The Grandview

Allegation investigated: Staff pushed resident

Licensing Program Analysts (LPAs) Evelin Rios and Michael Cava conducted a complaint visit to the facility to investigate the above allegation. LPAs met with the administrator, Yeni Flores, and advised her of the complaint. Today's investigation consisted of interviews with the administrator and staff, record review, and a physical plant inspection. Staff pushed resident: In regards to the allegation, it was alleged that on or around 09/13/23, Staff 1 (S1) pushed Resident 1 (R1). R1 had to use a wall for support and then lunged at S1. Interviews with the administrator and staff reveal that in the late night on or around 09/13/23, R1 was becoming agitated, and knocking on the doors of the other residents. S1 tried to intervene and stop R1 from doing so, but during the course of their intervention, R1 was becoming aggressive towards S1 prompting S1 to move R1 aside. In addition, S1 stated they never put their hands on R1. Review of facility surviellance reveal that S1's arm was raised, and forearm made Substantiated contact with R1s body, causing R1 to lose balance and lean back against the wall. Additional interviews were held, and there was no reports of any injuries sustained to R1. Review of facility files reveal that S1 received training in Intervention on Aggression, Positive Resident Communication, and Harassment. Although S1 received training with intervention on resident aggression, surveillance video confirms that that S1 made physical contact with R1, causing R1 to lose their balance. Therefore, the allegation is Substantiated. Citation issued on the 9099D. Administrator advised and appeal rights given.the state’s words, verbatim · CDSS document, Oct 25, 2023 · control 31-AS-20231019092238

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 25, 2023

Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following: To be accorded dignity in their personal relationships with staff, residents and other persons. This requirement was not met as evidenced by: LPAs received surviellance of an incident that occurred on or around 09/13/23, which reveals S1 pushing or making contact with R1, causing R1 to lose balance. This poses an immediate health and safety risk of the resident.the state’s words, verbatim · CDSS document, Oct 25, 2023

Plan of correction: As POC, administrator will hold training to address this section of the regulation. As proof training is held, documentation with training log is due to the licensing agency by November 1, 2023.

Allegation investigated: Staff does not keep facility free of vermin.

Licensing Program Analyst (LPA) LaQueena Lacy conducted a subsequent complaint visit for the above allegation on 08/02/2023 at 1:30pm to deliver investigative findings. LPA Lacy met with Administrator Yeni Flores and explained the purpose of the visit. It is alleged that resident #1 (R1) has roaches and bed bugs in their living space. To investigate the above allegation, LPA requested and obtained copies of facility files and documents including but not limited to the staff and resident rosters, a room fumigation schedule and Global Rodent & Pest invoices at 11:49am. LPA interviewed Administrator and staff at approximately 12:00pm, additional staff and resident interviews were conducted between 1:39pm to 3:46pm. Interviews with ten (10) out of one hundred fifty five (155) residents confirm they have not seen any roaches due to an exterminator visiting the facility weekly. (10) out of (155) have not seen any bed bugs and have not been told by any residents that they have bed bugs. Continued on 9099C. Substantiated During the investigation, LPA and administrator inspected ten (10) random bedrooms. Nine (09) out of (10) bedrooms observed the administrator removed all bed linens, comforters, pillows, and all mattress coverings. A plastic or zippered mattress protector was observed on all mattresses. LPA inspected mattress seams, bed frames and surrounding area of the bed, dresser drawers and cabinets, no bed bugs or roaches were observed during the inspection. At the time of the inspection LPA observed R1 sitting in their bed, R1 then confirmed they did not have bed bugs or roaches. R1 pulled back their comforter to exit their bed and R1, the Administrator and LPA observed bed bugs crawling on R1 and in their bed. Upon record review of weekly pest control invoices dated 03/08/2023 through 04/26/2023 from Global Rodent & Pest Services for cockroaches and monthly bait station maintenance. Although the facility was being treated for roaches, bedbugs were observed during the time of inspection. Based on interviews, observations and record review, there is enough evidence to prove the alleged violation did occur, therefore the allegation is SUBSTANTIATED at this time. No health and safety hazards are noted during this visit. Deficiency cited, exit interview conducted and a copy of report and appeal rights issued.the state’s words, verbatim · CDSS document, Aug 2, 2023 · control 31-AS-20230418101310

