Skyhill Quality Living #2

Allegation investigated: Staff are not treating residents with dignity and respect. Staff are over medicating residents.

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Flores met with Elmer Malang caregiver and explained the reason for the visit. The investigation consisted of the following: LPA Flores requested copies of staff and resident roster. LPA conducted interviews with Resident #1(R1), #2(R2), #3(R3), #4(R4), #5(R5), #6(R6), administrator, staff #2(S2) and #3(S3). LPA reviewed medication for R1,R5, R6, and requested copies of physician's report, centralized stored medication records for R1, R5, R6, trainings on personal rights and medication for staff. The investigation revealed the following: Regarding allegation: Staff are not treating residents with dignity and respect. It is alleged caregiver tossed boxes of resident's personal hygiene supplies at resident's feet while lying in bed. Interviews with residents revealed 4 out of 6 residents state staff is respectful and/or have not thrown items at them. 2 out of 6 residents were unable to answer due to cognitive skills. interviews with staff revealed 3 out of 3 staff have not witnessed or hear the residents state that staff has thrown items or been disrespectful (CONTINUED ON LIC 9099C) Unsubstantiated towards the residents. Staff's last personal training was provided on 10/21/22. During the interviews LPA observed several boxes the size of about 2 feet by 1 foot in bedroom #4(BR4) on the floor across from R5's bed against the closet. R5 stated boxes are orders place of personal items. No other boxes were observed in the facility. Personal Hygiene items are stored in closet. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Regarding allegation: Staff are over medicating residents. It is alleged caregiver tried to get resident to overdose by giving excess medications. Interviews with residents revealed 3 out 6 residents state that are currently receiving medication. 2 out of the 3 residents stated that they receive their medication daily and staff provide the correct amount. 1 out of the 3 residents stated staff provides the medication daily and "sometimes, too much". 3 out of 6 residents were unable to answer due to cognitive skills. LPA Flores conducted a review of medication for R1, R5, and R6 all medications listed in centralized stored medication and destroyed record were observed in resident's medication individual box. No additional medications were observed. LPA randomly reviewed prescribed medication bottles for R5 and R6 to check the quantities according to date of prescription and date of the visit. The amount of the pills in each prescription bottle were noted to match the dates. Facility does not maintain a medication sheet to track daily giving medication. Per administrator facility will implement medication sheet. Medication training on proper medication storage and administration was provided to staff on 10/21/22. During medication review a letter from R5 was observed to request a medication be provided during the night for a as needed physician's order. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Tina Arutyunyan administrator and a copy of this report was provided.the state’s words, verbatim · CDSS document, Dec 8, 2022 · control 28-AS-20221205071804

Type of visit: Case Management - Other

LPA Alberto Lopez made unannounced case management visit to facility to follow-up on office visit of 04/26/2022 LPA met with Administrator Tina Arutyunyan and discussed the purpose of the visit . LPA took tour of the 4 bedrooms and outside plant All the rooms had the required furniture and were clean. LPA measure the water temperature in 3 bathrooms and kitchen and it measured 107.6 in Bathroom #1 sink, tub in room #1 was 88.0 degrees, In bathroom #2, temperature was 87.2 Bathroom #4 and kitchen measured at 87.2. Bathroom in room #4 is uncleaned on the window sill and the screen is in disrepair and need too be repair or replaced. LPA reviewed P & I Logs for 2 residents and it was in order. 7 days of Non-perishable and 2 days of perishable food were observed, 1 bedridden residents was in room not designated for bedridden. Administrator has clearance for 2 bedridden residents in room #1 only. Administrator notified fire department on Tuesday 11/29/2021 - Danny King about getting bedridden fire clearance for 6 residents . It was discussed with R1 and administrator that R1 needs to move to room #1 unless his MD designates R1 as Non-ambulatory or fire clearance is granted to facility. deficiencies cited (see 809D for details) Exit interview was conducted with Administrator Tina Arutyunyan and copy of report and appeal rights provided.the state’s words, verbatim · CDSS document, Dec 2, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(e)(2) · Plan of correction due date: Dec 2, 2022

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Based on LPA's observation, LPA observed the bathroom #1 hot water temeperature was measured at 88.5 degrees Fin the tub. Siink in room #1 was 107.6. Bathroom 2 measured at 88.5, bathroom Room #4 measured at 87.2 and kitchen ,easured at 87.2 which poses a health and safty hazard to resident's in care.the state’s words, verbatim · CDSS document, Dec 2, 2022

