Sunshine Board & Care

Type of visit: POC

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced proof of correction (POC) visit to a deficiency issued on 06/12/2023. LPA last visited the facility on 07/31/23. LPA met with staff who phoned co-administrator Ahmad Abdallatef. Mr. Abdallatef arrived shortly and was informed of the purpose of today's visit. The following deficiency was not corrected by the POC due date nor at the time of this visit. Civil penalties are being assessed and will continue to accrue until correction has been submitted: Deficiency cited under Title 22 Regulation 87507(g)(5)(C)(2) and POC was for Licensee to refund all monthly payments made by Resident 1 (R1) authorized representative and proof of correction shall be provided to the Department by the POC date of 7/14/2023. Proof of refund issued or arrangements was not received by LPA during today's visit. The Regional Office has not received an appeal for the deficiency mentioned on this visit. Civil penalties assessed today at the rate of $100 per day per citation per violation per day. Today's civil penalty assessment of $3700.00 is for the period of 08/01/23 through 09/06/23. Civil Penalties assessed today total $3700. Exit interview conducted with and a copy of this report, LIC421FC, and appeal rights were provided to Mr. Abdallatef.the state’s words, verbatim · CDSS document, Sep 6, 2023

Allegation investigated: Staff did not prevent a resident from hitting another resident. Staff are not providing resident with his PNI. Staff are not safeguarding resident's personal belongings.

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Sunshine Board and Care Residential Care Facility for the Elderly to deliver the findings of the complaint investigation. LPA was greeted by Administrator, Najeh Hamed. LPA introduced self and stated the purpose of the visit. It is alleged that staff did not prevent a resident from hitting another resident. Resident interviews revealed that approximately one month ago. Residents were standing outside the front of the facility awaiting transportation. A resident approached another resident and hit him in the face closed hand. There were no other witnesses to the incident. No reason or cause for the physical altercation is noted. The incident was not reported to staff. According to the Community Care Licensing Duty Log there were no Special Incident Reports filed that involved a physical altercation between two residents. Staff denied witnessing or having knowledge of a physical altercation outside the facility a month ago. Please see 9099-C Unsubstantiated It is alleged that staff are not providing the residents with their P and I benefits. During resident interviews, LPA learned that staff provided documentation to the resident to sign up for Resource Oversight and Guidance, (ROG) There after the resident was told he would be earning $150 a month. Staff interviews revealed that the resident utilizes a Representative Payee Service to manage his finances. Resident’s benefits are sent to ROG. ROG in turn pays the resident’s bills and sends the remaining benefit to the residents separately. The amount of the benefit is based on the Social Security Award or the income source itself. According to the Administrator, ROG will cut two checks. One for the rental expenses to the facility and the other for the resident to spend as needed. This process takes place every month. ROG charges a fee for their services. It is not unusual for residents to complain they are not getting enough money. Staff do not determine the amount of benefit(s) residents receive. The amount is set by a third party. Staff deny that there have been any discrepancies with the residents in cares’ benefit. LPA reviewed P and I records and found they support and are consistent with what is reported. Furthermore, LPA contacted ROG services, and learned that the information provided was aligned with statements of the Administrator. It is alleged that staff are not safeguarding resident’s belongings. According to resident interviews, resident enter each other’s rooms and take their belongings and money. These incidents were not reported to staff or the Administrator at the time of occurrence. Nor reported to the Police Department, for reasons unknown. Staff denied that residents enter each other’s rooms and take their belongings and money. Staff also denied witnessing or having any knowledge of theft occurring in the facility. LPA searched the Community Care Licensing Duty Logs; there were no Special Incident Reports filed which involved theft or loss. Based on observations, interviews and record reviews; we have found the complaint allegation is 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. A copy of this report is being reviewed with and furnished to the facility representative.the state’s words, verbatim · CDSS document, Aug 8, 2023 · control 56-AS-20230720155918

Allegation investigated: Staff engaged in a physical altercation with resident in care. Staff engaged in a verbal altercation with resident in care.

