The Redwoods

Type of visit: Required - 1 Year

License Program Analyst (LPA) Hansen arrived unannounced to conduct an annual required 1 – year inspection visit of the facility. LPA was welcomed by CEO Hunter Moore, COO/Administrator Kyle Ruth-Islas arrived shortly after. There is a total of 124 residents, 9 of which have dementia diagnosis. There are 3 residents currently on Hospice. LPA toured the facility on 8/7/2023 at 8:45 AM with Administrator Kyle Ruth-Islas; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Fire Extinguishers were found to be last charged on 1/11/2023 at the time of the visit. Facility hallway smoke detectors are hard wired and sound directly to the fire station. Smoke detectors, carbon monoxide, and fire sprinklers are inspected, and inspection records are current with the last inspection being conducted on 4/6/2023. There are emergency lights in many of the fixtures in the common areas of the facility that come on should a power outage occur. Hot water temperature measured between 113.7 degrees F and 135.5 degrees F falling out of Title 22 acceptable regulation of 105 to 120 degrees F in 5 of 7 resident’s faucet bathrooms while touring facility on 8/7/2023 at 9:45 AM (see LIC809D). Facility serves residents with dementia and has special care plan of operation and programming. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations at the time of the visit. LPA toured the kitchen area on 8/7/2023 at 9:00 AM with Administrator Kyle Ruth-Islas and learned that there are provisions made for individuals/residents with special dietary needs. Facility kitchen has resident’s names and their needs. Food is available for residents any time of the day. There is a daily activity schedule for residents. Toxins are stored in a locked housekeeping room. There was a supply of cleaners, hygiene products and paper products available for residents. (Continue LIC 809-C) Bathrooms were equipped with necessary grab bars, and non-slip floors/mats were present in the bathroom shower. A sample of eight resident’s bedrooms was conducted, and bedrooms inspected have lighting & appropriate furnishing. LPA is advising facility to ensure that beds are outfitted with mattress pads as required by Title 22 Regulations. A sample review of five resident & seven staff records was conducted. LPA reviewed resident’s files at 12:00 PM on 8/7/2023 and learned that 5 out of 5 residents have an updated reappraisal/needs & care plan on file as well as medical assessments at this time as required by Title 22 Regulation. Medications were centrally stored in a locked medication cart in the facility medication room. LPA conducted a sample reviewed of staff records at 1:15 PM on 8/7/2023 and learned that all facility staff and other individuals who require caregiver background checks have received criminal record clearances or exemptions. In addition, Direct care staff have received the additional training requirements as per Title 22 Regulations and H&S Code. LPA was presented with proof of CPR & 1st Aid certification for all staff. LPA reviewed Licensing Information System (LIS) with administrator who stated that is corrected and updated at this time; no need to change any of the information other than email. Disaster Drills are conducted quarterly with the last one being conducted on 7/12//2023. Facility has just finished installation of full cite emergency generator. Kyle Ruth-Islas Administrator Certificate # 6029464740 expires on 1/15/2024. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) 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. (Continue LIC 809-C) LPA Hansen is requesting Licensee to update the following documents and submit to CCL by 9/1/2023: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 9020 Register of Facility Client’s/Resident’s Copy of Administrator Certificate Copy of Certificate of Liability Insurancethe state’s words, verbatim · CDSS document, Aug 7, 2023

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Hansen arrived unannounced at facility for the purpose of conducting a Case Management- incident inspection regarding a medication error. LPA met with Administrator Kyle Ruth-Islas & Jill Ciambriello, Social Worker. LPA is following up regarding a self-reported Incident Report received by Community Care Licensing (CCL) on 07/6/2023 of a medication error. The error occurred on 7/5/2023 at the nurse’s station. Resident (R1) came to station for medication, while R2 came into the office with Med Tech. Med Tech handed the agency nurse on duty medication for resident R2 and the nurse mistakenly gave it to R1. (See LIC809-D). All appropriate parties and prescribing physician were notified of the medication error. R1 was sent to hospital overnight for observation. LPA obtained copies of the in-house incident report indicating a medication error along with the Medication Assessment Record (MAR) for the month of July 2023 for R1 that reflects the said medication error. The following deficiencies were observed (see LIC 809D) 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, Jul 13, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5): · Plan of correction due date: Jul 13, 2023

87465(a)(5): Incidental Medical and Dental Care Services. The facility shall assist residents with self-administered medications when needed. This requirement is not met as evidenced by: Based off self-reported incident report and interview with Administrator and MSW, the Nurse provided R1, R2’s medication. The facility failed to ensure R1's medication was given as prescribed by doctor which poses an immediate health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Jul 13, 2023

Plan of correction: Facility has provided proof of Medication Inservice Training with staff names and signatures on it. Facility to also perform random audits on medication administration for 4 weeks to ensure compliance. Deficiency has been cleared during today’s visit.

