The Lighthouse

Allegation investigated: Staff failed to have complete medical records on file. Staff did not observe resident's change in condition.

Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced subsequent complaint visit at this facility. At 9:30 a.m., the LPA met with staff and explained the reason for the visit. At 9:55 a.m., the Administrator arrived at the facility. During the initial visit on 01/12/2023, between 10:33 a.m. and 12:45 p.m., the LPA conducted interviews with four (4) staff interview, five (5) resident interview and with the Administrator. The LPA also conducted a brief physical plant tour to ensure there are no health and safety hazards. During the initial visit, the LPA requested pertinent documents. Additionally, on 01/12/2023 at 12:17 p.m., the LPA conducted an interview with a Resident #1 (R1)’s family member. On 02/07/2023, the LPA conducted a file review of R1’s documents. During todays visit, at 10:21 a.m., the LPA conducted a physical plant tour. Continued on LIC 9099-C. Unsubstantiated Regarding the allegation: Staff failed to have complete medical records on file. On 01/03/2023, the Department received a complaint alleging that while the paramedics were at the facility for Resident #1 (R1) that staff did not have R1’s completed medical record or knowledge of R1’s medical history on hand. During the interview with the Administrator, it was revealed that resident files are located in two (2) areas throughout the facility. The original copies of resident files are located in the Administrators office and copies of the original files including residents’ physicians report are located in the medication room. The Administrator explained that staff have access to both areas. Interviews with Staff #1 (S1) revealed that when the paramedics are at the facility, that S1 typically goes to the medication room and makes copies of the residents file for the paramedics. S1 stated that sometimes if a file isn’t complete, they go to the Administrators office to complete the file. The Administrator explained that if the residents file isn’t complete in the medication room that it is complete in the Administrator office. On 01/12/2023, the LPA received a copy of R1’s file. On 02/07/2023, the LPA reviewed R1’s file and observed the file to be in compliance and complete. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. 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 deemed Unsubstantiated at this time. Regarding the allegation: Staff did not observe resident's change in condition. On 01/03/2023, the Department received a complaint alleging that staff did not observe R1’s change in condition within the past few days prior to R1’s hospitalization on 01/03/2023. The complainant believed that R1 had sepsis and that staff did not notice the symptoms of sepsis. During the interview with the Administrator, she stated that when caregivers conduct body checks or are assisting residents, that they always report back to the Administrator if a resident presents any changes or change of condition. The Administrator said that the caregivers constantly communicate with her regarding R1’s condition. The Administrator said that R1’s family member visits R1 twice a week and she constantly communicates with R1’s family member about R1’s condition and well-being. The Administrator said that if R1 has a change of condition, that she notifies R1’s responsible person and R1’s doctor. Interview with R1’s family member revealed that the Administrator and caregivers always update and communicate with R1’s family member about R1’s condition and well being. R1’s family member did not voice any concerns regarding R1’s care and supervision at the facility. Continued on LIC 9099-C. Additionally, a file review conducted by the LPA revealed that the Administrator faxed an Unusual Incident/ Injury Report to the Department on 01/05/2023 regarding R1’s hospitalization on 01/03/2023. The incident report described that on 01/03/2023, staff noticed R1’s right side of the face being droopy and right eye closed. Staff called 911 and R1 was transported to the hospital. Per the incident report, staff did notice a change in condition of R1 which they proceeded to call 911. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. 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 deemed Unsubstantiated at this time. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Aug 30, 2023 · control 29-AS-20230103143807

