Williams-Whittle Residential Care Home #3

Allegation investigated: Staff hit resident in care with an object

Licensing Program Analysts (LPAs) Katie Brown and Lissett Padgett arrived unannounced at the facility to deliver investigation findings. LPAs explained the reason for the visit and delivered the investigation findings to Administrator (AD) Cheryl Whittle. The Department investigated the allegation above. R1 passed away prior to the complaint being reported. R2 was interviewed and denied knowing about any abuse of residents at this facility. A record review was conducted which revealed that R2 “can distort the facts of an experience” and has a history of telling staff, “I can get you in trouble”. Based on interview and record review, R2 did not witness R1 being hit with an object but states overhearing what R2 believes was R1 being hit. See LIC9099-C for continuation of this report Unsubstantiated The above allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur. There were no citations issued An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.the state’s words, verbatim · CDSS document, Oct 3, 2023 · control 24-AS-20230705112128

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Katie Brown and Lissett Padgett arrived unannounced to conduct the Annual inspection. LPA met with and explained the purpose of the visit with Administrator (AD) Cheryl Whittle. During this visit, LPA toured the facility inside & out. Resident rooms contained required furnishings and lighting. LPA observed required items in bathrooms with hot water measuring 117 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was observed to be clean, in good repair with necessary items and appliances. LPA observed required food supply and paper products. Medications are centrally stored and locked. First aid kit contains required items. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the home including outdoors. Fire Extinguishers dated 3/20/23. Smoke and Carbon Monoxide detectors are present and in working order. LPA conducted resident and staff file reviews, interviews and a medication audit. Administrator certification expires 10/17/24. Emergency Disaster Plan and Infection Control Plan were reviewed during this visit. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D in the areas of: Safeguards for Resident Cash, Personal Property, and Valuables, Maintenance and Operation and Storage Space. An exit interview was conducted and a Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents. LPA requested the following updated forms faxed to CCLD by 10/12/23: Designation of Facility Responsibility (Lic308), Administrative Organization (Lic309), Affidavit Regarding Client/Resident Cash Resources (LIC 400), Surety Bond (Lic402), Personnel Report (LIC 500), Client Roster (LIC 9020) and Proof of current Liability Coverage, Emergency Disaster Plan LIC610E.the state’s words, verbatim · CDSS document, Oct 3, 2023

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.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Annual Infection Control Inspection. LPA met with and explained the purpose of the visit with Lucille Williams. LPA toured the facility inside and out. Infection control procedures which were observed and/or reviewed by LPA include: Daily symptom screenings for staff and program participants, testing & vaccination requirements, Isolation room procedures, social distancing, PPE and daily infection control procedures. Sanitizer is available throughout the facility. LPA observed 30-day supply of PPE, medications, paper goods and disinfecting products which were available for use. There were no citations issued during this inspection. LPA requested the following updated forms be submitted to CCL by 8/31/22: LIC 308, LIC 309, LIC 500, LIC 610E, LIC9020, current Liability Insurance and Administrator’s Certificate.the state’s words, verbatim · CDSS document, Aug 19, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Katie Brown conducted a Case Management in conjunction with am Annual Inspection. LPA met with and explained the purpose of the Case Management with Lucille Williams. The purpose of the Case Management is to follow up on a Special Incident Report (SIR) submitted by the facility which occurred on 6/18/2022. There were no citations issued during this Case Management An exit interview was conducted and a copy of this report was provided to Lucille Williams, whose signature on this form confirms receipt of these documents. LPA requested the following updated forms be submitted to CCL by 7/27/22: LIC 308, LIC 309, LIC 500, LIC 610E, LIC9020, Current Liability Insurance, Administrator’s Certificate.the state’s words, verbatim · CDSS document, Aug 19, 2022

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Katie Brown conducted a Case Management in conjunction with am Annual Inspection. LPA met with and explained the purpose of the Case Management with Lucille Williams. During the visit, LPA toured the facility and observed the following: 1. Sliding Screen door in Resident (R1's) room and outside the living room are in disrepair 2. Blinds in the kitchen are in disrepair 3. Residents R1 and R2 files were incomplete The following deficiencies were observed and noted on the attached LIC 809D. All violations that, if not corrected, will have direct and immediate risk to the health, safety or personal rights of clients in care. An exit interview was conducted and Plan of Correction was developed and reviewed. A copy of this report and Appeal Rights were discussed and provided to Lucille Williams, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Aug 19, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 80087(a) · Plan of correction due date: Aug 31, 2022

80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by: Licensee did not ensure the facility was clean, safe, sanitary and in good repair for the safety and well being of clients, employees and visitors. LPA observed the screen of R1's sliding door is torn and off the track, window screens outside TV room is bent and both kitchen window blinds are in disrepair and dirty. This poses a potential Health, safety or residents rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 19, 2022

Plan of correction: Facility has agreed to replace the screens for the sliding door, living room window and both kitchen window blinds and provide a picture of the repaired items to the LPA via email by 8/31/2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR80070(a) · Plan of correction due date: Aug 31, 2022

80070 Client Records (a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. This requirement was not met as evidenced by: Licensee did not ensure that 3/3 resident files were complete and current. LPA observed that R1 and R2 resident files did not contain all required documents. Resident emergency contact information needs to be updated in the event of an emergency for medical personnel. This poses a potential health, safety and resident rights risks to persons in care.the state’s words, verbatim · CDSS document, Aug 19, 2022

Plan of correction: Facility has agreed to conduct an audit of 3/3 resident files. Using LIC811, facility will add and/or update resident files to be complete and current. The facility will submit a "checklist" for each resident to show that all required items have been placed. Each checklist will contain resident's name and the date. Checklists will be emailed to LPA by 8/31/2022

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Infection Control Inspection. LPA met with House Manager Kimberly Williams Walker. The Covid Contact Questionnaire completed at entry. Facility Mitigation plan has been approved by CCL. Infection control procedures described in the plan which were observed and/or reviewed by LPA include: Daily symptom screenings (for staff, persons in care and visitors), testing, visitation, quarantine/isolation procedures, staffing, PPE storage/ use and daily infection control procedures. All clients and staff are fully vaccinated. LPA toured the facility inside and out. Required postings to encourage face coverings and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Staff were all observed wearing face coverings. Facility has multiple visitation areas available. LPA observed 30-day PPE and resident medication supply. Through LPA’s interviews and observations the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.the state’s words, verbatim · CDSS document, Aug 17, 2021