Plan of correction: Administrator will adjust water temperture and provide proof to LPA by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(a) · Plan of correction due date: Dec 9, 2022

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: This requirement is not met as evidenced by: LPA and Administtrator observed bathroom screen in disrepiar and window sill uncleaned and toleit uncleaned.the state’s words, verbatim · CDSS document, Dec 2, 2022

Plan of correction: Administrator will reapair or replace screen in bathroom number 4 and clean window sill and toilet by POC date

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a)(2) · Plan of correction due date: Dec 5, 2022

Licensee admitted residents that became bedridden resident #1(R1) . Facility does have approved bedridden clearacne for 2 residents but must be in room #1 fire clearance.is required before bedridden residents can reside in any other room other than room #1 This requirement is not met as evidenced by: R1 is bedridden and residing in room #4 which is not cleared for bedridden which poses a helath and safety issue to persons in care.the state’s words, verbatim · CDSS document, Dec 2, 2022

Plan of correction: Licensee shall submit appropriate request for bedridden fire clearance. Or move resident to room #1 or get updated Physicans report. LIC200, facility floor plan and plan of care for bedridden residents must be submitted to CCL by POC due date.

Allegation investigated: Facility staff did not meet resident's bathing needs. Facility staff did not ensure resident had clean bed sheets.

Licensing Program Analyst (LPA) Alberto Lopez visited this facility as an unannounced 10- Day Complaint Visit to investigate the allegations noted above. LPA Met with DSP Elmer Manalang and Administrator Tina Arutyunyan arrived a short time later. The investigations consisted of obtaining personnel and staff rosters and interviewing Administrator, staff 1 -2 (#1,#2) W#1-W#4, W (W1-W4) and residents 1-6 (R!-R6) Regarding Allegation: Facility staff did not meet resident's bathing needs. It is alleged that resident has not been bathed in 2 weeks. Administrator stated that resident is given bed bath 2 times per week and that R1 chooses to have Home Health employee bathe him. 6/6 residents could not collaborate the allegations. S1 stated S1 provides bed bath for R1 every day and R1 confirmed this. (Continued on 9099C) Unsubstantiated (CONTINUED FROM 9099) Administrator stated that R1 is too heavy to take to the shower and his bathing consist of bed baths and that R1 choose to have Home Health employee wash R1 hair and assist R1 with bathing. R1 pays W2 cash for her services. W2 stated that she comes 2 times per week and that R1 asked W2 to provide him with service. W2 stated she washes R1 hair and body from waist up only. W2 stated that R1 prefers S1 to wash from waist down and stated that S1 provides that service when she is there. LPA did not smell any body odors while in facility and R1 was clean. 3 of 4 witness could not collaborate the allegations. Regarding Allegation: Facility staff did not ensure resident had clean bed sheets. Administrator stated that sheets are changed 3 times per week or more if needed. 6/6 residents had clean sheets at the time of visit and 2/2 staff stated that sheets are changed if needed more that the regular changes of 3 times per week. LPA toured all 4 rooms and all had clean sheets at the time of visit. 3 of 4 witness could not collaborate the allegations. Based on statements and interviews conducted with staff, clients, witnesses. review of client files and observations there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Nov 22, 2022 · control 28-AS-20221121152003

Allegation investigated: Resident is being over medicated while in care

This report serves as an addendum and supersedes the complaint investigation report created on 7/14/22. This addendum is written to correct and add 2 deficiencies on LIC 9099D and does not change the complaint investigation report findings recorded on 7/14/2022. Subsequent visit on 10/20/2022 A complaint investigation was conducted by LPA Alberto Lopez at the time of the visit, LPA met with Elmer Manalang Caregiver and explained the purpose of the visit. Elmer stated that Administrator was out of the country. LPA reviewed medications and medication records for Resident #1. LPA also conducted an interview with R1-R2 and R3. R4 and R5 could not answer questions. Based on interviews and medication record review, LPA observed the following: Resident's #1's medication Ativan is labeled as a PRN and caregiver stated he gives one every night to resident because resident ask for. R1 is clear and oriented and stated he does not ask for it every day. Caregiver stated it is to help him sleep. (Continued on 9099C) Substantiated LPA reviewed medications and caregiver Elmer stated that he empties old bottle into new bottle whenever the resident gets new refills. Based on that, there were pills missing from: Medication Sertraline medication 50MG had 36 pills uncounted for based on count. Medication Monteluska 10mg had 31 pills missing and unaccounted for. Tamsulin medication .4mg had 5 pills missing. Caregiver could not account for the missing pills. Caregiver stated he did not throw them away. Facility does not have any documentation to keep track of medications given. All of R1 medication is missing doctor's order and PRN is missing physicians letter. Deficiencies cited on 809D Based on LPA observations, interviews and records review, the preponderance of evidence standard has been met; therefore, the Allegation above is Substantiated Exit interview conducted with Administrator via phone and report signed with prior approval of Administrator by Elmer Manalang, Caregiver. Copy of report emailed to administrator due to printer issues.the state’s words, verbatim · CDSS document, Oct 20, 2022 · control 28-AS-20220712085123

