Valley View Assisted Living

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Angel Ascencio arrived at the facility to conduct a required annual visit. The LPA met with Staff member at approximately 9:15 a.m. and explained the reason for the visit. Administrator Susanna Gasparyan arrived at the facility shortly after. The LPA along with Staff toured the physical plant areas inside and outside at approximately 09:30 a.m., to ensure that there are no health and safety hazards. This facility accepts resident under the Assisted Living Waiver Program (ALW). BEDROOMS: There are four (4) bedrooms designated for resident use. Bedroom #1 and #4 are shared. Bedroom #2 and #3 are private rooms. Bedroom # 2 has access to private restroom. Bedroom #3 has a direct access to the outside and the bedroom is considered their bedridden room. All resident rooms are set up with beds, night stands, lamps, chests of drawers, chairs and closet space. The beds are furnished with box springs, comfortable mattress and clean linen; which includes, a mattress pad, top and bottom linens, pillowcases, blanket (if needed) and a bedspread. Lighting in the rooms appeared adequate. The bedrooms were large enough to allow for easy passage. BATHROOMS: Resident bathrooms are clean, sanitary, and in operating condition with grab bars and non-skid surfaces. The LPA observed sufficient amounts of soap and paper products. The bathrooms hot water measured between 105.0 degrees Fahrenheit and 120.0 degrees Fahrenheit. KITCHEN: Kitchen knives are stored in a locked cabinet in the kitchen. The supply of dishes, utensils, pots, pans and drink ware is adequate. The freezer was maintained at zero degrees Fahrenheit (0*F) and the refrigerator was maintained at 40*F. The supply of perishable and nonperishable food is adequate. Continued on LIC 809-C COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. Chairs were observed to be at least 6 (six) feet apart for social distancing. The LPA observed the required postings in the common hallway. Fire extinguishers were observed to be serviced within the last year. The facility smoke alarm system and carbon monoxide detector was tested and operated normally at the time of visit. Medications were observed to be locked in a cabinet in the kitchen and contained at least 30 days of worth of medication. GARAGE: There is an attached garage containing a laundry room, cleaning supplies, additional Personal Protective Equipment (PPE) and incontinence supplies. The garage was observed locked. The administrator was reminded that it must be kept locked and inaccessible to residents at all times. INFECTION CONTROL: During today’s visit, LPA Ascencio spoke with Administrator regarding the facility’s infection control practices. There is 1 entry into the facility. Upon entry, the facility has a central entry point for symptom screening. The LPA noted that the facility is allowing visitors for both indoor and outdoor visitation. The LPA observed an adequate supply of Personal Protective 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 does not have a confirmed case of COVID-19 at this time. The facility’s policies and procedures as it pertains to infection control are adequate. The following was observed during today's visit: At 09:35 a.m., during facility tour, LPA observed 5 out of 6 residents with bed rails. At 11:05 a.m., upon further review of resident files, 4 out of 6 residents did not have bed rail order. Continued on LIC 9099 - C At 11:56 a.m., during medication review, LPA observed the Centrally Stored Medication Record was not accurate; Tylenol 500mg was not centrally stored, Eliquis Rx number did not match what was written, 1 Hydrocodone 325mg was not added to the Centrally Stored, 1 Pradexa 150 mg was not centrally stored and 6 out of 6 resident did not have the PRN Authorization letter. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). Exit interview conducted and a copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jul 14, 2023

Allegation investigated: Failure to seek timely medical attention. Facility failed to inform responsible party of a fall.

