Stockstill House

Type of visit: Required - 1 Year

License Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an Annual Required – 1 yr. visit of the facility. LPA was welcomed by Administrator Natalia Meyerson. There is a total of 8 residents with 4 residents currently on Hospice. LPA toured the facility on 9/26/2023 at 9:00 AM with administrator; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguisher was found to be last charged on 8/22/2023 at the time of the visit. Facility smoke detectors are hard wired and sound directly to the fire station. Smoke detectors and fire sprinklers are inspected annually. LPA is requesting a copy of annual smoke/alarm inspection. LPA observed Carbon monoxide detector that was found to be operational during the visit. Facility has a generator that will start if there is a power shut out. Hot water temperature measured between 109 degrees F and 113.5 degrees F within Title 22 acceptable regulation of 105 to 120 degrees F in 3 of 3 resident’s bathrooms while touring facility on 9/26/2023 at 9:15 AM. Facility serves residents with dementia and has special care plan of operation and programming. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations at the time of the visit. Food is available for residents any time of the day. There are activities schedule for residents' weekly. Toxins are stored in locked bathroom cabinets & locked kitchen cabinet under sink. There was a supply of cleaners, hygiene products and paper products available for residents. Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A sample tour of resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. Beds were outfitted with mattress pads as required by Title 22 Regulations # 87307 on 9/26/2023. Continue LIC 809-C A sample review of five resident & five staff records as well as two resident’s medications was conducted. LPA reviewed a random sample of resident’s files at 11:15 AM on 9/26/2023 and learned that 4 out of 5 residents have an updated reappraisal/needs & care plan on file (see LIC809D) & 5 out of 5 residents have updated medical assessments at this time as required by Title 22 Regulation. Medications were centrally stored in a locked medication cabinet in the facility medication room. The Medications of 2 out of 2 residents were found to be pre poured and records do not match medication counts per according to physicians’ directions on 9/26/2023 at 1:45 PM. Centrally Stored Medication Record (CSMR) of 2 out of 2 residents were found to be inaccurate (see LIC 809D). LPA conducted a sample reviewed of staff records at 1:15 PM on 9/26/2023 and learned that all facility staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. However, Direct care staff haven’t received the additional training requirements as per Title 22 Regulations and H&S Code (see LIC809D). LPA was presented with proof of CPR & 1st Aid certification for staff; although 2 of 5 staff do not have required First Aid certification (see LIC809-D). Natalia Meyerson Administrator Certificate # 6016748740 expires on 5/17/2024. LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information. In addition, LPA advised facility to check with the County regarding what is the County Emergency Plan; ensure that disaster drills are conducted in different shifts, and review facility emergency plan to ensure accuracy according to the needs of facility residents. Disaster Drills have been conducted with the last one being conducted on 8/21/2023. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. Continue LIC 809-C LPA Hansen is requesting Licensee to update and submit the following documents by 10/13/2023: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Control of Property (Deed or Lease) Copy of Certificate of Liability Insurance Copy of last Annual smoke/alarm inspectionthe state’s words, verbatim · CDSS document, Sep 26, 2023

The state marks this report as 8 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: Facility staff did not accurately maintain residents' records Facility staff did not accurately manage residents' medications

Licensing Program Analyst Bertozzi arrived unannounced to deliver findings regarding the above complaint allegations and met with Administrator, Natalia Meyerson. Facility staff did not accurately maintain residents' records – Complaint alleges that facility did not have a way to receive updated medication orders due to the fax machine not working. Per interviews, the facility fax machine was not working due to a storm, so doctor’s offices and hospice agencies were directed to send faxes to an alternate fax machine. The person checking the alternate fax machine would then send the written order to the facility staff via email or text message. Information received during investigation revealed that a hospice resident was receiving multiple medication changes per day and the hospice agency had representatives coming to the facility more frequently due to concerns that the medication orders were not being received timely, however, LPA was unable to confirm whether there was a significant delay or that a medication order was not received based on interviews or record review. Continued on LIC9099C Unsubstantiated Continued from LIC9099 Staff did not have records of resident’s medications– Complaint alleges that the facility’s fax machine did not work causing delays in updated comfort care orders to hospice patients, may have contributed to medication errors and likely contributed to increased suffering for patients. No specific examples were provided with complaint allegation. LPA conducted interviews and reviewed medication records and was unable to confirm that a medication error occurred or that the resident suffered due to alleged medication errors. A finding that the complaint allegations that Facility staff did not accurately maintain residents' records and Facility staff did not accurately manage residents' medications were unsubstantiated meaning that although the allegations may have happened there is not a preponderance of evidence to prove that the allegations occurred. No deficiencies cited during this inspection.the state’s words, verbatim · CDSS document, Dec 29, 2022 · control 21-AS-20221104150653