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87303(a) · Plan of correction due date: Aug 3, 2023

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on inspection, observation and record review the licensee failed to ensure the facility was free from bed bugs.the state’s words, verbatim · CDSS document, Aug 2, 2023

Plan of correction: At the time of the visit the administrator submitted weekly Global Rodent & Pest Services invoices dated 05/03/2023- 07/19/2023 for pest control and bed bug treatment. Administrator will continue current treatment until advised by professional and will submit weekly invoices for the month of August to the regional office. This citation is cleared during the visit.

Allegation investigated: Resident was inappropriately touched by another resident in care.

Licensing Program Analyst (LPA) LaQueena Lacy conducted a subsequent visit on 10/14/2022 at 11:02am to deliver investigative findings for the above allegation. LPA met with Administrator Yeni Flores and explained the purpose of the visit. It is alleged that another resident stuck their hand up resident #1 (R1) dress. To investigate the above allegation, LPA interviewed staff, residents and other witnesses involved in R1 care and supervision. During the investigation R1 did not know the last name, room number or description (race, height) of the resident who stuck their hand up R1 dress. Interviews conducted with fifteen (15) out of sixteen (16) residents on 04/28/2022 between 11:25am – 2:15pm and a later date on 06/08/2022 between 11:13am – 1:04pm, revealed no one have witnessed any one being inappropriately touched and thirteen (13) out of (16) have not heard of any one being inappropriately touched. Interviews with four (04) out of (04) staff on 04/28/2022 at 1:37pm and 06/08/2022 between 2:10pm – 2:37pm determined they knew R1, and R1 never reported being inappropriately touched by any resident. Continued on LIC9099C. Unsubstantiated Based on LPAs interviews, and observation, Although the allegation may have happened or may be valid, there is not enough corroborating evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies cited, Exit interview conducted. Copy of report, and appeal rights issued.the state’s words, verbatim · CDSS document, Oct 14, 2022 · control 31-AS-20220420115826

Allegation investigated: Facility did not safeguard resident's cash resources.

Licensing Program Analyst (LPA) LaQueena Lacy conducted a subsequent visit on 10/14/2022 at 11:02am to deliver investigative findings for the above allegation. LPA met with Administrator Yeni Flores and explained the purpose of the visit. It is alleged that March and April checks are missing. To investigate the above allegation, LPA interviewed resident #1 (R1) on 06/27/2022 at 11:03am and administrator on 06/29/2022 at 11:13am. During the investigation R1 informed LPA Lacy that the social security administration had confirmed two (02) of R1 monthly checks had been cashed by a person that R1 did not know. At the time of the investigation the Administrator confirmed that she did not know the person named by R1 or do not have any staff or residents by that name. The administrator informed LPA Lacy that R1 receives (2) checks a month and that the facility was the payee and she had returned March and April checks to the Social Security Administration. Upon document review LPA observed four (04) receipts from the Social Security Administration for returning R1 Continued on LIC9099C. Unsubstantiated checks for the month of March (02) and April (02). Based on interviews, observations, and record review, there is a not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. No deficiencies cited, Exit interview conducted. Copy of report, and appeal rights issued.the state’s words, verbatim · CDSS document, Oct 14, 2022 · control 31-AS-20220622154854