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Sunshine Board & Care facility unannounced to initiate a complaint investigation into the allegations listed above. LPA knocked on the front door. LPA greeted by Staff Member, Tyrone Powell. LPA introduced self and stated purpose of the visit. LPA asked to enter facility and was granted entry. Staff informed LPA Administrator is not at the facility. LPA contacted Administrator to inform him of the complaint investigation. Administrator agreed to meet LPA during visit. Today's visit consisted of staff and resident interviews, a walk through of the facility and record reviews. It is alleged that staff engaged in a physical altercation with a resident in care. Resident interviews revealed that all residents deny witnessing a physical altercation between staff and a resident. During staff interviews, it was discovered that the facility cares for residents with confusion, memory impairment, aggressive behaviors. Staff do have training in engaging with difficult residents. Staff denied witnessing and or engaging in a physical altercation between residents or staff. Staff denied having knowledge of any physical altercations between any residents in care. Please see LIC9099-C Unsubstantiated It is alleged that staff engaged in a verbal altercation with a resident in care. Resident interviews revealed that there was observation of staff speaking to residents in a loud tone, it is not known what specifically was said or the reason for it, only that the volume of the voice was as loud as yelling. Staff reported a verbal altercation between a resident and staff. It was reported that the resident was the aggressor and may have been under the influence. Police were contacted and made a visit. Police determined there was no action to be taken due to the resident's behavior. Based on observations and interviews, these allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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. An exit interview was conducted, where this report was reviewed, discussed then provided facility representative.the state’s words, verbatim · CDSS document, Aug 8, 2023 · control 56-AS-20230731195356

Type of visit: Case Management - Deficiencies

Licensing Program Analyst, Amber Coleman, (LPA) conducted an unannounced complaint visit for complaint #56-AS-20230731195356. During this visit, LPA's observed deficiencies not related to the complaint allegations. During the visit, LPA verified staff members present. LPA observed staff member Manal Terab, Yusef Nofal, Najeh Hamed and Tyrone Powell present at the time of the visit. LPA researched Guardian to locate staff members associated to the facility to compare with staff present at the time of visit. LPA observed that staff member, was not associated to the facility. On 7/27/23, LPA contacted Administrator Najeh Hamed to inquire about staff member. Administrator confirmed S1's employment, but could not recall the staff member's date of hire. While reviewing resident records, LPA observed that two, (2) resident's LIC602 - Physician's Report were out of date. Administrator acknowledged the LIC602's were out of compliance and agreed to have it addressed as soon as possible. Based on observations and review of records, two (2) deficiencies are being cited to address the concerns listed above.the state’s words, verbatim · CDSS document, Aug 8, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Aug 2, 2023

87355 CRIMINAL RECORD CLEARANCE (e) 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 ... This requirement is not met as evidenced by Based on observation & file review, licensee failed to ensure S1 was associated to the facility prior to working. LPA observed that S1 was not associated to the facility. This poses an immediate health & safety risk to the residents in care.the state’s words, verbatim · CDSS document, Aug 8, 2023

Plan of correction: Administrator agreed to review the Guardian website to update the list of staff members associated to the facility during the visit. LPA was able to verify the updated list. The POC was completed during the visit. Deficiency Continued: Administrator could not recall the exact date of hire for S1. (g) Violation of Section 80019(e) will result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation for a maximum of 5 days by the Department."

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Sep 15, 2023

87458 Medical Assessment Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. This requirement is not met as evidenced by: Based on observations and record reviews, the Licensee failed to ensure resident in care maintained documentation of and were provided an annual medical assessment which poses a potential Health, Safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 8, 2023

Plan of correction: Administrator agrees to assist residents in care in coordinating doctor appointments to obatin a complete medical assessment by way of an LIC602 - Physician's Report. Administrator will submit completed copies of this documentation to the Community Care Licensing Office to verify the task has been completed within the next 30 business days.

Type of visit: POC

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced proof of correction (POC) visit to a deficiency issued on 06/12/2023. LPA informed care staff Manal Terab of the purpose of today's visit and Terab phone co-administrator Yusef Nofal of LPA's presence. LPA informed Nofal of today's visit and Licensee Najeh Hamed arrived during the visit. The following deficiency was not corrected by the POC due date nor at the time of this visit. Civil penalties are being assessed and will continue to accrue until correction has been submitted: Deficiency cited under Title 22 Regulation 87507(g)(5)(C)(2) and POC was for Licensee to refund all monthly payments made by Resident 1 (R1) authorized representative and proof of correction shall be provided to the Department by the POC date of 7/14/2023. Proof of refund issued or arrangements was not received by LPA during today's visit. Licensee stated that they intend to appeal the deficiency and civil penalty. Civil penalties assessed today at the rate of $100 per day per citation per violation per day. Today's civil penalty assessment of $1700.00 is for the period of 07/15/23 through 07/31/23. Civil Penalties assessed today total $1700. Exit interview conducted with and a copy of this report, LIC421, and appeal rights were provided to Licensee Hamed.the state’s words, verbatim · CDSS document, Jul 31, 2023

Allegation investigated: Staff neglect led to hospitalization of a resident. Staff member mismanages medication. Staff failed to provide adequate food service. Facility is unsanitary. Insufficient staffing to meet residents' needs Staff failed to provide a comfortable environment for residents in care. Staff member sleeps while on duty.

