Health inspection·September 23, 2022

22 CCR § 72601. Alterations to Existing Buildings or New Construction. (a) Alterations to existing buildings licensed as skilled nursing facilities or new construction shall be in conformance with Chapter I, Division 17. Part 6. Title 24, California Administrative Code [Reference: 2019 California Building Code Section 1225.2 – New buildings and additions, alterations, or repairs to existing buildings subject to licensure shall comply with applicable provisions of the California Electrical Code, California Mechanical Code, California Plumbing Code and California Fire Code (Parts 3,4, 5 and 9 of Title 24)] and requirements of the State Fire Marshal. 22 CCR § 72605. Notice to Department. The Department shall be notified in writing, by the owner or licensee of the skilled nursing facility, within five days of the commencement of any construction, remodeling, or alterations to such facility. On 8/26/2022, the California Department of Public Health (CDPH, the Department) made an unannounced visit to the facility to investigate a complaint about physical environment. The facility failed to notify the Department, within five days of the commencement of any construction/alterations and failed to obtain the required written authorization, and/or building permits, and attain construction approval from the Department of Healthcare Access and Information (HCAI, previously known as the Office of Statewide Health Planning and Development or OSHPD; HCAI is the State Agency that reviews and approves plans for construction, repairs, renovations, and remodeling made to healthcare facilities to comply with State Building Codes) for the following renovations, alterations, and construction in the facility : 1. Installation of new floor covering and replacement of baseboards. 2. Installation of portable air conditioning (AC) units in sub-acute area (Station 2). 3. Installation of wall mounted touch screen tablets. 4. Installation of wall mounted televisions (TVs). 5. Installation of replacement of water heaters. 6. Installation, upgrade and/or alteration of fire alarm system. 7. Installation of recessed lighting fixtures. 8. Alteration of fire resistive assemblies. 9. Installation of new and/or altered electrical circuits and cabling. 10. Installation of security surveillance system. As a result, the facility reduced the fire resistance of the building, increased the potential for fire spread, and placed all residents occupying the facility at risk for accidents. 1. During a concurrent observation and interview with the Maintenance Supervisor (MS) on 8/26/2022, at 1:06 p.m., in the hallway between Nursing Stations 1 and 2 (Sub-acute station), the evaluator observed new floor covering and new gray baseboards (a board or molding covering the joint of a wall and the adjoining floor) were installed throughout the facility. The MS stated the facility started installation of new flooring “about a month ago” and that the floor installation was “about to be finished”. The MS stated that in all three stations (Nursing Stations 1, 2, and 3), new flooring and new baseboards were installed. The MS explained, the old flooring were tiles, and the new floor installed was plank/vinyl. During a concurrent observation and interview on 8/26/2022, at 1:10 p.m., the evaluator observed a floor installer/vendor (FV) in the beauty shop and old baseboards appeared to have been removed. Floor installer/vendor 1 (FV 1) stated he had been working in the facility for two months installing new flooring and baseboards. During a concurrent observation and interview with the MS on 8/26/2022, at 1:21 p.m., the evaluator observed FV 1 installing new gray baseboards inside the Beauty Shop. The MS stated that the old baseboards were brown in color and the new ones were gray. During a concurrent observation and interview on 8/26/2022, at 1:26 p.m., the evaluator observed floor installer/vendor 2 (FV 2) in Room 202, installing new vinyl floor covering. The FV 2 stated that new vinyl floor covering was being installed on top of the old tiles however, in the resident restroom, the old vinyl tiles were removed. During a concurrent observation and interview with the MS on 8/26/2022, at 1:27 p.m., the evaluator observed new floor covering installed in Rooms 208, 209, 210, and 211. The MS stated that new flooring was also installed in resident rooms, storage rooms, offices, and nursing stations. During an interview with the MS on 8/26/2022, at 3:14 p.m., the MS stated he did not have documentation from HCAI approving the installation of new floor covering and baseboards in the facility. The MS explained, installation of new equipment in the facility needs approval from HCAI, however, he was unsure of the requirement for floor covering installation. The MS also stated that there was no written plan or timeline for the new flooring project. The MS added, it may have been more than two months ago since the installation of new floor covering. On 8/26/2022, at 3:25 p.m. during an interview, the Administrator (ADM) stated new flooring was added to the existing flooring and confirmed old baseboards were removed from the wall before new baseboards were installed. The ADM stated that based on her understanding, the facility did not need approval from HCAI for the installation of new flooring and did not inform CDPH of the new floor installation. The ADM