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(e) · Plan of correction due date: Oct 21, 2022

87465 Incidental Medical and Dental: (e) For every prescription and nonprescription PRN medication... there shall be a signed, dated written order from a physician,... maintained in the residents file, and a label on the medication.... This requirement is not met as evidence by: None of R1 medications had doctor's orders and PRN physician letter was not on file for R1 PRN medications. Cream for skin rash was missing label and doctor's order which poses a health and safety issue to residents in care.the state’s words, verbatim · CDSS document, Oct 20, 2022

Plan of correction: Licensee will obtain doctor's orders for all of R1 medications and PRN letters and send proof to LPA by POC date. ****Licensee provided proof of PRN letter to LPA for R1**** NO FURTHER ACTION REQUIRED**

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(5) · Plan of correction due date: Oct 21, 2022

to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidence by: Staff stated that he transfers the new refill medications to the old bottles to consolidate the medications which poses a health and safety issue to residents in care.the state’s words, verbatim · CDSS document, Oct 20, 2022

Plan of correction: Licensee will provide training on proper medication storage and administration and send proof that all staff have attended the training by POC date

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Oct 20, 2022

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 is not met as evidence by:: Staff provided medications to resident without keeping log which resulted in medications being short. Medication Sertraline medication 50MG had 36 pills uncounted for based on count. Medication Monteluska 10mg had 31 pills missing and unaccounted for. Tamsulin medication .4mg had 5 pills missing. Caregiver could not account for the missing pills which poses a health and safety issue to residents in care.the state’s words, verbatim · CDSS document, Oct 20, 2022

Plan of correction: Licensee will conduct training in personal rights for all staff and send proof to LPA by POC date.

Allegation investigated: Resident is being over medicated while in care.

A complaint investigation was conducted by LPA Alberto Lopez at the time of the visit, LPA met with Elmer Manalang Caregiver and explained the purpose of the visit. Elmer stated that Administrator was out of the country. LPA reviewed medications and medication records for Resident #1. LPA also conducted an interview with R1-R2 and R3. R4 and R5 could not answer questions. Based on interviews and medication record review, LPA observed the following: Resident's #1's medication Ativan is labeled as a PRN and caregiver stated he gives one every night to resident because resident ask for. R1 is clear and oriented and stated he does not ask for it every day. Caregiver stated it is to help him sleep. LPA reviewed medications and caregiver Elmer stated that he empties old bottle into new bottle whenever the resident gets new refills. Based on that, there were pills missing from: (cont on 9099C) Substantiated Medication Sertraline medication 50MG had 36 pills uncounted for based on count. Medication Monteluska 10mg had had 31 pills missing and unaccounted for. Tamsulin medication .4mg had 5 pills missing. Caregiver could not account for the missing pills. Caregiver stated he did not throw them away. Facility does not have any documentation to keep track of medications given. All of R1 medication is missing doctor;s order and PRN is missing physicians letter. Based on LPA’s observations, interviews and records review, the preponderance of evidence standard has been met; therefore, the Allegation above is Substantiatedthe state’s words, verbatim · CDSS document, Jul 14, 2022 · control 28-AS-20220712085123

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(e) · Plan of correction due date: Jul 15, 2022

87465 Incidental Medical and Dental: (e) For every prescription and nonprescription PRN medication... there shall be a signed, dated written order from a physician,... maintained in the residents file, and a label on the medication.... This requirement is not met as evidence None of R1 medications had doctor's orders and PRN physician letter was not on file for R1 PRN medications. Cream for skin rash was missiing label and doctor's order.the state’s words, verbatim · CDSS document, Jul 14, 2022

Plan of correction: Licensee will obtian doctor's orders for all of R1 medications and PRN letters and send proof to LPA by POC date.