Licensing Program Analyst (LPA) Elsie Campos conducted an unannounced subsequent complaint visit to continue the investigation into the allegations noted above and to deliver the findings. LPA met with Administrator Susanna Gasparyan and explained the reason for the visit. On 05/24/2022, Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced initial 10-day complaint investigation visit regarding the above allegations. LPA Urena arrived at the facility at 12:30 p.m. At 1:00 p.m. the LPA and the administrator conducted a brief tour of the facility. At 1:14 p.m., the LPA requested records for review, and conducted staff and administrator interviews from 1:30 to 2:00 p.m. On 5/17/2023 LPA Campos conducted a subsequent visit to deliver findings, condcuted a brief facility tour at 2:40 p.m. and interviwed responsible party at 2:50 p.m. **Continued on LIC 9099-C** Unsubstantiated PAGE 2 Facility failed to inform responsible party of a fall On 5/20/2022, the Department received a complaint regarding the facilities failure to inform responsible party of a fall. It was reported that Resident #1 (R1) had fallen on 4/20/2022 and received a cold pack for wrist pain on the morning of 4/20/2022. R1’s responsible party (RP) arrived at the facility at around 11:00 am at which time they were notified of the incident. R1 did not show any signs of further injury and staff continued to monitor for any changes. Medical records revealed that the RP reported on 4/27/2022 that R1 had two falls at the facility on 4/20/2022 and that evening or following morning on 4/21/2022. It was noted that the RP disclosed that R1 had some swelling, but a cold compress was placed on their wrist and was better with no complaints of pain. At this time RP was aware of the falls and therefore contradicts reports of not being notified. Based on the information obtained, while this may or may not have happened the Department does not have sufficient evidence to support the above allegations. Therefore, the above allegations are deemed Unsubstantiated at this time. Failure to seek timely medical attention On 5/20/2022, the Department received a complaint regarding the facilities failure to seek timely medical attention. It was reported to that Resident #1 (R1) had stumbled and received a cold pack for wrist pain on the morning of 4/20/2022. R1’s responsible party (RP) arrived at the facility at around 11:00 am at which time they were notified of the incident. R1 did not show any signs of further injury and staff continued to monitor for any changes. Medical records revealed that the RP reported on 4/27/2022 that R1 had two falls at the facility on 4/20/2022 and that evening or following morning on 4/21/2022. It was noted that the RP disclosed that R1 had some swelling, but a cold compress was placed on their wrist and was better with no complaints of pain. On 4/29/22 a registered nurse visited R1 at which time it was not noted that R1 had a fracture and R! had no complaints of pain. On 5/3/2022 R1 was sent to the ER for chest pain and high blood pressure at which time there was no report of a fracture and was sent back home. **Continued on LIC 9099-C** PAGE 3 On 5/5/2022 R1 was seen by a physical therapist who did not note that R1 had a fracture or reported any pain. On 5/7/2022 R1 was visited by family at which time there were no concerns relating to a wrist fracture. On May 9th R1 was sent to the ER for high blood pressure at which time it was found that R1 had a fractured wrist. The administrator reported that at no time was R1 exhibiting pain or discoloration to their wrist post their falls in April. Pictures of resident on 4/23/2022 do not show bruising or swelling of R1’s wrist. The administrator reported that they conducted daily wellness checks on all residents. Based on the information obtained, while this may or may not have happened the Department does not have sufficient evidence to support the above allegations. Therefore, the above allegations are deemed Unsubstantiated at this time. No deficiencies cited at this time. Exit interview conducted with Administrator and report issued.the state’s words, verbatim · CDSS document, May 17, 2023 · control 29-NP-20220520162356

Allegation investigated: . Resident is left soiled while in care 2. Resident is not receiving medication as prescribed 3. Staff are not providing appropriate care and supervision to a resident while in care 4. Staff do not have planned activities for a resident 5. Resident is not being properly fed while in care

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced subsequent complaint visit to continue the investigation into the allegations noted above and to deliver the findings. LPA Yee met with Susanna Gasparyan, Administrator and the reason for today's visit was explained. An initial complaint vist was conducted on 10/19/2021 by LPA Teresa Camara. During the intial visit, LPA conducted a brief physical plant tour at 10:20 a.m., interviewed Administrator at 10:38 a.m., interviewed a witness at 11:45 a.m. and reviewed records at 11:15 a.m. Continued on LIC9099-C Unsubstantiated On today's visit, LPA Yee conducted additional interviews with the Administrator at 11:14am , interviewed Staff #1 at 1:13pm and reviewed facility files beginning at 11:58am - 12:43pm. Resident #1, who lived a very short time at the home could not be interviewed since the resident had been relocated to another home and then to a skilled nursing facility. The relocation site is unknown Per the investigation, the following is the information received for each allegation: Allegation #1: Resident is left soiled while in care - Per interviews conducted with the Administrator, staff and witnesses - Resident #1 was never left in soiled diaper. Residents are checked every 2 hours and they are also able to let the staff know when changing is needed. Residents are also asked if they want to bathe daily and encouraged to bathe a minimum of 1 to 2 times a week. During the short stay at the home, Witness #1, who provided health services to Resident #1 was interviewed and there no concerns expressed or any neglect was observed with the resident's care Allegation #2: Resident is not receiving medication as prescribed. Per review of the facility files, Resident #1 was given medications that came with the resident at the time of discharge from skilled nursing and documented on a Medication Administration Record. Medications that were added after admissions - Plavix and Pentroprazole were also documented as dispensed. Pain medication was not listed on the discharge paperwork. Since Resident #1 no longer resides at the home, it is unknown which medication(s) were not dispensed as prescribed. Per Witness #1, the medication list looked correct. Allegation #3: Staff are not providing appropriate care and supervision to a resident while in care. The facility has a Hoyer lift to transfer the resident to a wheelchair if Resident #1 wanted to get up. Resident #1 was helped getting to the bathroom and into the wheelchair when asked. Staff did not ignore the resident. Resident #1 preferred to remain in bed. Continue of LIC9099-C Allegation #4: Staff do not have planned activities for a resident - per interviews conducted with the Administrator, the facility has board games, residents like to play dominoes, card games, listen to music, exercise, celebrate birthdays and holiday, have discussions or watch television. One resident likes to crochet and the facility purchases yarns for the resident. The residents decide what they want to do or not to do. Allegation #5: Resident is not being properly fed while in care - Per interview with the Administrator and Staff #1, the residents are provided with 3 meals and 3 snacks a day. The facility makes plenty of food for second helpings. Staff ask residents what they want to eat and they will cook their favorite foods. Lunch was observed on today's visit and pizza was served at the residents' request. Based on the information received from interviews, Resident #1 would over eat and would feel miserable and would stick a finger in the throat to throw up. Resident would want food at all times of the day and night and it was provided when it was requested. Per staff, they never denied Resident #1 or any resident food. Based on the investigation, it was determined that all the above allegations were unsubstantiated. Exit interview was conducted with Susanna Gasparyan and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 21, 2023 · control 29-AS-20211011135312

