Follow-up on corrections·October 27, 2021

Licensing Program Analyst (LPA) A. Canela conducted an unannounced Case Management- inspection and met with staff Suzette Hojilla, Imelda Good and Jon Cafuir; Administrator, Lovelyn Hojilla was not available and was said to be at work, during this visit. The purpose of this case management visit was to follow up on self reported incident report that was submitted to Community Care Licensing (CCL) regarding resident R1. LPA went over incident details and requested copies of resident R1's file. On September 27, 2021 at about 10:00pm R1 sustained a fall in their room. It was reported staff were assisting other residents when they heard a noise and found R1 on the floor in their room. LPA is gathering additional information regarding the procedures facility took regarding this incident. The resident was sent to the hospital the next day, 9/28/2921 and diagnosed with a Femur Fracture and Lesser Trochanter medially displaced; R1 had surgery on 9/29/2021. The facility submitted a request for a Hospice exception for resident and later withdrew the request, when R1 passed away on 10/20/2021. During today's visit LPA received information R1 returned to this facility on Hospice services on 10/18/2021, aspirated and passed away on 10/20/2021. A hospice exception was never approved or granted to the facility. LPA will review information and will follow up with facility, once additional information is gathered and reviewed. During today's visit LPA found that tenant/staff S4, has fingerprint clearance, S4 is not associated to this facility as required. LPA reminded facility, that staff must wear a mouth covering while at the facility, staff S1 and S2 were not wearing a mask upon LPAs arrival. LPA also observed the facility auditory devices on the two sliding doors were not working properly and not completely turned/plugged on; review of records indicate there are at least 4 residents with Dementia. Continue report see LIC809-C and LIC809-D for deficiencies observed and cited. Physician report for resident R2 is dated 9/22/2020 and not done yearly as required. LPA informed facility, the administrator must be present at least 20% of the time during business hours. LPA consulted regarding requirements for a facility if a Hospice resident becomes bedridden. Facility does not have bedridden approval, facility will need to immediately call CCL and a Fire Clearance will need to be approved by the fire department for bedridden room. Facility to get additional records and forms needed to be submitted if there is ever a need. LPA also consulted regarding facility not able to admit a resident who requires Hospice services, if they do not have approval or number of Hospice residents exceed. LPA will follow up with facility regarding this matter. Facility not to accept any residents who are bedridden unless written approval has been granted from Fire department and CCL. LPA also reminded facility of having complete staff records and facility scheduled activities. The following deficiencies were observed (see LIC 809-C) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. A civil penalty in the amount of $100.00 was assessed today for staff S4 not being properly associated to this facility. Exit interview conducted and appeal of rights and this report will be emailed to facility due to computer problems. LPA informed administrator, due to computer issues, LPA will email report that LPA was unable to obtain signature.