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Sunshine Board and Care Facility to deliver findings of the complaint investigation. LPA introduced self and stated purpose of the visit. LPA spoke with Staff Member, Tyrone; who contacted Administrators to notify of LPA's visit. LPA met with Administrators and discussed the complaint findings. Staff neglect led to hospitalization of resident. It is alleged that the facility staff neglect led to the hospitalization of the resident. Resident interviews reflect that a resident was in need of assistance one evening, he could not get the attention of the night staff member scheduled that evening. He contacted 911 and was able to get assistance. Staff interviews reveal that staff members deny staff sleeps on the job or that a resident called for assistance and was unable to get assistance. Record reviews reflect that the resident went to the hospital for treatment, but nothing suggests that the resident was sent to the hospital because of neglect or lack of supervision. At this time, there are no Special Incident Reports in the Community Care Licensing Duty Logs... Please see LIC9099C Unsubstantiated Based on interviews and observations, we have substantiated the complaint allegation(s) as valid and that a violation has occurred based on the preponderance of available evidence. reporting that a resident in care was sent to the hospital. Based on interviews and record reviews, we have found the complaint allegation is 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. Staff member mismanages resident medications. It is alleged that staff mismanage resident medications. All staff deny that the resident’s medications are mismanaged. Resident interviews do not reflect residents in care have had a problems with their medications. LPA requested the Medication Administration Records, (MARS) for review. LPA reviewed the MARS for the residents in care and found the record did not display anything unusual. Staff failed to provide adequate food services. Resident interviews reflect that residents don’t have an issue with the food that is being served during meal time. Residents in care shared that there is always an ample amount of food. Resident can ask for seconds and if what is being cooked isn’t preferred there are alternatives offered. LPA walked through the kitchen for observation. LPA observed an operational refrigerator which included fresh fruits and vegetables, milk and juices in the amount appropriate for the number of residents in care. LPA observed the two pantries which revealed a number of canned goods with in good standing. Deep freezers held frozen meals, treats and meats appropriate for the number of residents in care. LPA was also present while lunch was being served and observed a clean cooking station and food being prepared and served according to regulation. Staff provided LPA with the monthly food menu to include a variety nutritional meals. It is alleged that the facility is unsanitary. During the visit, LPA observed the facility’s physical plant. LPA observed no obstructions of the pathways. The hallway did appear to be dark, but there are several light switches along the wall which adequately lights up the pathway. LPA observed the smell and fumes of cleaning products throughout the facility. Resident rooms contained all regulated furniture. Each room appeared clean and orderly. The kitchen area also appeared clean and orderly. Outside of the facility no obstructions observed. A patio included a shady area and adequate seating. Resident interviews revealed that staff cleans the facility frequently because they can smell the presence chemicals in use. During staff interviews, it was discovered that the facility is cleaned up to three times a day. In the mornings during Breakfast Administrators work on cleaning the resident rooms. This includes dumping trash cans, sweeping, removing clutter, making beds and cleaning the bathrooms. Please see LIC9099C It is alleged that the facility is unsanitary. During the visit, LPA observed the facility’s physical plant. LPA observed no obstructions of the pathways. The hallway did appear to be dark, but there are several light switches along the wall which adequately lights up the pathway. LPA observed the smell and fumes of cleaning products throughout the facility. Resident rooms contained all regulated furniture. Each room appeared clean and orderly. The kitchen area also appeared clean and orderly. Outside of the facility no obstructions observed. A patio included a shady area and adequate seating. Resident interviews revealed that staff cleans the facility frequently because they can smell the presence chemicals in use. During staff interviews, it was discovered that the facility is cleaned up to three times a day. In the mornings during Breakfast Administrators work on cleaning the resident rooms. This includes dumping trash cans, sweeping, removing clutter, making beds and cleaning the bathrooms. Insufficient staffing to meet resident needs. LPA was provided with the facility staff schedule which reflected that two staff members are present 7am to 6pm. One being an Administrator and the other a direct care staff member. The evenings 6pm to 7am are covered by another staff member. Staff interviews are consistent with the staff schedule. Resident interviews reflect that residents are able to get assistance in a timely manner. During LPA visit, LPA observed both Administrators present and two staff members. It is alleged that staff failed to provide a comfortable environment for the residents in care. During the visit, LPA observed that the facility appeared to be clean and orderly, free of obstructions. LPA observed the same of the residents’ rooms and hallways. LPA observed the temperature of the facility to be cool and comfortable. Resident’s rooms also appeared to be clean and orderly. Resident interviews did not support the allegation that the facility is not comfortable. Residents report feeling safe inside the facility. Staff interviews were consistent with resident interviews. Staff denied that a resident complained of the facility being uncomfortable or unsafe. It is alleged that a staff member sleeps while on duty. Staff reported that one staff member works during the evenings. According to Administrators, there have been no reports of the staff member sleeping during the shift. Staff also denied that they had ever went to sleep while on duty of the facility. Because the staff member who normally works in the evenings was not present during the visit, LPA is unable to interview her. One (1) Resident interview revealed that the staff member who works during the evenings does sleep during the shift. As he called out, and the staff member did not respond. This resulted in the resident having to call 911 himself. Due to conflicting statements and the inability to interview the staff member in question. We have found the complaint allegation is 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. A copy of this report is being reviewed with and furnished to the facility representative.the state’s words, verbatim · CDSS document, Jul 25, 2023 · control 56-AS-20230426145407

