The British Home in California

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection with the focus of the Infection Control domain. LPA met with the Nursing Manager, Jane Adams, and explained the purpose of the visit. The facility is approved for a capacity of 41 and serves elderly ages 60 and above. There can be 34 ambulatory with a maximum of 7 non-ambulatory residents, restricted to the Braemar Cottage. The facility may retain 2 hospice residents. LPA Chan toured the campus and observed the following: * There are 6 different cottages (Foskett, Ramona, Lambert, Shafer, Braemar, and Jameson) and each contains resident rooms, living room, small dining room, kitchen, and a laundry room. The main dining room and kitchen are located at the Armstrong building. Signage are posted by the entry points of each building and in the kitchen and common bathrooms. LPA randomly selected 6 resident rooms to inspect. They are clean and have the required furnishings. There are no pool or bodies of water on the premises. There are no items obstructing the walkways. The facility has proper Coronavirus (COVID-19) signage throughout the facility. LPA recommended to put additional signage such as cough/sneeze etiquette in the cottages and communal areas. Hand washing signs are posted in each of the bathrooms and kitchen sink. Sufficient PPE supplies are stored at the facility. Food supplies for 2 day perishable and a week of non-perishable were observed. Medications are centrally stored and locked in the med room located in the Jameson cottage. LPA reviewed medications for 6 residents and staff are administering them as prescribed by the physician. Emergency contact information for residents are current and emergency contact numbers are posted. All staff on duty were wearing face masks. No deficiencies were observed during the visit today. An exit interview was held and a copy of this report was provided to staff Jane Adams.the state’s words, verbatim · CDSS document, Feb 24, 2023

Allegation investigated: Staff member did not allow residents access to Ombudsman services.

**********This supersedes the report dated 09/07/2022. The report was superseded to correct initial visit date listed on the 1st page.********** Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint investigation and deliver findings for the allegation listed above. Upon arrival, LPA met with Executive Director, Marlene Rainen and explained the purpose of today’s visit. During the initial visit conducted telephonically (due to Covid-19) on 5/06/2021, LPA Elizabeth Irra requested the Administrator (via email) to provide the following documents: • Staff Roster (with contact phone numbers) • Resident Roster (with contact phone numbers) • Visitors Policy for March 2021 to current • Visitors log/sign-in sheet(s) for March 2021 to current • Staff schedule for March 2021 to current During today’s visit, LPA Pena interviewed the following: Two (2) Staff, Staff #1 (S1), Staff #2 (S2), (1) Witness, Witness #1 (W1), the Executive Director/Administrator (A1) and obtained a copy of the Visitor's log for March 2021. Continued on LIC 9099-C…………….. Substantiatedthe state’s words, verbatim · CDSS document, Oct 21, 2022 · control 28-AS-20210503103907

Allegation investigated: Facility did not inform responsible party of change in resident's condition.

