Simi Valley Residential Care IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Zabel Chochian conducted a Required Annual visit. LPA met with Licensee/Administrator Maria Mendez and staff. Reason for the visit was explained. Beginning at 2:45pm, LPA with the assistance of the Licensee took a tour of the physical plant. Required postings were observed in the living room and hallway. Dual smoke and carbon monoxide detectors are hardwired and was functioning properly during the visit. Fire extinguisher observed charged/serviced 7/12/24. Bedrooms: There are four bedrooms designated for residents' use. All bedrooms were properly furnished and had sufficient lighting. There was appropriate bedding and linens. There is a staff room that is kept locked when not in use. Bathrooms: There were two bathrooms designated for residents' use. All bathrooms were properly supplied and had functional fixtures. Hot water temperature was measured at 106.5*F degrees Common Areas: These included the living room and dining area which were observed properly furnished. Auditory alarms on all exit doors were on and functional at the time of the visit. Medications were locked in a cabinet in the office/kitchen area. Surrounding Grounds: Entry/exits were free of obstruction. The laundry area is in the garage. Cleaning supplies and detergents are stored in locked cabinets in the garage. Kitchen: The kitchen appliances and fixtures observed functional. Observed at least a two (2) day supply of perishable and seven (7) day supply of non-perishable food at the facility; properly stored. Knives observed stored in a locked drawer in the kitchen. Resident Files: All resident files reviewed at 3pm. Resident files included a current medical assessments, appraisals, consent forms, and admission agreements. Staff Files: Reviewed at 3:45pm. Files included current first aid certifications and training documentation. All staff have criminal record clearance and are associated to this facility. Medications: Reviewed at 4pm. Files included medication administration records and centrally stored medication logs. Medications and logs were consistent. First aid kit observed complete. PPE supply observed sufficient for at least three weeks. No deficiencies will be cited at today's visit. Exit interview conducted, copy of report issued.the state’s words, verbatim · CDSS document, Oct 23, 2023

Allegation investigated: Facility staff did not wear facemasks around resident

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint visit to the facility regarding the above noted allegation. LPA met with administrator Maria Mendez and explained the reason for the visit. On 3/1/2022 at 9:49 a.m., LPA conducted an initial complaint investigation visit to the facility. LPA reviewed and obtained pertinent documents. LPA conducted staff interviews with two staff. On 3/1/2022 at 12:50 p.m., LPA conducted a visit to Adventist Health Simi Valley Hospital. LPA interviewed three hospital staff and resident 1 (R1). (continued on page 2; 9099-C) Substantiated (continued from page 1; 9099) Upon arrival to the facility on 3/1/2022, LPA observed two staff at the facility not wearing facemasks. Both staff put their masks on when LPA pointed out they were not wearing their masks. LPA spoke with the administrator regarding the allegation staff were not wearing masks at the facility. Administrator stated that staff told her they had used the restroom and forgot to put it back on. LPA pointed out that both staff were not wearing masks but working with residents. Based on LPA’s observations, the allegation facility staff failed to wear facemasks around residents is deemed Substantiated at this time. It is noted that the California Department of Public Health COVID-19 masking requirements ended on 4/3/2023. The Centers for Disease Control may still recommend masks based on local community levels (by county). Administrator is aware she must stay up to date on any requirements which may change based on COVID-19 community levels. She will ensure all staff follow the most current mandates. Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (refer to LIC 9099-D). Exit interview conducted, appeal rights discussed, and a copy of this report issued. (continued from 9099-A; page 4) LPA reviewed R1’s admission agreement. R1 was admitted to the facility in 2015, therefore any preadmission fees are not refundable as R1 resided at the facility longer than three months. R1’s admission agreement stated the scenarios in which the facility would provide a prorated refund: death of resident or facility closure (both are Title 22 requirements), otherwise the facility requires a 30-day notice. R1 left the facility on 2/2/2022 to go to the hospital, R1’s health condition progressed and R1 needed a higher level of care so R1’s representative moved R1’s belongings out of the facility on 2/12/2022. Although R1’s representative did not provide the facility with a 30-day notice, the facility did provide a refund to R1 for 2/12/2022-2/28/2022 on 2/28/2022 which was not required by Title 22. Therefore, the allegation the facility failed to provide a refund is deemed Unsubstantiated at this time. LPA reviewed R1’s medical documents from R1’s dietician at the facility. The documents state the type of diet R1 was to have. R1 did not have any dietary restrictions, however due to R1’s condition all food must be pureed/soft, and liquids must be thickened. In addition, the facility was to provide R1 with Ensure for between meal snacks. Staff stated R1 was able to eat the pureed diet but must eat slowly and be constantly observed to ensure R1 did not choke on their food. Staff stated they provided R1 with thickened Ensure, however R1 didn’t like the type of Ensure he was sent by his representative and/or the VA. LPA interviewed R1 at the hospital, R1 indicated facility staff did provide Ensure but R1 didn’t like the Ensure. R1 said they liked living at the facility, staff treated R1 with respect, and R1 liked the pureed/soft food provided at the facility. LPA interviewed hospital staff to see if they were providing Ensure to R1. Hospital staff explained that due to R1’s condition progressing, R1 could not safely swallow, and they were not able to give anything by mouth at that time. Based on interviews and records review, the allegation facility staff failed to follow resident's prescribed diet is deemed Unsubstantiated at this time. Exit interview conducted and a copy of this report issued.the state’s words, verbatim · CDSS document, May 12, 2023 · control 29-AS-20220225161030

