Sherry's RCFE

Allegation investigated: Staff did not address resident’s toileting needs Staff did not assist resident with showering

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced complaint inspection at Sherry's RCFE on 8/1/23 at 8:30am to inform the licensee of complaint allegations mentioned above and deliver findings. During this investigation LPA Gould interviewed two staff members, one former resident (R1) and the reporting party (RP) (See confidential name list LIC-811 dated 8/1/23). Based on interviews conducted and statements obtained during the investigation process, the above allegations were corroborated by RP and R1 that the staff members did not follow the physician report indicating the resident required assistance with showering and toileting needs. Per interviews a portable commode was provided to resident but no assistance was provided. Additionally, both parties interviewed corroborated that R1 received one shower while in placement and staff did not provide direct assistance and only provided stand-by assistance that did not meet all the resident's needs with assistance with daily living. Licensee denies the allegations. Substantiated 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 food services are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies cited per California Code of Regulations, TITLE 22. Exit interview was conducted with the licensee. Appeal Rights were issued, and a copy of this report was left at the home. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of neglect/lack of supervision is substantiated. The following deficiency is cited per California Code of Regulations, TITLE 22 Exit interview was conducted with the licensee. Appeal Rights were issued, and a copy of this report was left at the home.the state’s words, verbatim · CDSS document, Aug 1, 2023 · control 27-AS-20230727115647

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(f)(4) · Plan of correction due date: Aug 4, 2023

Basic Services: Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. this requirement was not met as evidenced by statements obtained from R1 and RP who indicated the facility did not provide assistance with toileting or showering to meet the resident's needs per their physician report. which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 1, 2023

Plan of correction: LPA and licensee developed a plan for the facility to incorporate a ADL checklist for all residents and staff will mark down when a service is provided by staff or declined by a resident. licensee will provide a copy of the checklist.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced case management deficiencies inspection at Sherry's RCFE on 8/1/23 at 8:30am to address LPAs observations that the garage has been converted to a bedroom and is not a part of the facility's fire clearance. LPA observed a bed in the garage and LPA compared the facility sketch from the pre-licensing inspection and LPA did not observe that the garage was identified as a staff bedroom and was not indicated on the facility sketch. The facility is currently not in compliance with their fire clearance. The following deficiency is cited per California Code of Regulations, TITLE 22 Exit interview was conducted with the licensee. Appeal Rights were issued, and a copy of this report was left at the home.the state’s words, verbatim · CDSS document, Aug 1, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Aug 2, 2023

All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by LPA observations of a bed in the garage and statements from staff that indicate they sleep in the garage and was not part of the facility's initial fire clearance. which poses a potential health safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 1, 2023

Plan of correction: Facility will follow up with fire marshal and obtain a new fire clearance that includes the garage being utilized as a bedroom.

Allegation investigated: Personal Rights: 1) Staff yell and intimidate residents. 2) Staff threatened resident.

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Sherry's RCFE (RCFE) on 5/26/23 at 9:00am 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 because all clients interviewed were unable to corroborate the allegations. LPA conducted interviews with two staff members who denied the allegations. LPA interviewed six residents and all residents interviewed identified the staff as treating residents with respect and kindness. LPA was unable to interview one of the alleged victims as their current whereabouts were unknown to the reporting party. LPA was able to interview one of the alleged victims who did not identify any issues concerns during their placement at the facility. Report Continued on LIC 9099-C Unsubstantiated 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 Personal Rights 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.the state’s words, verbatim · CDSS document, May 26, 2023 · control 27-AS-20230320162518

Type of visit: Required - 1 Year

On 5/26/23 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Sherry's RCFE for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Sherry Ahuja and together conducted a tour of the home. Current census is 4. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed a pool located in the back yard which is covered and secured from residents. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA was unable to verify all staff documentation and training. A follow up POC inspection will verify all required documents. LPA measured the water temperature, temperature measured at 114 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 610E Emergency Disaster Plan, Current Administrator Certificate. Per California Code of Regulations, Title 22 the following deficiencies are cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 26, 2023

Allegation investigated: Facility accepting residents beyond the level of care they can provide.