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69(3) · Plan of correction due date: Jul 25, 2023

Employees assisting residents with self-administration of medication; training requirements An employee shall be required to complete the training requirements for hands-on shadowing training described in this subdivision prior to assisting any resident in the self-administration of medications. This requirement is not met as evidenced by: Based on observation and file review, Administrator did not ensure that all staff who handle medications for the residents in care were adequately trained to do so. This poses an immediate Health, Safety or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 25, 2023

Plan of correction: Administrator agrees to have all staff who assist residents with self administration of medications be properly and adequately trained with in the next 24 hours. Administrator also agrees to submit a statement of understanding by way of LIC9098 that the regulation is understood.

Allegation investigated: Facility did not give resident’s representative the right to participate in decision-making regarding the care and services to be provided to the resident (R1).

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to deliver findings on the above complaint allegations. LPA met with staff Manal Terab. Terab phoned licensee Najeh Hamed was notified of the reason for today’s . Co-administrator Ahmad Abdallatef arrived shortly. The investigation included interviews with witness and staff and records review. The allegation is that the facility did not give resident’s representative the right to participate in decision-making regarding the care and services to be provided to the resident (R1). Witness interview confirmed that R1 is self-responsible for decisions related to their care however R1 has a court-ordered fiduciary. The interview further revealed that the fiduciary is solely responsible for R1 finances and does not need to be consulted for any services that R1 wishes to use or add. Staff interviews revealed that R1 is a former resident who needed a higher level of care and was transferred to a hospital and has not returned to the facility since. This allegation is therefore unsubstantiated. A finding of UNSUBSTANTIATED means 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. A copy of this report was reviewed and provided to Ahmad Abdallatef. Unsubstantiated Refer to LIC809-D for deficiency cited. An exit interview was conducted where this report, LIC809-D, and appeal rights were discussed with and provided Ahmad Abdallatef.the state’s words, verbatim · CDSS document, Jun 12, 2023 · control 56-AS-20220714134111

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(C)(2) · Plan of correction due date: Jul 14, 2023

(g) Admission agreements shall specify the following: (5) Refund conditions. (C) The licensee shall refund any prepaid monthly fees to a resident or the resident’s representative, if any, as follows: (2) If there is a change of use of the facility pursuant to Section 87224(a)(5). This requirement was not met as evidenced by: Records reviewed show that R1 monthly payment continued from March 2021 through July 2022. Staff and witness interviews confirm that R1 has moved out of the facilty in March 2021.the state’s words, verbatim · CDSS document, Jun 12, 2023

Plan of correction: Licensee shall refund the monthly payments to R1 and their authorized representative from March 2021 through July 2022. Licensee shall provide proof of correction no later than end of day of POC date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA met with Administrator Najeh Hamed and was granted entry to the facility. At the time of the visit there were four (4) staff, and twelve (12) residents present. LPA toured the facility inside and out and went over COVID-19 best practices for infection control and prevention with Najeh Hamed. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating residents and properly caring for residents with COVID-19 positive results and/or exposures. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE. The entrance of the facility has a check in process for staff and visitors that includes a temperature and symptom check. The facility has hand sanitizer available and the bathrooms were stocked with hand soap and paper towels. Postings were seen throughout the facility for proper cough etiquette, proper hand washing procedure, and social distancing guidelines. LPA requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was located in the hall closet. The facility has a supply of PPE items such as gloves, gowns, disinfectant, surgical masks, and hand sanitizer. The facility was informed they need to obtain a supply of N95 masks. All staff and residents are practicing COVID-19 precautions, which minimize the risk of them contracting COVID-19. During today’s visit, LPA found that Staff(S1) has been working at the facility for four (4) years without a criminal background clearance which poses an immediate health, safety, or personal rights risk to persons in care. The facility will be issued a type A deficiency and a $500-dollar civil penalty. During todays visit, LPA found that the residents centrally stored prescription medications were removed from the original received containers and were being stored in plastic weekly containers which poses an immediate health, safety, or personal rights risk to persons in care. The facility will be issued a type A deficiency. LPA took pictures of the medication stored in the plastic weekly containers. Based on the observations made during today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, LIC811, LIC421BG, LIC9102, and appeal rights were discussed and provided to Najeh Hamed.the state’s words, verbatim · CDSS document, Nov 4, 2022

