Carewell Manor

(Continued from LIC9099) On 11/26/2024 LPA conducted a visit to the facility to initiate investigation into the above allegations. LPA obtained copies of resident roster, staff roster, infection control plan, disaster plan, training records, personnel records, CPR certification, admission agreements and facility sketch . On 1/16/2025, LPA returned to the facility to continue the investigation. LPA obtained photos of the following documents: criminal record clearances, physician's reports and health screenings. Regarding the allegation of "Staff do not have fingerprint clearance," LPA reviewed staff files and observed Criminal Record Clearances in all staff files. LPA also reviewed the facility's personnel records through Guardian and observed 6 out of 6 staff have been cleared to work at the facility. Regarding the allegation of "Staff insert suppositories to residents in care," LPA interviewed the 5 residents in care and all of them stated the facility does not insert suppositories or other medication into them rectally. Regarding the allegation of "Staff did not maintain resident records," the allegation indication LIC602s are missing or outdated in resident files. LPA observed LIC602s all resident files. 4 out of 5 LIC602s were created in 2024. 1 out of 5 LIC602s was created in December 2023. Regarding the allegation of "Residents are not provided proper food service," LPA interviewed 5 residents in care. Of the residents interviewed all stated they are provided proper food service and have no complaints. Regarding the allegation of "Staff did not inform resident's physician of resident's change of condition," LPA reviewed resident files and noted one resident with dementia. LPA observed an admission agreement for this resident stating they moved into facility on 7/24/2024. LPA observed a completed physician's report indicating the resident has dementia. This report was signed by the resident's physician and dated 8/23/2024. Regarding the allegation of "Staff did not ensure sufficient food items were available at the facility for residents in care," LPA observed the food supply in the facility. LPA noted the facility has 7 day supply of non-perishable foods and a 2-day supply of perishable foods. LPA conducted interviews with 5 residents in care. Of the residents interviewed, all stated there is enough food in the facility and that they receive enough. Regarding the allegation of "Centrally stored medications are accessible to residents in care," LPA observed medications to be locked in a kitchen cabinet behind a lock that requires a key to open. Of the residents and staff interviewed, all stated medication remains locked in the kitchen. (Continued on 2nd LIC9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (Continued from 1st LIC9099-C) Regarding the allegation of "Staff do not have a fire evacuation plan at the facility," LPA observed a completed LIC610E posted in the facility. Regarding the allegation of "Staff do not have an infection control plan at the facility," LPA observed a completed LIC9282 posted in the facility. Regarding the allegation of "Staff are not following reporting requirements," LPA reviewed documents and interviewed residents in care. Based on LPA's review and interviews, LPA could not determine if any incidents occurred that went unreported. Regarding the allegation of "Staff did not ensure resident's diapering needs were met," LPA conducted interviews with 5 residents in care. Of the residents interviewed, 3 stated they wear diapers. Of these residents, all of them stated they are changed appropriately and when they need to be. Regarding the allegation of "Staff consume liquor while on shift," LPA observed no liquor or consumable alcoholic products in the facility. LPA conducted interviews with 5 residents and two staff. Of the 7 individuals interviewed, all of them denied this allegation. Regarding the allegation of "Staff left residents unattended," LPA conducted interviews with 5 residents in care. Of the the residents interviewed, all of them stated the staff do not leave them unattended and that there is always a staff member present at the facility. LPA conducted interviews with 3 staff. 3 said the staff do not leave residents unattended. Based on observations made, interviews conducted and records reviewed there is insufficient evidence to support the allegations of " Staff do not have fingerprint clearance," "Staff insert suppositories to residents in care," "Staff did not maintain resident records," "Residents are not provided proper food service," "Staff did not inform resident's physician of resident's change of condition," "Staff did not ensure sufficient food items were available at the facility for residents in care," "Centrally stored medications are accessible to residents in care," "Staff do not have a fire evacuation plan at the facility," "Staff do not have an infection control plan at the facility," "Staff are not following reporting requirements," "Staff did not ensure resident's diapering needs were met," and "Staff consume liquor while on shift. " Although the allegations may have happened or are valid; there is not a preponderance of evidence to prove that the alleged violation(s) did or did not occur, therefore the allegation are UNSUBSTANTIATED. LPA reviewed this report with staff and provided a copy. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (Continued from LIC9099) On 11/26/2024 LPA conducted a visit to the facility to initiate investigation into the above allegations. LPA obtained copies of resident roster, staff roster, infection control plan, disaster plan, training records, personnel records, CPR certification, admission agreements and facility sketch. On 1/16/2025, LPA returned to the facility to continue the investigation. LPA obtained photos of the following documents: criminal record clearances, physician's reports and health screenings. Regarding the allegation of "Staff lock facility doors to prevent residents from leaving," LPA observed facility staff unlock and lock the front door to the facility from inside the facility with a key. Of the 5 Residents interviewed, 4 of them stated the facility door locks from the inside with a key. Regarding the allegation of "Staff did not complete required trainings," LPA interviewed Staff 1. S1 stated they were hired at the facility in April of 2024. LPA reviewed S1's file and observed a completed in-service training for PRN medication administration. LPA observed no other completed trainings. LPA conducted interview with S1 and AD. Both stated S1 had not completed their required training. LPA interviewed S1 about their previous work experience. S1 stated they did not do food preparation or medication administration at their previous job. LPA determined S1 has not received training and does not have previous work experience in multiple areas related to their current role as caregiver Regarding the allegation of "Staff facility records are falsified," LPA observed a CPR card for Staff 1. LPA contacted the company named on the CPR card. The company had no record of the reference number on S1's CPR card. The company representative stated anyone who completed their course will have valid login credentials to their website. S1 stated they have valid login credentials to the website but was unable to login. S1 stated the CPR card was falsified and that they did not complete CPR certification through the company named on the CPR card. Regarding the allegation of "Staff did not provide adequate medication assistance to residents in care," LPA conducted interview with 5 residents in care. Of the residents interviewed, all of them stated they receive adequate medication assistance. Based on record review, the staff present at the facility at the time of the inspection has not received full medication administration training. Although the LPA observed record of this staff member attending an in-service training for PRN medication, the facility could not produce proof of any other medication training. S1 also stated they did not administer medication at their previous job. LPA determined staff are not providing adequate medication assistance to residents. (Continued on LIC9099-C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 (Continued from LIC9099-C) The preponderance of evidence standard has been met. The allegations of "Staff lock facility doors to prevent residents from leaving," "Staff did not complete required trainings," "Staff facility records are falsified," and "Staff did not provide adequate medication assistance to residents in care" is determined to be SUBSTANTIATED, meaning the complaint allegation is valid and that violations have occurred. An exit interview was conducted, and this report was reviewed with facility staff. A copy of this LIC-9099, deficiency page and appeal rights were provided to the facility.