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Sherry's RCFE on 11/17/22 at 12:20pm 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 because Resident #1 denied that she was unable to transfer from her bed. Resident #1 (R1) and Staff interviewed stated to LPA that R1 was able to transfer out of bed with the assistance of a sliding board and was able to transfer out of bed and into wheelchair. LPA also conducted interview with A1 who disputed the allegation and stated he had positive impressions of the facility and felt the staff were able to meet the resident's needs. Facility also utilized a Hoyer lift for R1 who distrusted the assistive device and would often refuse to utilize. As R1 has been relocated LPA was unable to have R1 or staff demonstrate a lift or transfer. Unsubstantiated 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 Level of Care 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.the state’s words, verbatim · CDSS document, Nov 17, 2022 · control 27-AS-20221024165316

Type of visit: POC

On 11/17/22 at 12:20pm Licening Program Analayst (LPA) Kevin Gould conducted an unannounced Plan of Correction (POC) inspection to ensure previously cited deficiencies have been corrected an to review medication administration logs for continued compliance with regulations. LPA met with Licensee and together reviewed POC documents. LPA reviewed Medication Administration records for all residents in care and observed no errors in documentation of medication administration. Additionally LPA reviewed written plan of correction which meets requirements for the correction. The previous deficiency has been cleared and a POC clearance letter generated. an exit interview was conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Nov 17, 2022

Type of visit: Case Management - Deficiencies

On 10/28/22 at 3:15pm Licensing Program Analyst (LPA) Kevin Gould conducted a Case Management Deficiencies inspection to address documentation of resident's medication administration records (MAR). LPA met with Administrator and together discussed LPA's concerns. Upon reviewing Resident MARs, LPA observed that Resident's MARs were not completed in a timely manner and LPA observed missing documentation for medications on 10/26/22, 10/27/22 and 10/28/22. LPA and Administrator discussed the importance of documenting medication administered in a timely manner and the potential dangers of not documenting medications administered to residents in a timely manner. The following deficiency is cited per California Code of Regulations, TITLE 22. Exit interview was conducted with the licensee. Appeal Rights were issued, and a copy of this report was left at the home.the state’s words, verbatim · CDSS document, Oct 28, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: Oct 31, 2022

Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by LPAs review of resident medication administration records and observed 2 of 3 residents did not have documentation that medications had been given to residents in care which poses a potential health, safety and personal rights for residents in care.the state’s words, verbatim · CDSS document, Oct 28, 2022

Plan of correction: Licensee will submit a written plan of correction indicating the steps facility will take to ensure medication administration is documents as soon medications are administered to resident.

Type of visit: Prelicensing

On 5/18/22 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Sherry's RCFE for the purpose of conducting a pre-licensing inspection. LPA met with Licensee, Sherry Ahuja and together conducted a tour of the home. The facility is a single story home located in a residential neighborhood equipped with four bedrooms, two bathrooms, living room, dining room, kitchen and attached garage. LPA observed a pool with required fencing. LPA and Licensee evaluated the physical plant to ensure the health and safety of future residents. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed a pool located in the back yard with and enclosed fencing that meets regulations. LPA notes that the pool gate is secure and resident access is restricted. LPA observed the facility to be free of odor, clean and in good repair. LPA observed one of the bathrooms still requires a non-slip mat in the shower and grab bars for the shower and toilet. All rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 119 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. Licensee will send pictures of new grab bars and non-slip mats to LPA to ensure the home meets all regulations. At the time of inspection the facility is not ready to be licensed. Once bathroom changes have been made and the grab bars and mats are in place LPA will approve the facility for licensure. Exit interview conducted and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 18, 2022

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: Prelicensing

On 5/18/22 at 9:00am Licensing Program Analyst (LPA) Kevin Gould arrived at Sherry's RCFE for the purpose of conducting a Component III Orientation. LPA Gould discussed Operating Requirements, Physical Environment, Personnel Requirements, Resident Records, and Health Related Services and Conditions. LPA discussed the department's and LPA's responsibilities and the responsibilities of the Administrator and reporting requirements including but not limited to the forms required for reporting and documenting any changes in resident files. Exit interview was conducted.the state’s words, verbatim · CDSS document, May 18, 2022

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Sherry Ahuja, Administrator Interview Method: Telephone interview On April 8, 2022, Administrator participated in COMP II. Identification of the Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Administrator confirmed the understanding of the California Code Title 22 Regulations. During COMP II, CAB analyst confirmed Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Administrator. Report sent via PDF email and informed Administrator to return sign copy to Analyst by end of business day, today.the state’s words, verbatim · CDSS document, Apr 8, 2022

Type of visit: Office

Component II completion: Unsuccessful Facility Type: Residential Care Facility for Elderly (RCFE) Application Type: Initial Capacity: 6 Census (if any clients in care): none COMP II Participants: Sherry Ahuha, Administrator Interview Method: Telephone interview On April 5, 2022 at 9:00 AM, Administrator participated in COMP II. Identification of the Administrator was verified through interview questions based on photo ID and other identifying personal information. Administrator did not provide sufficient knowledge the program and the California Code Title 22 Regulations. Component II will be rescheduled to March 8, 2022. Exit interview conducted with Administrator. Analyst information Administrator to review Title 22 and Health and Safety codes. Email PDF report to Administrator and notated to return report signed to Analyst by close of business today, March 5, 2022.the state’s words, verbatim · CDSS document, Apr 5, 2022