Roseleaf Oroville

Allegation investigated: A resident eloped from the facility Facility A/C is in disrepair Facility water system is in disrepair Facility fire alarm system is in disrepair Facility gate is in disrepair

On 07/15/2022, Licensing Program Analyst (LPA) Jaclyn Avila conducted an announced complaint investigation visit regarding the above allegations, and Crystal Cumminskey, Lead MT. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 LPA was not screened at the front door. Cont'd on LIC 9099-C Substantiated This Department has investigated the above listed allegations and found them to be substantiated. This Department has conducted interviews and made observations during a tour of the facility on 7/15/2022. Allegation: A Resident (R1) eloped from the facility. This Department conducted staff interviews which revealed R1 was located outside of the facility by a different resident’s family. Although R1 was not witnessed leaving the building, staff interviewed believed it was through a gate in which the egress was not working. The mechanism in the gate needed to be repaired and the gate door would swing open. The facility placed pots and chairs to prevent the gate from opening. After the elopement, the facility utilized a cable to lock the gate. This Department requested a copy of the incident report. Staff present during the site visit on 7/15/2022 where unable to provide a copy. This Department contacted the administrator who stated she thought she sent the unusual incident report regarding the elopement of R1 however the facilities internet has been working off and on. No staff were able to provide the date of occurrence, but all confirmed it happened during interview. This department reviewed R1’s physicians report dated 3/30/2022 which is marked that R1 can not leave the facility unassisted. Allegation: Facility A/C is in disrepair- This Department conducted interviews with facility staff to include administrator. The investigation revealed that the A/C has been broken for approximately a month. The facility has reached out to their vendor and were told the unit needed to be replaced. To date the air conditioning unit has not been fixed nor replaced. Allegation: Facility water system is in disrepair. The investigation revealed that a valve on the water heater needs to be replaced and residents nor staff can control the temperature of the water. Due to this, residents affected have not been showering in their own shower but are taken to a different location in the building to shower which has resulted in some refusals of residents to shower. The water system has been in disrepair for approximately a month and has not been fixed to date. Allegation: Fire alarm system is in disrepair. In June of 2022, Roseleaf Oroville experienced the fire alarm system malfunctioning at which time they reached out to the vendor who inspected the system. The vendor recommended the system be replaced due to the system being antiquated and provided the invoice to the administrator who provided it to the Chief Operating Officer for the licensee. To date the system has not been replaced as recommended. Deputy Fire Marshal joined this department in a tour of the facility and strongly recommended the fire alarm system be replaced. Three egress lighting units did not function during the inspection on 7/15/2022 at 3:50 PM. These lights are instrumental in the event there is a power outage. Allegation: Gate is in disrepair. During a tour of the facility this Department observed that the gate is being secured by a cable and lock. This cable and lock were not implemented until an elopement of a resident occurred. The mechanism securing the gate has been in disrepair since May 2022 and has not been fixed to date. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D. The following deficiencies were cited per Title 22 of the California Code of Regulation (See LIC 9099D ). Appeal Rights were explained and provided to the facility representative listed above and an Exit Interview was conducted. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed.the state’s words, verbatim · CDSS document, Jul 15, 2022 · control 25-AS-20220711103123

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(4) · Plan of correction due date: Jul 16, 2022

87705(c)(4) Care of Persons with Dementia-Licensees who accept and retain residents with dementia shall be responsible for ensuring: There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs. This requirement is not met as evidenced by: Based upon observation and interview the Licensee failed to provide enough care staff to ensure the safety and health care needs of 1 of 1 residents. This poses an immediate Health, Safety and/or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 15, 2022

Plan of correction: Licensee agrees to increase staffing levels during each shift to ensure the safety and health care needs of all residents. Licensee will provide staffing plan by 5pm on 7/16/2022 to LPA via e-mail. Licensee will provide daily schedules to LPA for the remainder of July 2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Jul 16, 2022

87303(a) Maintenance and Operation-The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based upon observation and interview the Licensee failed to keep the gate, air conditioning unit and water heater in good repair. This poses an immediate Health, Safety and/or Personal Rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 15, 2022

Plan of correction: Licensee agrees to repair the gate, air conditioning unit and water heater within 24 hours of this citation. Licensee agrees to read reg 87303 and provide memo of understanding to include a policy to ensure this will not occur again. Due to LPA Avila via e-mail within 24 hours.

