The Isles Assisted Living Facility

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct an Annual Required 1 Year inspection and met with Administrator, Suzette Tawzar. Upon arrival, LPA observed that staff continue to wear masks per current guidance. LPA initiated a tour of the facility and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Residents rooms were furnished per regulation. Water temperature in bathrooms measured at 112 and 117 degrees F which is within the required allowed regulation range of 105 to 120 degrees F. Extra hygiene products and linens were available. Cabinet containing cleaning supplies was locked. Facility has at least two days of perishable and one week of non-perishable foods which appeared to be of quality and stored per regulation. Medications were centrally stored and locked. Fire extinguisher were last inspected March 3, 2023. Smoke and Carbon Monoxide detectors located throughout the facility were tested and operational. Exit doors have an auditory alarms to alert staff, if a door is opened. Three staff files and 3 resident files were reviewed. Staff have required First Aid and CPR certificates but lack the required Health screenings and required staff training. Administrator Certificate for, Suzette Tawzer expires 12/27/2023. Continued on LIC809C Continued from LIC809 One of six residents did not have a fully signed pre-appraisal on file or completed/signed Admission Agreement. Per conversation with Administrator, resident, R1s POA was returning to the facility to complete. LPA discussed with Administrator, that the left side yard gate is not opening properly and getting stuck, gate is also not self closing and latching as required and needs to be repaired and corrected. In addition LPA went over several areas (8) the backyard wooded deck that are loose, broken and not firm and will be required to be correct or replace. Administrator and LPA discussed their Emergency Disaster Plan and Infection Control Plan. Licensee/Administrator to submit updates of the following documents by 4/21/2023: LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan (If changes) LIC9020 Register of Residents LIC308 Designation of Responsibility Infection Control Plan (If changes) Liability Insurance Copy of current Lease Agreement current facility sketch LPA was unable to review medication and 3 additional resident files and will return at a later date to complete annual inspection. No deficiencies cited at this time, LPA will return and issue citations warranted.the state’s words, verbatim · CDSS document, Mar 23, 2023

Allegation investigated: Illegal Eviction

Licensing Program Analyst (LPA), Araceli Canela arrived unannounced for the purposes of delivering findings and gathering copies of records regarding the above investigation for complaint number 21-AS-20220919152649. LPA toured the facility and made observations. It was alleged resident R1 received an illegal eviction. R1 sustained a fall, fractured their hip and was sent to a rehabilitation facility after surgery. Investigation revealed, R1 was ready to be discharged and return to the Isles Assisted Living facility. Facility did not issue a lawful legal eviction and expressed to R1's family they were unable to take R1 unless they received a current Physician report and negative Covid test, but also explained they were unable to meet R1's needs as R1 was needing more assistance. see LIC9099-C for continuation of report Substantiated LPA received information, facility spoke with hospital discharge social worker and explained to them, they would not accept R1 back as R1 required more staff to watch R1 all the time, for their safety. Based on LPA’s record review and statements received, R1 did not receive a Legal eviction, the preponderance of evidence standard has been met, therefore, allegations for, "Illegal Eviction" is found to be SUBSTANTIATED. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. It was also alleged resident's property was disposed due to sudden eviction. Investigation revealed, residents property was picked up by a company that R1's family hired to pick up items and discard. Facility explained, they informed R1's family they could not accept R1 and they would need to remove their belongings, but did not ask them to throw away. Facility had previously informed R1's family several months before that R1 required more assistance and had issued an eviction to R1. Facility was unable to accept resident back from skilled nursing facility and asked the family to remove R1 belongings. Although the allegations may be true, or are valid, there is not a preponderance of evidence to prove the alleged violations did, or did not, occur. Therefore, the allegations for Licensee refused to reimbursed resident's representative and Resident's property was disposed due to sudden eviction is UNSUBSTANTIATED. No citations issued regarding the above allegations.the state’s words, verbatim · CDSS document, Feb 14, 2023 · control 21-AS-20220919152649

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Feb 21, 2023

87224(a) Eviction Procedures. The licensee may, upon thirty (30) days written notice to the resident, evict the resident for nonpayment of the rate for basic services, failure to comply with state or local law, failure to comply with the general policies of the facility, development of a need not previously identified, and/or a change of use of the facility. This requirement was not met as evidenced by: R1 did not receive a proper eviction letter as required. This is a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Feb 14, 2023

Plan of correction: Facility to send in written plan, they understand regulation and how they will ensure they follow it. POC due date 2/21/2023 LPA Araceli Canela

Allegation investigated: Facility does not have not have a proper system for residents to alert staff for assistance. Facility staff left resident in soiled bedding for an extended period of time.

