Health inspection·July 19, 2022

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. 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 5/25/2022, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a complaint about physical environment. The facility failed to obtain the requisite permits/construction sign-off final approval from the Department of Healthcare Access and Information [HCAI, previously known as the Office of Statewide Health Planning and Development (OSHPD)] for the installation/replacement of the Heating, Ventilation & Air Conditioning (HVAC) unit. The facility also failed to obtain HCAI approval for the installation/replacement of three water heaters. 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. In addition, the facility failed to notify the Department (CDPH), within five days of the commencement of any construction/alterations to the skilled nursing facility. As a result, all residents were placed at risk of accidents, including fire, from unauthorized construction, remodeling, or alterations. During a complaint investigation visit to the facility on 5/25/2022 and 6/15/2022, the evaluator observed one new HVAC unit on the roof and three new water heaters elsewhere in the facility. The following was confirmed by the Maintenance Supervisor (MS) and the Administrator (ADM): 1. On 5/25/2022, at 12:20 p.m., during a concurrent observation and interview with the MS, the evaluator observed new HVAC unit #3 on the roof. The nameplate on the unit indicated a manufacturer’s date of May 2019. The evaluator asked the MS if the facility obtained HCAI approval and a building permit for replacing the HVAC unit #3. The MS did not know if HCAI’s approval and a building permit were obtained. The MS stated, "the ADM would know". The evaluator then asked the MS if the Department was notified for the HVAC unit # 3 replacement. The MS did not know and stated, "the ADM would know". 2. On 5/25/2022, at 1:02 p.m., during a concurrent interview and record review with the ADM, the evaluator asked the ADM if the facility obtained HCAI’s approval and building permit for replacing HVAC unit #3. The ADM was not aware that HVAC unit #3 was replaced. The ADM was not able to locate any documentation to show the facility obtained the requisite permits/construction sign-off final approval from HCAI for the installation/replacement of HVAC unit #3. The evaluator further asked the ADM what the negative outcome would be for not obtaining HCAI’s approval and building permit for the HVAC unit #3 replacement. The ADM stated, "if HCAI approval was not obtained then it's possible the unit might not be installed according to the regulation". The ADM was also not able to locate any documentation to show the facility notified the Department for the HVAC unit #3 replacement. The ADM stated, "we will contact the consultant to inform HCAI to bring this into compliance". HVAC unit #3 was in use at the time of inspection. 3. On 6/15/2022, from 1:10 p.m. to 1:20 p.m., during a concurrent observation and interview with the MS, the evaluator observed a newer 100-gallon water heater inside an enclosure on the roof that provided hot water to the kitchen and two newer 100-gallon water heaters inside the boiler room that provided hot water to the patient care areas and the laundry. The evaluator and MS were not able to locate the nameplate on these three water heaters. The evaluator asked the MS when these three water heaters were installed/replaced. The MS stated, "I don't know". The evaluator further asked the MS if the facility obtained HCAI’s approval and a building permit for the replacement of the aforementioned water heaters. The MS stated, "the corporate and ADM would know". The evaluator asked the MS what the negative outcome would be for not obtaining HCAI’s approval and building permit for the water heater replacements. The MS stated, "the installation might not be done properly which could affect everybody in the building". The evaluator then asked the MS if the Department (Licensing/Certification) was notified for the three water heaters replacement. The MS was not sure and stated, "the ADM would know". 4. On 6/15/2022, at 1:50 p.m., during a concurrent interview and record review with the ADM, the evaluator asked the ADM when the three water heaters were installed/replaced. The ADM did not know. The evaluator then asked the ADM if the facility obtained HCAI’s approval and building permit for replacing the three water heaters. The ADM was not able to provide any documentation to show the facility obtained the requisite permits/construction sign-off final approval from HCAI for the installation/replacement for the three water heaters. The evaluator further asked the ADM what the negative outcome would be for not obtaining HCAI’s approval and building permit for the water heater replacements. The ADM stated, "probably the work was not done per code, and it could endanger staff and resident". The ADM further stated, "we will contact the consultant to inform HCAI to bring this into compliance". All the aforementioned water heaters were in use at the time of inspection. The MS and ADM were unable to locate any documentation that the Department was notified of the installation/replacement for HVAC unit #3 and the three water heaters which were in use at the time of inspection. The facility failed to obtain the requisite permits/construction sign-off final approval from HCAI for the installation/replacement of the HVAC unit. The facility also failed to obtain HCAI approval for the installation/replacement of three water heaters. In addition, the facility failed to notify the Department within five days of the commencement of any construction/alterations to the skilled nursing facility. As a result, all residents were placed at risk of accidents, including fire, from unauthorized construction, remodeling, or alterations. The above violations had a direct relationship to the health, safety, and security of all residents in the facility.