Other·April 6, 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 2/17/2022, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate three complaints related to physical environment. The facility failed to obtain required written authorization, building permit, and attain construction approval from the Department of Health Care Access and Information (HCAI, the State Agency that reviews and approves plans for construction, repairs, renovations, and remodeling made to healthcare facilities to comply with State Building Codes) and failed to notify the Department, in writing, within five days of the commencement of any construction, remodeling, or alterations, of the following: 1. Two Nurses' Station, two shower rooms, three anchored televisions (TVs), a kitchen freezer, a swamp cooler, and an oven/range. 2. Heating, Ventilation, and Air Conditioning (HVAC) units, removal of PVC conduit, and drain lines from the roof. 3. Water heater replacement/installation, fire sprinklers at the front canopy and rear storage cabinet, low voltage cameras and firestopping, anchorage of new washing machines, anchorage of bug zappers, parking barrier removal, and general firestopping. 1. On 2/17/2022, from 10:45 a.m. to 1:45 p.m., during a facility tour of the building with the Assistant Maintenance Supervisor (AMS) and the Administrator, the following was observed: 1a. On 2/17/2022, at 10:56 a.m., during an observation of the kitchen and concurrent interview, Dietary Aide (DA) stated, "within the last three years the facility changed the oven/range, the kitchen freezer, and the swamp cooler." The Administrator confirmed the replacements. 1b. On 2/17/2022, at 11:25 a.m., during an observation of the granite countertop at Nurses’ Station #1 and #2 and concurrent interview, Director of Nursing (DON) stated that around 2011, the two Nurses’ Stations countertops were replaced with granite. The Administrator stated not working at the facility during that time. 1c. On 2/17/2022, at 11:39 a.m., during an observation of Shower Room #3 that was under construction and concurrent interview, the Administrator stated, "in 2021, the construction work inside Shower #3 was stopped due to the COVID-19 outbreak." The Administrator further stated, "the end goal is to remodel all four showers. Currently, Shower #4 was completely remodeled, but it needed final HCAI approval; Showers # 1 and #2 had no work done on them." 1d. On 2/17/2022, at 12:11p.m., during observation of three residents’ room (Room 236 Bed A, Room 225 Bed A, and Room 118 Bed A) the TV anchorage were installed too close to the door and if fully extended, it would prevent the door from closing. The Administrator stated, "we will either install smaller TV anchorage or relocate the TV, but we need to contact HCAI before we do that." On 2/17/2011, at 2:33 p.m., during an interview, the Administrator stated, "back in 2017, we initiated a large scoop umbrella project, and during that time we had an emergency project, such as replacing the kitchen freezer, swamp cooler, and the oven/range. I was told by our old consulting firm the emergency project would become part of the umbrella project. The umbrella project became inactive due to a change in the consulting firm, personnel changes, and COVID-19 related issues. We could not move forward until we signed a new contract with the new consulting firm. The contract was signed today, and it will go back to the consulting firm who will give approval to the architect to reapply with HCAI to bring all outstanding projects into compliance and receive a Construction Final." The Administrator provided a copy of the "Design Fee Proposal" for Project #1 (S172210-19-00), Project #2 (S172211-19-00) and Project # 3 (S182348-19-00). The Design Fee Proposal was emailed to the Administrator on 2/4/2022 but the Administrator did not read the e-mail until 2/17/2022. The Administrator was unable to provide documented evidence of permits/construction sign-off approvals from HCAI for the construction/alteration and the installation/replacement of the two Nurses' Station, two shower rooms, three TV anchorage, the kitchen freezer, the swamp cooler, and the oven/range. 2a. On 3/11/2022, at 12:17 p.m., during a roof observation, there were 13 HVAC units. The Administrator, present at the time of the observation stated, "nine HVAC units need final OSHPD/HCAI approval. We are in the process of reopening Project #3 (S182348-19-00). The proposal for Project #3 was signed on 2/17/2022. On 3/16/2022, the architect and the builder will conduct a walk through to create new plans. We anticipate within 3-4 weeks they will submit the new plans to HCAI." The Administrator provided a copy of an application form, dated 3/3/2022, the consultant submitted to HCAI for a new project (Reference S182348-19-00)". 