Incident investigation·April 15, 2024

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit and met with Administrator (ADM) Debbie Aguilar. LPA Rai stated the purpose of the visit and conducted a health and safety check at the facility. On April 12, 2024, the Department received an in incident report stating resident, R1 sustained burn injuries after a fire incident at the facility. R1 was transported to the hospital via ambulance. During visit, LPA Rai toured the inside and outside of the facility. When touring the outside area of the facility, the exits were cleared of obstruction. LPA Rai observed construction materials in the backyard. Staff (S1) stated they replaced the flooring in the resident bathroom and the materials will be disposed this afternoon. LPA Rai toured the facility kitchen and observed food supply of at least 2 days of perishable food and at least 7 days of nonperishable food. During the tour of the kitchen, LPA Rai observed a cabinet with locking capability which is where the facility staff lock the sharps, such as knives. LPA Rai observed the cabinet unlocked during the visit. LPA Rai observed the kitchen was not being used by staff to prepare food and no staff were observed in the kitchen. Staff S1 locked the cabinet during visit. During the tour of the laundry room, LPA Rai observed a cabinet with locking capability which is where the facility staff lock the chemical solutions, such as laundry detergents. LPA Rai observed the cabinet unlocked during the visit. LPA Rai observed the laundry room was not being used by staff and no staff were observed in the laundry room. Staff S1 locked the cabinet during visit. Continuation on LIC 809-C, Page 1 of 2. Page 2 of 2. LPA Rai toured the resident bedrooms. 5 out of 5 resident bedrooms had available bedding, drawers, and functioning lights. 1 Out of 5 resident bedrooms (Bedroom #2) was occupied by a bedridden resident. LPA Rai observed the exit door located in Bedroom #2 was blocked by recliner chair and the exit door was not accessible. Staff S1 was not able to move the recliner chair as it was extended to lay flat and required a remote to adjust the setting as it was an electric powered recliner. S1 was able bring down the foot rest of the recliner but the passageway was still not clear. ADM stated they will talk to the family and ensure the passageway to the exit door is clear. LPA Rai toured the dining room and observed the medication cabinet. LPA Rai observed the cabinet door had locking capabilities but it was unlocked during visit. LPA Rai observed the staff were not administering medications. Administrator locked the medication cabinet during visit. LPA Rai observed no smoking signs posted around the facility and 1 out of 5 residents observed using oxygen in the facility. LPA Rai was not able to observe Bedroom #1. Staff S1 stated the resident R2 prefers to lock the room and staff are not able to access the bedroom and was not able to verbalize how staff would be able assist R2 in an emergency. ADM stated they will submit a plan of action to ensure the health and safety of the resident R2. LPA Rai obtained the following documents: R1's Physician's Report dated 10/21/2023, R1's Appraisal/Needs and Services dated 7/24/2023, R1's Centrally Stored Medication Log and Medication Administration Record (MAR) from July 2023 to April 2024, R1's Admission Agreement, R1's Functional Capabilities Assessment dated 7/25/2023, and R1's After Visit Summary 7/25/2023 and 11/7/2023. This case management will be kept open pending investigation. Deficiencies were cited per California Code of Regulations, Title 22, please see LIC 809-D. This report was reviewed with Administrator (ADM) Debbie Aguilar and a copy of the report was provided. Appeal Rights were provided.