to be incomplete or missing data.the state’s words, verbatim · CDSS document, Sep 1, 2023

Plan of correction: Administrator to submit a statement of intent to provide training to all staff in regard to correct documentation of Centrally stored medication and destruction record (CSMDR). Administrator to conduct medication audits routinely and ensure medication is refilled in a timely manner.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(a) · Plan of correction due date: Sep 15, 2023

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator... When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section... This requirement was not met as evidenced by: A qualified substitute was not designated and present at all times while Administrator was on leave.the state’s words, verbatim · CDSS document, Sep 1, 2023

Plan of correction: Citation was cleared prior to visit with change of Administrator

Allegation investigated: Residient sustained multiple injuries due to staff neglect Staff does not ensure that residents are adequately fed

Licensing Program Analyst (LPA) K. Kaur arrived at the facility unannounced for a subsequent inspection. LPA discussed the purpose of the visit and the elements of the allegations with administrator. The Department investigated the allegations listed above. Based on interviews conducted and documents reviewed no evidence was found to support staff neglect led to resident sustaining injuries. LPA toured the facility kitchen and found sufficient food and observed mealtime and found sufficient food for a single meal time being served to residents. Based on the interviews conducted, the allegations listed above are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur; therefore, these allegations are unsubstantiated Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 27, 2023 · control 24-AS-20230202110713

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff hit resident while in care Staff failed to treat resident with dignity and respect

Licensing Program Analyst (LPA) K. Kaur arrived at the facility unannounced for a subsequent inspection. LPA discussed the purpose of the visit and the elements of the allegations with administrator. The Department investigated the allegations listed above. Based on interviews conducted and documents reviewed no incident was found to indicate resident abuse or disrespect of a resident. Based on the interviews conducted, the allegations listed above are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur; therefore, these allegations are unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 27, 2023 · control 24-AS-20221228150217

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Facility staff are not following visitor guidelines for COVID-19

Licensing Program Analyst (LPA) K. Kaur arrived at the facility unannounced for a subsequent inspection. LPA discussed the purpose of the visit and the elements of the allegations with administrator. LPA delivered the following findings. Based on the interviews conducted, the allegations listed above are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur; therefore, these allegations are unsubstantiated. Exit Interview conducted with Administrator. Report signed on site; printed copy of report was provided Unsubstantiatedthe state’s words, verbatim · CDSS document, Feb 28, 2023 · control 24-AS-20221228104529

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Mar 1, 2023

87468.1(a)(11) Personal Rights of Residents in All Facilities (11)To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement was not met as evidenced by: Interviews conducted by the Department revealed facility was requiring unvaccinated family members to COVID test before entry to the facility for visits.the state’s words, verbatim · CDSS document, Feb 28, 2023

Plan of correction: Administrator agrees to follow current COVID protocols as indicated in PINS

Allegation investigated: Staff engaged in verbal altercation with resident

On 10/12/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint inspection and deliver complaint finding on the above allegation. LPA met with Administrator Martin Vale and stated purpose of visit. During the course of the investigation, the Department conducted interviews with staff and resident. Based on review, there was insufficient evidence to prove or disprove that staff engaged in verbal altercation with the resident. Therefore, the preponderance of evidence standard has not been met, the above allegation is found to be UNSUBSTANTIATED. A copy of this report was provided to the Administrator. Unsubstantiatedthe state’s words, verbatim · CDSS document, Oct 12, 2022 · control 24-AS-20220915114213

Type of visit: Case Management - Deficiencies

On 09/23/22, Licensing Program Analyst (LPA) M. Yang conducted case management-deficiency visit to the facility. LPA met with Administrator Martin Vale and stated the purpose of the visit. The purpose of the visit is to address incident that occurred where R1 went AWOL on 09/15/22. Therefore, as mentioned, R1 went AWOL from facility. As a result, a deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached 809D. Exit interview was conducted. Administrator was informed that as COVID-19 precautionary measure, this report and appeal rights was be provided via email.the state’s words, verbatim · CDSS document, Sep 23, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87413(a)(2) · Plan of correction due date: Sep 25, 2022

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 interview and record review, staff did not provided care and supervision when R1 left the facility unsupervised on 09/15/22 at approximately 09:00PM and was located approximately two blocks down from the facility by a pedestrian which poses an immediate health and safety risks to persons in care.the state’s words, verbatim · CDSS document, Sep 23, 2022

Plan of correction: Licensee shall to submit a plan detailing steps the facility will take to ensure the requirements are met by the POC due date. Licensee has agreed to submit AWOL in-service training and rooster of staff attendance 09/26/22 to the Department.

