River Fountains of Lodi

Allegation investigated: Staff are verbally and physically abusing residents Staff does not ensure residents medications are taken once dispensed

Licensing Program Analyst (LPA) Renee Campbell conducted an unannounced complaint visit at River Fountains of Lodi on 09/20/23 at 8:00 AM to present findings regarding the complaint allegations mentioned above. In regards to “Staff are verbally and physically abusing residents”, LPA Renee Campbell Interviewed clients R1 to R8. Of the eight residents interviewed, eight of them reported that they had not been showered in cold water by staff. LPA Campbell was also provided with a shower schedule that shows that residents select their preferred shower times. None of the residents interviewed, reported verbal abuse or heard that other residents were abused. In regards to “Staff does not ensure resident medications are taken once dispensed”, of the eight clients interviewed, seven reported that staff watched them taking medication or remained in the room. All residents reported they took their medication regardless. Residents interviewed also reported that medication is being passed either in the dining room during meals where residents can be observed or in their rooms where staff can confirm meds are consumed. Unsubstantiated Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore these allegation are UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore this allegation is unsubstantiated. Per California Code of Regulations (CCRs) - Title 22, Division 8, no deficiencies cited. Exit interview was held and a copy of report was given to Rebecca Cobb, Administrator.the state’s words, verbatim · CDSS document, Sep 20, 2023 · control 27-AS-20230530163220

Type of visit: Required - 1 Year

On 08/30/23, Licensing Program Analyst (LPA), Renee Campbell arrived at the facility at 8:30 am to conduct a Required - 1 year visits. LPA Campbell met with Rebecca Cobb, Administrator and discussed the purpose of the visit. In the hallway near the dining room, LPA Campbell identified a poster size See Something Say Something sign. A poster size display of the Long Term Care Ombudsman's(LTCO) information with the number for the San Joaquin County Ombudsman's phone and fax number was also observed. The facility is licensed for a capacity of 80 non-ambulatory residents age 60 and above. The facility also has an approved hospice waiver for 10 residents. There is no bedridden approval. There are 63 residents of which, 1 receives hospice care services and there are no bedridden residents at this time. The temperature inside the facility was 70 degrees Fahrenheit which is within the required range of 68-85 degrees Fahrenheit. The hot water temperature was measured at 117 degrees Fahrenheit in one bathroom and at 120 degrees Fahrenheit in a bathroom at the other side of the building. Both measurements are within the required range of 105 to 120 degrees Fahrenheit. LPA observed fire extinguishers that were fully charged that had been last checked on 06/01/23. Smoke and carbon monoxide detectors were also identified in the facility. A Fire Safety drill report was reviewed as well. Central air was functioning in the facility. LPA observed enough food to support residents and staff for 2 days and enough non-perishables for 7 days. LPA Campbell observed the centrally stored medications area to be locked and inaccessible to residents. The first aid kit contained the required items such as sterile dressings, bandages, adhesive tape, scissors, tweezers, antiseptic solution and gauze. (cont LIC809-C) Upon a file review the following items were discussed to be submitted with any changes annually: Designation of Facility Responsibility (LIC308) Personnel Report (LIC500) Administrator Certificate Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies observed or cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Aug 30, 2023

Type of visit: Case Management - Health Checks

Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct a health and safety check on residents residing in the facility on 08/16/23 at approximately 9 am. LPA was met by Administrator Rebecca Cobb and Michelle Rodriguez, Care Coordinator and stated the purpose of the visit. LPA observed that the air conditioning was working in all areas of the facility except in the office area or the Group #1 section. The thermostat on the wall read 80 degrees Fahrenheit during this visit which is within the required range of 68-85*F. LPA interviewed resident #1 who was aware that the air conditioner was not working but who stated that she was not hot. LPA Campbell observed that the resident was wearing a fleece pullover. The forecast for today is up to 103 degrees*F in Lodi, CA during this visit. LPA reviewed the plan of action with the Administrator for residents while the AC is not working. The Administrator stated that all residents who wanted a fan received one. The administrator used two swamp coolers and three air blowers to circulate air as observed by LPA Campbell. All eleven residents in the area had their doors open. Staff were checking on residents hourly and utilizing a hydration cart to provide constant liquids. LPA observed 1 caregiver checking on a resident during this visit. Administrator submitted an IR on the same day of the event. In the event the facility loses power and no fans work, Care Coordinator Rodriguez stated residents are brought into the living room immediately. If any symptoms of heat exhaustion are not alleviated, arrangements with other residential facilities have been made to transport River Fountain residents to another facility if needed. Per the California Code of Regulations, Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview held, copy of report giventhe state’s words, verbatim · CDSS document, Aug 16, 2023

