Santa Monica Home & Care 4

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the annual inspection. LPA Allen, met with Svetlana Dagala- Caregiver and she was inform of the purpose of the visit. The facility is licensed for (4) non-ambulatory residents age 60 and over. The facility has a hospice waiver for three (3) residents. Currently, there are 3 residents, all are over the age of 60. There is 2 (two) residents receiving hospice care services. The facility does not handle any of the residents’ money. The facility is a two-story structure located in a residential neighborhood. The first-floor licensed facility consists of the following: 3 resident bedrooms, (2) bathrooms, living room, dining room table and full kitchen. There is an adjacent enclosed patio/activity room area. There is a laundry area (located in the attached garage) and an outdoor shaded patio area. LPA toured the Resident bedrooms which had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 105- 120.F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. LPA Allen, reviewed two (2) clients’ files for admission agreements, updated physician reports, and needs and services plan which appeared to be up to date. LPA reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings which appeared to be up to date. Outside grounds were toured and no bodies of water were observed. Indoors and outdoors were free of obstructions. The kitchen was inspected, and there was a 5-day supply of perishable and a 7day supply of non-perishable food items available, which was adequately maintained and stored. The fire extinguishers, carbon monoxide detectors and smoke detectors were fully charged and operable. Based on the observations made during today’s visit, no deficiencies were cited. An exit interview was conducted, and this report was discussed and provided to at the conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was discussed. The facility is licensed for (4) non-ambulatory residents age 60 and over. The facility has a hospice waiver for three (3) residents. Currently, there are 3 residents, all are over the age of 60. There is 2 (two) residents receiving hospice care services. The facility does not handle any of the residents’ money. The facility is a two-story structure located in a residential neighborhood. The first-floor licensed facility consists of the following: 3 resident bedrooms, (2) bathrooms, living room, dining room table and full kitchen. There is an adjacent enclosed patio/activity room area. There is a laundry area (located in the attached garage) and an outdoor shaded patio area. LPA toured the Resident bedrooms which had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 120.1F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. During todays visit LPA did not observe any deficiencies. An Exit interview was conducted with Jennifer Block, Asst Administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 18, 2024

Allegation investigated: Staff do not ensure that COVID safety practices are being followed Staff did not ensure resident has personal privacy in accommodations Staff allowed resident to sleep in a common room

This report supersedes the report dated 12/20/2022, the purpose of this amendment is to provide clarification on the circumstance surrounding the allegations. although this report supersedes the previous report the complaint investigation findings remain the same: Unsubstantiated On 12/20/22 LPA Alvizar obtained the following documents Personnel Report, Resident Roster, Residents #1-2’s Admissions Agreements, Physician Report, ID and Emergency Information, and Unusual Incident Report for R#1. LPA conducted Interviews with administrators, residents #1- #2 (R1-R2), Staff #1- #6 (S1-S6) and witness #1-#2 (W1 – W2). LPA Alvizar and Administrator Jennifer toured the facility physical plant. During todays visit 7/23/2024 LPA Sparkle Day conducted an subsequent visit to do interviews. At approximately 10:00 am LPA Day interviewed Staff #1 - Staff # 4 and Resident #1. Due to R2s medical diagnoses they are unable to provide an answer.LPA toured the facility at approximately 10:40am. Regarding the allegation : Staff do not ensure that COVID safety practices are being followed. Unsubstantiated During interviews conducted, 1 out of 2 residents disagreed with the allegation, R#1 states the facility follows Covid safety practices always. Due to R#2’s medical diagnoses they are unable to provide an answer. 4 out of 4 staff interviewed disagreed with the allegation. Staff state, We follow our Covid plan we clean and wear full gear, mask, gown, gloves when there is a positive COVID in the facility. We sanitize everything, take temperature and wash hands continuously. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.” Regarding the allegation: Staff did not ensure resident has personal privacy in accommodations During interviews conducted, 1 out of 2 residents disagreed with the allegation, resident R1 states they all have their own rooms if we wany privacy , but we come out when we want to mingle with the other residents and staff. Due to R #2’s medical diagnoses they are unable to provide an answer. 4 out of 4 staff interviewed disagreed with the allegation. Staff state we always provide residents with privacy if and when they choose. Everyone has their own room, they can stay in their rooms whenever they want Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Regarding the allegation: Staff allowed resident to sleep in a common room During interviews conducted, 1 out of 2 residents disagreed with the allegation, R#1 states they all have their own rooms and no one sleeps in the common rooms. Due to R2 medical diagnoses they are unable to provide an answer. 4 out of 4 staff interviewed disagreed with the allegation and state all residents have their rooms and only if they are in the common rooms and take a short nap while watching television is the only time they are sleep in a common area. Residents go to bed at night in their bedrooms only. Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. A copy of the Complaint Investigation Report was provided to Administrator, Jennifer Block. An exit interview was conducted.the state’s words, verbatim · CDSS document, Jul 23, 2024 · control 11-AS-20221216140503

Allegation investigated: Staff interfered with a resident from having a visitor while in care

This report supersedes the report dated 12/05/2023, the purpose of this amendment is to provide clarification on the circumstance surrounding the allegations. although this report supersedes the previous report the complaint investigation findings remain the same: Unsubstantiated. On 12/05/2023 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10-day visit to Santa Monica Home and Care 4. LPA Calderon initiated an investigation into the above-mentioned allegation and conducted an interview with Administrator Gary Strathearn (A1). The investigation consisted of the following: On 12/05/2023 LPA Calderon interviewed A1, staff S1 and S2, residents R1 through R4, and witnesses W1 and W2. LPA Calderon obtained and reviewed the following: Needs and Service Plan (dated 07/12/2021), Physician Report (dated 05/12/2021), Incident report (dated 11/22/2023), texted messages (dated 11/22/2023) and admission agreement (dated 08/24/2021) for R1. Unsubstantiated The investigation revealed the following: Regarding Allegation: “Staff interfered with a resident from having a visitor while in care.” This complaint alleged that the facility staff asked a private caregiver to leave the facility on 11/22/202. Interviews with staff indicate, that resident R1’s private caregiver W2 had an argument and yelled at staff S2 and W2 was asked to leave the facility as indicated on residents’ admission agreement. Staff added that W2 was allowed back into the facility and W2 continued to provide care for R1 on the same day. 4 out of 4 residents #1-#4 (R1-R4) unable to answer questions due to their health conditions. Witness interviews indicate the following: On 11/22/2023 W2 was allowed back into the facility to care for R1. Record reviews indicate: The incident report (dated 11/22/2023), indicated that a verbal disagreement between S2 and W2 happened regarding R1 sitting at the patio table and W2 yelled at S2. R1’s Needs and Services Plan indicate R1 is non-ambulatory and requires assistance from staff for overall care. Admission Agreement dated 08/24/2021, page 26 section 11, indicate that Santa Monica Home & Care (SMHC) has the right to refuse entry to any persons, including home health care agencies for cause, the cause will be potential harm, including physical, mental, or verbal abuse to residents or staff. Based on interviews and record reviews: the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is Unsubstantiated. An exit interview was conducted, and a copy of the Complaint Report was provided to Administrator Gary Strathearn.the state’s words, verbatim · CDSS document, Dec 5, 2023 · control 11-AS-20231127151151