The state marks this report as 7 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA met with Administrator Najeh Hamed and was granted entry to the facility. At the time of the visit there were four (4) staff, and twelve (12) residents present. LPA toured the facility inside and out and went over COVID-19 best practices for infection control and prevention with Najeh Hamed. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating residents and properly caring for residents with COVID-19 positive results and/or exposures. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the proper use and disposal of PPE. The entrance of the facility has a check in process for staff and visitors that includes a temperature and symptom check. The facility has hand sanitizer available and the bathrooms were stocked with hand soap and paper towels. Postings were seen throughout the facility for proper cough etiquette, proper hand washing procedure, and social distancing guidelines. LPA requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was located in the hall closet. The facility has a supply of PPE items such as gloves, gowns, disinfectant, surgical masks, and hand sanitizer. The facility was informed they need to obtain a supply of N95 masks. All staff and residents are practicing COVID-19 precautions, which minimize the risk of them contracting COVID-19. During today’s visit, LPA found that Staff(S1) has been working at the facility for four (4) years without a criminal background clearance which poses an immediate health, safety, or personal rights risk to persons in care. The facility will be issued a type A deficiency and a $500-dollar civil penalty. During todays visit, LPA found that the residents centrally stored prescription medications were removed from the original received containers and were being stored in plastic weekly containers which poses an immediate health, safety, or personal rights risk to persons in care. The facility will be issued a type A deficiency. LPA took pictures of the medication stored in the plastic weekly containers. Based on the observations made during today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D, LIC811, LIC421BG, LIC9102, and appeal rights were discussed and provided to Najeh Hamed.the state’s words, verbatim · CDSS document, Nov 4, 2022

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 10/25/21 Licensing Program Analyst (LPA) Shaunte Henry arrived at the facility to conduct an unannounced annual inspection with an emphasis on infection control. LPA met with caregiver, Esther Vargas, explained the nature of the inspection and was granted entry into the facility. There are currently 11 residents at the facility. As of this date, there are no positive COVID-19 cases or individuals with COVID-like symptoms present in the facility. LPA toured the facility with the caregiver. There is one point of entry for routine COVID-19 symptoms screening is initiated for all residents, staff and visitors. Signs have been posted throughout the facility, which indicates the visitor policy and proper hand washing, cough/sneeze etiquette, and social distancing practices. Facility also documents daily temperature and COVID-19 symptom checks, and any change in condition for staff and clients. LPA observed hand sanitizer throughout the facility. All clients have at least a 30-day supply of medications. LPA observed a sufficient supply of hand hygiene, cleaning and disinfecting items. LPA observed a sufficient supply of Personal Protective Equipment (PPE). The facility has a designated infection control person who is responsible for ensuring that the facility is compliance with infection control practices. The facility has a COVID mitigation plan in place, which outlines testing requirements, isolating/quarantining positive COVID-19 cases, proper cleaning/sanitizing/disinfecting and monitoring of individuals for COVID-like symptoms. The facility is aware that it is mandatory that Community Care Licensing (CCL) is contacted if anyone tests positive for COVID-19. According to California Code of Regulations, Title 22, Division 6, there were no deficiencies observed or cited during this visit. An exit interview was conducted where this report was discussed with and provided to the Esther Vargas.the state’s words, verbatim · CDSS document, Oct 25, 2021

Allegation investigated: Staff misused resident's finances.