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. At 9:30 a.m., the LPA met with staff and explained the reason for it visit. At 9:55 a.m., the Administrator arrived at the facility. At 10:21 a.m., the LPA, along with staff, toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: The LPA observed the kitchen/dining area. Knives are stored in the locked kitchen which is inaccessible to residents. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 10:34 a.m., hot water measured at 105.2-degree Fahrenheit. BEDROOMS: The LPA observed multiple resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:26 a.m., hot water measured between 105.6 and 108.5-degree Fahrenheit in multiple restrooms. The sinks had sufficient liquid soap, and paper towels. Signs are posted throughout the facility restrooms to promote handwashing. Continued on LIC 809-C. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. The LPA observed the fire extinguishers throughout the facility to be fully charged and last serviced on 02/06/2023. Fire alarm system/ emergency lighting was observed and was last tested on 02/2023. At 3:52 p.m., the carbon monoxide detector was tested and functioned properly. The LPA observed cameras installed in the hallways and common areas. All exits have functioning auditory devices and were operational at the time of the visit. Required postings were observed in the hallway. Medications and first aid kits are located in a locked medication room. OUTDOOR SPACE: At 10:36 a.m., the LPA observed the courtyard area, which has a covered outdoor area for resident use. Passageways and exits were free and clear from obstruction. There is a gate on the side of the facility designated for an emergency exit. The laundry units are located in the laundry room near the courtyard. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the janitor room and a storage room. Between 10:54 a.m. and 11:45 a.m., the LPA conducted interviews with five (5) out of twenty-five (25) residents and four (4) staff. RECORD REVIEWS: Between 2:26 p.m. and 3:06 p.m., the LPA conducted a file review for five (5) residents and five (5) staff and observed the following: Staff have current first aid and training documentation showing required training completed. Resident records were reviewed for, but not limited to care plans, medical records, admissions agreement, consent forms. All files were in order. Between 3:09 p.m. and 3:25 p.m., the LPA conducted a review of medication and medication documentation with Administrator for five (5) out of twenty-five (25) residents and observed that all medications were properly documented and assisted with as prescribed. Copy of valid liability insurance and Facility Emergency Plan was provided to the LPA during the visit. No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.the state’s words, verbatim · CDSS document, Aug 30, 2023

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. LPA was greeted and screened by staff. At 2:17 p.m., the LPA met with the Administrator and explained the reason for the visit. This annual had a specific emphasis on infection control practices and procedures. At 2:36 p.m., the LPA, along with staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and that the facility is in compliance with Title 22 Regulations. KITCHEN: At 2:40 p.m., the LPA observed the kitchen/dining area. Knives are stored in the locked kitchen which is inaccessible to residents. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 2:42 p.m., hot water measured at 108.5-degree Fahrenheit. BEDROOMS: The LPA observed multiple resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 2:38 p.m., hot water measured at 105.3-degree Fahrenheit. Additionally, one of the common restroom water temperature measured at 106.0 degree Fahrenheit. COMMON AREAS: The LPA observed common area to be relatively clean and properly furnished. At 2:54 p.m., the LPA observed residents and staff playing a game of bingo. The LPA observed the fire extinguishers throughout the facility to be fully charged and last serviced on 02/07/2022. Signs are posted throughout facility to promote handwashing, cough/sneeze etiquette, and physical distancing. Fire alarm system was observed and was last tested on 02/15/2022. The LPA observed cameras installed in the hallways and common areas. Continued on LIC 809-C. Medications and first aid kits are located in a locked medication room. Cleaning solutions, toxins, chemicals and hazardous items were inaccessible and locked away in the janitor room near the kitchen area. The laundry units are located in the laundry room near the courtyard. OUTDOOR SPACE: At 2:46 p.m., the LPA observed the courtyard area, which has a covered outdoor area for resident use. Passageways were free and clear from obstruction. There is a gate on the side of the facility designated for an emergency exit. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. The LPA observed a 30-day supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility’s policies and procedures as it pertains to infection control are adequate. At 2:26 p.m., the LPA conducted the Infection Control mitigation module with the Administrator. No deficiencies were observed at this time. Exit interview conducted with the Administrator. Report issued and a copy of the report will provided via email.the state’s words, verbatim · CDSS document, Jul 19, 2022

Allegation investigated: Staff physically abused resident. Staff denied resident food and water.