Type of visit: Case Management - Other

On 12-9-22 at 10:17am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding facility billing procedures for resident1 (R1). LPA met with Administrator Rebecca Cobb and explained the purpose of the visit. LPA conducted interview with Administrator, R1's responsible party, and reviewed invoices for R1. LPA also reviewed regulation section 87464(e). Based on interview and record review, it was determined that R1 became a social security income (SSI) recipient as of 6/28/22 and was billed facility's basic service rate after this date. Based on interview with Administrator, facility corporate billing office is now in the process of adjusting R1's invoice to reflect the proper amounts to be billed for R1 and send the revise invoice to R1's responsible party. Additionally, Administrator is in process of revising Admission agreement for R1 to reflect new amounts to be billed. Adjustments as noted above shall be completed within one week of the date of this report. Administrator is also in process of following up on R1's status for the assisted living waiver program. LPA will return at a later date to conclude this case management visit. No deficiencies cited at this time. An exit interview was conducted with Rebecca Cobb and a copy of this report was left with Rebecca.the state’s words, verbatim · CDSS document, Dec 9, 2022

Type of visit: Required - 1 Year

On 9-6-22 at 10:26am, Licensing Program Analyst (LPA) Michael Bilger and Ellie Holloway arrived at this facility unannounced to conduct an annual inspection visit. LPA met with the administrator Rebecca Cobb and explained the purpose of the visit. LPA Bilger inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV areas, and outside backyard of the facility to ensure compliance with Title 22 regulations. Facility is an 80 bed facility with a current census of 56. Facility has 50 rooms available for residents. LPA also conducted the infection control domain tool. The facility has an approved COVID Mitigation plan LIC 808 form in place. The facility has central entry point and has implemented screening and sign in procedures at the front door area. The facility conducts routine symptom screening for employees, residents, and visitors. LPA observed the facility to have hand washing, COVID - 19 informational, and social distancing signs posted throughout the facility, on the front door, and back yard. The facility has a designated infection control lead. The facility is able to designate and dedicated a Covid-19 room/bathroom if needed. Common touch surfaces are cleaned after each use. Water temperature reads between 105*F and 120*F in the bathroom and room temperature reads 76*F. LPA observed the facility to have adequate food supply. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 6/3/22. Facility has an emergency food and water kit. Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Rebecca Cobb.the state’s words, verbatim · CDSS document, Sep 6, 2022

Type of visit: Required - 1 Year

On 09/07/2021 at 8:50 am, Licensing Program Analyst (LPA) T. White contacted facility staff, regarding facility risk assessment questions. Facility staff confirmed no staff or clients have experienced symptoms within the last 10 days. At 1:05 pm, LPA T. White arrived unannounced to conduct a required 1-year annual inspection. LPA met with Administrator, Rebecca Cobb and explained the purpose of today’s inspection. LPA was allowed entry into the facility that is licensed to serve a total capacity of 80 non-ambulatory residents which 7 may be on hospice. LPA toured the facility including but not limited to apartments, bathrooms, kitchen, common area, and courtyard. All outdoor and indoor passageways are kept free of obstruction. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ bathrooms was measured at 115, 116.8 and 114.1 degrees Fahrenheit. There is a minimum of 7-day supply of nonperishable and 2-day of perishable foods. LPA observed smoke detectors and carbon monoxide is interconnected with the fire department. Fire extinguisher was last serviced on 06/01/2021. LPA observed mitigation plan is complete. LPA observed 3 isolation rooms accessible to residents in care. Fire drill last conducted on 06/30/2021. Updated copies of the following documents were requested for facility file and are to be submitted to CCL by 09/14/2021: LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan No deficiencies cited during inspection. Exit interview conducted with Administrator and a copy of report given.the state’s words, verbatim · CDSS document, Sep 7, 2021

