Tender Home Senior Care

Type of visit: POC

On 7/12/23 at 12:55pm Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced Plan of Correction (POC) inspection at Tender Home Senior Care to review corrections from citations from previous inspections and complaint investigations. LPA reviewed all pending POCs and ensured that all had been completed by the licensee. LPA observed all plans of corrections have been completed and LPA confirmed all POCs have been completed and meet the agreed stipulations of the plan of correction. LPA Gould generated five POC clearance letters during today's inspection and provided to the licensee. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 12, 2023

Type of visit: Required - 1 Year

On 6/28/23 at 8:45am Licensing Program Analyst (LPA) Kevin Gould arrived at Tender Home Senior Care for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Valentina Marinova and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA measured the water temperature, temperature measured at 120 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jun 28, 2023

Allegation investigated: Qualifications: 1) staff did not received appropriate medication training as required 2) staff lacked the ability to effectively communicate with residents as required.

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Tender Home Senior Care RCFE on 8/26/22 at 10:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, and observations made by LPA the allegations have been corroborated. LPA reviewed staff training files for staff member assigned to administer medications in the Licensee's absence. LPA observed that wile the staff member did have the required annual training hours, the licensee could not produce an examination that tested the medication administration skills as required by regulations. The licensee was unaware of the requirement as it was part of the health and safety code and not part of the Title 22 regulations. Report continued on LIC 9099-C. Substantiated LPA observed that during an inspection on 6/29/22, when LPA arrived at the facility, a staff member was present alone at the facility who was unable to communicate effectively with residents and potentially emergency responders in the case of an emergency. Although the staff member was alone with residents for a short time, an emergency can take place at any moment and there must be a staff member present who can communicate with residents and emergency responders at all times. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of qualifications is substantiated but if any additional information is received this complaint can be amended and the finding can be changed. The following deficiencies are cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility. There are no deficiencies noted or cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Aug 26, 2022 · control 27-AS-20220624114911

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.69(a)(5) · Plan of correction due date: Sep 2, 2022

To complete the training requirements set forth in this subdivision, each employee shall pass an examination that tests the employee’s comprehension of, and competency in, the subjects listed in paragraph (4). This requirement was not met as evidenced by LPA review of staff file which and statements from the licensee that the staff member did not complete an examination regarding medication administration and was not aware of the requirement which poses a potential health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 26, 2022

Plan of correction: Licensee will provide a written statement to LPA that the Licensee understand the requirement and to identify all staff that will be administering medications to residents in the future and provide LPA with a sample examination that meets the requirements in the Health and Safety code.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(d)(3) · Plan of correction due date: Sep 2, 2022

Personnel Requirements - General: Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met as evidenced by observations by LPA who observed a staff member alone at the facility who could not speak english and would not be able to communicate effectively with residents to meet their needs and communicate with emergency responders in the case of an emergency at the facilty which poses a potential health, safety and personal rights risk to residents in care. The department emphasizes that we are not prohibiting non-english speakers from working in a licensed facility, but one staff member must be present who can effectively communicate with residents to meet their needs at all times a resident is present in the facility.the state’s words, verbatim · CDSS document, Aug 26, 2022

Plan of correction: Licensee will provide a written statement that they understand that the staff member cannot be at the facility alone with residents due to their inability to communicate effectively with residents. Licensee will provide LPA and update LIC 500 which shows a new staff shedule that include an addidtional staff member whenever a staff present is unable to communicate with residents.

Type of visit: POC

On 7/29/22 at 9:30am Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced Plan of Correction (POC) inspection at Tender Home Senior Care to review corrections from citations from previous inspections and complaint investigations. LPA reviewed all pending POCs and ensured that all had been completed by the licensee. LPA observed all plans of corrections have been completed and LPA confirmed all POCs have been completed and meet the agreed stipulations of the plan of correction. LPA Gould generated five POC clearance letters during today's inspection and provided to the licensee. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 29, 2022

Allegation investigated: Medication: Facility staff are not properly trained to dispense medications. Neglect/Lack of Supervision: Facility failed to seek timely medical attention for resident after sustaining a fall.

Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to Tender Home Senior Care RCFE on 7/14/22 at 9:00am to conclude the investigation of the above allegations and to deliver the findings. LPA met with Administrator and together discussed the investigation details. Based on the interviews and statements obtained during the investigation process, the allegations have been corroborated. LPA reviewed file of staff responsible for medication identified as S2 and observed S2 had received 5 hours of annual medication administration training dated 3/30/22. LPA observed that S2 was three hours of training short of the required 8 hours of training per the California Health and Safety Code. Report continued on LIC 9099-C Substantiated Additionally, based on the interviews conducted with S1, S2, R1, and A1 and facts related to R1's injury sustained at the facility the second allegation of Neglect/Lack of Supervision is also substantiated. Facility staff members and reporting party all acknowledged R1 sustained a fall on 2/21/22. Facility staff members all denied any other falls occurring for R1. On 3/10/22 a home health aid observed bruising and swelling on R1's ankle and R1 was transported to the hospital where she was diagnosed with a broken ankle. The department has determined the bruising and swelling should have been observed in routine care of R1 prior to discovery by home health aid over 1 week after the documented fall. The Department has determined, based on the preponderance of the evidence obtained during this investigation, that the allegation of Medication and Neglect/Lack of Supervision is substantiated but if any additional information is received this complaint can be amended and the finding can be changed. The following deficiencies are cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility. The Department has investigated the complaint alleging Medications. Based on the investigative interviews, record reviews and other supportive evidence, the complaint is determined to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. The Complaint has been dismissed. There are no deficiencies noted or cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator and a copy of this report was left at the facility. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Neglect/Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 14, 2022 · control 27-AS-20220401115115

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.69(b) · Plan of correction due date: Jul 15, 2022

Employees assisting residents with self-administration of medication; training requirements: Each employee who received training and passed the examination required in paragraph (5) of subdivision (a), and who continues to assist with the self-administration of medicines, shall also complete eight hours of in-service training on medication-related issues in each succeeding 12-month period. This requirement was not met as evidenced by training records for S2 only contained 5 hours of annual training instead of the required 8 which poses an immediate health, safety and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 14, 2022

Plan of correction: Facility will conduct the remaiining medication training for all staff who administer medications to residents. Licensee will ensure all staff members are trained on medications in accordance with regulations of the health and safety code.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Jul 15, 2022

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met as evidenced by the injury sustained and bruising observed by home health aid after the date of the reported fall by R1 and the injury was not reported or observed prior to Home health aid which poses an immediate health, safety and personal rights risk to reidents in care.the state’s words, verbatim · CDSS document, Jul 14, 2022

Plan of correction: Facility will develope a weekly resident checklist where staff members will inspect residents during routine care and documents any observed changes for the Licensee to review and recommend changes.

Type of visit: Required - 1 Year

This is an amended report to remove reference to a pool in the back yard as there is no pool at this facility and the reference to a pool was written in error. On 6/24/22 at 9:15am Licensing Program Analyst (LPA) Kevin Gould arrived at Tender Home Senior care for the purpose of conducting a required 1 year annual inspection. LPA met with Licensee, Valentina Marinova and together conducted a tour of the home. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms; resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. Facility has an updated infection control plan and will send to LPA prior to 6/30/22 LPA measured the water temperature, temperature measured at 113 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven day non-perishable and two day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA conducted file review for all residents and observed all residents with dementia did not and an updated physicians report conducted within the last 12 months and did not have updated needs and services updates regarding dementia care within the last 12 months. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report and Client Roster. Per California Code of Regulations, Title 22 the following deficiencies were cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jun 24, 2022

Type of visit: Case Management - Deficiencies

On 5/4/22 at 1:30pm Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced case management inspection to address deficiencies observed while at the facility for an unrelated complaint investigation. LPA arrived at the facility and looked into the facility from the front window. LPA observed Staff member not wearing a mask and quickly dawn a mask when she opened the door and observed LPA was at the door. When LPA entered the facility LPA observed three visitors in the living room visiting with a resident. All were not wearing masks. LPA informed Administrator of LPAs observations and administrator provided masks to the visitors who all dawned them without comment or complaint. . Additionally, LPA conducted file review of the program statement and plan of operation for the facility at the program office. LPA observed the plan of operation to state: "All medications will be self administered, recorded and given per physician's orders". During a previous inspection LPA attempted to review medication logs and was informed by Licensee that the facility was not documenting medication administration. Licensee has resumed medication documentation per the plan of operation. The following deficiencies are cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 4, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: May 5, 2022

Personal Rights of Residents in All Facilities: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by, on 5/4/22 licensee did not ensure the personal rights of persons in care to safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of persons in care, in that facility staff Tamaka Holder and three visitors did not wear face coverings while in the facility, as required by the Order of the State Public Health Officer dated June 11, 2021 requiring compliance with CDPH Guidance for the Use of Face Coverings, and as required by COVID-19 Prevention Emergency Temporary Standards (ETS) at Title 8, CCR section 3205, and an individual mask exemption did not apply.the state’s words, verbatim · CDSS document, May 4, 2022

Plan of correction: Licensee will submit daily attestations to department indicating the Administrator has been at the facility and has observed all staff and visitors wearing face coverings as required. If a staff or visitor is observed without a mask Licensee will submit what steps and discipline was enacted to correct the staff or visitors.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87208(a) · Plan of correction due date: May 5, 2022

Plan of Operation: (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement was not met as evidenced by LPA review of facility plan of operation which included language that all medications administered would be recorded and documented. LPA observed the facility had not been following the plan of operation and recently reinstituted documenting medication administration.the state’s words, verbatim · CDSS document, May 4, 2022

