Follow-up on corrections·December 12, 2024

On 12/12/24 around 10:40 AM L. Holmes, Licensing Program Analyst (LPA) arrived unannounced to conduct a case management for complaint #15-AS-20240716140724 received on 07/16/2024. LPA Jesus Gonzalez, Executive Director (ED) and explained the purpose of the visit. During the investigation of the above complaint, LPA interviewed ED, Staff (S1, S2, S3, S4, S5) Witnesses (W1, W2, W3, W4), obtained a resident roster, and requested the following for Resident #1 (R1): current Physician's Report, Admission Agreement, ID/Emergency Contact information, hospice care plan, care notes, incident reports, hospice notification, facility's regulations and documentation regarding Stage 3 and 4 pressure wounds, emails and/or written communications to R1's family regarding pressure wound injuries. -On 07/23/24, LPA requested R1’s Initiation of Hospice notification and Physician’s Report (LIC602) from S1. LPA requested the reports be provided to the Community Care Licensing Department (CCLD) by 07/30/2024 for preliminary review. The records weren’t provided to LPA during the investigation. -On 07/23/24, LPA requested R1’s Unusual Incident Reports (UIRs) from S1. R1 was transported to Alta Bates Medical Center in Berkeley for emergency services to treat a stage 3 to 4 pressure wound. Notification of deviation of R1’s hospice care plan on 07/14/24 was not provided to CCLD. Continued on LIC809C... ...continued from LIC809. -W1 and S5 confirmed that Private PALs were not available throughout the entire duration of R1’s admission agreement. The licensee did not provide any written notice (30 or 60 days) for the change in services noted below on pages 5, 10 and 30. Records and interviews revealed that W1 hired a private caregiver from 12/2022 to 07/2024 to aid in the care of R1. Page 5 II. Personal Assistance and Care “… Appendix A . We may change the scope and pricing of the services and our discretion upon sixty (60) days’ written notice to you. Page 10 C. Private PALs and Services from Home Health Agencies “To accommodate additional resident needs and preferences, we offer private care-giving and companion services for an additional fee as set forth in Appendix B ” Page 30. B. Termination by Us . (1) Upon (30) Days’ Notice . We may terminate this Agreement upon (30) days’ written and verbal notice to you and your personal representative if any of the following events occur: d. If, after admission, we determine that you have a need not previously identified and a reappraisal has been conducted pursuant to Section 87463 of Title 22 of the California Code of Regulations, and we and the person who performs the reappraisal believe that the community is no longer appropriate for you. Deficiencies are cited from Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction by plan of correction due date, and any repeat violations within a 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights were provided to ED.