Parkway Gardens Retirement Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Renita Hall conducted an unannounced annual required visit to the above-mentioned facility. Upon arrival, LPA met with the House Manager. The facility operates as a Residential Care facility for the Elderly with Dementia. A facility tour was conducted, which included indoor activity areas, restrooms, kitchens, and outdoor space. All areas were clean, safe, and in good repair. Furniture and equipment were in good condition and appropriate for the clients in care. The facility has sufficient space and seating for all clients, with no exit obstructions. The restrooms were equipped with adequate supplies. The hot water temperature was measured within the required range of 105°F to 120°F. Staff prepared meals, and menus were available at the time of the visit. A random sample of client files was reviewed. Files contained current physicians’ reports, admission agreements, emergency information, needs and services plans, and other required documentation. Staff records reviewed contained criminal record clearance, health screening, current first aid/CPR certification, and required training. Continued on 809 C LPA conducted interviews with 3 staff member, 4 residents, and 1 on hospice. No concerns were noted. The facility’s emergency disaster plan was observed to be current and posted. Fire drills are conducted as required, and documentation is available for review. Fire extinguishers were serviced within the past year, and smoke/carbon monoxide detectors were operable. No deficiencies were cited during today’s visit. An exit interview was conducted with the House Manager, and a copy of this report, along with the Licensee Rights (LIC 9058), was provided to the House Manager. His signature on this form confirms receipt of the documents.the state’s words, verbatim · CDSS document, Dec 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced Required 1 year Annual Visit. LPA was allowed entry by Carminda Ramirez, Licensee. LPA identified herself and disclosed the purpose of the visit with the Licensee. Physical Environment: The facility was clean, maintained, and free from any safety hazards. Adequate lighting and ventilation were observed in all areas of the facility. All necessary safety equipment, such as fire extinguishers and emergency exits, were present and in good working condition. The facility's outdoor spaces were properly maintained and accessible to residents. Staffing and Training: The facility had a sufficient number of qualified staff members to meet the needs of the residents. The staff member was observed to be professional, courteous, and knowledgeable in their respective roles. All staff members had completed the required training and certifications per the licensing regulations. Staffing schedules were posted and adhered to, ensuring adequate coverage. Continued on 809C Resident Care and Services: Residents' care plans were reviewed and found to be comprehensive and up-to-date. Medication administration was observed to be in accordance with the facility's policies and procedures. Residents' nutritional needs were met, and the meals provided were nutritious and well-balanced. Recreational activities and social engagement opportunities were available to residents regularly. Health and Safety: Regular health assessments and monitoring of residents' well-being were conducted by qualified healthcare professionals. Infection control measures were in place and followed by staff members. The facility had established protocols for emergencies and evacuation plans were readily available. Overall, the facility was found to comply with the licensing regulations. An exit interview was conducted, and a copy of this report and the Licensee Rights (LIC 9058) were provided to the Licensee. Her signature on this form confirms receipt of the documents.the state’s words, verbatim · CDSS document, Dec 6, 2024

Allegation investigated: Questionable deaths Staff mismanaged residents' medications Staff failed to meet the residents' needs Staff unable to communicate with residents due to a language barrier. Untrained staff

Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit to deliver findings regarding the above-mentioned allegations LPA was allowed entry by Art Vinarao,Caregiver. LPA identified herself and disclosed the purpose of the visit and elements of the findings with the Caregiver. The Department’s investigation consisted of interviews with staff, residents, outside sources, a review of records, and a tour of the facility. It was alleged that neglect by facility staff resulted in the questionable deaths of Residents #1-2 (R1-R2). A review of records revealed R1 was non-ambulatory and required assistance with toileting, bathing, dressing, feeding, and incontinence care. R1 was confused/disoriented but was able to communicate their needs. R1 began receiving hospice services from a hospice agency on September 1, 2020. Interviews with staff indicated staff checked on R1 approximately every two hours and assisted R1 with repositioning and incontinence care. R1 was prescribed oxygen and morphine to aid in comfort care. {Continued on 9099C} Unsubstantiated The investigation confirmed that the individual in question was not listed in the facility's clearance records. They did not possess the required background checks or clearance as an employee. The staff interviewed corroborated that the individual had been present in the facility without the proper clearance. The allegation that an uncleared adult was an employee within the facility is substantiated as there is a preponderance of evidence to prove the alleged violation occurred. The individual was hired as a caregiver without the necessary background checks and approvals, which is a violation of Health and Safety Code section 1569.17 (e )(1). An exit interview was conducted; a copy of this report along with Licensee Appeal Rights LIC 9058 (REV 3/22) were provided to Art Vinarao, Caregiver and his signature confirms receipt of these documents. On October 26, 2020, hospice staff documented wounds, of unknown staging, to R1’s forearm and coccyx. On November 25, 2020, hospice staff documented R1 was noted to have developed a stage 3 pressure injury. Interviews with outside medical professionals who visited the facility and observed R1 did not have concerns regarding neglect or unmet needs for R1. Additionally, there were no concerns regarding assistance with medication administration or mismanagement of R1’s medication. R1 passed away at the facility on November 26, 2020. According to the County of San Diego Certificate of Death, R1’s cause of death was listed as Cardiac Arrest and Respiratory Arrest with Hepatic failure, unspecified without coma, and Non-Alcoholic Cirrhosis of Liver noted as the underlying causes of death. A review of records revealed R2 was non-ambulatory and required assistance with bathing, dressing, feeding, transferring, and incontinence care. R2 was able to communicate their needs. R2 began receiving hospice services from a hospice agency before their admission to the facility. Interviews with staff indicated staff checked on R2 approximately every two hours to assist with repositioning and assisted R2 with incontinence care. R2 was prescribed oxygen due to their medical condition. Interviews with medical professionals revealed R2 was oriented and able to operate their oxygen machine. Interviews with outside sources and outside medical professionals who visited the facility and observed R2 did not have concerns regarding neglect or unmet needs for R2. Additionally, there were no concerns regarding assistance with medication administration or mismanagement of R2’s medication. R2 passed away at the facility on October 3, 2020. R2’s cause of death was listed as Interstitial Lung Disease. Outside source and residents interviewed regarding the language barrier, there are no concerns, and staff could communicate with residents in their preferred language. Based on the investigation findings, the allegations made against the staff regarding all allegations of Questionable Deaths, Staff Mismanagement of Residents' Medications, Staff Failure to Meet Residents' Needs, Untrained staff, and Staff Unable to Communicate with Residents Due to a Language Barrier—are unsubstantiated. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Art Vinarao, Caregiver. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Caregiver and his signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Sep 26, 2024 · control 08-AS-20201202155827

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.17(b)(1). · Plan of correction due date: Aug 23, 2024

(b)All individuals subject to a criminal record review pursuant ....... shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department This requirement was not met as evidenced by: Based on interview, records, and systems review, the licensee did not ensure Staff #1 had a CA criminal record clearance prior toworking or volunteering in the licensed facility which posed an immediate Health, Safety and Personal Rights Risk to person in care.the state’s words, verbatim · CDSS document, Sep 26, 2024

Plan of correction: Immediate Action: Ensure that the uncleared individual do not have access to the facility until proper clearance is obtained. POC cleared on 12/14/2020

Allegation investigated: Staff mismanaged resident's medication.

Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to open a complaint and deliver findings. LPA was allowed entry by Art Vinarao, Caregiver. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Manager. On February 20, 2024, a complaint was received regarding Staff mismanaged residents' medication. The purpose of this investigation was to determine the validity of the allegation and take appropriate actions if necessary. The following were reviewed and observed as part of the investigation: Residents' records, Medication Administration Records (MAR), and a facility tour on February 29, 2024. {Continued on 9099C} Substantiated Allegation: Staff mismanaged residents' medication. The investigation found that staff members did not follow prescribed medication administration per the prescription order. LPA interviewed staff, outside sources, and the resident all stated that the dosage had been given as prescribed it was only at bedtime according to the medical records in December 2023. The increase took place on January 23, 2024. However, it was noticed by the outside source that the medication was given at the prior dosage on February 2, 2024, during a visit with the resident. The staff, outside sources, and resident all stated that the medication had been given at the correct dosage as of February 20, 2024. Based on the evidence obtained during the complaint investigation, the allegation was found to be SUBSTANTIATED, as there is a preponderance of evidence to prove the alleged violation occurred. An exit interview was conducted with Art Vinarao, Caregiver. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Caregiver and his signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Feb 29, 2024 · control 08-AS-20240220090113