Allegation investigated: Financial Abuse

An Informal Meeting was held at the Monterey Park Adult and Senior Care (CCLD) Regional Office to deliver findings on the above allegation and discuss the Trust Audit completed on 3/8/2022 by CCLD Audit Section. The purpose of the meeting was explained to Licensee Tina Arutyunyan and Assistant Administrator Akop Ekimyam. Attendees present were: CCLD Regional Manager Araceli Ramirez, Licensing Program Manager (LPM) Lisa Hicks, Licensing Program Analysts (LPAs) Noemi Galarza, and Mary Flores, Woodland Hills ASC staff, and Auditor Jacqueline Juarez. The investigation consisted of the following: On 9/1/2021, LPA inspected the facility and interviewed staff (S2) & residents (R1-R5). R6 was not interviewed due to cognitive impairment. The following documents were obtained: ID/Emergency Information, Admission Agreements, Appraisals, Physician's Report, LA County Department of Mental Health/Brilliant Corners Flexible Housing Subsidy Pool (FHSP) Program Agreement. Personal & Incidental (P &I) records/purchase receipts were not observed or obtained. On 9/10/2021, Licensee was interviewed telephonically and was asked to submit the facility’s business account bank statements and proof of Surety Bond. On 9/20/2021, an Audit request was initiated. On 11/3/2021, a MS Teams meeting was held with Licensee, CCL Audit Manager Jaqueline Juarez, and Regional office staff to discuss LA County Department of Health Services [Housing for Help], Brilliant Corners program and resident P & I money management. Substantiated Allegation: "Financial Abuse". It is alleged that Licensee misappropriated Personal & Incidental (P&I) funds of two (2) residents (R1 & R2), who are enrolled in the LA County Department of Health Services/Department of Mental Health [Housing for Help] Enriched Residential Care (ERC) program, that contracts a non-profit organization called Brilliant Corners. The Department of Health Services places persons in licensed facilities. Brilliant Corners is the payee and is responsible for making rent payments and issuing P & I money. Recipients of the program are usually homeless, do not qualify for Social Security benefits, and are provided wrap-around services by Brilliant Corners. Brilliant Corners issues a lump sum payment to the facility for resident participants. The Brilliant Corners Agreement is signed by the Licensee and specifies how the amounts should be allocated (Rent, Personal & Incidental expenses, and Enhanced Services). Resident (R1) moved in to the facility on 1/6/2021 and resident (R2) moved in on 7/2/2021. Both residents receive $138.00 a month of P & I money. On June 2, 2021, the Department of Health Services conducted a random Quality Assurance audit visit. It was noted that personal and incidental monies were not documented or accounted appropriately. Licensee Tina Arutyunyan was informed of the deficiency and submitted hand-written amounts on the Plan of Correction documents. The receipts documented excess expenditures of items never requested or received by residents (R1 & R2). The items listed do not have resident’s initials or original receipts to support transactions. It is clear from the documents that they are prepared after the fact, as they are dated with 8/11/2021 as a plan of correction. There were no supporting original receipts for items allegedly purchased for the residents with the P & I monies. P & I is strictly to be used for residents personal spending money. On 9/1/2021, LPA interviewed residents (R1-R5). Residents (R1 & R2) confirmed they have not been given P & I monies. Resident (R2) stated Licensee has not given the resident any allegedly purchased items like an electric razor; resident only owns a regular razor, and a nail trimming services have not been received. P & I records/purchase receipts were not observed in resident files during the initial complaint visit. Ms. Arutyunyan was not present during the initial complaint visit and was interviewed on 9/10/2021. Licensee denied managing or spending resident (R1 & R2’s) P & I money. She stated that resident (R1) is a smoker and “all the P & I money goes to cigarettes.” On November 3, 2021, the licensee was notified and told by CCLD Auditor Jacqueline Juarez how to keep records of and distribute P & I amounts. Per record review, Licensee Tina Arutyunyan provided Department of Health Services and Community Care Licensing inaccurate information and documentation about the distribution of P & I monies and the money was spent. See LIC 9099C for report continuation. The Department of Social Services Community Care Licensing Division Auditor Jacqueline Juarez completed a Trust Audit to determine if Licensee misappropriated residents personal & incidental (P & I) funds. The Trust Audit Report was finalized on 4/8/2022. The findings were: 1. Residents (R1 & R2) did not have access to or were not distributed P & I funds 2. Proper documentation for expenditures was not maintained. 3. Licensee is commingling facility funds with P & I amounts. 4. Licensee does not have policies and procedures or proper bonding. The licensee violated the rights of the residents by not distributing their P & I funds or keeping records of the funds entrusted to her. Licensee shall: Pay back residents (R1 & R2) all P & I amounts since placement/admit date to November 2021. The licensee owes resident (R1) $1,518.00 and owes resident (R2) $690.00. Work will Brilliant Corners house coordinators when residents needs increase, and not use P & I monies to cover the cost. Provide proof of Surety Bond that covers the facility license and not the corporation. Licensee is to furnish a plan to the Regional Office on how P & I funds will be distributed to residents and provide a copy of the bank statement showing P & I funds have been deposited into separate trust accounts. As part of the plan of correction, the Licensee in six (6) months [10/8/2022] from the Trust Audit report date (April 8, 2022), is to provide to the Audit Section the P & I LIC 405's and corresponding receipts to ensure proper recording keeping. Based on record review and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Division 6 and Chapter 8 is being cited. See attached LIC 9099D. Exit interview was conducted with Licensee Tina Arutyunyan. A copy of the appeal rights and report was issued.the state’s words, verbatim · CDSS document, Apr 26, 2022 · control 28-AS-20210824090807