Type of visit: Case Management - Incident

During Licensing Visit at 10:30 AM LPA spoke with the facility staff and residents. Information received revealed the following; On 09/07/2022, R1 was last seen by their roommate resident #2 (R2) roughly fifteen minutes prior to the incident, around the dinner time. R2 went for dinner and R1 did not wish to join R2. R2 grabbed dinner and returned to their room and needed to use the restroom, knocked on the door several times, and when R1 did not respond R2 opened the door saw R1’s feet outside of shower curtains. R2 alerted staff, and they found R1 hanging from the shower head using a belt. R1 was unhooked, staff called 911 and began CPR as they waited for paramedics to arrive. Paramedics arrived and resumed CPR but with no results. Police arrived, took the belt and corners arrived shortly after. The family of the deceased were notified, and responsible member stated that R1 had a previous incident. During this visit at 11:30 AM, LPA requested and reviewed R1’s facility records. A review of records revealed that R1 had Mental Health problems and needed medication assistance. R1 did not require any assistance with other Activities of Daily Living (ADL) and was able to leave facility unassisted, able to care for personal needs and had no suicidal ideation. LPA Duguma was informed that the Administrator has contacted a psychologist to speak with staff and residents. No immediate health and safety hazards were noted during the visit. Exit interview conducted and a copy of the report was issued.the state’s words, verbatim · CDSS document, Sep 9, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPAs) LaQueena Lacy, Gary Tan and Associate Governmental Program Analyst (AGPAs) Daniel Pacheco and Michael Moriel arrived at the facility at 9:30am to conduct a One (1) year Required Infection Control visit. LPAs and AGPAs meet with the administrator Yeni Flores and explained the purpose of this visit. A tour of the physical plant was conducted at 10:13am and the following was observed: The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette, and physical distancing) posted and hand sanitizers wall mounted throughout the facility. The PPE screening station is located in the administration front desk office equipped with sufficient PPE readily accessible a thermometer, hand sanitizer, gloves, mask, and sign in sheet at the time of visit. Fire Extinguishers located throughout the facility first, second and third floor all serviced dated May 6, 2022. The facility has multiple first aid kits with manuals throughout the facility (medication room, administration office, kitchen common areas, etc.). The facility has an approved mitigation plan on file. Medication: At 10:18am observed to be inaccessible to residents in care, storing medication in clear bins, refrigerator, and medication carts. Medication is prepared for residents and then placed in medication carts observed to be locked until distribution in the front office inaccessible to residents. Kitchen: At 10: 27am the kitchen was observed to be clean and an adequate supply of perishables and non-perishable food located in the fridge, freezer, and pantry. Food was properly labeled and stored. The emergency food is stored and observed to locked in a room labeled "Emergency Plan" across from the elevator and sprinkler valve room. Trash cans observed with lids. Lunch is staggered and served in individual plastic bags to maintain social distancing, lunch may be taken on the go or seated in the dining room. Sharps are stored in the kitchen inaccessible to residents. Continued on LIC9099C. Storage Rooms: LPAs and AGPAs observed multiple locked storage rooms throughout the facility at 10:39am to be storing PPE, facility toiletries, incontinent supplies, linens wrapped in plastic protective covering, wash and dry towels, toxins, trash bags, laundry soap, bleach, other cleaning supplies and paper good items. The storage rooms located in the activity room is storing Client Bedrooms: At 10:53am LPAs and AGPAs observed random rooms with bathrooms located inside on the first and second floor to be appropriately furnished with sufficient lighting. LPAs and AGPAs observed appropriately bed linen and comforters on all beds. Bedrooms contain single and double occupancy. All bedrooms observed to be clean and clear from obstruction. The water temperature measured at 105.7 between 132.6 degrees Fahrenheit. LPAs and AGPAs observed appropriate grab bars in shower and toilet area. Bathrooms are stocked and equipped with soap and paper towels. Hand towels are not shared. Laundry Room: LPAs and AGPAs observed two (02) laundry rooms located on the lower level at 11:14am to be clean and clear from obstruction. Residents are allowed to do their own laundry if they choose, the industrial laundry machines were observed to be locked and used by staff, all laundry soap is locked in storage and is given by staff from the locked storage room if needed. Living, dining room and common areas: LPAs and AGPAs observed at 11:21am to have sufficient tables and chairs for seating. Social distancing mark on floor. Outside and surrounding area of the facility observed to be clean and clear from debris and obstruction. At 11:33am the fire alarm system was observed to be tested by Los Angeles Fire Department on 05/19/2022 and 06/29/2022 to be working and operational, it is hard wired equipped with a water sprinkler system and a smoke detector test conducted by the facility dated 8/23/2022. Record Review: At 12:45pm until 2:30pm LPAs reviewed sixteen (16) or ten (10%) percent of randomly selected resident files and nine (09) staff files. All required documents are present in resident and staff files. Deficiency cited, exit interview conducted. Copy of appeal rights and report issued.the state’s words, verbatim · CDSS document, Sep 1, 2022