Licensing Program Analyst (LPA) Emily Peraldi conducted a subsequent complaint visit to deliver findings for the above allegations. At 12:20 p.m., LPA met with Administrator, Gabriela Visovan and explained the reason for the visit. Regarding the allegation: Staff physically abused resident. On 08/21/2020, the Department received a complaint regarding Physical Abuse. Resident #1 (R1) was admitted to the hospital with bruising on left hand and both arms. R1 stated the facility staff “bang” on her. On 08/24/2020, the complaint was referred to Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Edward Hector. Continued on LIC 9099-C. Unsubstantiated Continued from LIC 9099. On 08/24/2020, from 12:30pm to 1:22pm, Licensing Program Analyst (LPA) Desaree Perera conducted the initial complaint visit. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint visit was conducted via FaceTime with Administrator Gabriela Visovan. During the visit, LPA Perera conducted a virtual physical plant tour at 12:37pm. LPA also conducted an interview with Administrator and requested documentation pertinent to the allegations at 12:50pm. No immediate health and safety concerns were noted. LPA determined further investigation was required. On 09/10/2020, at 8:55am, Investigator Hector reviewed facility documents related to R1. According to the Physician Report dated 03/13/2018, R1 had a history of skin condition or breakdown, specifically, pressure injuries. R1 had a high capacity for self-care that included being able to feed, toilet, bathe and dress self; manage own cash resources independently; conduct grooming with assistance; and able to independently transfer to and from bed. According to the Appraisal Needs and Services Plan dated 06/12/2020, R1 was described as “unhappy with everything and everyone”. It also stated R1 was abusive towards all staff. According to a hospital assessment involving R1’s emotional/psychological health, R1’s representative reported that R1 accuses “others of stealing belongings” that are later found to be in R1’s room and R1 “accuses others of poisoning R1”. R1’s representative said they are skeptical of any abuse reported because, when R1 “doesn’t want to cooperate R1 will claim that R1 is being abused”. On 11/25/2020, from 8:50am to 9:30am, Investigator Hector conducted interviews with the Long-Term Care Ombudsman (LTCO); at 9:59am, left a voicemail for the reporting party; at 10:25am, with the Los Angeles Police Department (LAPD) North Hollywood Community Police Station; on 12/01/2020, at 9:34am, attempted to contact the reporting party, voicemail full/unable to leave message; at 11:56am, with the reporting party; at 12:07pm, with R1’s primary care physician; and from 2:50pm to 3:08pm, with facility residents and Administrator. Continued on LIC 9099-C. According to the medical records, R1 was transported via ambulance to the Providence Saint Joseph Medical Center on 08/17/2020, at 5:38pm, for the chief complaint of “weakness”. During the assessment the nurse denied seeing signs of abuse, the MD confirmed no signs of abuse found. The medical records listed R1’s overall behavior as noncompliant. More specifically, the records describe R1 as “alert, very rude and hitting caregivers, spitting meds, refused to eat in spite encouragement”. R1 was observed to have multiple skin issues. However, when hospital staff attempted to do wound care, R1 refused. The nurse noted R1 had no bruising. R1 presented to the hospital with Stage 1 pressure injuries on posterior medial coccyx and upper posterior back and Stage 2 pressure injuries on right ischial tuberosity and upper lateral scapula. R1 also had other wounds of dryness and scaling of leg and moisture damage wounds near the groin and buttocks area. R1 was also diagnosed with dehydration and a Urinary Tract Infection (UTI). However, the records indicate R1 refused food and meds from hospital nurses. R1 also tested positive for the COVID-19 virus. R1 was discharged on 08/24/2020. R1 returned to the hospital on 08/26/2020 and was diagnosed with UTI, still tested positive for the COVID-19 virus, severe protein-calorie malnutrition condition, and a Stage 1 pressure injury on left heel. The physician noted R1 had altered mental status and lethargic. Progress notes listed that the readmission within the last 30 days was due to the previous discharge plan was unsuccessful. The medical staff met with R1’s representatives to review R1’s overall health. Hospital staff reviewed potential causes of R1’s altered mental status could possibly be attributed to testing positive for COVID-19 or due to UTI. The hospital staff also advised that the altered mental status may possibly be attributed to R1 approaching the end of life and would need 24-hour care. As a result, the hospital staff recommended R1 be placed on Hospice care. R1 was discharged on 09/01/2020. . According to the medical records, the doctors and nurses noted no signs of abuse. Furthermore, R1’s primary care physician confirmed R1’s bruising was attributed to “fragile” skin. The physician also had no concerns of rough handling by the facility staff. Based on the information obtained, the Department does not have sufficient evidence to support the above allegation. Therefore, the above allegation is deemed Unsubstantiated at this time. Continued on LIC 9099-C. Continued from LIC 9099-C. Regarding the allegation: Staff denied resident food and water. On 08/21/2020, it was alleged that the staff denied food and water to resident. During the initial visit, conducted virtually to implement mitigation measures related the Coronavirus Disease 2019 (COVID-19) on 03/25/2020, LPA Desaree Perera conducted a virtual physical plant tour, and interviewed the Administrator and requested pertinent files and documents between 12:30 p.m. and 1:22 p.m. On 03/18/2022 at 12:20 p.m., LPA Peraldi conducted a subsequent complaint visit. At 12:26 p.m., LPA Peraldi conducted a physical plant tour. Between 12:27 p.m., and 1:12 p.m., LPA Peraldi interviewed five (5) out of twenty-four (24) residents. Additionally, between 12:40 p.m. and 1:30 p.m., LPA Peraldi interviewed two (2) staff and the Administrator. At 12:30 p.m., LPA Peraldi observed residents eating in the dining area. Interviews with residents and staff revealed that the facility has an accessible water fountain that dispenses filtered hot and cold water. At 1:34 p.m., LPA Peraldi observed the water fountain located outside in the patio. Additionally, interviews with residents revealed that the facility does not deny residents of food and water. Based on the information obtained, the Department does not have sufficient evidence to support the above allegation. Therefore, the above allegation is deemed Unsubstantiated at this time. Exit interview conducted with Administrator. A copy of the report and appeal rights will be provided via email.the state’s words, verbatim · CDSS document, Mar 18, 2022 · control 29-AS-20200821132223