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Shannan Hansen arrived unannounced to conduct an investigation into a self reported incident report received by Community Care Licensing (CCL) on 06/21/2023 regarding an incident that occurred on 06/18/2023. LPA met with Kyle Ruth-Islas, Administrator . Based on incident report of 6/21/2023, resident (R1) left the facility unassisted and after search of facility ground and surrounding areas R1 was found across the street approximately 30 minutes later. No injuries noted. R1 then walked back with staff. R1’s Physician's report dated 1/3/2023 indicates R1 cannot be in the community without assistance from the staff. 24 hr private caregiver has been put in place to monitor. Facility reported to physician, responsible party and Community Care Licensing. The following deficiencies were observed (see LIC 809D) 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, Jun 29, 2023

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.312(d) · Plan of correction due date: Jun 30, 2023

1569.312(d) Being aware of the resident's general whereabouts, although the resident may travel independently in the community. Based on review of incident report and interview with Administrator, this requirement has not been met as evidence by: Facility reported that R1 left facility unassisted. LPA gathered statements and documents from Administrator and Social Worker. R1's Physician Report states that R1 cannot leave facility unattended. This is a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Jun 29, 2023

Plan of correction: Facility to conduct elopement staff training and provide documentation of completion with staff signatures & dated, due by POC date 6/30/23. Facility & family have implemented 24 hr private caregiver for R1. Facilty having 602 updated today and will provide with Care PLan on POC due date.

Allegation investigated: Facility did not dispense medication as prescribed by doctor.

kThe Department conducted a complaint investigation regarding the allegation listed above. Licensing Program Analyst Fernandes-Goes arrived unannounced for the purpose of closing the investigation and met with Catherine Scott - Administrator. On 8/17/2022, LPA Fernandes-Goes toured the facility with Thanh Nguyen - LVN AL; conducted interviews; acquired documentation; and made observations of the facility. During interviews with complainant and staff on 8/16 and 8/17/2022 and documentation reviewed on 8/17/2022, Department learned that facility residents R2, R3, R4 have had medication that were not dispensed as prescribed by doctor. Resident R2 care plan dated 1/22/2022 states that resident needs medication setup and reminders in addition to medication management by facility including ordering medications – Continued LIC 9099-C Substantiated resident is signed up for Pharmerica; physician’s assessment dated 12/31/2021 states that resident can’t store and/or administer medications; doctor’s orders dated 1/23/2022. Resident R2 missed the following medication: Losartan 50 mg daily from 8/2/2022 to 8/10/2022 – family member was contacted on 8/10/2022 and was able to bring a refill of 7 tablets and on 8/15/2022 facility was able to receive a refill for 3 tablets according with records and Centrally Stored Medication Records (CSMR); facility contacted pharmacy however wasn’t able to receive prescription; Elequilis missed from 4/23/2022 to 4/26/2022; and Amoldine missed from 5/22/2022 to 5/23/2022 – according with CSMRs and Medication Administration Records (MARs) with state that medications were not available. (see copy of records) Resident R3 physician’s assessment dated 8/25/2017 states that facility manages medication and orders from pharmacy – Pharmerica; resident R3 has missed the following medications due to medication “not available” (see copy of MARs): Omeprazole 20 ml once daily from 5/1/2022 to 5/5/2022 and 6/20/2022 to 6/30/2022, Omeprazole 40 ml once daily from 6/21/2022 to 7/13/2022 – records show that facility contacted pharmacy letting them know that “had run out of medication”, Amoldipane 2.5 mg once daily from 6/10/2022 to 6/14/2022 – records show fax to pharmacy stating “ran out of medication on 6/7/2022, Valsartan 160 mg once daily “not available” from 5/30/2022 to 6/14/2022. (see copy of records, LIC 811 confidential name list, LIC 9099-D). Administrator and staff S1 stated that they had knowledge of resident R1 missing medication on August 2022 and that it was due to Pharmerica waiting for a renew doctor’s order to refill; doctor had been contacted and submitted refill order to the wrong pharmacy. Facility didn’t learn that refill had been submitted to the wrong pharmacy until resident R1 had already missed 8 days of medication. In addition, facility didn’t not submit incident report for any of the missing medication for R1 and R3 as it is required by Title 22 Regulations # 87211 Reporting Requirements. R4 missed Calcium from 7/21/22 to 7/25/22 .(see case management datimg 9/12/2022) Based on observations, interviews and documentation reviewed, Department was able to prove that facility did not dispense medication as prescribed by doctor. Continued LIC 9099-C According with complaint allegation "Facility did not dispense medication as prescribed by doctor.” there were related observations made during visit. Based on LPA observations, file reviewed, and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) 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, Sep 12, 2022 · control 21-AS-20220811091318