Allegation investigated: Staff did not provide adequate supervision resulting in a resident being abused by another resident.

Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced subsequent complaint visit to the facility on 8/19/2022 at 11:00am to deliver the investigative findings. Upon arrival LPA Lacy met with Administrator Yeni Flores and explained the purpose of this visit. It is alleged that Resident #1 (R1) roommate hit R1 over the head with a slipper, slapped her hand, yells, and cusses. To investigate the above allegation, LPA interviewed residents and staff on 11/23/2021 at approximately 1:40pm – 2:39pm and on 04/29/2022 at approximately 12:39- 3:18pm. Interviews with nine(09) out of fourteen (14) residents determined that no one has witnessed any fights/physical altercations between any residents. Eleven (11) out of (14) have not seen or heard of any arguments or abuse between any residents. Interviews with staff revealed that five (5) out (5) staff have not been told by any residents that anyone is being abused or physically assaulted and have not witnessed any physical altercation between any residents. Continued on LIC9099C Unsubstantiated During the investigation LPA interviewed R1, when asked specific questions regarding the abuse, R1 could not detail when the abuse occurred or confirm that they informed S1 or other staff of any abuse/physical altercations towards R1. Based on interviews and observations, there is a not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. No deficiencies cited, Exit interview conducted and a copy of report and appeal rights issued.the state’s words, verbatim · CDSS document, Aug 19, 2022 · control 31-AS-20211117154132

Allegation investigated: Facility staff member inappropriately sexually touched resident. Facility staff member is impaired while caring for residents. Facility staff member offered resident marijuana.

An unannounced subsequent complaint visit was conducted on 8/19/2022 at 11:00am by Licensing Program Analyst (LPA) LaQueena Lacy. Upon arrival LPA met with Yeni Flores the administrator and explained the puropse of the visit. This investigation was conducted by Investigator Jose Santana with the Community Care Licensing Division’s (CCLD) Investigations Branch (IB). #1 Facility staff member inappropriately sexually touched resident. It was alleged that staff #1 (S1) came to bring R1 medication, and touch resident #1 (R1) on the breast, then started sucking it and pulled R1 close to feel S1’s erection. During the investigation on 11/29/2021 interviews were conducted with residents, staff and other witnesses involved in R1’s care and supervision. Interviews at approximately 3:15pm with six (6) out of eight (8) staff on Continued on LIC9099C Unsubstantiated duty revealed that, the staff has limited interaction with S1 due to working different shifts/days and work duties. S1 works in the front office and dispense medication to residents in the office or delivers to residents room for those whom do not come to the office to receive their medications, also S1 is observed to be quite, nice and keeps to self and appears to eat lunch and take breaks in the car. During the investigation it was revealed that R1 had spoken to various witness and made inconsistent statements regarding the encounter with S1 and has made false allegations in the past. R1 was interviewed on 11/19/2021 and at a later date of 12/09/2021 by Investigator Santana at approximately 3:00pm regarding claims by R1 which was observed through video surveillance to be false. R1 had no explanation regarding the discrepancies. R1 asked Investigator Santana more than once whether the allegation could be used to avert an impending eviction for possessing, distributing, and consuming alcohol at the facility. Based on interviews, observations, and record review, there is a not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. No deficiencies cited, Exit interview conducted. Copy of report, and appeal rights issued. #2. Facility staff member is impaired while caring for residents. It is alleged that Staff #1 (S1) is always high, smokes marijuana while at work in the car and had offered R1 marijuana. To investigation the above allegation, interviews were conducted with staff and residents on 11/23/2021 and 04/29/2022. Interviews conducted on 11/23/21 began at approximately 2:30pm and 04/29/2022 at 9:15am, with eleven (11) out of (12) residents have not witnessed staff under the influence of drugs or alcohol while on duty. During the investigation interviews with five (5) out of (5) staff confirmed that no staff have been witnessed to be under the influence of drugs or alcohol while on duty. Based on interviews, and observations, there is a not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. No deficiencies cited, Exit interview conducted. Copy of report, and appeal rights issued. Continued on LIC9099C #3: Facility staff member offered resident marijuana. It is alleged that Staff #1 (S1) offered Resident #1 (R1) marijuana. To investigate the above allegation, interviews were conducted revealed that ten (10) out of (12) residents have not heard or been told that staff offers drugs to residents. Five (5) out of (10) have not witnessed staff offering drugs to any residents. During the course of the investigation interviews with (5) out of (5) staff confirmed they have not witnessed any staff offering drugs to residents. Based on interviews, and observations, there is a not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. No deficiencies cited, Exit interview conducted. Copy of report, and appeal rights issuedthe state’s words, verbatim · CDSS document, Aug 19, 2022 · control 31-AS-20211122140439