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(c)(1) · Plan of correction due date: May 10, 2022

Safeguards for Resident Cash, Personal Property, and Valuables. Every facility shall account for any cash resources entrusted to the care or control of the licensee or facility staff. Cash resources include but are not limited to... personal and incidental need allowances from funding sources such as SSI/SSP. This requirement was not met evidenced by: Based on the Trust Audit report, record review, and interviews conducted the findings indicate Licensee did not distribute P & I funds to residents (R1 & R2), and did not keep proper records of funds entrusted to her. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee agrees to: 1. Pay back residents (R1 & R2) all P & I amounts due. Licensee owes: Resident (R1) $1,518.00 Resident (R2) $690.00. 2. Submit proof (bank statements) that the amounts due were issued to R1 & R2.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(e) · Plan of correction due date: May 10, 2022

Safeguards for Resident Cash, Personal Property, and Valuables. Cash resources and valuables of residents which are handled by the licensee for safekeeping shall not be commingled with or used as the facility funds or petty cash, and shall be separate, intact and free from any liability the licensee incurs in the use of his own or the facility's funds and valuables... This requirement was not met evidenced by: Based on Trust Audit report and record review Licensee is commingling facility funds with personal and incidental funds. Facility bank statements were obtained. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee agrees to deposit residents' P & I funds into a bank trust account. Facility bank account should not have any residents' monies. Provide copies of bank statements showing P & I funds have been deposited into a trust account.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87216(a) · Plan of correction due date: May 10, 2022

Bonding. Each licensee, other than a county, who is entrusted to safeguard resident cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. The amount of the bond shall be in accordance with the following schedule: Total Safeguarded Per Month- Bond Required $750 or less= $1,000, $751 to $1,500= $2,000 $1,501 to $2,500 =$3,000. This requirement was not evidenced by: Based on record review and interviews conducted Licensee acknowledged that a Surety Bond was not in place on 9/1/2022. The bond provided covers the corporation and does not cover each license. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee agrees to submit a copy of the Surety Bond by POC due date. NOTE: The Surety Bond should cover the facility and not the corporation.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(2-3)(5) · Plan of correction due date: May 10, 2022

Administrator - Qualifications and Duties.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. (3) Ability to maintain or supervise the maintenance of financial and other records. (5) Good character and a continuing reputation of personal integrity. This requirement was not evidenced by: Based on the Trust Audit report and record review the findings indicate Licensee failed to maintain financial records; and provided DHS and CCL inaccurate documentation and information.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee/Administrator will schedule vendorized training related to the cited section as well as all other sections cited on this report. See below: Licensee will attend continued education classes provided for Administrators. By POC due date, the Licensee will secure the appointment to attend the classes and inform CCL about the attendance.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: May 10, 2022