Type of visit: Case Management - Deficiencies

On 09/09/22, Licensing Program Analyst (LPA), M. Yang arrived unannounced to conduct a Case Management - Deficiencies inspection. LPA introduced self, stated the purpose of the visit and met with Administrator Martin Vale. The purpose of today's inspection is to address the facility's failure to submit Incident Reports to the Fresno Community Care Licensing (CCL) office on: 08/01/2022, 08/11/2022, 08/13/2022, 08/17/2022 and 08/18/2022. A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached 809D. An exit interview was conducted. A Plan of Correction was reviewed and developed with Administrator. As COVID-19 precautionary measure, this report and appeal rights will be provided via email. Report signed on-site.the state’s words, verbatim · CDSS document, Sep 9, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Sep 16, 2022

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports…(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… This requirement is not met as evidenced by: Based on record review: Licensee did not ensure a written report was submitted to the Fresno CCL office within 7 days of occurrence on 08/01/2022, 08/11/2022, 08/13/2022, 08/17/2022 and 08/18/2022. Licensee submitted written report to CCL on 08/29/22 and on 08/30/22, which this poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 9, 2022

Plan of correction: Licensee agrees to submit a plan detailing steps the facility will take to ensure the requirements of Reporting requirements are met by the POC due date.

Type of visit: Required - 1 Year

On 08/24/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and met with Administrator Martin Vale. Upon entry facility staff was observed with facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. LPA observed social distancing and cough etiquette postings. Food supply was checked and appeared to be an adequate supply. LPA observed 30 days PPE supplies. Ten percent of resident’s room toured and observed to be adequately furnished and lit. Ten percent bathrooms are observed with securely fastened grab bars. Bathrooms observed trash bin with no lid. Hand washing posting observed by bathroom sinks. The exterior tour was conducted. Outside free of obstruction and debris. LPA checked residents’ locked medications. A sample of resident records reviewed to have updated emergency contact information. No deficiencies issued during this inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 8/30/22. The following updated forms were requested: Lic 308, Lic 309, Lic 500, Lic 610E, Lic 9020, current Administrator Certificate, and current liability insurance. A copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Aug 24, 2022

Allegation investigated: Staff is taking pictures of residents without consent

On 3/21/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint investigation visit and deliver complaint finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator Martin Vale. During the course of the investigation, the Department reviewed records and conduct interviews. Based in records reviewed and interviews conduct with staffs and residents, residents’ photos are taken by staffs with consent. Based on interviews conducted and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. An exit interview was conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 21, 2022 · control 24-AS-20220315081316

Type of visit: Case Management - Deficiencies

On 03/21/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to delivery an amended complaint investigation and met with Martin Vale, Administrator. LPA interviewed staffs and resident. During the course of an investigation, a deficiency was observed relation to personal rights of resident in care. Specifically, S1 yelled at R1 while caring for R1. Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit interview conducted. Administrator was informed that as a COVID-19 precautionary measure, this report and appeal rights will be provided via email. Report signed on-site.the state’s words, verbatim · CDSS document, Mar 21, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Mar 21, 2022

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met: On 1/13/22, S1 yelled at R1 while caring for R1 which poses an immediate health and safety and personal rights risk to the person in care.the state’s words, verbatim · CDSS document, Mar 21, 2022

Plan of correction: Appropriate action was taken on staff. However, administrator submit a plan of correction detailing the steps that will be taken to ensure the regulations will be met in the future. Deficiency cleared.

Allegation investigated: Resident sustained scratches while in care as the result of rough handling by staff

On 3/11/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint investigation visit and deliver complaint finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator Martin Vale. During the course of the investigation, interviews were conduct with staffs and resident. Base on the staffs and resident’s interviews, the allegation resident sustained scratches while in care as the result of rough handling by staff, is UNFOUNDED, meaning they were false, could not have happened, and/or are without reasonable basis. We have therefore dismissed the complaint. Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site. Unfoundedthe state’s words, verbatim · CDSS document, Mar 11, 2022 · control 24-AS-20220110160058

The state marks this report as 3 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Allegation investigated: Staff speaks disrespectfully to residents in care