Licensing Program Analyst (LPA), Araceli Canela arrived unannounced for the purposes of opening the above investigation for complaint number 21-AS-20230203105830. LPA toured the facility, made observations and took statements. The Administrator, Suzette Tawzer arrived a few minutes later. It was alleged Facility does not have not have a proper system for residents to alert staff for assistance. LPA A Canela conducted a walk through and observed 2 resident bedrooms(R1, R2)with no bells or alert system and 1 resident bedroom(R3) with a bell that was broken and non operational. This facility has long hallways and staff bedrooms are on the front side of the facility and residents who may need assistance at night require a way to properly alert staff for help. See continuation of report LIC9099-C Substantiated It was also alleged facility staff left resident in soiled bedding for an extended period of time. Investigation revealed resident R1 was not able to get assistance at night. It was corroborated, staff respond during the day, when residents call for assistance, but when the bell is used at night, staff cannot hear and do not respond. In addition R1 did not have a bell. It was disclosed to LPA resident R1, called for assistance to use the bathroom/potty chair and staff did not respond. R1's physician report states R1 needs assistance out of bed as they are at fall risk. R1 stated they slipped to the floor, urinated and then grabbed blanket to cover themselves as it was cold and remained on the floor in a soiled floor/blanket until the morning when staff found R1. There was no indication of the exact time R1 was left without assistance as they were not able to communicate with staff. LPA received contradicting statements from staff who stated, R1 was found hiding on the floor, was not urinated but had heard/seen R1 throwing up. Staff later disclosed, they found R1 with throw up sitting on the floor at 4 am. Staff also stated R1 was not there long and had probably just threw up, yet staff disclosed to LPA they last saw R1 at 1am and then saw R1 again around 4am. Based on LPA’s record review, statements received, and contradicting statements from staff, the preponderance of evidence standard has been met, therefore, allegations for, "facility does not have not have a proper system for residents to alert staff for assistance and facility staff left resident in soiled bedding for an extended period of time; are both found to be SUBSTANTIATED. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.the state’s words, verbatim · CDSS document, Feb 10, 2023 · control 21-AS-20230203105830

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87464(a)(d) · Plan of correction due date: Feb 13, 2023

87464 Basic Services (a) The services provided by the facility shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care....... (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. This requirement was not met as evidenced by: R1 was left in soiled clothing when they did not receive assistance at night to use the bathroom This is an immediate risk to residents in carethe state’s words, verbatim · CDSS document, Feb 10, 2023

Plan of correction: Facility to send in a written statement they understand regulation, and proof of staff training. POC due date 2/13/3023 Attention LPA A CanelaPP

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(i)(2) · Plan of correction due date: Feb 17, 2023

87303 Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria:(2) Facilities having more than one wing, floor......provided each meets the above criteria. This requirement was not met as evidenced by: This facility is L shape with long hall way. Residents require a signal system to alert staff for assistance. R1, R2 and R3 do not have a working bell or system. This is a potential risk to the Health & Safety of residents in carethe state’s words, verbatim · CDSS document, Feb 10, 2023