Allegation investigated: Staff are illegally evicting resident

Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced subsequent complaint visit to the facility on 06/29/2022 at 10:23am to deliver the investigative findings. Upon arrival LPA Lacy met with Administrator Yeni Flores (S1) and explained the purpose of this visit. This is an amedment to the original report. LPA conducted a physical plant tour at 10:35am, to ensure there are no immediate health and safety concerns. It is alleged that resident #1 (R1) is being evicted for nonpayment of rent. R1’s rent is partially paid by a placement agency. Staff #1 (S1) is refusing to accept R1 portion of the rent but is still accepting payments from the placement agency. To investigate the above allegation, on 12/20/21 LPA interviewed S1 at 1:15pm, S1 confirmed that an eviction notice was served to R1 for nonpayment of rent and other reasons and admitted to accepting partial payments from the placement agency, while refusing to accept payment from R1. Continued on LIC9099C Substantiated delivered by any courier service (Fed Ex, Amazon, etc.) to the facility. Ten (10) out of (12) residents check regularly with the office to inquiry if they have mail, and seven (07) out of (12) is notified by the office that they have mail ready for pickup. Interviews with staff confirmed that residents have mailboxes and mail is placed with the room number in the box and some residents check with the office frequently for mail or they notify the resident by calling them to the office for pickup. During the investigation LPA observed the resident’s mailboxes with room numbers listed on the mail, and residents inquiring about their mail at the front desk. Based on interviews, observations and record review, Although the allegation may have happened or is valid, there is not enough evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANIATED No deficiencies cited, exit interview conducted, copy of report and appeal rights issued. Partial payments were received in the months of October and November 2021 and a payment for the month of December 2021 was not received yet. S1 was unable to explain if she took all reasonable steps to prevent the eviction. R1 was interviewed at 1:38pm on 12/20/2021. R1 states the reason for the eviction is because S1 states that R1 has not paid rent, but the truth is that S1 has not accepted R1s rent. R1 states the eviction is illegal because S1 is still receiving the partial rent payment and refusing her portion of the rent. Based on LPAs observations and interviews it was concluded, that the facility did not follow proper eviction procedures prior to serving an eviction notice to R1. Therefore the above allegation is SUBSTANTIATED. Deficiencies cited, exit interview conducted, copy of report and appeal rights issued.the state’s words, verbatim · CDSS document, Jun 29, 2022 · control 31-AS-20211210123001

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a)(2)(A) · Plan of correction due date: Jun 29, 2022

87224(a)(2)(A) Eviction Procedures(a)The licensee may evict a resident ...(2) Provide each resident or the resident’s responsible person with a written notice... (A)The reason for the eviction, with specific facts to permit a determination ...This requirement was not met as evidenced by: Based on interviews with Administrator, the reason for eviction was not consistant with the actions taken by the administrator which poses a potential Health and safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 29, 2022

Plan of correction: The administrator has returned all payments recived for R1 back to the issuing agency. This citation has been cleared during the LPA visit.