Licensing Program Analyst (LPA) Javina George made an unannounced visit to deliver findings for the allegation listed above. LPA met with Caregiver Estrella Heller, Administrator was avialble via telephone and explained the purpose of the visit, and elements of the allegation. The allegation was investigated by the department. The investigation consisted of interviews, and review of facility documentation. On April 1, 2021 LPA George interviewed the previous facility Licensee Lilibeth Swanson of Sunshine Inc., who admitted that she did ask Resident #1 (R1) for money. Previous Licensee used the monies received from R1 to pay for Swanson’s child16th birthday party. Swanson agreed the amount of monies taken from R1 is equal to the sum of around $10,000. Lilibeth stated “What I did was wrong, and I apologize as well accept it 100%, I plan on paying it back and I will give interest. I was paying $100 every week, here and there.” As of April 1, 2021, R1 stated to have received in payment roughly $1,900 back. Substantiated According to interviews conducted, there was a verbal agreement between R1 and Swanson that the money would be back paid on a weekly basis, however the payments stopped in February 2021. R1 kept the money in their however estimates that the money was first given out from their Chase bank account in 2018. Swanson would transport R1 to the bank where R1 would withdraw the money and then gave the funds to Swanson. Note that these transactions occurred prior to the facility had a change of ownership in October 2019. According to facility Administrator Najed Hamed once he became aware of what happened made an attempt made to file a police report, however, law enforcement instructed against and suggested to take the matter to small claims court. Administrator stated that R1 does not have bank statements or receipts proving that the transaction occur. Based on Swanson’s direct statements admitting to taking R1s money for personal use; LPA found that Swanson being a previous licensee misused R1s money by taking and spending the money in personal matters; as such the allegation Staff misused resident's finances is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted and a copy of this report, 9099D and appeal rights was provided to Caregiver Estrella Heller.the state’s words, verbatim · CDSS document, Sep 23, 2021 · control 18-AS-20210326083509

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80026(b) · Plan of correction due date: Oct 7, 2021

80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents (b) If such a client is accepted for or maintained in care, his/her cash resources, personal property, and valuables not handled by a person outside the facility who has been designated by the client or his/her authorized representative shall be handled by the licensee or facility staff, and shall be safeguarded in accordance with the requirements specified in (c) through (n) below This requirement is not met as evidenced by: Based on observation, interview and record review the licensee did not safeguard R1s cash resources. This is a potential health, saftey and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Sep 23, 2021

Plan of correction: The licensee agrees to conduct an inservice on personal rights. Proof is to be submitted to the department by 5pm on the due date indicated.

Allegation investigated: Resident received a unlawful eviction

Licensing Program Analyst (LPA) Crystal Colvin arrived to investigate the above allegations of the complaint. LPA Colvin met with Designated Facility Representative Adam Ahmad "Adam" Abdallatef, as the Licensee/Administrator was unavailable at this time. LPA Colvin advised Adam of the purpose of the visit. Regarding allegation "Resident received a unlawful eviction": LPA Colvin interviewed resident, staff, and Administrator/Licensee (via telephone), as well as reviewed resident file for the investigation of this complaint. During LPA Colvin's interviews, there were conflicting statements regarding whether or not R1 was in fact being evicted. Additionally, there was no physical eviction notice provided to R1 to memorialize this. Due to lack of physical evidence for the allegation of R1 being unlawfully evicted as well as conflicting statements regarding the situation, the allegation of "Resident received a unlawful eviction" is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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. Unsubstantiated LPA Colvin additionally spoke with Licensee/Administrator Najeh "Nick" Hamed on the telephone at length regarding Title 22 Regulations for evictions, so that if the Licensee/Administrator does choose to issue an eviction notice to R1, in attempts to ensure that R1's personal rights are not violated. An exit interview was conducted where this report was discussed. A copy of this report was provided to Designated Facility Representative Adam Ahmad "Adam" Abdallatef during the exit interview, and LPA Colvin will be emailing a copy of the report to Administrator/Licensee Najeh "Nick" Hamed as well.the state’s words, verbatim · CDSS document, Aug 11, 2021 · control 18-AS-20210805155349