Plan of correction: Facility to send in written plan on how they will ensure they follow regulation and proof of staff training.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Araceli Canela arrived unannounced regarding another matter. The purpose of this Case Management visit is to address the facility unpaid annual fees. Administrator explained, they did not receive notification but will be paying the annual fees within 5 days and send proof to LPA Canela. LPA advised, failure to bring her facility fees current may result in the facility being cited. No citations issued during this visit.the state’s words, verbatim · CDSS document, Sep 22, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) A. Canela arrived unannounced to conduct a Case-Management - Incident visit, and met with assistant Administrator, Maria Buna. The purpose of the visit was to follow up on a self-reported incidents submitted to Community Care Licensing (CCL). CCL received a call from Licensee and several self-reported incident reports regarding resident R1. Reports submitted include incident dated 7/27/2022 where resident R1 went to an area of the yard that is not paved using their motorized wheelchair and sustained a fall. R1 was sent to emergency Kaiser Vallejo for a skin tear. Facility expressed the area where R1 fell, is a dirt area where the facility has some trees planted and the residents have the entire surrounding wooden deck and paved area to use. Facility placed a wood board to prevent R1 in going to that area of the yard. On 8/17/2022 R1 sustained another fall, fire department assisted and R1 refused to go to the hospital. On 8/22/2022 R1 sustained another fall, fire department assisted in lifting and R1 refused medical treatment. On 8/26/22 and additional incident report was submitted, reporting R1 used their electric chair and was in the inside of the facility by the front gate, when their chair got stuck, staff S1 stated to LPA, R1 got up and attempted to walk and fell. Staff S1 rushed out to help but when S1 got there, R1 was already on the floor. R1 complained of right pain, facility called 911, fire department and ambulance arrived and R1 was sent to the hospital. It was reported R1 sustained a hip fractured and required surgery. R1 was sent to a skilled nursing facility and facility expressed they will not be able to meet the current needs of the resident as they have changed and R1 requires a higher level of care and a 30 day eviction is in the process. LPA will review information, no citations issued at this time.the state’s words, verbatim · CDSS document, Sep 13, 2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a Required - 1 Year inspection and met with, care staff Iverette "Joy" Villa, Marilou Barrola and toured the facility. The annual inspection is focused on the Infection Control procedures and practices of this Residential Care Facility for the Elderly. This facility is licensed for a total of 6 non ambulatory residents, there are currently 5 residents in care, none receiving Hospice services. LPA toured facility and grounds and observed COVID-19 precaution signs posted in common areas to promote hand washing. LPA was screened for COVID-19 symptoms upon entrance to this facility. Visitors are said to be screened for COVID-19 symptoms upon arrival to the facility. Infection control practices present: entry procedures, daily monitoring and temperatures checked for residents and staff, and 30-day PPE supply. Facility staff were observed wearing no mask, LPA requested staff to wear mask and follow Covid procedures and Mitigation plan at all times. Facility to follow indoor visitation requirement of verifying and tracking COVID-19 vaccination or verify non-essential visitors have proof of a negative COVID-19 test. Facility states staff clean and disinfect the facility daily. Bathrooms are equipped with liquid soap and paper towels. Covid-19 Mitigation plan will be reviewed. Caregivers have completed PPE training but have not been N-95 Fit tested. In addition, facility was found to be clean at a comfortable temperature with all exits free from obstruction. Facility has at least two days of perishable and one week of non-perishable foods and items are stored properly. Fire Extinguisher was found to be charged, but last serviced 2/16/2021. During today's inspection staff S1 had the proper fingerprint clearance but was not properly associated to this facility as required Continue report see LIC809-C The facility Administrator has changed and the facility has not submitted paperwork to Community Care Licensing (CCL) for the change. It was also reported to CCL, there has been facility ownership changes and LPA previously called and left a message for Suzzette Tawzler, that a New License may be required and an Application must be submitted immediately if there is a change of Ownership. Licensee Suzette Tawzler was not present during the inspection and spoke with LPA by phone. Licensee gave care staff approval to sign licensing reports. A civil penalty for $100.00 is issued during todays visit, for facility failure to Associate staff S1 to this facility prior to working as required. Facility staff to get N95 fit tested Send in updated LIC500 Personnel Report Send in LIC308 Designation of Responsability See LIC809-D for: Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 8 and the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Appeal rights and report will be emailed today to facility, due to technical issues..the state’s words, verbatim · CDSS document, Mar 3, 2022

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.