Allegation investigated: Fire was started at facility due to lack of supervision. Staff did not treat resident with dignity and respect. Minor distributing medication to residents.

At 11:00 a.m. Licensing Program Analysts (LPAs) Melissa Ruiz and Angela Panushkina arrived at the facility to conduct a subsequent complaint visit. Upon arrival, LPAs met with Administrator Yeni Flores and explained the purpose of the visit, and an entrance interview was conducted. Allegation #1 - Fire was started at facility due to lack of supervision. To investigate this allegation, LPAs interviewed the Administrator, five (5) staff and ten (10) residents. Administrator Yeni provided an incident report with a date of occurrence 7/21/21 in which a resident was smoking inside, their sweater caught ashes and the fire alarm went off. Out of all interviews conducted no one has witnessed or heard of a fire starting at the facility. Interviews with staff revealed that although smoking is prohibited, they do know that there have been instances where residents have smoked in their room. The Administrator and a staff (S4) stated that on 7/21/21 at 5:40 p.m., they were leaving the facility and went upstairs to a resident’s room, to check it out. Unsubstantiated As soon as they arrived, there was smoke in the room from the cigarette, which was already put out and the sweater had ashes on it. Staff proceeded to throw the sweater away but there was no fire. Administrator and S4 also stated that they frequently deal with smelling fires or smoke because across the street, a lot of homeless people start fires at the park. Ten (10) residents deny seeing a fire inside the facility. Based on interviews and document review, this allegation is unsubstantiated. Allegation #2 – Staff did not treat resident with dignity and respect. In relation to this allegation, LPAs interviewed the Administrator, five (5) staff and ten (10) residents. LPAs also obtained relevant documents. Out of the interviews conducted, five (5) staff members stated they have never witnessed any staff members not treat residents with dignity and respect. All staff do recall an incident that occurred in July 2021 between a previous staff member and a resident (R1). No staff witnessed the incident, and all staff stated the previous staff was well liked by everyone at the facility. Administrator provided an incident report which stated that on 7/18/21, R1 was upset because of their medication and verbally harassed the previous staff member. R1 also grabbed and pinched previous staff’s arm. Additionally, LPA was provided with “Resident Communication Contact Reports” dated 7/16/21, 7/17/21, and 7/18/21 all of which were written by the previous staff member and include dates and times where R1 became upset and started name calling previous staff. Lastly, on 9/2/21 LPA Gary Tan conducted a complaint investigation regarding the 7/18/21 altercation. During that visit, the allegations were deemed unsubstantiated. Based on interviews and documents obtained, this allegation is unsubstantiated. Allegation #3 - Minor distributing medication to residents. To investigate this allegation, LPAs conducted interviews with the Administrator, five (5) staff and ten (10) residents. Five (5) staff members stated that they have never witnessed a minor distributing medication to residents. All staff members stated that the Administrator’s daughter frequently comes to the facility and volunteers, especially during summer vacation. All staff stated that the Administrator’s daughter helps S4 in the kitchen and S4 stated the daughter assists with unloading groceries and putting desserts in containers. Lastly, all staff deny ever seeing or working with the daughter distribute medication and nine (9) residents deny ever being given medications by a minor. Based on interviews conducted, this allegation is unsubstantiated. No deficiencies issued. Report was signed and delivered. Exit interview conducted.the state’s words, verbatim · CDSS document, Apr 7, 2022 · control 31-AS-20210802143412

Allegation investigated: Facility is receiving payments for a resident no longer in care