Safeguards for Resident Cash, Personal Property, and Valuables. (b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources. This requirement was not met evidenced by: The Trust Audit findings revealed that Licensee failed to document expenditures of items purchased with P & I monies. Hand written amounts were submitted without original receipts. Receipts were prepared after the fact dated 8/11/21. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee agrees to give residents receipts for all articles or cash resources, and keep proper documentation for expenditures. Submit a written plan addressing facility procedures and protocols.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87215 · Plan of correction due date: May 10, 2022

Commingling of Money. Money and valuables of residents entrusted to the licensee of one community care facility licensed under a particular license number shall not be commingled with those of another residential care facility for the elderly of a different license number, regardless of joint ownership. This requirement was not evidenced by: Based record review and interview condcuted during the audit investigation the Licensee failed to maintain accurate financial records; and provided DHS and CCL inaccurate documentation and information.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee agrees to provide a copy of the bank statement showing P & I funds have been deposited into a trust account. Submit by POC due date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87207 · Plan of correction due date: Apr 27, 2022

False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by providing inaccurate information and documentation to Department of Health Services and Community Care Licensing. This poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee/Administrator will schedule vendorized training related to the cited section as well as 87408: Denial or Revocation of a Certificate 87777: Exclusions Personal Rights. Verification of scheduled training with the trainers credentials will need to e submitted by 4/29/2022 and completed by 5/13/2022.

Type of visit: Office

An office meeting was held at the Monterey Park Adult and Senior Care Regional Office (MP ASCRO) to deliver the Final Findings of a Trust Audit Report involving the following facilities: Skyhill Quality Living #2 197609098: [complaint investigation - Control#:28-AS-20210824090807], Skyhill Quality Living 197608910, Our Sweet Home Inc 197607711, Our Sweet Home Inc #2 197608083, and Our Sweet Home Inc #3 197608084, Attendees present during the meeting were: Licensee/Administrator Tina Arutyunyan and Assistant Administrator Akop Ekimyam, CCLD Regional Manager Aracely Ramirez, CCLD Audit Department Manager, Jacqueline Juarez, Licensing Program Manager(s) Lisa Hicks, Naira Margaryan, Stefanie Coronel, and Licensing Program Analyst(s) Noemi Galarza, Mary Flores, Yelena Avetisyan, Tuesday Cabiness, and Rosaura Valenzuela. The purpose of the meeting was explained to Licensee Ms. Arutyunyan. On 08/24/2021 Community Care Licensing Division (CCLD) received complaints against all above noted facilities operated by the same Licensee. The complainant was alleging financial abuse of the residents' Personal and Incidental (P&I) funds. An initial investigation visit was conducted on 09/01/2021. As a part of the complaint investigation, the complaints were referred to the CCLD Audit Department for a Trust Audit. The audit investigation conducted by Jacqueline Juarez concluded the following: * The Licensee/Administrator Misappropriated residents Personal and Incidental (P&I) funds. Multiple residents did not have access to, or were not distributed P&I funds. * The Licensee/Administrator failed to maintain adequate safeguards and records for residents' cash resources. Proper documentation for expenditures was not maintained. * The Licensee/Administrator Commingled the residents P&I monies with facility funds. See 809-C for report continuation. On today's date, CCLD Audit Manager Jacqueline Juarez delivered findings on the Trust Audit Report and discussed required plan of corrections (POCs). The Licensee/Administrator was notified that she will need to complete the following: * Refund all residents' enrolled in the Brilliant Corners program the amounts identified in the Trust Audit report and submit proof of repayment. * Provide proof of Surety Bond that covers each facility license and not the corporation. * Submit a written plan on how they will distribute P&I funds to residents and bank statements showing that P&I funds have been deposited in a separate trust account. * Submit an updated Plan of Operation reflecting the changes in population that will be served. On 10/8/2022, Licensee/Administrator is to submit to the Audit Section the LIC 405's and corresponding receipts for each facility to ensure proper record-keeping. The deficiencies related to the complaint allegation were also discussed during today's Office meeting, and were disclosed in the final complaint investigation report delivered to the Licensee Ms. Arutyunyan. See complaint control number 28-AS-20210824090807. During the initial complaint investigation visit dated (9/1/2021) resident's files were reviewed. Based on record review observation, LPA observed the resident files were incomplete and/or missing required forms i.e. personal and incidental (P & I) records, original receipts, hospice care plans, and admission agreements were missing authorized representative parties contact information. In addition, copies of the LIC 500 Personnel Report, resident roster, and resident (R6's) file records were not obtained or available at the facility. Licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Update all facility admission agreements to include contact information for all residents’ representative parties. Garage "guest house" and permit requirements were discussed. If applicable, update the Plan of Operation. LPA will review the facility sketch on file. Licensee was informed that Quarterly case management visits will be conducted. Technical Support Program brochure was emailed to Licensee during this meeting, and a referral will be submitted to the Residential Technical Support Program. Per Title 22 Regulations, Division 6 Chapter 8, Article 09, a deficiency was cited. See LIC 809D. An exit interview was conducted and a copy of this report and appeal rights was issued to Licensee Tina Arutyunyan.the state’s words, verbatim · CDSS document, Apr 26, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: May 10, 2022