also stated she was responsible for ensuring compliance for anything relating to the building, which includes construction, alterations, and renovations to the building. On 8/30/2022, at 3:16 p.m., during an interview, HCAI’s Fire Marshal (FM) stated the facility did not obtain the required authorization for the installation of new floor covering from HCAI. The FM explained that HCAI reviews floor renovations for the materials used and the exit plans while facility construction was underway. A review of a HCAI Construction Advisory Report, dated 9/1/2022, authored by the HCAI Area Compliance Officer (ACO indicated “the facility had not informed the Office of this project” and the “Flooring replacement project is considered a maintenance project exempt from a project, however a discussion ahead of time and review of the egress plan and materials to be used is requested”. 2. During a concurrent observation and interview with the MS on 8/26/2022, at 1:26 p.m., the evaluator observed white tubing inside the restroom of Room 202. The MS stated that there was portable air conditioning (AC) unit ducting (tubes or pipes that carry air in and out of the building) extending outside from the restroom window. The MS added, most of the rooms in the sub-acute unit were using a similar portable AC unit. During a concurrent observation and interview with the MS on 8/26/2022, at 1:43 p.m., the evaluator observed a portable AC unit in Room 204, with ducting extending outside from the restroom window. The MS stated that the nurses asked him to install portable ACs in the rooms. During a concurrent observation and interview with the MS on 8/26/2022, at 1:57 p.m., the evaluator observed portable AC units, in use, with ducting extending outside, through the restroom windows, in Rooms 206, 207, 209, and 210. The MS confirmed the findings. During a concurrent observation and interview with the MS on 8/26/2022, at 2:01 p.m., the evaluator observed a portable AC unit, in use, with ducting extending outside, through the bedroom sliding door, in Room 212. The MS confirmed the finding. During an interview on 8/30/2022, at 3:16 p.m., the FM stated the facility had installed the portable AC units without first obtaining the required approval/authorization from HCAI. The FM explained, the installation of portable ACs was putting an additional strain on the facility’s electrical system. During a record review of OSHPD/HCAI’s Construction Advisory Report, dated 9/3/2019, and authored by the HCAI’s FM, the report indicated the use of Portable HVAC (Heating Ventilation and Air Conditioning) Air Conditioning Units and Equipment without required Authorization or Approval from OSHPD in Sub-Acute and other areas of Facility was in violation of California Health and Safety Code. Equipment observed in use in the Sub-Acute area of the facility included individual portable AC units in the patient sleeping rooms. 3. During a concurrent interview and observation with Certified Nursing Assistant 2 (CNA 2) on 8/30/2022, at 2:30 p.m., CNA 2 stated that touchscreen tablets, used for charting, were mounted on the walls about one or two weeks ago. CNA 2 showed the areas where the tablets were mounted. The evaluator observed a wall mounted tablet and electrical conduit next to Room 206 and another next to the oxygen room. During a concurrent interview and observation with MS on 8/30/2022, at 2:40 p.m., the MS stated that touchscreen tablets were mounted on the wall the week prior. The MS explained, four holes were created on the walls to anchor each tablet, there were seven tablets in total that were installed. The MS showed the evaluator the areas where the tablets were mounted. The evaluator observed wall mounted tablets and electrical conduit next to Room 103 and Room 109. During an interview on 8/30/2022, at 3:16 p.m., the FM stated the facility did not obtain the required authorization from HCAI for the installation of wall mounted touchscreen tablets. The FM explained that HCAI reviews wall mountings along the corridor walls for penetrations on the wall and the size of the equipment installed. 4. During a concurrent observation and interview with the MS on 8/30/2022, at 2:44 p.m., the evaluator observed wall mounted televisions (TVs), in use, in Rooms 113, 116, and 117. The MS stated that TVs were mounted on the walls throughout the facility. During a concurrent observation and interview with the MS on 8/30/2022, at 2:46 p.m., the evaluator observed wall mounted TVs in use in Rooms 102, 103, 106, and 107. The MS stated that the TVs had been installed on the wall “for a while”. During an interview on 8/30/2022, at 3:16 p.m., the FM stated the facility had installed wall mounted TVs without first obtaining the required authorization/approval from HCAI. The FM explained that HCAI reviews the wall mounting of TVs for the weight of the TV installed, the data cabling connected to it, and the supports used for the mounting of the TV’s. During a record review of OSHPD/HCAI’s Fire and Life Safety Report, dated 9/11/2019, and authored by the HCAI’s FM, the report indicated that on 2/22/2013, the FM noted “installation of wall-hung flat panel televisions in several locations” without OSHPD plan approval, inspection, or testing. The facility had opened a project but was closed due to “inactivity.” No changes or progress were noted. 