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Staff / Rosario Munoz and Administrator / Marlene Rainen who assisted with the visit. LPA Katrdzhyan explained the purpose of today’s visit is to discuss the above mentioned allegation of "Facility did not inform responsible party of change in resident's condition." During today's visit, LPA interviewed the Administrator and Staff 1 (S1). LPA made multiple attempts to speak with Staff 2 (S2) but was unsuccessful as phone calls were not returned. LPA was unable to interview Resident 1 (R1) as R1 is not at the facility and remains hospitalized at Huntington Memorial Hospital. Also copies of the following documents were obtained and reviewed in reference to R1; • In-house Incident/Unusual Occurrence Report • Emergency Information Sheet • Physician's Report • Annual Assessment/Re-Appraisal of Needs & Services • UPDATED Unusual Incident/Injury Report dated 9/15/22 • Physician Note dated 9/8/22 Substantiated The investigation revealed the following; Allegation: Facility did not inform responsible party of change in resident's condition. The details of this allegation states that the family of R1 was not notified after R1 sustained a fall on 9/8/22. Based on interviews conducted, the statements obtained were consistent and corroborated with the allegation. Interviews conducted with staff and records reviewed confirmed that R1 sustained a fall on the morning of 9/8/22, at 5:30am. Facility staff failed to inform the family regarding the fall incident involving R1. Facility staff notified the family of R1 regarding a separate incident which occurred on 9/9/22, where R1 was transferred to Huntington Memorial Hospital, where she remains hospitalized. During today's visit, LPA obtained a copy of the UPDATED Unusual Incident/Injury Report dated 9/15/22, notifying CCL/Licensing of the fall incident (9/8/22) involving R1. Based on the investigation conducted, LPA found sufficient evidence to support this allegation to be true. Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was provided to the Administrator along with the Appeals Rights. The investigation revealed the following; Allegation: Resident did not receive medical attention as needed. The details of this allegation states that R1 was not sent to the hospital after she sustained a fall. Based on interviews conducted and records reviewed, the statements obtained were inconsistent and did not corroborate with the allegation. Staff interviewed denied not sending R1 to the hospital after R1 sustained a fall. R1 sustained a fall on the morning of 9/8/22, at 5:30am. R1 was seen by her Physician on 9/8/22, at 10am, at which time the Physician advised to keep an eye on R1 and if R1's symptoms worsen to take R1 to the ER. On 9/9/22, at 11:10am, facility staff observed a decline in R1 condition and transferred R1 to Huntington Memorial Hospital (E.R.), per Physician's instructions. Based on the investigation conducted, LPA found insufficient evidence to support this allegation to be true. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Sep 15, 2022 · control 28-AS-20220914092736

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Sep 22, 2022

Reporting Requirements. A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D). This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement is not being met as evidenced by: Interviews conducted with staff and records reviewed confirmed that R1 sustained a fall on the morning of 9/8/22, at 5:30am. Facility staff failed to inform the family regarding the fall incident involving R1.the state’s words, verbatim · CDSS document, Sep 15, 2022

Plan of correction: Administrator will review Title 22 Regulations, Section 87211 on Reporting Requirements, and submit a written plan detailing how facility will ensure that Reporting Requirements are followed as required according to the regulation. POC must be submitted to CCL by the POC due date.

Allegation investigated: Staff member did not allow residents access to Ombudsman services.

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced subsequent complaint investigation and deliver findings for the allegation listed above. Upon arrival, LPA met with Executive Director, Marlene Rainen and explained the purpose of today’s visit. During the initial visit conducted telephonically (due to Covid-19) on 5/06/22, LPA Elizabeth Irra requested the Administrator (via email) to provide the following documents: • Staff Roster (with contact phone numbers) • Resident Roster (with contact phone numbers) • Visitors Policy for March 2021 to current • Visitors log/sign-in sheet(s) for March 2021 to current • Staff schedule for March 2021 to current During today’s visit, LPA Pena interviewed the following: Two (2) Staff, Staff #1 (S1), Staff #2 (S2), (1) Witness, Witness #1 (W1), the Executive Director/Administrator (A1) and obtained a copy of the Visitor's log for March 2021. Continued on LIC 9099-C…………….. Substantiated In regard to the allegation: Staff member did not allow residents access to Ombudsman services. It was alleged that on 3/09/2021, Ombudsman (OMB) was stopped by A1, who would not allow the OMB to enter the facility to check in with residents. A1 indicated the OMB can only meet with residents if they happen to come out of their rooms. On 5/06/2021 and 5/07/2021, the Executive Director, Marlene Rainen (A1) stated (via email) that she never prevented OMB from seeing the residents in their campus and only asked her to follow their Covid policy and protocols. A1 claimed that OMB did not sign-in when requested to do so and did not present any identification to the staff, not even a business card. A1 stated that the facility did not allow any family or strangers into buildings due to their Covid protocols. LPA's interview with A1 today confirmed that she did not allow anyone, including medical personnel, ombudspersons, local health personnel, etc. to go inside the residents cottages. A1 stated she allowed outside visit only after following covid protocols and that applied to everyone. LPA's interview with S1 revealed that the facility was very strict with visitors around that time due to Covid-19 pandemic. She could not recall if the OMB was not allowed entry to see residents but S1 stated that A1 was only protecting the vulnerable residents. S2 stated that she recalled that OMB was asked to go around the facility but could not go inside the cottages until after seeing A1. Interview with W1 stated that he was not aware that A1 or the facility was not allowing visitors entry. When he visited, he was allowed to visit outdoors only, and had to make a reservation and follow covid screenings. Based on LPAs’ interviews and record reviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC 9099D. Exit interview conducted with Marlene A. Rainen. Copy of the Reports and Appeal Rights given.the state’s words, verbatim · CDSS document, Sep 7, 2022 · control 28-AS-20210503103907