Licensing Program Analysts (LPAs) Dwayne Mason Jr. and Faith La arrived at the facility unannounced for the purpose of conducting a required annual inspection. LPAs were greeted and granted entry into facility by Karen Moralde and John Moralde, Caregivers. Facility Administrator Carol Wilson joined the inspection after the tour. The facility is a one-story home with six client bedrooms, one staff room, three bathrooms, kitchen, dining room, living room, TV room, backyard and attached 2-car garage. LPAs noted there are two vacancies at the facility. All four residing residents were present. All client rooms had required elements, including bed, chair, closet space and ample lighting. Facility has extra linens for residents in the hallway closet. Restrooms are stocked with soap and paper towels. LPAs measured water all three bathrooms. LPAs measured hot water to be 109.8, 114.2 and 110.5 degrees Fahrenheit in the three bathrooms. LPAs noted Fire Extinguisher was last serviced on 04/22/2024. LPAs observed hazardous items such as knives, chemicals and cleaners to be locked up in cabinets in the kitchen. Knives are locked up separate from toxic chemicals. Medication for each client is kept locked in a kitchen cabinet. The backyard has a shaded sitting/lounging area. Exit gate is unlocked. LPAs observed exit gate to be unobstructed. LPAs reviewed two of the four resident files and three staff files. LPAs also reviewed medication for two out of four clients. LPAs interviewed two residents and two staff. LPAs issued Technical Assistances (TA) to advise the facility to maintain a plan of operation including a dementia care plan and bedridden care plan. Based on record review, LPAs determined that only one disaster drill was conducted and documented at the facility in the last year. Two deficiencies are being issued based on today's inspection. An exit interview was conducted and a copy of this report and appeal rights were provided to the facility.

It is alleged that the staff is not providing adequate care and supervision to the individuals in care. During the visit conducted on February 14, 2024, from 3:15pm to 5:30pm, LPA Cho observed six residents and two caregivers on duty. The Administrator was also on premises upon LPA’s arrival. Per LPA’s observations, caregivers were actively assisting the residents during the visit today and on February 14, 2024. Per review of the appraisals, it was documented that two out of the six residents need special observation/night supervision. Based on the interviews conducted, one out of the two residents indicated that care and supervision is not provided after 7:00pm. Two out of the three staff interviewed indicated that care is only provided upon request when their shift ends at 7:00pm. Both staff also indicated breaks are taken at staggered times to ensure residents’ needs are met throughout the day, however routine checks are not conducted after 7:00pm. It is alleged that the residents are left in their soiled clothing. Based on the observations made on February 14th during the diaper inspection requested by LPA, LPA along with the staff observed that the diaper for one out of six residents was visibly wet at 3:34pm evidenced by the yellow and heavy appearance. The stool was also observed to be impacted in the rectum. During today’s inspection with the staff approximately 9:40am, all diapers were dry. Per interviews conducted on February 14, 2024, one out of the two residents indicated that requests for diaper changes would go unanswered after 7:00pm until the next morning. Three out of the three staff interviewed indicated that routine checks are conducted every two hour interval during the day while checks during the nocturnal hours are not conducted unless requested. Based on LPA’s investigation, although residents are routinely checked every two hours during the day and upon request during the day and after 7:00pm, residents who are non-verbal, confused, and disoriented are unable to verbalize their needs. Documentation also noted that the two out of the six residents need special observation/night supervision to ensure that their needs are being met at all times. Therefore, based on LPA's observations, interviews, and the records reviewed, the preponderance of evidence standard has been met, therefore the following allegations: Staff is not providing adequate care and supervision to individuals in care and Residents are left in their soiled clothing are deemed SUBSTANTIATED as per the California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are being cited on the attached LIC 9099D. An exit interview was conducted with Administrator Carol Wilson, and a copy of this report including the LIC9099C, LIC9099D, and the appeal rights were provided at the end of the visit.