Type of visit: Case Management - Deficiencies

Licensing Program Bruce Jacobs conducted a case management visit at the facility to issue deficiencies relating to an incident report not submitted to the Department. LPA met with Facility Manager Julia Fragoso and the purpose of the visit was disclosed. On August 12, 2021, Licensing Program manager Liza King conducted a phone call the Administrator. During that phone call, information was obtained that the facility had a resident (R-1) who had tested positive for an infectious disease while hospitalized. Upon further review, the facility did not submit an incident report as required. In addition, it was determined that the facility did not conduct the required testing of staff of staff per Provider Information Notice (PIN) 21.32 or PIN 21.32.1 for surveillance testing or response testing after received a positive test result, per standard guidance as well. Case management deficiencies are being issued on the following 809Ds. Appeal rights provided and exit interview conducted.the state’s words, verbatim · CDSS document, Aug 23, 2021

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569 · Plan of correction due date: Aug 31, 2021

Conduct Inimical: Conduct which is inimical to the health, morals, welfare, or safety of either an individual in, or receiving services from, the facility or the people of the State of California. This requirement was not met as evidenced by: Facility did not follow the Department's guidance of conducting surveillance testing of unvaccinated staff once per week per Provider Information Notice (PIN) 21.32 and later PIN 21.32.1 This poses an immediate health and safety risks to clients in care.the state’s words, verbatim · CDSS document, Aug 23, 2021

Plan of correction: Plan of Correction: The Facility Administrator will review the PINs that provides instructions for staff testing. Facility will submit a statement to the Department by 8/31/21 that the PINs have been reviewed, understood and are being followed

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211(a)(1)(B) · Plan of correction due date: Aug 31, 2021

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:(B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision 87211(a)(2) Occurrences, such as epidemic outbreaks, This requirement was not met as evidenced by: A resident of the facility was hospitalized and determined to have an infectious disease on 7/26/21. The facility failed to submit an incident as required to the department. This poses a potential Health and Safety risk to clients in care.the state’s words, verbatim · CDSS document, Aug 23, 2021

Plan of correction: Plan of Correction: The Facility Administrator will review the corresponding regulation on reporting requirements. Facility will submit a statement to the Department by the POC due date that this regulation has been reviewed, understood and is being followed

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(2) · Plan of correction due date: Aug 31, 2021

Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.(2) Knowledge of and ability to conform to the applicable laws, rules and regulations. this requirement was not met as evidenced by: Facility Administrator did not follow the reporting requirements or the staff testing requirements of PIN # .21.32 and 21.32.1. The Facility Administrator is responsible for knowledge of CCR regulations and compliance of the regulations. This poses a potential Health and Safety risk to clients in care.the state’s words, verbatim · CDSS document, Aug 23, 2021

Plan of correction: Plan of Correction: The Facility Administrator will review this regulation and the corresponding PINs that provides instructions for staff testing. Facility will submit a statement to the Department by 8/31/21 that both this regulation the PINs have been reviewed, understood and are being followed.

Allegation investigated: Neglect/Lack of Supervision: 1) Resident sustained serious injuries due to a fall 2) Staff did not notify residents authorized representative of residents change in condition 3) Staff did not check on resident in a timely manner Physical Plant: 1) Residents bathroom light is in disrepair 2) Residents bedroom was filthy

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to River Fountains of Lodi RCFE on 07/12/21 at 10:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated. Interviews with hospital staff were unable to determine if R1s fall contributed to her condition or death. Investigator could not determine if R1 was at risk for falls or if the facility staff were negligent in caring for R1. Investigator also could not determine if R1 had a change in conditional that was not reported by facility staff. Investigator received conflicting statements from parties interviewed and could not make a determination. Report Continued on LIC 9099-C Unsubstantiated LPA Gould conducted interviews with staff member who responded to request for assistance fro R1. LPA received contestant statements from staff that responded once request was received and calls were made to staff to assist R1 in her room. Several staff responded and assisted R1. LPA Gould also could not evaluate the physical plant complaints regarding R1's bedroom and bathroom. When LPA inspected the physical plant all personal items had been removed and the room had been cleaned. LPA also observed the bathroom light to be operational at the time of inspection. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of neglect/lack of supervision and physical plant are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility. There are no deficiencies noted or cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator. Appeal Rights were issued and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 12, 2021 · control 27-AS-20210120095513