Resident Records. The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met evidenced by: Based on record review observations during the visit dated 9/1/21) in reference to complaint # 28-AS-20210824090807, residents' files were incomplete and/or missing required forms i.e. P & I ledgers, hospice care plans, original receipts of P & I expenditures, and authorized representative contact information, and R6's file was not observed. This poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Apr 26, 2022

Plan of correction: Licensee agrees to ensure that all resident records are complete and accurrate. Administrator is to review Title 22 regulations section 87506(b)(1-17) as a guide to required resident record information. Submit a signed statement of understanding and intent to abide by the cited regulation.

Type of visit: Required - 1 Year

Licensing Programming Analysts (LPA) Jewel Baptiste conducted and unannounced visit with focus on infection control, food and medication review. LPA met with caregiver Elmer Manalang and explained the reason for our visit. LPA also spoke to Administrator Tina Arutyunyan and explain the reason for the visit. Facility is licensed to serve 6 over the age of 60 of which 6 is non-ambulatory and 2 can be bedridden. Hospice waiver approved for 2 residents. Facility is a one-story house with a Living room, dining room, kitchen, 4 bedrooms and 3 bathrooms. Facility has multiple fire extinguishers, carbon monoxide detectors with sprinkler system throughout the facility. LPAs and Caregiver toured the facility: Bedrooms #1(R1), #2, #3 and #4 was observed to have all the furnishings of 1 desk, chair, lamp and linens. Bathroom #1 toilet has stains and rings of yellow and brown color. Bathroom #2 shower contained dark stains throughout. Caregiver stated he purchased paint for toilet and tub. Bathroom #3 designated for staff only. Water temperature was tested in Bathroom#1 at 114.6, and Bathroom #2 at 115 , which is within the required 105-120 degrees F. LPA toured the kitchen and observed sufficient food supplies of 7 days non-perishables and 2 days perishable. LPA toured the backyard with caregiver and observed laundry detergent and cleaning supplies place on the floor next to washer and dryer. LPA also observed mattress, box spring and other trash on the side of the house. Caregiver confirmed that theey have tried to get the items removed. Medication was reviewed for Residents #1, #2 #3, #4, #5 and #6. LPA observed 2 of R6 medications empty. Caregiver confirmed medications has been empty for a week and resident usually calls and update his prescription. Deficiencies was observed during this visited and noted on LIC809D, per California code of regulations, Title 22. Exit interview was conducted with Caregiver Elmer Manalang and a copy of this report, LIC809D and appeals rights was provided. Deficiencies was observed during this visited and noted on LIC809D, per California code of regulations, Title 22. Exit interview was conducted with Caregiver Elmer Manalang/ Tina Arutyunyan over the phone and a copy of this report, LIC809D and appeals rights was provided to caregiver.the state’s words, verbatim · CDSS document, Apr 18, 2022