Plan of correction: Facility will continue to document all prescribed medications and PRNs administered to residents. Licensee will email LPA with updated MARs for each resident weekly (Mondays) to verify that medications are being documented and recorded by staff. If it is noted a medication was given and not recorded, an incident report will be sent to the department.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(2) · Plan of correction due date: May 13, 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. This requirement was not met as evidenced by LPAs observations that staff continue to not wear masks when inside the facility as required by the Order of the State Public Health Officer dated June 11, 2021 requiring compliance with CDPH Guidance for the Use of Face Coverings, and as required by COVID-19 Prevention Emergency Temporary Standards (ETS) at Title 8, CCR section 3205, and an individual maskthe state’s words, verbatim · CDSS document, May 4, 2022

Plan of correction: Licensee will submit daily attestations to department indicating the Administrator has been at the facility and has observed all staff and visitors wearing face coverings as required. If a staff or visitor is observed without a mask Licensee will submit what steps and discipline was enacted to correct the staff or visitors.

Type of visit: Case Management - Deficiencies

On 4/6/22 at 2:00pm Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced case management inspection to address deficiencies observed while at the facility for an unrelated complaint investigation. LPA arrived at the facility and was greeted by a staff member not wearing a mask. LPA asked if staff had a mask and if she could please put one on. LPA observed staff put a mask around her wrist and continue to provide support and assistance to residents despite LPAs request. LPA was later greeted by the facility Administrator who quickly donned a mask when entering the facility. LPA informed Administrator of LPAs observations and Administrator had a discussion with staff who proceeded to wear a mask for the duration of LPAs inspection. The following deficiency are cited per California Code Regulation, TITLE 22. Exit interview was conducted with the facility administrator. Appeal Rights were issued, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Apr 6, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Apr 7, 2022

Personal Rights of Residents in All Facilities: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by, on 4/6/22 licensee did not ensure the personal rights of persons in care to safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of persons in care, in that facility staff Tamaka Holder did not wear face coverings while in the facility, as required by the Order of the State Public Health Officer dated June 11, 2021 requiring compliance with CDPH Guidance for the Use of Face Coverings, and as required by COVID-19 Prevention Emergency Temporary Standards (ETS) at Title 8, CCR section 3205, and an individual mask exemption did not apply.the state’s words, verbatim · CDSS document, Apr 6, 2022

Plan of correction: Licensee will submit a written plan of correction stating that all staff are required to wear a facemask and the steps the facility will take to ensure the mask requirement is adhered to. Licensee understands that another citation will result in an immediate civil penalty.

Type of visit: POC

On 7/16/21 at 12:30pm, Licensing Program Analyst (LPA) Kevin Gould conducted an unannounced Plan of Correction (POC) inspection to ensure the hot water temperature was increases to the correct temperature and meets Title 22 regulations. LPA met with Staff Tamaka Holder and together conducted the POC inspection. LPA Gould tested the hot water in the kitchen and recorded a hot water temperature of 107 degrees F which meets the 105-120 degree Fahrenheit regulation. LPA Gould has cleared the POC and a POC clearance letter will be generated and provided to the facility. Per California Code of Regulations, Title 22 there were no deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Jul 16, 2021

Type of visit: Required - 1 Year

On 7/12/21 at 12:15pm Licensing Program Analyst (LPA) Kevin Gould arrived at Tender Home Senior Care for the purpose of conducting a required 1 year annual inspection. LPA met with Administrator, Valentina Marinova and together conducted a tour of the home. Facility is a single story home in a residential community. There are four resident bedrooms, two shared rooms and two private rooms. There is a room for live-in caregivers. LPA and Administrator evaluated the physical plant to ensure the health and safety of the residents in care. Areas inspected are including but not limited to the kitchen, resident bedrooms, resident bathrooms, living and dining room and outdoor areas. LPA observed the facility to be free of odor, clean and in good repair. LPA observed that all rooms are equipped with the required furniture and sufficient lighting throughout the facility. LPA observed one of the shared rooms to be equipped with a couch instead of a bed for one resident that was done at the request of the resident and family. LPA confirmed with the resident and family. LPA measured the water temperature, temperature measured at 122 degrees F which does not meet the 105-120 degree Fahrenheit regulation. LPA observed sufficient seven-day non-perishable and two-day perishable food supplies. Fire extinguishers and smoke detectors are current and in compliance with fire safety. LPA notes the facility had the required carbon monoxide detectors. First aid kit was checked and is complete. LPA observed centrally stored medications secure from residents. LPA Requested the following documents for facility file: LIC 308 Designation of Facility Responsibility, LIC 500 personnel report, LIC 610E Emergency Disaster Plan, Current Administrator Certificate and Client Roster Per California Code of Regulations, Title 22 the following deficiencies were cited during today's inspection. An exit interview was conducted, and a copy of this report and appeal rights were left at the facility.the state’s words, verbatim · CDSS document, Jul 12, 2021