Walnut Senior Home

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Facility Administrator Gulvarg Kaur and was granted entry to the facility. LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected client bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the kitchen to be at 105.6 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to clients in care. There was a designated storage space for client/staff files. Food Service: Non-perishable and perishable food supply is sufficient for number of clients in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed (3) client files for admission agreements, updated physician reports, and needs and services plans. LPA audit (3) client's medication. During medication audit, LPAs observed the facility did not have resident’s PRN response documented and maintained in the resident's facility record for medication. A technical violation will be issued. LPA also reviewed one (2) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Based on the observations made during today’s visit, one technical violation will be issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) (LIC9102) was discussed and provided to Facility Administrator Gulvarg Kaur.the state’s words, verbatim · CDSS document, Sep 20, 2024

Allegation investigated: Facility staff did not assist resident with transferring out of bed Facility staff did not follow resident's care plan Facility staff did not allow resident to have private phone calls Facility staff spoke inappropriately to resident Facility staff did not assist resident with hygiene needs Facility staff did not seek medical attention in a timely manner Facility staff did not ensure that resident drank enough fluids

Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to deliver findings on a complaint investigation regarding the allegations listed above. LPA met with Licensee/ Administrator, Administrator, Gulvarg "Maya" Kaur and explained the purpose of the visit and the elements of the allegations. LPA Banrasavong conducted the investigation which consisted of observation, interviews with staff members and residents, and record review. On 07/17/2020, Community Care Licensing (CCL) received a complaint that alleged facility staff did not assist resident with transferring out of bed, facility staff did not follow resident’s care plan, facility staff did not allow resident to have private phone calls, facility staff spoke inappropriately to residents, facility staff did not assist residents with hygiene needs, facility staff did not seek medical attention in a timely manner, and facility staff did not ensure that resident drank enough fluids. Unsubstantiated Information obtained from Administrator Kaur stated the staff that worked at the facility in 2020 were no longer employed and Administrator did not have contact information. It was also advised that Administrator discarded staff and residents’ files that were older than 3 years. No residents that were placed in 2020 are currently at the facility. During the investigation, LPA attempted to contact Resident 1 (R1), and it was revealed that the R1 had passed away on 12/04/2022. In regards to the facility staff did not follow resident's care plan, it was alleged that the facility did not follow the care plan provided to the facility. Administrator stated that they followed the care plan, but there was another care plan that R1’s Responsible Party wanted the facility to follow on top of the care plan agreed by facility representatives and Responsible Party. Administrator stated due to Covid restrictions and the extreme nature of the care plan, they presented R1 with an eviction notice, which was served on 05/17/2020. In regards to the allegations that the facility staff are not allowing R1 to have private phone calls and facility staff spoke inappropriately to resident. It was reported that staff would stand at the bed side R1 while they spoke on the phone and interrupt their phone calls. This allegation was not able to be corroborated or disputed due to R1 passing away and no staff member that were able to be interviewed regarding their 2020 employment. During the course of the interview, Administrator denied the allegations. In regards to the allegation that the facility staff did not assist resident with hygiene needs, it was reported that Resident needed additional assistance with ambulating and hygiene needs due to Resident #1 being blind. Additional details stated that facility did not ensure R1’s toenails were cut. The department did not receive any proof or documentation that the allegations occurred. During the course of the interview, Administrator denied the allegations. Based on the inability to interview pertinent residents, staff, and additional witnesses, the allegations listed above are deemed unsubstantiated at this time. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, an LIC 811, a copy of this report was provided to the Licensee, Gulvarg "Maya" Kaur as evidenced by her signature.the state’s words, verbatim · CDSS document, Jan 23, 2024 · control 18-AS-20200717095959

Type of visit: Required - 1 Year

Licensing Program Analyst, Amber Coleman, (LPA) arrived unannounced at the Walnut Senior Home to conduct an Annual Inspection. LPA introduced self and stated purpose of the visit. LPA was greeted by Facility Staff, Emilie Malto and invited inside facility. LPA was asked to sign in. While signing in, LPA observed a COVID station which included PPE, hand sanitizers and information regarding infection control. All made accessible to those who visit the facility and its residents. LPA was provided a place to work then completed a walk through of the physical plant. Personnel Records/Training/and Staffing- LPA began review of employee records. Three (3) records were reviewed. LPA reviewed employee record for first aid certification, fingerprint clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights and training verification, and current administrator certification. Staff files found to be in compliance. Resident Rooms - Each resident bedroom can accommodate any non-ambulatory resident. All resident bedrooms were adequately furnished with bed, chair, large closets, appropriate linens, adequate lighting, and an operational smoke alarm. Bathrooms: All bathrooms have a working toilet, wash basin, and shower with an adequate supply of towels, toilet paper, and toiletries. Hand rails were observed near toilets and in showers/tubs. Bathrooms also observed to be clean and orderly. Resident Records/Incident Reports/Personal Rights/Residents with Special Needs/Incidental Medial and Dental- LPA began review of resident records. Three (3) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. Food Service- Food prep areas are clean and organized. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables food on hand. General: Disaster drills are completed every other month. Most recent disaster drill conducted June 2023. Fire Extinguisher last inspected March 2023 No deficiencies observed during today's visit. Technical Violations are being issued to address concerns noted within CARE Tool. An exit interview was conducted where this report was discussed and provided to the Facility Representative.the state’s words, verbatim · CDSS document, Sep 28, 2023

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.