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with administrator Natalia Meyerson. There are 6 residents with 1 under hospice at facility. Facility has activities planned for residents during the day. LPA arrived at the facility and had her temperature checked and logged into a log. During facility tour on 8/17/2022 with administrator; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 8/2022 at the time of the visit. Sample test of Carbon monoxide detector was found to be operational during this visit. Fire sprinklers are inspected annually, and inspection records are current with the last inspection being conducted on 6/14/2022. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Facility has residents with a special diet which is posted in the kitchen and administrator goes over with staff when there is a change and/or they are first hired. Toxins are stored in a locked garage and under the kitchen sink. Dangerous items were stored inaccessible to clients. Facility hot water temperature in clients' bathroom faucet measured between 114.8 degrees F and 116.0 degrees F in 2 out of 2 faucets within Title 22 acceptable regulations of 105 to 120 degrees F. There was a supply of cleaners, hygiene products and paper products available for clients. All resident’s bedrooms have lighting & appropriate furnishings. Disaster drills are being conducted quarterly. Continued LIC 809-C Infection Control: Facility has submitted a mitigation program plan that has been approved, and infection control plan has been submitted. Some posters have been placed at entrance and throughout of the facility. Facility has hand sanitizer available; visitors and staff before coming into work have temperature checked. Facility has PPE supply stored in hallway closet. There has been new staff hired and new resident’s admission since COVID. Residents’ medications are stored and locked in the medication cabinet by kitchen area. Facility has a 30-day supply of medication for clients. Residents are not wearing masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit. Visitors are being allowed. Residents have also available virtual and telephone calls when contacting with family members and others. Staff stated that all required COVID training is on file in addition to N-95 fit testing for staff. There were no deficiencies cited at this time. Department is requesting facility to submit the following update documents by 8/24/2022: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Client’s/Resident’s Copy of Certificate of Liability Insurance Copy of last Disaster Drillthe state’s words, verbatim · CDSS document, Aug 17, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with Administrator Natalia Meyerson. Facility has 8 residents present. Facility offers activities of music, arts & crafts, puzzles and other activities. During facility tour on 9/2/2021 with Admin Natalia Meyerson facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was last charged on 7/2021. Smoke Detectors & Carbon monoxide detectors were found to be operational during the visit. Facility has a smoke detector system that is connected, and last inspection occurred on 9/15/2020. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Dangerous items were stored inaccessible to clients in locked garage, and under kitchen sink. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. Facility administrator understands that hot water temperatures must measure within Title 22 acceptable regulations of 105 to 120 degrees F. Infection Control: Facility has submitted a mitigation program plan that has been approved. Posters have been placed at facility and entrance has a table with hand sanitizer and other items designated for visitors and staff before coming into work. Facility has PPE supply stored in the garage and upstairs office room. Facility has hired and admitted new residents and staff since COVID-19. Residents’ medications are stored and locked in the locked armory by the kitchen storage. Facility has a 30-day supply of medication for residents. Residents are not wearing masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit. Continued LIC809-C In addition, facility has a designated area for visitors which are being allowed for visits. Residents also have available Zoom and telephone calls when contacting with family members and others. Staff had all PPE training required on file and have obtained N-95 fit testing. In addition, LPA advised facility to contact local County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or COVID-19 + in the facility. Disaster Drills had been conducted quarterly last being done 7/2021. Facility understands that unvaccinated staff must be tested once a week if PCR and vaccinated staff doesn’t need to be tested at this time if staff is able to show proof of vaccination which copy of vaccination card must be kept on facility file for staff at this time according with PIN 21-32 & PIN 21-32.1-ASC: UPDATED FACILITY STAFF TESTING AND MASKING GUIDANCE FOR CORONAVIRUS DISEASE 2019 (COVID-19). In addition, LPA had a discussion with administrator regarding visitation guidelines per PIN 21-40-ASC: UPDATED STATEWIDE VISITATION WAIVER, AND TESTING AND VACCINATION VERIFICATION GUIDANCE FOR VISITORS RELATED TO CORONAVIRUS DISEASE 2019 (COVID-19). LPAs reviewed Licensing Information System (LIS) with staff who stated that is correct and updated at this time. There were no deficiencies cited at this time.the state’s words, verbatim · CDSS document, Sep 2, 2021

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.