Type of visit: Required - 1 Year

Licensing Programming Analysts(LPAs) Mary Flores and Jewel Baptiste conducted and unannounced visit with focus on infection control, food and medication review. LPAs met with caregiver Elmer Manalang and explained the reason for our visit. Facility is licensed to serve 6 over the age of 60 of which 6 is non-ambulatory and 2 can be bedridden. Hospice waiver approved for 2 residents. Facility is a one story house with a Living room, dining room, kitchen, 4 bedrooms and 3 bathrooms. Facility has multiple fire extinguishers, carbon monoxide detectors with sprinkler system through out the facility. LPAs and administrator toured the facility: Bedrooms #1(R1), #2, #3 and #4 was observed to have all the furnishings of 1 desk, chair, lamp and linens. PRN medication was observed in R1 belonging to resident #4. Bathroom #1 toilet has stains and rings of yellow and brown color. Bathroom #2 shower contained dark stains throughout. Bathroom #3 toilet bedside commode was rusted. Water temperature was tested in Bathroom#1 at 152.3, Bathroom #2 at 155.5 and Bathroom #3 at 145.5, which is not within the required 105-120 degrees F. LPAs toured the kitchen and observed sufficient food supplies of 7 days non-perishables and 2 days perishable. LPAs also observed knives in a drawer to the right of the kitchen's sink and chemical solutions for cleaning and pest sprays were located under the sink and a small drawer without a lock. Medication cabinet was observed unlocked. Medication was reviewed for Residents #1, #2 and #3. Facility was observed not following COVID-19 recommendations of screening staff, residents and visitors. Screening needs to be updated to include all COVID symptoms questions and hand washing guidance's. Upon arrival staff was observed not wearing a face covering, Staff need to get fit tested and facility must provide closed lids trash can. Deficiencies was observed during this visited and noted on LIC809D, per California code of regulations, Title 22. Exit interview was conducted with Caregiver Elmer Manalang and a copy of this report, ,LIC809D and appeals rights was provided.the state’s words, verbatim · CDSS document, Nov 30, 2021

The state marks this report as 12 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Galarza initiated a Case Management- Deficiencies visit as a result of observations made during complaint control #: 28-AS-20210824090807. The purpose of the visit was explained to staff Elmer Manalong. Observations: Staff (S1) was observed in the garage "staff room" hiding in the restroom. Staff does not have Criminal Background Clearance. At 10:37 AM, LPA observed 2 large cockroaches in the kitchen wall. At 11:59 AM, a cockroach was observed on top of the kitchen dining table. Caregiver staff acknowledged there are many cockroaches in the home. The resident beds do not have mattress pads. Discarded stove was observed in the front yard. The exterior sides of the home had discarded mattresses, bed rails, and mattress springs. Trash was observed in the backyard on the floor and trash bins were overfilled with resident incontinence supplies. Per Title 22 deficiencies are being cited. See LIC 809D. An exit interview was conducted with staff Elmer Manalong. A copy of the report and appeal rights were issued.the state’s words, verbatim · CDSS document, Sep 1, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Sep 2, 2021

87355(e)(1) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement was not met by evidence of: Based on observation during the physical plant inspection of the garage "staff room". Staff (S1) was observed hiding in the restroom. Staff does not have Criminal Background clearance. This poses a potential health and safety threat to residents in care. Civil penalties are being assessed in the amount of $ 500.00.the state’s words, verbatim · CDSS document, Sep 1, 2021

Plan of correction: Licensee shall ensure that all staff obtain a Criminal Record Background Clearance prior to starting employment. Uncleared persons cannot return to work until they are cleared and associated to the facility. Submit proof of Livescan and transfer requests by POC due date (tomorrow).

From the deficiency page — Deficiency type: Type B · Section cited: CCR87307(a)(3)(C) · Plan of correction due date: Sep 8, 2021

87307 (a)(3)(C) Personal Accommodations and Services. Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. This requirement was not met by evidence of: Based on observation during the physical plant inspection none of the resident beds had mattress pads in the beds. Staff confirmed mattress pads are not placed on the bed mattresses. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 1, 2021

Plan of correction: Licensee shall purchase mattress pads for all resident beds. Submit picture proof and receipts by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Sep 8, 2021

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 was not met by evidence of: Based on observation at 10:37 am and 11:59 AM cockroaches were observed in the kitchen area. Staff confirmed there are cockroaches in the home. This poses a potential health and safety issue to residents in care. In addition, discarded stove was observed in the front yard, the exterior sides of the home had discarded mattresses, bed rails, mattress springs, and trash was observed in the backyard.the state’s words, verbatim · CDSS document, Sep 1, 2021

Plan of correction: Licensee shall: 1. Remove all discarded equipment and trash from the front/back, and side areas of the home. Provide picture proof of correction. 2. Hire a pest control company and provide proof of weekly treatment for a total of 4 weeks. Submit pest control service in-voice and contract of a minimum of 4 weeks.