This an amended report. On 3/11/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint investigation visit and deliver complaint finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator Martin Vale. During the course of the investigation, LPA conducted interviews with staffs and residents. Based on interviews conducted, it could not be proven or disproven that S1 and S2 spoke disrespectfully to R1. The preponderance of evidence standard has not been met, therefore the above allegation is found to be UNSUBSTANTIATED. Exit interview conducted. As a COVID-19 precautionary measure, a copy of this report will be provided via email. Report signed on-site. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 11, 2022 · control 24-AS-20220106124155

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Mar 12, 2022

Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met: Based on the interviews conducted, staffs and resident confirmed S2 yelled at resident while caring for the resident which poses an immediately health and safety and personal rights risk to the person in care.the state’s words, verbatim · CDSS document, Mar 11, 2022

Plan of correction: Appropriate action was taken on staff. However, administrator will submit a plan of correction detailing the steps that will be taken to ensure the regulations will be met in the future to Fresno CCL by 03/12/22.

Allegation investigated: Facility staff did not adequately supervise resident. Resident was found covered in urine and feces.

An unannouced Complaint visit was conducted by Licensing Program Analyst (LPA) K. Mcclurg. LPA met with Executive Director (ED) Martin Vale. LPA stated purpose of visit. The Department has investigated the above allegations. Based on availble information, it could not be determined that there was a lack of care & supervision of Resdient 1 (R1), therefore the allegations are unsubstanitated. Exit interview conducted with ED. Report provided. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 7, 2022 · control 24-AS-20210409102750

Allegation investigated: Staff not wearing mask.

On 12/10/2021, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint findings on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator Martin Vale. During the course of the investigation, LPA toured the facility with Administrator. During the facility tour, LPA observed S1 not wearing face covering in facility kitchen. All staff in facility observed to be wearing face covering during the tour. Based on observation, the facility failed to protect the personal rights of clients in care to receive safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of clients in care in that 1 out 2 kitchen staff were observed to be not wearing facial covering in violation of official government orders requiring the wearing of face coverings while working under specified conditions. Therefore, the above allegation are found to be SUBSTANTIATED. A deficiency is being cited in accordance with the California Code of Regulations, Title 22, Division 6, Chapter 8. An exit interview was conducted and a Plan of Correction was reviewed and developed with Administrator. As a COVID-19 precautionary measure, a copy of this report and Appeal rights will be provided via email. Report signed on-site. Substantiatedthe state’s words, verbatim · CDSS document, Dec 10, 2021 · control 24-AS-20211112131114

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Dec 16, 2021

87468.1 Personal Rights of Residents in All Facilities (a)(2): Residents…shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on observation, the facility did not ensure staff are wearing facial coverings as mandated when it was observed that 1 out of 2 kitchen staff were not wearing facial coverings during the lunch period. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 10, 2021

Plan of correction: By the due date, the Administrator will submit a plan detailing steps the facility will take to ensure S1 wear face mask while in the facility as mandated. The plan shall include S1 training on facial covering and proof shall be submitted with POC.

Type of visit: Case Management - Deficiencies

On 11/18/21, Licensing Program Analyst (LPA) M. Yang arrived to conduct an unannounced initial complaint investigation and met with Martin Vale, Administrator. LPA toured the facility, interviewed Administrator and staffs. During the course of the investigation, LPA observed knives in an unlocked kitchen drawer. Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit interview conducted. Administrator was informed that as a COVID-19 precautionary measure, this report and appeal rights will be provided via email. Report signed on-site.the state’s words, verbatim · CDSS document, Nov 18, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(f)(1) · Plan of correction due date: Nov 18, 2021

87705 (f) (1) The following shall be stored inaccessible to residents with dementia: Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above when LPA observed knives in memory care kitchen drawer unlocked accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 18, 2021

Plan of correction: Licensee and caregivers immediately removed the knives from the unlocked kitchen drawer into a locked kitchen drawer. POC cleared during visit.

Allegation investigated: Resident was assaulted by another resident.

On 09/30/2021, Licensing Program Analyst (LPA) A. Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with Administrator. LPA met with Administrator, Martin Vale. During the course of the investigation, LPA conducted staff interviews and reviewed records. Staff interviews and record reviews revealed that, R1 entered the dining area through the courtyard of the facility. Upon entry, R2 approached R1 and R2 began “saying something mean like” to R1. R2 then “pushed” R1. S1 observed R2 approaching R1 and attempted to intervene before the incident escalated, however, before S1 arrived to the area where R1 and R2 were standing, R2 had already “pushed” R1. S1 immediately escorted R2 to R2’s apartment while the S2 assisted R1. Facility staff initiated emergency services. An EMT arrived, assessed R1, and transported R1 to the hospital. Facility staff contacted the responsible parties for both R1 and R2. CONTINUED TO LIC9099C Unsubstantiated It was determined that the facility did not act negligently and the incident that occurred was not due to a lack of care or supervision. Based on interviews conducted with staff and records review, the allegation: Resident was assaulted by another resident 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. No deficiencies issued during this inspection. An exit interview was conducted with Administrator. Due to COVID-19 precautionary measures, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. Report signed on-site by Facility Representativethe state’s words, verbatim · CDSS document, Sep 30, 2021 · control 24-AS-20210611102316

