Stephen House

Allegation investigated: Staff did not do wound care for resident Staff did not ensure resident wore her neck brace

On 03/08/2023 Licensing Program Analyst (LPA) V Gorban visited facility stated above and met with Administrator Sundari Susan Kendakur to report findings pertaining to investigation with allegations: Staff did not do would care for resident Based on interview and medical records reviews the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allege violation did or did not occur, therefore the allegation is unsubstantiated. Staff did not ensure resident wore her neck brace Based on interview, records review, The allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allege violation did or did not occur, therefore the allegation is unsubstantiated. Unsubstantiatedthe state’s words, verbatim · CDSS document, Mar 8, 2023 · control 24-AS-20221208110333

Type of visit: Required - 1 Year

On 08/19/22 Licensing Program Analyst (LPA) M. Yang arrived unannounced at the above facility. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. LPA met with Marcos Garcia, caregiver. Administrator Sundari Susan Kendakur and Shannon Steele Care Coordinator (CC) was called and arrived shortly. LPA conduct tour with Administrator. Four residents were present during the tour. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility staff was observed with mask on. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Staff records were reviewed for good health and infection control training. Food supply was checked and there appeared to be an adequate supply. LPA checked residents’ locked medications and observed a 30-day PPE supplies. Fire extinguisher observed served date 06/01/22. All bathrooms are observed with trash cans with lid and securely fastened grab bars. There are non-skid mat in the bathrooms. LPA observed hand washing posting in all bathroom sinks. All bedrooms are single occupant. Approximately at 11:46 AM, LPA, Administrator, and CC observed inside unlocked garage laundry detergent. The exterior tour was conducted. Side gate was self-closing and self-latching. All residents have updated emergency contact information. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit interview was conducted. The following documents are requested and submitted to Fresno CCL by: 8/26/22. The following updated forms were requested: Lic 308, Lic 309, Lic 500, Lic 610E, and current liability insurance. LPA received copy of Lic 9282. A copy of this report and appeal rights was provided to Administrator via email. Signed report on file.the state’s words, verbatim · CDSS document, Aug 19, 2022

From the deficiency page — Deficiency type: Type A · Plan of correction due date: Aug 20, 2022

Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above when approximately at 11:46AM, LPA, Administrator, and CC observed two laundry detergent buckets stored in the garage unlocked accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 19, 2022

Type of visit: Case Management - Incident

On 8/19/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct a Case Management inspection. LPA introduced self, stated the purpose of the visit and met with Administrator Sundari Susan Kendakur and Shannon Steele Care Coordinator (CC). The purpose of today's inspection is to address the facility's failure to submit Incident Report to the Fresno Community Care Licensing (CCL) office on incident that occurred on 07/15/22. Administrator and CC stated incident report was faxed on 07/15/22 but no confirmation was provided on facility report. Facility office staff dropped off incident report after no confirmation received on 07/28/22. No deficiencies issued. An exit interview was conducted. LPA discussed with Administrator plan to ensure incident report are confirmed received by CCL. A copy of this report will be provided via email to Administrator and an electronic read receipt confirms receiving these documents. Signed report on file.the state’s words, verbatim · CDSS document, Aug 19, 2022

Allegation investigated: Staff did not have proper training to administer medication

On 7/27/2022, Licensing Program Analyst (LPA) M. Medina arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by Caregiver and stated the purpose of the visit. During the investigation, LPA L. Salazar conducted interviews and records review and it was revealed that staff who is not an appropriately skilled medical professional, was administering morphine to R1 as R1 was unable to self-administer, without the presence of hospice personnel. Based on records review and interviews, the preponderance of evidence standard has been met therefore the allegation is found to be substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. An exit interview was conducted with Luijean De Castro Abragan, Care Coordinator. A copy of this report and appeal rights were discussed and provided Luijean De Castro Abragan. Substantiatedthe state’s words, verbatim · CDSS document, Jul 27, 2022 · control 24-AS-20210423082143

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87633(b)(4)(B) · Plan of correction due date: Jul 28, 2022