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Sep 21, 2022

87468.1 Personal Rights of Residents in All Facilities....(a) Residents...shall have all of the following personal rights:(11)To have their visitors, including ombudspersons..permitted to visit privately...without prior notice,..provided that the rights of other residents are not infringed upon. The requirement is not met as evidenced by: On 3/09/2021, Administrator refused OMB to visit and check-in with residents. OMBs are essential visitors and should have not been refused entry.This possess a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 7, 2022

Plan of correction: Administrator will review plan of operation and abide by the visitation regulation, that allows all essential workers to visit at any time unannounced. Administrator will provide in-service training to staff on visitation and provide a copy to LPA by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted a site visit for the Required - 1 Year inspection. Upon arriving at the facility, LPA met with Staff / Rosario Munoz and Carrie Crowley and was later joined by the Executive Director / Marlene Rainen who assisted with the visit. The facility is licensed to serve for a capacity of 41 residents (34 Ambulatory and 7 Non-Ambulatory only) ages 60 and above. The facility does NOT have an approved fire clearance for residents who may be bedridden. The facility has an approved Hospice Waiver on file for two (2) Residents. There are currently two (2) Residents on Hospice. British Home in California LTD does not have an approved Dementia Care Plan in their plan of operation and does not accept residents with dementia. LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. During the tour, LPA was accompanied by Rosario Munoz. A tour of the facility consists of a campus style setting that has six (6) cottages for residents and a separate building (Armstrong) which is used as a lounge/living room/dining room. The cottages are named Foskett, Ramona, Lambert, Braemar, Jameson, and Shafer. Each cottage has private resident bedrooms and bathrooms; its own living, dining, kitchen and laundry area. The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. No large bodies of water were observed. There are no security bars or weapons on the premises. The facility has central air and heating accommodations. LPA toured a random selection of resident rooms in each cottage. Resident rooms were furnished appropriately. Each resident room has their own bathroom. The bathrooms were observed to be clean and operational w/grab bars. The resident rooms have signal systems located in each bathroom and facility phones to call the front desk. The signal system was tested in various locations and is operable. The hot water temperature was tested throughout the facility and measured within Title 22 Regulation guidelines. The facility has central air and heating accommodations. (Please see LIC 809C for additional information) The kitchen was observed. There was a sufficient amount of perishable and non-perishable food supplies and perishable food was stored in covered containers at the appropriate temperatures. No pesticides or poisons were stored in the food areas. Storage areas for cleaning solutions, toxics, knives, and hazardous items were secured and made inaccessible to Residents. The fire extinguishers were observed to be fully charged and in compliance. The facility has carbon monoxide detectors in each resident room. A shaded area with chairs is provided to the residents. Medications are centrally stored in the locked medication room located in the Jameson cottage. A random selection of medications were reviewed to ensure they are being administered as prescribed. No deficiencies were observed during this visit An exit interview was conducted and a copy of this report was provided to the Executive Director.the state’s words, verbatim · CDSS document, Dec 15, 2021