From the deficiency page — Deficiency type: Type B · Section cited: HSC 80075(b) · Plan of correction due date: Feb 29, 2024

80075(b)Clients shall be assisted as needed with….medications. (5) If the client's physician has stated in writing that the client is unable to determine his/her own….the licensee shall be permitted to assist the client... (B) Once ordered by the physician the medication is given according….This requirement was not met: Based upon interviews and records reviewed. This deficiency may pose a potiential Health and Safety risks to residents in care.the state’s words, verbatim · CDSS document, Feb 29, 2024

Plan of correction: The correction had been made based on records reviewed, outside sources, resident statements. The PRN did not have any side affects per the SW and no immediate health risk. date corrected 02/20/2024

Allegation investigated: Staff mismanaged resident's medication

Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to open a complaint and deliver findings. LPA was allowed entry by Art Vinarao, Caregiver. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Caregiver. On February 2, 2024, a complaint was received regarding Staff mismanaged residents' medication. The purpose of this investigation was to determine the validity of the allegation and take appropriate actions if necessary. The following were reviewed and observed as part of the investigation: Residents' records, Medication Administration Records (MAR), and a tour of the facility. Continued on 9099 C Substantiated Allegation: Staff mismanaged residents' medication. The investigation found that staff members did not follow prescribed medication administration per the prescription order. Interviewed staff, outside sources, and the resident all stated that additional dosages were given to the resident because the resident requested more due to anxiety. The staff, outside sources, and resident all stated that the medication had been given at the correct dosage as of February 2, 2024. An exit interview was conducted with Art Vinarao, Caregiver. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Caregiver and his signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Feb 7, 2024 · control 08-AS-20240202103131

From the deficiency page — Deficiency type: Type B · Section cited: HSC 80075(5)(b) · Plan of correction due date: Feb 7, 2024

80075(b)Clients shall be assisted as needed with….medications. (5) If the client's physician has stated in writing that the client is unable to determine his/her own….the licensee shall be permitted to assist the client... (B) Once ordered by the physician the medication is given according….This requirement was not met: Based upon interviews and records reviewed. This deficiency may pose a potiential Health and Safety risks to residents in care.the state’s words, verbatim · CDSS document, Feb 7, 2024

Plan of correction: The correction had been made based on records reviewed, outside sources, resident statements. The PRN did not have any side affects per the SW and no immediate health risk. Corrected on February 2, 2024

Allegation investigated: Staff neglect resulting in hospitalization Staff did not meet resident's needs

Licensing Program Analyst (LPA) Renita Hall, conducted an unannounced visit to deliver findings regarding the allegations mentioned above LPA was allowed entry by Art Vinarao, Caregiver. LPA identified herself and disclosed the purpose of the visit and elements of the findings to the Caregiver. The Department investigated the above-listed complaint allegations. The investigation consisted of a tour of the facility, interviews with staff and outside sources, and a records review. On November 30, 2023, the Department received a complaint alleging that Staff neglect resulted in hospitalization and Staff not meeting the resident's needs. The records reviewed indicated that the resident was referred to the facility by the hospital for comfort and care on November 27, 2023. No admission agreement was signed by the Power of Attorney (POA) for the resident nor was a Hospice agreement signed. Continued on 9099 C Unsubstantiated The Administrator, Carminida Ramirez stated that she had spoken to the POA several times to come and sign the admission agreement with no response. Hospice also stated that on the date the resident was taken to the hospital, the POA denied assistance. Based on the investigation findings, it can be concluded that the allegations of staff neglect resulting in hospitalization and staff not meeting the resident's needs are unsubstantiated. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of this report along with the Licensee Rights (LIC 9058) was provided to Art Vinarao, Caregiver. His signature on this form confirms receipt of the documents.the state’s words, verbatim · CDSS document, Feb 7, 2024 · control 08-AS-20231130163001