Type of visit: Required - 1 Year

At 10:40 a.m., Licensing Program Analyst (LPA) Emily Peraldi arrived at the facility unannounced to conduct a required annual visit. LPA was greeted and screened by Administrator, GABRIELA VISOVAN. This annual had a specific emphasis on infection control practices and procedures. At 10:50 a.m., 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. OUTDOOR SPACE: At 11:05 a.m., LPA observed the patio, which has a covered outdoor area for resident use. There is a gate on the side of the facility designated for an emergency exit. Passageways were free and clear from obstruction. KITCHEN: At 11:03 a.m., LPA observed the kitchen/dining area. Knives are stored in a locked cabinet. Kitchen appliances are in operable condition. The facility has a sufficient supply of perishable and non-perishable food. At 11:05 a.m., LPA observed staff preparing food in the kitchen. Medications and first aid kits are located in a locked medication room. BEDROOMS: LPA observed resident bedrooms, which were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Inside temperature was maintained at a comfortable level. RESTROOMS: Restrooms are relatively clean and sanitary and in operating condition with grab bars and non-skid mats. At 10:52 a.m., LPA observed over the counter medication in resident room #1. The staff removed these items upon observation. At 11:44 a.m., hot water measured at 113.3-Degree Fahrenheit. Continued on LIC 809-C. Continued from LIC 809. Common Areas: LPA observed common area to be relatively clean and properly furnished. At 10:53 a.m. LPA observed the fire extinguisher to be fully charged and last serviced on 02/03/2021. INFECTION CONTROL: During today’s visit, the LPA spoke with the Administrator regarding the facility’s infection control practices. Upon entry, the facility has a central entry point for symptom screening, temperature checks, and a sanitation station. LPA observed a 30-day supply of Personal Protection Equipment (PPE) and the facility is able to obtain additional supplies as needed. The facility’s cleaning protocol is sufficient. If needed, the facility has the capacity to designate a single isolation room if the facility has a confirmed case of COVID-19. The facility has not had a confirmed case of COVID-19 at this time; however, the facility’s policies and procedures as it pertains to infection control are adequate. Between 11:00 a.m. - 12:00 p.m., LPA conducted Infection Control mitigation module with Administrator. The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. Report issued and a copy of the report and appeal rights was provided via email.the state’s words, verbatim · CDSS document, Aug 24, 2021