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Elsie Campos arrived at the facility unannounced to conduct a required annual visit at approximately 1:45 p.m. This annual had a specific emphasis on infection control practices and procedures. The LPA met with Administrator Susanna Gasparyan and explained the reason for the visit. The 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. KITCHEN: Knives are stored in a locked cabinet in the kitchen. Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. BEDROOMS: The LPA observed four bedrooms, two bedrooms observed were shared and two were private with one containing a private bathroom and the other with an exit to the exterior. All bedrooms were furnished appropriately with clean linens, furnishings, and sufficient lighting. RESTROOMS: Restrooms are clean, sanitary and in operating condition with grab bars and non-skid surfaces. The LPA observed appropriate hand-washing signs. Water temperature measured between 108.1 degrees Fahrenheit and 131.5 degrees Fahrenheit at the time of the visit. Administrator used a personal thermometer which read the temperature from a short distance. Temperatures read within department guidelines however would not register temperature over 120 degrees Fahrenheit. Administrator indicated they would replace thermometer to ensure and accurate reading. Continued on LIC8 09-C COMMON SPACES: Walls and flooring were checked for cleanliness and good condition. Passageways were clean and clear of obstructions. A locked and inaccessible pool was observed in the backyard at the time of the visit. Facility has a designated visitation area located outside under a covered patio area with appropriate furniture and seating for residents. The LPA observed all the required postings in the dining room and the hallway that promoted cough etiquette, signs and symptoms of COVID-19, and appropriate hand hygiene. Medications are kept locked inaccessible in the kitchen area filing cabinet. A medication lock box was observed in the kitchen refrigerator with a key attached and unlocked. Administrator was reminded that medication box is to remain locked and inaccessible at all times. Hand sanitizer was available for staff and resident use. Fire Extinguisher was last bought 5/31/2022. GARAGE: There is an attached garage containing a laundry room, cleaning supplies, additional Personal Protective Equipment (PPE) and incontinence supplies. The garage was locked with a single latch making it accessible to residents with a single turn. The administrator was reminded that it must be kept locked and inaccessible to residents at all times. The administrator indicated that they would use the dead-bolt to ensure that the garage is kept appropriately secured at all times. INFECTION CONTROL: The facility has a central entry point for symptom screening, temperature checks, and sanitation station. The LPA observed an adequate supply of Personal Protection Equipment (PPE). The facility’s cleaning protocol is sufficient. The facility can designate a single isolation room if the facility has a confirmed case of COVID-19. The Administrator continues to conduct testing, regardless of vaccination status. The facility’s policies and procedures as it pertains to infection control are adequate. Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): An exit interview was conducted, and Plan of Corrections were reviewed and developed with the Licensee. A copy of this report, LIC 809-D, and Appeal Rights were discussed and provided to Administrator, whose signature on this form confirm receipt of these documents.the state’s words, verbatim · CDSS document, Jul 6, 2022