The state marks this report as 6 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Type of visit: Office

An informal conference was conducted today via Microsoft Teams Platform. The purpose of this informal conference meeting was to discuss sister facility Roseleaf Senior Care and the transition of Licensees. Present in the meeting is Regional Manager Alycia Berryman, Licensing Program Manager Laura Munoz, Licensing Program Analyst Jaclyn Avila, Licensee Raj Rao, Chief of Operations Stephen Ratliff, Audre Smith and Roseleaf Senior Care Administrator Samantha Guarino. The informal conference process was explained during this meeting. Topics discussed during the meeting were: · Licensee/Administrator accountability · Transition as Peer Services separates as Licensee/Management · Ensuring all staff regardless of position are fingerprint cleared and associated The following Forms are due by June 10th, 2022 and are to be submitted to LPA LIC 308 The following Forms are due by June 30th, 2022 and are to be submitted to LPA Infection Control Plan Cont'd on LIC 809-C The following Forms are due by July 8th, 2022 and are to be submitted to LPA LIC 500 Personnel Roster Resident Roster LIC 9020 LIC 309 and Organizational flow chart Copy of this report will be e-mailed to the Licensee for Signature and a signed copy will be returned same day to LPA.the state’s words, verbatim · CDSS document, Jun 8, 2022

Type of visit: Case Management - Incident

05/20/2022 1:30 PM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with Amber Farmer - Resident care coordinator, and Lisa Sapp, Sales Director. The purpose of this visit was to conduct a case management investigation. Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask, gloves. Today's meeting concerns an investigation into an incident report that was received from the facility on 05/10/2022 regarding an incident that occurred at the facility on 05/09/2022. It was reported that on 05/09/2022 Resident 1 (R1) was playing the piano and Resident 2 (R2) asked R1 to stop playing the piano. R1 yelled at R2 and R2 became upset and pushed R1 down. R1 hit their wrist causing a gash in their skin. 911 was called and R1 was transported to the local ER where R1 was treated for a right forearm laceration. R1 received stitches as a result of the injury and was released back to the facility the same day. It was learned that R1 has dementia and R2 has cognitive decline. R1's stitches were removed on 5/16/22 and the wound has healed. R2 is new to the facility, it was their first week at the facility. R1 is very vocal but has never had a conflict with another resident. In order to prevent this from happening again the facility held a care conference with R2’s family and explained the situation. It was explained this is inappropriate behavior. They suggested that R2 speak with administration or care staff and tell them when they are upset and staff will help to solve the problem. R2 was very apologetic and remorseful and apologized to R1 and staff. No deficiencies cited. Exit interview conducted and a copy of the report was emailed to Amber Farmer - Resident care coordinator.the state’s words, verbatim · CDSS document, May 20, 2022

Allegation investigated: Staff are not appropriately wearing masks.