Type of visit: Case Management - Other

On 09/24/2021 , Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management visit. LPA introduced self, stated the purpose of the visit and requested to meet with Administrator. LPA met with Administrator, Martin Vale. The purpose of today's visit is to amend the Facility Evaluation Report dated 8/19/2021. Exit interview conducted. As a COVID-19 pre-cautionary measure, a copy of this report will be provided to Administrator via email and an electronic read receipt confirms receiving this email.the state’s words, verbatim · CDSS document, Sep 24, 2021

Type of visit: Required - 1 Year

On this date 8/27/2021, Licensing Program Analyst (LPA) M. Medina arrived to conduct an Annual Required Infection Control Inspection. LPA allowed entrance into facility by front office staff. Upon meeting with Business Office Director, Shannon See, LPA Medina was notified of positive COVID within the last 7 days. LPA notified Department and will continue Infection Control Inspection at a later date. No facility tour conducted during this visit.the state’s words, verbatim · CDSS document, Aug 27, 2021

Type of visit: Case Management - Deficiencies

This is an amended report. On 08/19/2021, Licensing Program Analysts (LPAs) Walton and Yang arrived unannounced to conduct a Case Management visit. LPAs introduced selves, stated the purpose of the visit, and requested to meet with the Administrator. Administrator, Martin Vale is not available during this inspection. LPAs met with Business Office Director (BOD), Shannon See. The purpose of this visit is to follow up on an Incident Report that was submitted to the Fresno CCL office on 08/09/2021. It was reported that on 07/23/2021, a Noc-shift medication technician (Med-Tech) found multiple medications in R1's room. The Med-Tech reported that R1 was "not R1's self" and was "more confused" than usual. Med-Tech contacted 911 and R1 was transported to the hospital. Medications were removed and placed in a locked room inaccessible to residents in care. Upon further review of this incident, it was determined that resident obtained the medication while on an outing and brought it back to facility unbeknownst to facility staff. Facility informed resident’s responsible party that all medications have to be secured for resident’s safety. Also discussed were multiple incident reports received from facility that were not submitted within seven days of the incident’s occurrence. Deficiency regarding reporting requirements is being cited in accordance to California Code of Regulations, Title 22, on the attached 809D. An exit interview conducted with (BOD). A plan of correction was developed and reviewed with BOD. Due to COVID-19 pre-cautionary measures, a copy of this report and appeal rights will be provided via email and an electronic read receipt confirms receiving these documents.the state’s words, verbatim · CDSS document, Aug 19, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Oct 25, 2021

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency... (1) A written report...to the licensing agency and to the person responsible for the resident within seven days of the occurrence. This requirement was not met as evidenced by: Based on record reviews, Licensee submitted late incident reports on the following dates: 7/23/21, 7/27/21 and 8/1/21. This poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Aug 19, 2021

Plan of correction: Licensee agrees to submit a plan detailing steps the faciltiy will take to ensure incident reports are submitted to the Fresno CCL office and responsible party. The plan will be submitted to the Fresno CCL office by 10/25/2021.

Allegation investigated: Resident is being mistreated by another resident while in care.

Licensing Program Analyst (LPA) Katie Brown conducted the subsequent complaint investigation visit to the facility to obtain additional information. LPA met with Cynthia Galvan, Resident Care Director. During the course of this visit LPA reviewed facility Narrative Charting Notes, Physicians Reports, Outside Agency Documentation and Needs and Services Plans for R1 and R1. LPA also interviewed S1 and S2. The Department has investigated the allegation that a resident was mistreated by another resident while in care. Based on Record Review and Interview, it was found that when R1 and R2 were roommates, they had episodes of verbal altercations. There was no evidence provided or reported to show that one resident harmed another. On 3/18/21 before R1 returned from a hospital stay, R2 was moved to a different room. Both R1 and R2 are in their own rooms. The allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 26, 2021 · control 24-AS-20210319135011