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: May 12, 2023

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on interviews and observation, the licensee did not comply with the section cited above. LPA observed staff working with residents while not wearing facemasks, which posed a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 12, 2023

Plan of correction: During LPA’s visit, the administrator counseled staff regarding wearing masks in the facility at all times. Administrator stated she would ensure staff wears masks when mandated by the government (federal, state, and local authorities).

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Teresa Camara arrived at the facility unannounced to conduct a required annual visit at 10:11 a.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Maria Mendez and explained the reason for the visit. The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. The carbon monoxide and smoke alarms were tested and all functioned properly. The fire extinguisher appeared fully charged and was last inspected by the fire department on 07/18/2022. KITCHEN: Knives were stored in a locked drawer and cleaning supplies were stored in the locked cabinet under the sink and locked cabinets in the garage. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: The LPA observed one staff bedroom, two double-occupancy client bedrooms and two single-occupancy client bedrooms which were furnished appropriately. RESTROOMS: Restrooms are clean and sanitary and in operating condition. COMMON SPACES: At the time of the visit, living room and dining room furniture was observed to be in good condition. The LPA observed the required postings throughout the facility. The backyard patio is equipped with furniture for clients' use. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening and sanitation station. All facility staff were observed wearing masks. The LPA observed an adequate supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility has appropriate plans in place in the event of clients and/or staff showing symptoms of COVID or testing positive for COVID. No deficiencies observed. Exit interview conducted. Report emailed to Administrator.the state’s words, verbatim · CDSS document, Sep 12, 2022

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA's) JoAnn Rosales and Teresa Camara conducted an unannounced Required -1 Year inspection. LPA's met with Administrator Maria Mendez. Today's evaluation included but was not limited to: building and grounds, resident rooms, bathrooms, hot water temperature (read at 105.2 degrees F) in common resident bathroom, common areas, personal accommodations, food and first aid supplies. LPA observed lamps/lights as well as sufficient furnishings and linens for each room. LPA observed fire extinguisher fully charged. Centrally stored medicines are kept in a cabinet just outside the kitchen. Hygiene items are being provided. Grab bars and non-skid materials were present in the bathrooms. LPA observed facility to be a comfortable temperature throughout the visit. Smoke alarms and carbon monoxide detectors were tested and were operable at the time of the visit. Indoor and outdoor area toured passageways were free from obstruction. LPA reviewed resident records and medications. LPA reviewed staff records. During facility tour LPA observed one central entry point designated for universal entry screening. Cleaning supplies were observed and infection control practices were discussed. During the facility tour on 9/21/21 at 11:30 am with the Administrator LPA observed resident #2 (R2's) ibuprofen in a kitchen drawer accessible to residents. During the facility tour on 9/21/21 at 11:41 am with the Administrator LPA observed antacid tablets and menthol cough suppressant/oral anesthetic drops in R1's bedroom accessible to residents. During a review of resident medications on 9/21/21 starting at 1:42 pm with the Administrator LPA observed that R1 is prescribed Melatonin 3 mg 1 tablet at BT and is being given Melatonin 5 mg 1 tablet at BT. Continued on 809C Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted, today's reports and appeal rights were reviewed and emailed to the Administrator.the state’s words, verbatim · CDSS document, Sep 21, 2021