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Sep 13, 2022

87465(a)(5)Incidental Medical & Dental Care. This requirement isnot met as evidenced by: Based on interviews & record reviews facility didn't comply w/section cited above in 2 out of 4 residents for which medications were not filled in a timely matter which poses an immediate health & safety risk to persons in care.Dep. learned that R2 had meds that werenot filled timely in August,April,May of 2022;R3 in May, June and July 2022. (see copies)the state’s words, verbatim · CDSS document, Sep 12, 2022

Plan of correction: Facility to ensure that residents's medications will be filled in a timely matter to avoid missing meds. Facility to update and submit to Department policy and procedures on the process to fill medications on time including the staff title responsible for ordering & who to contact when problems arrive by POC date of 9/13/22. In addition, facility to submit med tech staff training on update procedures by 9/26/22 in order to clear.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Fernandes-Goes arrived unannounced with the purpose of closing a complaint investigation. During subsequent complaint investigation Department learned there are related deficiencies observed during the visit. LPA met with Catherine Scott - Administrator. Following item were observed during investigation visits: Department observed during resident’s R4 file review and staff S2 interview on 8/17/2022 that resident R4’s physician assessment dated 7/15/2022 has a diagnostic of Type 2 diabetes; resident came back from SKNF with order for Humalog 100 units 3x a day and glucose testing needed; resident R4 physician’s assessment states that R4 can’t manage his medication including injections and glucose testing; on 7/21/2022 facility faxed doctor stating “ Resident back from SNF insulin VIAL order sliding scale,” and requesting a new order for Lispro inulin – “Insulin pen need to be available in order for Medication Technician to coach resident on getting it once nurse is not available during weekend.” According to records reviewed Lisopro filled 8/2/2022 and for the month of August 2022 resident R4 has self-administer its own injection and glucose test from 8/1/2022 to 8/16/2022. (see copy of documentation, LIC 811 confidential name list, LIC 809-D) Per Title 22 Regulations #87628 Diabetes “The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional.” (Continued LIC 809-C) In addition, facility have not submitted Department with incident reports that are required for any missed medication, refusal of medication, and/or 911 calls including when a resident have refused and/or have been taken to ER as follows: Resident R1 medication refusal on 8/12/2022 and 7/6/2022 for 5 days; resident R2 for missing medications of Losartan from 8/2 to 8/10/2022, Amoldine 5/22 to 5/23/2022, and Elequilis from 4/23 to 4/26/2022; Resident R3 Azelastine 8/7/2022 “not administered”, Omeprazole 5/1 to 5/5 and 6/20 to 6/30/2022 “not available”, Valsartan 6/1 to 6/14/2022 “not administered”, 911 contacted for fall on 6/23/2022 – family refused that resident was transported to ER; Resident R4 medication refusal 5/20/2022, 911 contacted on 4/14/2022 fue to a fall, resident sent to ER due to a fall on 6/12/2022, medication refusal on 6/23/2022 w/ 911 contacted and ER refusal by resident, and ER visit on 6/24/2022. (see copy of documentation on file, LIC 811 confidential name list, LIC 809-D) Department is requesting a death certificate for resident R5 that passed away on 9/4/2022. Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) 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, Sep 12, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87628 · Plan of correction due date: Sep 13, 2022

87628Diabetes This equirement is not met as evidenced by: Based on observation,interview, & record review licensee didn't comply w/section cited above in 1outof1 resident w/diabetes which poses an immediate health & safety risk to persons in care.Resident R1 has LIC 602 stating that R1 is not able to administer insulinshots or glucose testing.Per interviews & file review R1 has self administer injections& glucose testing.the state’s words, verbatim · CDSS document, Sep 12, 2022

Plan of correction: Facility to ensure that to accept & retain resident with diabetes if not able to perform his/her own glucose testing and/or able to administer injections that a skilled professional will be available to perform these tasks as needed. Administrator to submit self certification that there is a skilled professional conducting testing & plan for glucose testing by POC due date of 9/13/22 in order to clear this citation and avoid civil penalties.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87211 · Plan of correction due date: Sep 26, 2022

87211 Reporting Requirements - This requirement is not met as evidenced by:Based on interview & file review facility didn't comply w/this section for 4 of 4 residents which posses potential health, safety, personal rights risk to residents in care.Depart.learned that there were multiple incident reports for R1,R2,R3, &R4 that were not submitted to CCL such as refusal of meds, missing meds, 911calls w/&/out residents being transported to ER(copies)the state’s words, verbatim · CDSS document, Sep 12, 2022