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with administrator Yeni Flores and explained the reason for the visit. LPA conducted physical plant tour at 9:45 AM, requested facility documents relevant to the investigation at 10:15 AM and interviewed the administrator at 10:45 AM. Regarding the allegation that Facility is receiving payments for a resident no longer in care, it was alleged that the facility is still receiving payments for Resident #1 (R1)'s Social Security Administration (SSA) benefits. LPA's record review 09/02/21 at around 2:40 PM and today at 11:37 AM, revealed that R1 left the facility on 07/01/2020 and SSA benefits checks for R1 were sent to the facility until September of 2021, but were returned to the SS Administration with acknowledgement receipt that they received the returned check. LPA's interview with the administrator today at 12:05 PM, revealed that once a resident or any person has assigned a payee, SSA do not change the payee until that resident or person designate another payee, hence, the continuation of payment to the facility. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) LPA's interview with the Reporting Party (RP) on 09/15/2021 at 9:30 AM, revealed that R1 is currently in a mental health unit and was not able to to explain to the RP what was going nor R1 remembered anything about own SSA Benefits. Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Oct 15, 2021 · control 31-AS-20210831085127

Allegation investigated: Staff physically abused resident Staff spoke to resident inappropriately

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced complaint visit to this facility to investigate the above allegations. LPA met with Administrator Yeni Flores and explained the reason for the visit. LPA conducted physical plant tour at 9:30 AM. Requested facility documents relevant to the investigation at 10:03 AM and interviewed the administrator, residents and staff between 10:15 AM to 1:30 PM. Regarding the allegation that the staff physically abused resident, LPA's interview with Resident #1 (R1) at 12:45 PM, revealed that there was no one else in the elevator when Staff #1 (S1) allegedly punched R1 in the right arm. S1 denied hitting or even touching R1 when they were in the elevator as they were at each corner of the elevator both facing the door during LPA's interview at 1:10 PM. Further, R1 denied any bruising on the arm that was allegedly hit by S1. (continued on LIC 9099-C) Unsubstantiated (continued from LIC 9099) Regarding the allegation that the staff spoke to resident inappropriately, LPA's interview with Resident #1 (R1) at 12:45 PM, revealed that there was no one else in the elevator when Staff #1 (S1) spoke inappropriately at R1. LPA's interview with S1 revealed that while on the elevator, S1 was on the phone trying to call the administrator to report R1's behavior as directed by the administrator when S1 begins acting up. Further, S1 also denied saying anything inappropriate to R1. Based on the information gathered during this visit, the allegations are deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.the state’s words, verbatim · CDSS document, Sep 2, 2021 · control 31-AS-20210830094114

Allegation investigated: Residents are smoking in their rooms

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced initial (10) day complaint visit and met with Administrator Yeni Flores. The following was determined: It is being alleged that residents are smoking in their rooms. From 930am to 1145am, LPA conducted interviews, and made visual observations of residents and the physical plant, which included the common areas, the front entrance, and the inside patio. LPA observed residents smoking outside the front entrance, and other designated smoking areas. According to the information obtained, it was confirmed by the Administrator that there was a resident that was recently caught smoking in the room. The Administrator reported to LPA, there was a discussion with the resident, who was instructed to not smoke in the room. The resident has complied and has been seen smoking in the designated areas. Substantiated Also through interviews, resident # 1 (R1) confirmed smoking in the room. It was also reported to LPA, there have been previous issues with other residents smoking in the room; those issues have been resolved. Although the Administrator has confirmed residents have smoked in their rooms, it is known, it is a violation of the facility’s house rules and the Administrator continues to address the issue. This poses a potential health and safety risk to residents in care. Therefore, based on interviews, the allegation, “Residents are smoking in their rooms” is SUBSTANTIATED.the state’s words, verbatim · CDSS document, Aug 23, 2021 · control 31-AS-20210813133024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Aug 30, 2021

Personal Rights of Residents in All Facilities:(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2)To be accorded safe, healthful comfortable accommodations..This requirement was not met, evidenced by: Interviews revealed residents have been caught smoking in their rooms. This is a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Aug 23, 2021

Plan of correction: Administrator will continue to monitor residents who are observed smoking in the rooms and will have a contract signed that violation of that policy will constitute a consequence. LPA obtained a notice that will be provided to the resident for violation of the policy. POC cleared at the visit.