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Absence of Supervision Facility staff are not fingerprint cleared and/or associated to the facility

Licensing Program Analyst (LPA), Martha Guzman Chavez conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 11/23/2020 by LPA A. Richardson. On today’s visit, LPA Guzman Chavez met with Administrator, Susanna Gasparyan. Entrance interview conducted. During the initial visit on 11/23/2021, LPA A. Richardson conducted a virtual tour of the physical plant with the Administrator at 3:00 p.m. and conducted a telephonic interview with the Administrator, two staff, a Los Angeles Fire Department personnel (LAFD), and requested copies pertinent documents. ...Continued on LIC 9099C... Substantiated ...Continued from LIC 9099... It was alleged that there was an absence of supervision and that facility staff are not fingerprint cleared and/or associated to the facility. It was reported that LAFD responded to an emergency call and arrived at 7:56 p.m. Additionally, the LAFD remained on scene until a staff member arrived at the facility at 8:20 p.m. Record review revealed that Individual #1 (I1) developed a medical emergency on 11/22/2020 and was found to be anxious and hyperventilating and in a room that appeared to be used by an employee. When I1 was asked if they were an employee, I1 stated they were not a worker but a family member of the owner and was only there for the night. Also, interviews conducted revealed that I1 had stated there was no other staff in the facility when asked if there were any other workers there. Furthermore, the LAFD waited for another staff to arrive at the facility after I1 was transported to the hospital due to there being no other staff present to care and supervise the residents. When Staff #1 (S1) arrived at the facility, they were asked if they worked at the facility to which S1 stated that they did. S1 was asked if I1 was an employee and S1 stated that I1, ‘’was not a worker, but was asked sometimes to stay the night by the owner’. Additionally, record review of files revealed that there was no staff file for S1. Information gathered revealed that neither S1 nor I1 were associated and/or were listed on the facility’s employee roster. Based on all information gathered during the course of the investigation, the above allegations, “absence of supervision” and “facility staff are not fingerprint cleared and/or associated to the facility” are deemed Substantiated at this time. A Civil Penalty for $200 will be assessed today. Pursuant to CCR, Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC LIC9099-D). Exit interview conducted. Citation issued. Appeal Rights discussed. A copy of report provided via email.the state’s words, verbatim · CDSS document, May 18, 2022 · control 29-AS-20201123113645

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: May 18, 2022

87411(a) Personnel Requirements - General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on interviews and information gathered, the licensee did not comply with the section cited above as they failed to have staff at the facility supervising and caring for residents at all times, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 18, 2022

Plan of correction: The administrator will submit a detailed plan on how they will ensure the facility will always have staff at the facility and submit staff schedule for the previous month and submit to CCL by 5/18/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: May 18, 2022

87355(e)(1) Criminal Record Clearance. All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. Requirement not met as evidenced by: Based on interviews and information gathered, the licensee did not comply with the section cited above as they failed to have staff at the facility fingerprint cleared and/or associated to the facility before caring and supervising residents, which poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 18, 2022

Plan of correction: The administrator will submit a Statement of Understanding detailing how they will obtain fingerprint clearance for future staff and submit to CCL by 5/18/2022.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Ashley Smith arrived at 1:45 p.m. to meet with Administrator Susanna Gasparyan for a technical support visit with this facility. In attendance included Public Health Nurses Brenna De Leon, Amber Fayton, and Dr. Camellia Babaie, from Los Angeles County Public Health. This visit had a specific emphasis on infection control practices. This facility has a central entry point for signing in, symptom screening, and temperature checks. The facility has appropriate signs to promote mask-wearing and regular usage of hand sanitizer; recommendations were made around signage placement to further promote physical distancing, proper hand hygiene, and how to appropriately utilize Personal Protection Equipment (PPE). Additional feedback was provided regarding isolation and quarantine requirements, disinfection practices, and documentation of vital signs for staff and residents. During today's visit, discussion was had regarding testing, symptom screening, and adjusted procedures around visitation. The cleaning and disinfectant protocol is adequate; however, staff were reminded to observe the contact time needed for surfaces to be properly disinfected. It was recommended to provide additional staff training pertaining to donning, doffing, and appropriate disinfecting of reusable Personal Protection Equipment. Further discussion was had with the Administrator around the recent Provider Information Notice (PIN) as it relates to visitation and staff vaccination requirements. No health and safety hazards noted during today's visit. Exit interview conducted. A copy of the report was provided via email for signature.the state’s words, verbatim · CDSS document, Nov 4, 2021