Plan of correction: Facility to ensure that all Incident & Death Reports are submitted to CCLD according to Title 22 Regulations. Licensee to submit a self certification that facility understands this regulation and plan on how facility will ensure that this requirement will be followed by facility to CCL by POC date of 9/26/2022 in order to clear this citation.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Fernandes-Goes conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and met with Administrator Catherine Scott. There are 126 residents with 4 under hospice at facility. Facility has activities planned for residents during the day. LPA arrived at the facility and had her temperature checked and logged. During facility tour on 7/20/2022 with staff Taylor; facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguisher was found to be last charged on 1/22 at the time of the visit. Sample test of Carbon monoxide detector was found to be operational during this visit. Fire sprinklers are inspected annually, and inspection records are current with the last inspection being conducted on 1/14/2022. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Food stored in the kitchen refrigerator were properly stored as per regulations on this day at the time of the visit. Facility has residents' with a special diet which is posted in the kitchen board and kitchen file. In addition, special menus have residents' names with specific meals according with their needs. Toxins are stored in a locked housekeeping area. Dangerous items were stored inaccessible to clients. There was a supply of cleaners, hygiene products and paper products available for clients. All resident’s bedrooms have lighting & appropriate furnishings. Disaster drills are being conducted quarterly with records for last fire drill on 6/29/22. Continued LIC 809-C. Infection Control: Facility has submitted a mitigation program plan that has been approved, and infection control plan has been submitted. Some posters have been placed at entrance and throughout of the facility. Facility has hand sanitizer available; visitors and staff before coming into work have temperature checked. Facility has PPE supply stored in office room and shed. There has been new staff hired and new resident’s admission since COVID. Residents’ medications are stored and locked in the medication room. Facility has a 30-day supply of medication for clients. Residents are not wearing masks inside the facility, however; staff stated that they are able to wear masks when going on outings. All staff had masks on during this visit. Visitors are being allowed. Residents have also available virtual and telephone calls when contacting with family members and others. Staff stated that all required COVID training is on file in addition to acquired N-95 fit testing for staff. There were no deficiencies cited at this time. Department is requesting facility to submit the following update documents by 7/27/2022: LIC 308 Designated LIC 500 Personnel Summary LIC 610 Emergency Disaster Plan LIC 610E-S Supplemental Emergency Disaster Plan for RCFE LIC 9020 Register of Facility Client’s/Resident’s Copy of Certificate of Liability Insurance Copy of Administrator Certificatethe state’s words, verbatim · CDSS document, Jul 20, 2022

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) Shannan Hansen conducted an unannounced Annual Required – 1 yr. Infection Control inspection to this facility and was welcomed by William Orellana Executive Asst. to CEO & Maria del Rosario Director of Clinical Nursing Services. There were 122 residents present at the facility of a max capacity of 150. LPA arrived at the facility and had her temperature checked and logged. All staff are temperature checked and logged each shift and wear masks. LPA toured the facility with Maria del Rosario Director of Clinical Nursing Services. During tour on 7/26/2021 with Maria del Rosario facility was found to be clean and at a comfortable temperature with all exits free from obstruction. Resident’s bedrooms, common areas, kitchen & food storage areas were inspected. Fire Extinguishers were found to be last charged on 12/1/2020 at the time of the visit. Facility smoke detectors are hard wired and sound directly to the fire station. Smoke detectors and fire sprinklers are inspected annually, and inspection records are current with the last inspection being conducted on 10/13/2020. There was a sufficient supply of both perishable and nonperishable foods as required by Title 22 Regulations. Hot water temperature measured between 113.5 degrees F and 120 degrees F within acceptable regulations of 105 degrees F. to 120 degrees F. in resident’s bathroom faucets. There was a supply of cleaners, hygiene products and paper products available for residents. All resident’s bedrooms have lighting & appropriate furnishings. At the end of LPA tour, Administrator Catherine Scott arrived to facility and answered further questions regarding Infection control and facility. Infection Control: Facility has submitted a mitigation program plan that has been approved. Posters have been placed at facility. Facility has PPE supply stored in nurse’s office and on-site storage facility. Residents’ medications are stored and locked in nurse’s station. Facility has a 30-day supply of medication for residents. Residents do not wear masks inside the facility. Continue LIC 809-C In addition, facility has a designated area for visitors outside which are being allowed for scheduled visits. Residents also have available zoom and telephone calls when contacting with family members and others. Staff had all PPE training required on file as well as N95 Fit Testing. LPA reviewed Licensing Information System (LIS) with staff who stated that is correct and updated at this time. In addition, LPA advised facility to contact Marin County Public Health and DSS/CCL Community Care Licensing immediately if symptoms or cases of COVID-19 +occur in the facility. There were no deficiencies cited at this time.the state’s words, verbatim · CDSS document, Jul 26, 2021

The state marks this report as 5 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.