Correction check·December 21, 2021

An unannounced Plan of Correction (POC) in conjunction with a Subsequent Complaint (Complaint Control # 31-AS-20210604142033 ) visit was conducted on this day by Licensing Program Analyst (LPA) Yelena Avetisyan the purpose of this visit is to follow up on the Plan of Corrections (POCs) that were issued on 6/7/2021 On 6/9/2021, 11/27/2021, 12/9/2021 LPA Avetisyan sent an email to virgil.lopez@yahoo.com notifying the administrator that plan of corrections are still outstanding. A discussion was made via email however as of today's visit the licensee/administrator have failed to submit plan of corrections to the Department. Upon arrival to the facility LPA met with staff Consuelo Connie Cipriano and Manuel Cipriano. Ms. Cipriano contacted the licensee Waldi Lopez. Ms. Lopez informed the staff that administrator Virgilio Lopez is currently unavailable. Neither licensee or administrator were available to come to the facility. Per Staff the licensee has asked her to sign for the report. Approximately 2:30 pm LPA conducted a tour of the facility with Ms. Cipriano. While conducting tour LPA observed the following. RM 1: Currently being occupied by 2 residents. Resident 1 (R1) is currently utilizing a full rail and Resident # 2 (R2) is utilizing a half rail At 2:32 pm when asked staff stated that neither resident are currently receiving hospice services. Staff also informed the LPA that they have to reposition both residents every 2 hours because they are unable to do so. RM # 2 is currently being used as a staff room. RM # 3 is currently occupied by 1 resident (R4) RM#4 is currently being occupied by 1 hospice resident (R3) who is utilizing a full rail. LPA asked Ms. Cipriano where the 5th resident in residing. Staff walked the LPA to the living room and pointed toward a resident watching TV. LPA asked which room the resident is staying in. At 2:39 pm staff stated that the resident does not stay at the facility. Resident 5 (R5) is dropped off by family 7:00 am and picked up at 5:00 pm Tuesday through Saturday. From 2:45 pm LPA conducted review of the residents files and observed them to be incomplete. LPA also observed that licensee failed to complete the plan of corrections as cited during the 6/7/2021 visits. On 6/7/2021 the licensee was cited the following deficiencies. 87608 (a)(5)(B) : Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. During that visit the licensee was utilizing full bed rails for a resident who was on hospice however did not have the hospice care that documented the need for the full rails. Licensee was to submit copy of the hospice care plan as POC. During todays visit LPA observed 2 residents who are utilizing full rails (R1 and R4). R1 is not on hospice. R4 is on hospice however the licensee does not have the care plan that would indicate the need for the full rail. 87608 (a)(3) Postural Supports. A written order from a physician indicating the need for postural support shall be maintained in the resident’s record. The licensing agency is authorized to require additional documentation if needed. This requirement is not met as evidenced by: During that 6/7/2021 visit the licensee was utilizing postural support for 2 residents. Licensee was to obtain orders for the postural support and submit it to the LPA as POC. During today's visit LPA observed that R2 is currently utilizing postural supports and the licensee does not have any order from the physician. 87705 (c)(5)(A) Licensees who accept & retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment, & a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. During the 6/7/2021 licensee did not have current medical assessment for 4 residents who were diagnosed with Dementia. Licensee was to obtain current Medical Assessment for the residents, complete re-assessments and submit copies as POC. During todays visit LPA observed that the licensee does not have a current physicians report for R1. and physicians report for R2 is incomplete and inaccurate. At 3:23 pm LPA contacted the office of R1's PCP who will review the information and provide an update to the LPA. R1 was one of the 4 residents identified during the 6/7/2021 visit. 87465(a)(6)(D): Assistance with self-administration does not include forcing a resident to take medications, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. Licensee was to contact the residents physician and obtain orders to crush medications. During todays visit at 4:50 pm staff informed the LPA that she is currently crushing medications for R1 and R2 who are on a puree diet. Resident files did not document the order from the physician to crush the medications. 87465 (b)(c)(d) Licensee is required to have PRN authorization letter on file signed by a physician to determine whether or not the residents can communicate the need and/or symptoms clearly for the as needed (PRN) medication. During the visit licensee did not have PRN authorization letter for 4 out of 4 residents. During this visit while conducting review of the resident files LPA observed that the licensee/administrator did not obtain PRN authorization letters for any of their residents. 87465 (C3)(D3) (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. During the 6/7/2021 visit and todays visit record reviews revealed that the licensee is not utilizing PRN administration logs for resident. Licensee was to submit copy of blank PRN administration log and a written statement that the log will be completed as necessary. 87202 (a) (2) FIRE CLEARANCE. All facilities shall maintain a fire clearance. Prior to accepting persons over 60 years of age none ambulatory and/or bedridden the licensee shall notify the licensing agency and obtain an appropriate fire clearance. The licensee was retaining two bedridden residents without proper fire clearance. During the visit the administrator was informed that because this was a zero tolerance violation civil penalties in the amount of $500 was issued and that civil penalty in the amount of $100 per day would continue to accrue until they submitted an LIC 200 and facility sketch. LPA made several attempts to obtain the information, emailed the administrator a blank LIC 200 however the plan of correction was not submitted. During todays visit while speaking with staff and reviewing records revealed that the licensee continues to retain 2 bedridden residents (R1 and R2) in addition both residents rely on staff to perform all activities of daily living for them For failure to submit plan of corrections a civil penalty of $100 per day is hereby assessed for the period of 6/8/2021 to 12/21/2021 totaling $19,800.00 . The $19,800.00 penalty assessed is a continuation of the civil penalty issued on 6/7/2021 in the amount of $500.00 because this is a zero tolerance violation. On 6/7/2021 LPA conducted an initial 10 day complaint visit at which time the licensee was cited for the following deficiencies. Plan of Corrections were not submitted. 87466 Observations of Resident - Licensee/administrator was to notify the department in writing what steps would be taken to ensure that they are in compliance with the cited regulation 87465 (a)(5) Incidental Medical and Dental Care Services - Licensee/administrator and staff failed to provide proper medication assistance to residents. The licensee/administrator and all staff were to schedule and complete vendorized medication training and request a medication audit to be completed by a pharmacist. When asked staff confirmed not receiving medication training. 87465 (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: all the required information. The licensee/administrator/staff for not completing Centrally Stored Medication and Destruction record for prior resident. During todays visit LPA observed that the licensee does not have current/complete Centrally Stored Medication and Destruction record for all residents. 87465 (e) Incidental Medical and Dental Care: For every prescription ... for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Licensee/administrator did not have order from and a discontinue order signed by a physician for prior resident. Licensee/administrator was to contact the physician for the resident and obtain the needed prescriptions and discontinue orders. This Deficiency is cleared because the resident is no longer living at the facility. Pursuant to CCR, Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC 809-D). Exit interview conducted, with staff and copy of report, citations, civil penalties and appeal rights emailed to info@trudezhomecare.com and virgil.lopez@yahoo.com