5. During a concurrent observation and interview with the MS on 8/30/2022, at 3:04 p.m., outside Station 1 near Room 103, the evaluator observed a water heater with serial number E22-03458. The MS stated that the water heater was replaced a week or two ago. During a concurrent observation and interview with the MS on 8/30/2022, at 3:08 p.m., outside Station 1 near Room 115, the evaluator observed a water heater with serial number F16-2723. During a concurrent interview, the MS stated he was unsure when the water heater was replaced. During an interview on 8/30/2022, at 3:16 p.m., the FM stated the facility had replaced water heaters without the required permit/approval from HCAI. The FM explained, included in the HCAI review for the installation of replacement water heaters, was the mounting of the equipment and the expansion tanks. During a concurrent observation and interview with the MS on 9/1/2022, at 11:44 a.m., the evaluator observed a water heater in the basement laundry room with serial number L21-9335. The MS confirmed the water heater supplied hot water to the laundry room, but he was unsure when the water heater was replaced. During a record review of OSHPD/HCAI’s Fire and Life Safety Report, dated 9/11/2019, authored by the HCAI’s FM, the report indicated that on 2/22/2013, the FM noted “installation of several replacement water heaters that have already been placed in service without required permits, plan approval, inspection, testing or approvals” and “doors to several of the water heater enclosures appear to have been replaced and now there is no upper opening in the enclosures for combustion air for the gas appliance”. The facility had opened projects but were closed due to “inactivity” or “non-compliant.” No changes or progress were noted. During a review of HCAI Construction Advisory Report, dated 9/1/2022, and authored by HCAI Area Compliance Officer (ACO), the ACO noted the following: a. The water heaters had been recently replaced based on the serial number/dates on the water heaters. b. The water heater reported to be serving Station 1 in the North of the parking lot was dated "E22" (May 2022). c. The water heater reported to be serving Station 1 in the south end of the parking lot was dated "F16" (June 2016). d. The water heater reported to be serving Station 3 at the Northwest corner of the facility was dated "B20" (February 2020). e. A search on the OSHPD/HCAI website of recently permitted projects indicated the water heaters were installed without the benefit of Plan approval, a Building Permit, testing and inspection. 6. During a record review of OSHPD/HCAI’s Fire and Life Safety Report, dated 9/11/2019, authored by the HCAI’s FM, the report indicated that on 2/22/2013, “installation, upgrade and/or alteration of the fire alarm system” without required permits, plan approval, inspection, or testing from OSHPD. The facility had opened a project but was closed due to “inactivity”. No changes or progress were noted. During an observation on 9/1/2022 with the MS, at 2:32 p.m., the evaluator observed smoke barrier doors with a surface mounted magnetic door holder and cable conduits going through the ceiling between Stations 1 and 2, at the lobby, and near Room 212. The MS confirmed the observation. During an observation on 9/1/2022 with the MS, at 2:45 p.m., in the facility’s attic, the evaluator observed intertwined electrical wires and cabling including a red cable wire from the Dietary Storage Room attic entrance. 7. During a record review of OSHPD/HCAI’s Fire and Life Safety Report, dated 9/11/2019, authored by the HCAI’s FM, the report indicated that on 2/22/2013, the FM noted “several areas where the bottom membrane and/or bottom and top membranes of the fire resistive roof-ceiling assembly have been removed, altered or otherwise diminished by the installation of recessed lighting fixtures, skylights and etc. without required review, permits or approvals from OSHPD”. On 9/11/2019, the FM indicated on the report that no changes or progress were noted. During an observation on 9/1/2022, at 2:41 p.m. with the MS, the evaluator observed recessed light fixtures (with lights on) in the lobby, near the ADM’s office. The MS stated that this was the only area in the facility with recessed light fixtures. 8. During a record review of OSHPD/HCAI’s Fire and Life Safety Report, dated 9/11/2019, and authored by the HCAI’s FM, the report indicated that on 2/22/2013, the FM noted “several areas where fire resistive assemblies have been disassembled, have been altered or otherwise have not been maintained and the fire resistance diminished or reduced”. The facility had opened a project but was closed due to “inactivity”. On 9/11/2019, the FM indicated on the report that no changes or progress were noted. During a concurrent observation and interview on 9/1/2022 with the MS, at 2:45 p.m., in the facility’s attic, the evaluator observed a large hole on the fire resistive assembly (smoke barrier wall) from the Dietary Storage Room attic entrance. The MS confirmed and stated, he was unsure of the reason for having a hole on the fire resistive wall and estimated the size to be 16 inches wide and 40 inches high. During an interview with the ADM on 9/1/2022, at 5:02 p.m., the ADM stated that the fire resistive wall was intended to prevent fire from continuing to the other compartment. During a review of the facility’s Preventative Maintenance Manual, re