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Amy Rodgers, made an unannounced visit to conduct the required One-Year Inspection to ensure substantial compliance with Title 22 regulations. LPA Rodgers was granted entry into the facility by Administrator Carminda Ramirez, after identifying herself and stating the purpose of the inspection. Facility serves elderly residents ages 60 and above; approved for fifteen (15) residents of which six (6) can be non-Ambulatory. Hospice waiver for 3. The facility does not feature a secured perimeter. LPA was accompanied by Administrator Ramirez during a tour of the facility. A tour of the facility was conducted which included a sample of resident units, the dining area, recreation rooms, and food storage areas. Signal systems are in place and operational. PPE supplies are onsite. Passageways were free from obstructions. Each resident had clean and sufficient bed linens. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars and Non-skid mats. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA observed an activities calendar; however, licensee explained most clients prefer to not participate. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Refrigerator and Freezer temperature were compliant. Food was observed to be properly stored and labeled. The food service area was observed to be neat and clean. Food menus were posted. Chemicals and cleaning supplies were stored in a locked closed cabinet under sink not assessable to residents. Centrally stored medications were properly stored and locked in medication cart. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions. Resident records were reviewed and confirmed compliant. LPA reviewed the theft and loss policy and procedures. Transportation procedures are compliant. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. There was a technical violation observed and two technical advisories were given during the inspection. An exit interview was conducted with Administrator Ramirez, to whom copies of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. Their signature on this form acknowledges receipt and a copy of the report was given to Administrator Ramirez.the state’s words, verbatim · CDSS document, Dec 19, 2023

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Allegation investigated: Lack of supervision resulted in sexual abuse.

Licensing Program Analyst (LPA) Renita Hall conducted an unannounced visit to deliver findings regarding the above-mentioned allegation LPA was allowed entry by, Carla Hayag, Caregiver. LPA identified herself and disclosed the purpose of the visit and elements of the findings with the Caregiver. It was alleged that lack of staff supervision resulted in the sexual abuse (inappropriate touching) of a resident at the facility on 7/11/23 by an unknown individual. Evidence obtained during interviews confirmed that residents at this facility could come and go from the facility unsupervised. There are staff that reside at the facility, but due to the residents’ independent status, staff are not required to do room checks. Administrator Carminda Ramirez said Resident 1 (R1, LIC 811 provided for name of resident) would often leave their door open at night to allow their pet to freely come and go from their room. Unsubstantiated Carminda stated she had admonished R1 to close and lock their door during the evening hours for safety. R1 admitted that Carminda had advised them on several occasions to close and lock their door during the evening. An interview was conducted with R1, Resident 2 (R2) and Resident 3 (R3), who all had brief interactions with the unknown male on the evening of 7/11/2023. All three residents witnessed the Suspected Abuser (SA) asking for the location of the manager’s office and about the possibility of a vacant room. R1 described the SA as “grazing” their left breast with his hand when his hand slipped from R1’s shoulder and was unable to say if the SA did it intentionally or not. R3 was in the room with R1 when the SA was at the front door. R3 stated they did not hear any conversation between R1 and the SA, and R3 did not see the SA touch R1. R2 described the SA as “cordial.” R2 said the SA escorted them down the stairs by holding their elbow with his hand, but did not act inappropriately. In this case, the SA involved in this incident was unknown and the witnesses/residents were only able to provide a vague description of the SA. Based on R1’s statement, it is unknown if the SA touched R1's breast intentionally or accidently. Local law enforcement sources indicated that even if the SA were to be identified, it would still be difficult to prove the SA touched R1 for sexual gratification. In addition, there is no requirement to check on the residents at night and R1 admitted that Administrator had admonished them many times to close and lock their door at night. Based on the investigation, there was insufficient evidence to support the allegation that lack of supervision resulted in sexual abuse, therefore it has been unsubstantiated. No further investigation is warranted. A finding that is unsubstantiated means that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Carla Hayag, Caregiver copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Caregiver and her signature on this report confirms receipt of the Licensee Rights.the state’s words, verbatim · CDSS document, Dec 7, 2023 · control 08-AS-20230713130511