Licensing Program Analyst (LPA) Dawn Keane conducted an unannounced complaint investigation visit regarding the above mention allegation: Staff are not appropriately wearing masks. LPA met with Administrator (AD) Terry Brown and informed AD of the reason for the visit. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA contacted facility and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering he facility and the following Personal Protective Equipment (PPE) was worn: N95 mask. Additionally, LPA was screened at the front door. Continued on 9099-C Substantiated During the investigation it was determined that there was sufficient evidence to Substantiate that facility staff were not wearing masks appropriately. LPA's Keane and Valencia entered the facility on 8/27/21 at 12:30 p.m. and waited for approximately (5) five minutes for an employee to screen them. After about (5) five minutes, LPA's screened themselves. While LPA's were screening they observed an office with an open door and (2) two people sitting at a desk. One person was wearing a mask and the other, identified by AD as the Human Resources person was wearing a mask under her nose. LPA's toured the facility with AD, where LPA's observed another office with an open door and a person sitting behind the desk with a mask under her chin. LPA's went to AD's office after touring the facility and AD admitted that staff do not wear masks appropriately and need constant reminders about this issue. LPA received the LIC 808 (Mitigation Plan) from AD on 5/24/2021. LPA reviewed the LIC 808 and on page 13, the mitigation plan it states; "All facility staff are wearing a face covering while on the premises." Facility is not following the mitigation plan that was submitted to Licensing. Based on the evidence obtained, the preponderance of evidence standard has been met; therefore , the allegation is found to be Substantiated. California code of Regulations (Title 22) is being cited on the attached LIC 9099D. Appeal rights were provided and exit interview conducted.the state’s words, verbatim · CDSS document, Mar 7, 2022 · control 25-AS-20210825130006

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87470(c)(1)(F) · Plan of correction due date: Feb 16, 2022

87470(c)(1)(F) Infection Control Requirements: An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. The Infection Control Plan shall include all of the following: Staff shall demonstrate knowledge of and skill in infection control... This requirement has not been met as evidenced by: LPA's interviews and observations. Staff did not follow infection control requirements as required. This poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Mar 7, 2022

Plan of correction: AD agrees to develop a plan that includes the importance of staff wearing masks at all times when in the facility. The AD shall submit the POC to the licensing agency within 24 hours.

Allegation investigated: Staff does not give resident phone time. Staff does not give resident television time.

On 2/8/22 at 12:10 p.m. Licensing Program Analyst (LPA) Misty Valencia interviewed Administrator (AD) Terry Brown regarding the above allegations. AD reports that per the admission agreement, the facility does not provide phones nor TV's for residents in their rooms, although phones and TV's are available throughout the facility in common areas. LPA Keane reviewed admission agreement and the agreement states that "Your apartment will be furnished with basic cable television hook-up, water, electricity, garbage removal, heat and air conditioning. You will be responsible for telephone, cable television and internet services which will be billed directly to you by the responsible company or companies " On 3/7/22, LPA Keane interviewed 3/24 staff and 4/29 residents who all stated that phones are available to residents for private use in (4) areas of the building. Also, residents have personal phones and Ipads for use as well. The preponderance of evidence standard has not been met. LPA finds the allegation to be Unfounded. Meaning the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Exit interview conducted copy of the report given to AD. Unfoundedthe state’s words, verbatim · CDSS document, Mar 7, 2022 · control 25-AS-20220131100608

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: Required - 1 Year

On 3/7/2022 11:40 AM Licensing Program Analyst (LPA) Dawn Keane arrived at the facility unannounced to conduct a Required-1 Year Inspection utilizing the infection control domain. LPA met with Terry Brown, Administrator (AD) and explained the purpose of the visit. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA contacted AD and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95. Additionally, LPA Keane was screened by AD/staff person. LPA Keane and AD toured facility to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, three (3) bathrooms, four (4) bedrooms, kitchen, storage areas. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA Keane and the AD completed the infection control domain and facility was found to be in substantial compliance at this time. No deficiencies are being cited as a result of today’s inspection. Exit interview conducted and copy of report was given to AD.the state’s words, verbatim · CDSS document, Mar 7, 2022

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Jacob Williams conducted a case management visit to the facility on today's date for the purpose of delivering an Order To Individual of Immediate Exclusion from all facilities and the Order to Licensee/Facility of Immediate Exclusion From Facility. LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 respirator. Additionally, LPA was screened by staff upon entering the facility. LPAs met with Executive Director, Terry Brown and explained the purpose of today's visit. Staff Pauline Willyard is excluded as a result not related to this facility. LPA Williams handed the Order to Licensee/Facility of Immediate Exclusion From Facility letter to Terry Brown and explained that staff, Pauline Willyard is not allowed at the facility. A copy of this report was provided to Executive Director..the state’s words, verbatim · CDSS document, Feb 16, 2022