87633(b)(4)(B)A description of the area of licensee’s responsibility for implementing the plan including, but not limited to, facility staff duties; record keeping; and communication with the hospice agency, resident’s physician, and the resident’s responsible person(s), if any. This description shall include the type and frequency of the tasks to be performed by the facility. (B) The plan shall specify, by name or job function, the licensed health care professional on the hospice agency staff who will control and supervise the storage and administration of all controlled drugs (Schedule II - V) for the hospice client. Facility staff can assist hospice residents with self-medications without hospice personnel being present. **This requirement was not met as evidenced by staff who is not an appropriately skilled medical professional administering morphine to R1 due to R1 being unable to self-administer, without the presence of hospice personnel.the state’s words, verbatim · CDSS document, Jul 27, 2022

Plan of correction: Licensee shall submit plan by the due date, detailing medication administration limitations for staff who are not skilled medical professionals. The plan shall iclude a date by which all staff will be trained on this section within 7 days of the POC due date.

Type of visit: Case Management - Other

On 7/27/22, Licensing Program Analyst (LPA) M. Medina arrived unannounced on another matter. LPA met with Luijean De Castro Abragan, Care Coordinator and explained the purpose of the visit. During the Department’s complaint investigation, it was determined staff member Staff 1 (S1) and Staff 2 (S2) were fingerprint cleared but not associated to work at facility. This was confirmed by interviews conducted and Licensing Information Systems records. Care Coordinator stated paperwork will be submitted to Department to resolve fingerprint association issue. Both staff were removed from facility during Case Management visit. Deficiency cited on the attached 809 D per the California Code of Regulations, Title 22. The Department is assessing an immediate CIVIL Penalty in the amount of $500.00 per staff person. Exit interview conducted. Appeal rights provided. A copy of this report provided for facility records.the state’s words, verbatim · CDSS document, Jul 27, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jul 28, 2022

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or ***This was not met as evidenced by LPA observed that S1 and S2 were fingerprint cleared and not associated to facility by review of deparment facility personnel report summarythe state’s words, verbatim · CDSS document, Jul 27, 2022

Plan of correction: Licensee to submit required documentation to associate S1 and S2 to facility by POC due date. Staff will not work in facility until fingerprint transfer association is completed by Department. CIVIL PENALTY ASSESSED

Type of visit: Required - 1 Year

On 09/15/2021, Licensing Program Analysts (LPA) M. Yang and A. Walton arrived unannounced at the above facility. LPAs introduced self, stated the purpose of the visit, and requested to meet with the Administrator. LPAs met with Administrator Sundari Susan Kendakur who arrived a short time later. LPAs conduct tour with Administrator. All four residents were present during the tour. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Fire extinguisher observed to be last serviced 05/7/2021. Social distancing is maintained in the common and dining areas. All bathrooms are observed with trash cans with lid and securely fastened grab bars. There are non-skid surfaces in the bathrooms. LPAs observed no hand washing posting in 2 of the 3-bathroom sinks. Bedrooms are single occupant. LPAs checked residents’ locked medications and observed a 30-day PPE supplies. Food supply was checked and there appeared to be an adequate supply. Facility staff was observed with mask on. Staff records were reviewed for good health and infection control training. All residents have updated emergency contact information. Facility has not submitted LIC 808 Mitigation plan to Community Care Licensing. No deficiencies issued during this inspection. Exit interview was conducted. Please submit the LIC 808 to Fresno CCL by: 09/21/21. Please submit the following forms/information to Fresno CCL by: 09/28/21: LIC 308 Designation of Facility Responsibility, LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan for Residential Care Facilities for The Elderly, LIC 9020 Register of Facility Clients/Residents, updated Liability Insurance, current property lease, LIC 309 Administrative Organization, current Administrator Certification, LIC 808 Covid-10 Mitigation Plan. Due to COVID-19 precautionary measures, a copy of this report will be provided via email and an electronic read receipt confirms receiving this email. Report signed on-site.the state’s words, verbatim · CDSS document, Sep 15, 2021