Allegation investigated: Facility staff are not keeping residents safe

Licensing Program Analyst (LPA) Crystal Colvin arrived to deliver findings for the allegations of the complaint. LPA Colvin met with Designated Facility Representative Adam Ahmad "Adam" Abdallatef at the facility, and spoke with Licensee over the telephone. LPA Colvin advised Adam and Licesensee of the purpose of the visit. Regarding allegation "Facility staff are not keeping residents safe": LPA Colvin interviewed residents and staff regarding an incident that occurred between two residents (R1 & R2) in 2020, wherein R1 got into a physical altercation (restrained) with R2. Through interviews it was confirmed that the incident occurred, and that there had been numerous instances of verbal altercations between R1 and R2 prior to this event. LPA Colvin additionally reviewed the file for R1, where LPA Colvin observed that R1 was documented to have a mental illness, for which he was prescribed medication and was refusing to take. This was further documented with a Medication Administration Record (MARs) that was blank. LPA Colvin confirmed during interviews that R1 had shown signs leading up to the incident, such as acting strange and not getting along with other residents. Substantiated Throughout LPA Colvin's investigation, LPA Colvin confirmed that the altercation between R1 and R2 did take place and that the police were later called out and detained R1. The altercation consisted of R1 putting R2 in a head lock with their arms, pinning R2 to the wall, and taking R2 to the ground and restraining R2 there for a period of time. Through interviews conducted, LPA Colvin learned that there was no immediate staff intervention done by staff during the incident or prior as the argument between residents was escalating. Additionally, LPA Colvin was informed that after the incident, no additional mental health treatment, assistance, or evaluation, was sought for R1 by the Administrator. During LPA Colvin's investigation, she was provided with a document which claimed to be an eviction notice for R1, which was dated for 4/29/20. However, this Eviction Notice was not carried out, as R1 did not move out of the facility until December 2020. Furthermore, no documentation of this Eviction Notice was provided to Licensing, and it was not readily available in R1's file or for LPA Colvin to review during a physical inspection of the facility and was provided to her electronically later by facility staff. Lastly, the validity of the Eviction Notice is in question as LPA Colvin interviewed outside parties in relation to R1's move from the facility, and no one interviewed other than facility staff could verify that R1 was ever given an eviction notice or asked to leave the facility. The Licensee failed to address the physical altercation between R1 and R2 adequately by either seeking additional assistance from mental health (such as an evaluation or increase of services), knew that R1 was diagnosed with a mental health diagnosis and had been refusing medication and treatment, and failed to provide/enforce an eviction notice for R1 when R1 violated the facility's rules and posed a safety risk to other residents. Additionally, staff failed to provide adequate supervision to residents as it was reported in LPA Colvin's investigation by multiple persons that R1 was showing signs of odd behavior prior to the incident between R1 and R2, and both staff members on duty were in the kitchen cooking and not providing supervision to the residents when the altercation occurred. Based on LPA Colvin's interviews and records review, the allegation of "Facility staff are not keeping residents safe" is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met. Due to observations made by LPA Colvin, the facility was cited, and deficiency noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy of this report was provided to Designated Facility Representative Adam Ahmad "Adam" Abdallatef during the exit interview, and LPA Colvin will be emailing a copy of the report to Administrator/Licensee Najeh "Nick" Hamed as well.the state’s words, verbatim · CDSS document, Aug 11, 2021 · control 18-AS-20200803114859

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Aug 13, 2021

Additional Personal Rights...in...Facilities: (a) In addition to the rights...residents...shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met by: Based on interviews and record review, the Licensee did not comply with the above regulation with 1 resident (R1). R1 got into a physical altercation with R2. No mental health treatment was sought or eviction notice enforced. This was an immedaite person rights violation.the state’s words, verbatim · CDSS document, Aug 11, 2021

Plan of correction: R1 has been relocated to another facility and there has been no further conflict. Licensee agrees in the future to keep documentation of all efforts made by the facility for prevention and follow-up to ensure residents' safety and well-being. No further Plan of Correction required.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced in order to investigate two complaints (#18-AS-20200803114859 & #18-AS-20210805155349). During LPA Colvin's investigation of the complaints, LPA Colvin observed some additional deficiencies. LPA Colvin met with Facility Representative Adam Ahmad "Adam" Abdallatef at the facility and Administrator/Licensee Najeh "Nick" Hamed was contacted via telephone. LPA Colvin advised Adam and Nick of the purpose of the visit. During LPA Colvin's investigation of a complaint (#18-AS-20200803114859), LPA Colvin was provided with an Eviction Notice from staff member (S1) for a prior resident (R1). In review of this Eviction Notice, LPA Colvin observed the following issues: 1. Notice was not provided to Licensing when given to the recipient, 2. Notice did not contain the required resources for the resident. The Notice was alleged to have been provided to R1 on 4/29/20, as indicated on the date for the typed notice, as well as the date signed by designated staff. Community Care Licensing (CCL) was not provided with a copy of this Notice until 6/24/21 when LPA Colvin was discussing the issues at hand in the complaint investigation with S1. Title 22 Regulations require facilities to provide CCL with copy of all Eviction Notices within 7 days after they are supplied to the resident. Deficiency cited. Additionally, LPA Colvin observed that while the Notice did provide a reason allowable under Title 22 for eviction, the Notice did not supply R1 with any resources required to aid R1 with finding alternative housing. Since the eviction notice was not upheld and the Licensee assisted with finding a new facility for R1 to move to, LPA Colvin will not be issuing a deficiency and instead will be issuing a Technical Violation Advisory Note (TV). Additionally, the Notice should have also detailed the specifics for why R1 was being provided with an eviction notice, whereas the notice provided to LPA Colvin only states "recent misbehavior and complaints". Deficiency cited. Lastly, the base incident of the complaint (#18-AS-20200803114859) was regarding a physical altercation between three residents on 5/19/20, one of which was taken into custody by law enforcement. A Special Incident Report (SIR) was not submitted to CCL until 8/11/20, when it was requested by LPA Colvin for the purpose of investigating the situation. Facilities are required to report incidents which pose a risk for safety of any resident within seven (7) days. SIR was not submitted for nearly three (3) months. LPA Colvin will be issuing a Technical Violation Advisory Note (TV) instead of a deficiency since the facility had copies of the incident reports in the file with notations that they were faxed to Licensing. LPA Colvin consulted with Licensee/Administrator over possibly mailing the SIRs or emailing them to Licensing's office email address at CCLDASCPRiversideRO@dss.ca.gov and to keep additional records/documentation to show proof of submission to Licensing. Due to observations made by LPA Colvin, the facility was cited, and deficiencies noted on the LIC809D. A copy of this report was provided along with LIC809D, LIC9102 Technical Violation, and appeal rights during the exit interview with Facility Representative Adam Ahmad "Adam" Abdallatef. LPA Colvin will be emailing a copy of the report to Administrator/Licensee Najeh "Nick" Hamed as well.the state’s words, verbatim · CDSS document, Aug 11, 2021