2b. On 3/11/2022, at 12:26 p.m., during an observation of a metallic conduit on the roof and a concurrent interview, the Administrator stated, "this was the PVC conduit that was replaced with the metallic conduit, and it needs final HCAI approval. We are in the process of reopening Project #3 (S182348-19-00). The proposal for Project #3 was signed on 2/17/2022. On 3/16/2022, the architect and the builder will conduct a walk through to create new plans. We anticipate within 3-4 weeks they will submit the new plans to HCAI." 2c. On 3/11/2022, at 12:34 p.m., during an observation, the bottom portion of the drain lines from the roof was connected to the drain in the patio. The Administrator, present at the time of the observation, stated, "I think it was not connected before. This will be part of the project. We are in the process of reopening Project #3 (S182348-19-00). The proposal for Project #3 was signed on 2/17/2022. On 3/16/2022, the architect and the builder will conduct a walk through to create new plans. We anticipate within 3-4 weeks they will submit the new plans to HCAI. On 3/11/2022, at 10:25 a.m., during a concurrent record review and interview, the Administrator stated OSHPD/ HCAI approved Project #3 (S182348-19-00) on 10/13/2020 but could not say with confidence the project was or not completed with the approval OSHPD/HCAI. The Administrator was unable to provide documentation of permits/construction sign-off approvals from HCAI. 3a. On 3/10/2022, at 12:37 p.m., during an observation of the water heater room, there three 100-gallon water heaters. One water heater provided hot water to the laundry room, the second water heater provide hot water to Nurses’ Station 1, and the third water heater provided hot water to Nurses’ Station 2. The Administrator, present at the time of the observation stated, "the water heater for the laundry was replaced few years ago. I think OSHPD/ HCAI approval was obtained, but we never got the final approval document from OSHPD/ HCAI." The Administrator further stated, "we are in the process of reopening Project #1 (S172210-19-00). The proposal for Project #1 was signed on 2/17/2022. On 3/16/2022, the architect and the builder will conduct a walk through to create new plans. 3b. On 3/11/2022, at 12:48 p.m., during an observation of the rear storage cabinet, there were sprinkler being repaired. The Administrator, present at the time of the observation, stated OSHPD (HCAI) approval was obtained, but did not get the final document. 3c. On 3/11/2022, at 12:53 p.m., during an observation, there was a tankless water heater behind the kitchen. The Administrator, present at the time of the observation, stated it was installed in 2017 as an emergency OSHPD (HCAI) project, but the facility did not get a final approval. 3d. On 3/11/2022, at 1 p.m., during a concurrent observation and interview with the Administrator and AMS, there was repair work to the sprinklers at the front canopy. The Administer stated, "OSHPD/HCAI approval was obtained, but we never got the final from OSHPD/HCAI." The ADM further stated, "we are in the process of reopening Project #1 (S172210-19-00). The proposal for Project #1 was signed on 2/17/2022. 3e. On 3/11/2022, at 1:13 p.m., during a concurrent observation and interview with the Administrator and AMS, the parking barrier located in the back parking lot in front of the back door was removed. The Administrator stated, "OSHPD/HCAI approval was obtained, but we never got the final from OSHPD/HCAI." 3f. On 3/11/2022, at 1:20 p.m., during a concurrent observation of the firestopping on the low voltage cameras and interview with the Administrator and MA, the Administrator stated, "OSHPD/HCAI approval was obtained, but we never got the final from OSHPD/HCAI." 3g. On 3/11/2022, at 1:23 p.m., during a concurrent observation of the laundry area and interview with the Administrator and MA, there were washing machine anchored. The Administrator stated, "OSHPD/HCAI approval was obtained, but we never got the final approval from OSHPD/HCAI." 3h. On 3/11/2022, at 1:36 p.m., during an observation of the "bug zappers," the Administrator stated, "OSHPD/HCAI approval was obtained, but we never got the final document form from OSHPD/HCAI." The facility failed to obtain required written authorization, building permit, and attain construction approval from HCAI and failed to notify the Department, in writing, within five days of the commencement of any construction, remodeling, or alterations, of the following: 1. Two Nurses' Station, two shower rooms, three anchored TVs, a kitchen freezer, a swamp cooler, and an oven/range. 2. HVAC units, removal of PVC conduit, and drain lines from the roof. 3. Water heater replacement/installation, fire sprinklers at the front canopy and rear storage cabinet, low voltage cameras and firestopping, anchorage of new washing machines, anchorage of bug zappers, parking barrier removal, and general firestopping. The above violations had a direct relationship to the health, safety, and security of all residents.