Allegation investigated: Facility not providing a safe environment for resident

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced complaint visit to gather additional information and to deliver the finding for the above noted allegation. LPA met with Candy Hernandez, Receptionist. The purpose of the visit was discussed. Facility not providing a safe environment for resident. To investigate this allegation, LPA Valenzuela conducted an unannounced visit on 2/26/21 and between 3:33pm and 4:05pm, initiated staff and resident interviews, Staff and resident interviews revealed that no one is aware of any altercations between residents. At 3:45pm, LPA toured Resident #1 (R1) and Resident #2 (R2)'s room. Both residents were present at the time and were co-habiting peacefully. LPA interviewed both residents. R2 denied assaulting R1. When LPA interviewed R1, they were unable to concentrate and answer any questions, On 7/16/21 between 4pm and 5pm, LPA conducted document review, which did not reveal any pertinent information to support the allegation. Based on interviews, observation, and record review, this allegation is UNSUBSTANTIATED at this time. Exit interview conducted and a copy of the report was issued. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jul 18, 2021 · control 31-AS-20210223090521

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility at 9:45am to conducted a One (1) year Required Infection Control visit. LPA meet with the administrator and explained the purpose of this visit. A tour of the physical plant was conducted at 10:00am and the following was observed: The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) posted and hand sanitizers wall mounted throughout the facility. The PPE screening station is located in the administration front desk office equipped with sufficient PPE readily accessible a thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit. Visitors are allowed in the facility in residents rooms or in the common areas, activity room or outside patio shaded area with benches for seating. Fire Extinguishers located through out the facility first, second and third floor all serviced dated May 7, 2021. At 11:30am the fire alarm system was tested and observed to be working, it is hard wired and they have a water sprinkler system. The facility has four (4) First Aid kit storing locations. The medication room, administration office, kitchen and room 126 which is the shower room also equipped with PPE. The facility has an approved mitigation plan on file. Kitchen: The kitchen was observed to be clean and an adequate supply of perishables and non-perishable food was located in the fridge, freezer and pantry. Food was properly labeled and stored. The emergency food is stored and observed to locked in a room labeled "Emergency Plan" across from the elevator and sprinkler valve room. Trash cans were observed to be open without a lid. Lunch is staggered and served in individual plastic bags to maintain social distancing, lunch may be taken on the go or seated if room permits. Sharps are stored in the kitchen inaccessible to residents. (Continued on LIC 809C) Storage Rooms: LPA observed four (4) locked storage rooms: Storage one (1) located at the entrance to the right in the tv room has been built to storage for PPE and facility toiletries. Storage two (2) located across from the medication room which is stocked with toxins, trash bags and other cleaning supplies. Storage three (3) located across from the medication room stocked with sufficient supply of linen individually wrapped in plastic protective covering. Client Rooms: Rooms numbers 118: slow water drainage in sink and shower grab bars loose, 123: slow water drainage in sink, 141: slow toilet flush, shower grab bars loose. They all were observed on the second floor to be clean and appropriately furnished and without trash can lids. Water temperature on second floor range from 105.9 to 117.3 Rooms number 201, 226 246 were all observed on the third floor to be clean and appropriately furnished and without trash can lids. Water temperature range from 105.4 to 110.2 The emergency response cord were pulled and tested in all of the rooms which received a response within ten seconds from the front desk. No hospice residents at the time of visit. Laundry Room: Located on the first floor observed to be clean and clear from obstruction. Residents are allowed to do there own laundry if they choose, all laundry soap is locked in storage and is given by staff from the locked storage room if needed. Living, dining room and common areas: Observed to have sufficient tables and chairs for seating. Social distancing mark on floor. Part of the parking lot is being used to store remolding supplies and flooring materials. No resident access to the parking lot. It is gated and requires entry into the facility. Citation issued, appeal rights discussed and given. Exit interview conducted. Copy of this report issuedthe state’s words, verbatim · CDSS document, Jul 15, 2021