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(f) · Plan of correction due date: Aug 25, 2021

Eviction Procedures: (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement was not met as evidenced by: Based on record review, the Licensee did not comply with the above regulation with one resident (R1). R1 was provided with an eviction notice dated 4/29/20, but Licensing was not provided with a copy of the eviction notice until 6/24/21. This was a potential personal rights violation for R1.the state’s words, verbatim · CDSS document, Aug 11, 2021

Plan of correction: Licensee agrees to review Title 22 Regulation Section 87211 regarding Reporting Requirements. Licensee to self-ceritfy to LPA Colvin once complete. Plan of Correction due by 8/25/21.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87224(d) · Plan of correction due date: Aug 25, 2021

Eviction Procedures: (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement was not met as evidenced by: Based on record review, the Licensee did not comply with the above regulation with one resident (R1). R1 was provided with an eviction notice that only stated "recent misbehavior" with no further details. This was a potential personal rights violation for R1.the state’s words, verbatim · CDSS document, Aug 11, 2021

Plan of correction: Licensee agrees to review Title 22 Regulation Section 87224 regarding Eviction Procedures. Licensee to self-ceritfy to LPA Colvin once complete. Plan of Correction due by 8/25/21.

Allegation investigated: Resident’s personal belongings are stolen.

Licensing Program Analysts Melody Brown and Natalie Gayoso conducted an unannounced complaint visit to investigate the above allegation. LPA's were greeted and allowed entrance by caregiver Estrella Heller. Administrator Najeh "Nick" Hamed was contacted and unable to come to the facility. The investigation consisted of interviews with pertinent parties. The allegation indicates residents personal belongings are stolen. Interview with Staff 2 (S2) stated Resident 1 (R1) tends to always misplaced his belongings. R1 tends to misplace their glasses throughout the facility. S2 stated R1 never informed them that two (2) of R1's watches were missing. Interview with R1 stated that his glasses and watches were found. They were informed by another resident, Resident 2 (R2), that R1 had left their glasses and watches on the front table were residents, staff, and visitors sign in. Unsubstantiated Based on interviews, which were conducted, the allegation is UNSUBSTANTIATED. A finding of Unsubstantiated means 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, there fore the allegation is Unsubstantiated. An exit interview was conducted and a copy of the report was provided to caregiver Estrella Heller.the state’s words, verbatim · CDSS document, Aug 5, 2021 · control 18-AS-20210727140234

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPAs) Melody Brown and Natalie Gayoso arrived to the facility to investigate allegations made against the facility. In the process of conducting the investigation it was discovered that the facility allowed two (2) caregivers, Staff 3 (S3) and Staff 4 (S4) to work at this facility without fingerprint clearance. It appears that S3 and S4 have been allowed to work at the facility for the last 3 months. Although the administrator claims S3 and S4 were sent to get fingerprint cleared, there is no proof provided that S3 and S4 were cleared to be allow to work at the facility. Therefore, this facility will be cited for civil penalties.the state’s words, verbatim · CDSS document, Aug 5, 2021

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g)(1) · Plan of correction due date: Aug 6, 2021

87411 Personnel Requirements Prior to employment or initial presence in the facility, all employees... shall obtain a California clearnace... This requirement is not met as eveidenced by: based on interviews, licensee failed to ensure S3 and S4 were fingerprinted and associated to the facility prior to employment.This is an immediate health and safety risks to the resident in care.the state’s words, verbatim · CDSS document, Aug 5, 2021

Plan of correction: Licensee will remove S3 and S4 from the facility immediately. Licensee will submit an LIC 9182 along with clear photo ID by mail or in person to CCL by POC date 08/06/2021. A civil penalty will be assessed.