Emerald Home Care

On 08/10/22, while at the facility for another reason, LPA observed staff failed to submit an incident report within 7 days of occurrence to CCL regarding resident’s (R1) fall on 07/13/22. LPA also observed staff failed to submit a death report (LIC624A) within 7 days of occurrence to CCL on resident’s (R1) demise that occurred at the facility on 07/18/22. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided via email.

On 05/09/2022 at 1:11 pm Licensing Program Analysts (LPAs) J. Clancy-Czuleger and K. Nguyen arrived unannounced to conduct infection control inspection LPA meet with Licensee Carmen Nica and explained the purpose of the visit. During the Infection Control Inspection, LPA toured facility including but not limited to front entrance, screening station, hand washing stations, bedrooms, common areas, kitchen, and backyard. Facility has a sufficient 2-day perishable and one week non-perishable food supply. There is one central entry point for universal screening for staff, residents, and visitors. Hand washing posters were observed. Facility has a 30-day supply of PPEs maintained at central location and easily accessible for staff. The facility has a mitigation plan. Cabinet for knives, cleaning supplies, and central storage for medications were observed with locks. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

While investigating a complaint (Control # 15-AS-20211105095643), Licensing Program Analyst (LPA) Delmundo requested for resident’s (R1) documents to be submitted by 11/12/21. LPA did not receive the requested documents. On 8/14/24, LPA called and requested again for the documents and licensee stated R1’s documents were already in the attic and if she cannot find them in her computer, she will not get to the attic to retrieve the documents. On August 27, 2024, LPA called and left an urgent message on licensee’s voicemail and requested to submit the documents by August 30, 2024. Licensee did not submit the documents. LPA reviewed the documents that were received via fax by the Department's Regional Office for October 2021, November 2021 and December 2021 and didn’t observe any documents for R1 from the facility. On this day, 5/13/25, LPA learned that the staff (S1) is not fingerprinted. LPA asked S1 who stated she started working Monday, May 5, 2025. The above were discussed with Carmen Nica, licensee, and John Nica, administrator (ADM). Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty is assessed for S1 who is not fingerprinted and will continue for $100.00/day until corrected. Failure to submit proof of correction by plan of correction due date for the other deficiency may also result in civil penalty. Deficiencies and plan and proof of corrections were discussed. Exit interview conducted. Appeal Rights, LIC421BG Civil Penalty, LIC9098 Proof of Correction form and copy if this report provided to ADM.

On 04/02/2025 at 12:05 PM, Licensing Program Analyst (LPA) Ardalan Gharachorloo arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with caregiver, Bintia Loznianu and explained the purpose of the visit. Facility Manager, Carmen Nica arrived at 12:35 PM. LPA explained the purpose of the visit to the facility manager. At 12:10 PM, LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 72 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 109 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum of one week supply of non-perishable and 2 day of perishable foods. Centrally stored medication and sharps were locked and inaccessible to residents. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last serviced on 07/01/2024. Emergency Disaster Plan was last posted on 07/21/2017. First aid kit was observed to be complete. Emergency disaster drill was last conducted on 02/10/2025. At 1:10 PM, LPA reviewed 3 residents records and 3 staff records; all were complete. LPA also reviewed a sample of resident’s medications . The following documents were observed during the inspection: LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan, and Liability Insurance. The current Administrator’s Certificate expires on 10/26/2026. No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

Page 2 Allegation: Resident (R1) not provided call equipment/buzzer. FM stated R1 was not provided call buzzer/call pendant. The 2 staff interviewed stated R1 had call bell which LPA observed in the vacant room used by R1 when R1 was at the facility. R1 stated she had buzzer. Due to medical diagnosis, LPA was not able to obtain information from another resident (R2). Therefore, the allegation is unsubstantiated. Allegations: · Staff is charging for services not received. · Staff did not follow admission agreement. FM stated the contract states residents would be bathed 2 times per week and that was not adhered to even after the family brought this issue to the licensee, they found R1 lacking proper hygiene with greasy matted hair and dressed in the same blouse 3 days in the same week. Review of Admission Agreement for R1 showed bathing twice a week. LIC602A Physician’s Report showed substantial assistance with bathing and partial to substantial assistance with dressing and grooming. S1 stated residents are given bath on Wednesdays and Saturdays. S1 denied missing giving bath to R1 and stated that she remembers giving R1 a bath 3x in a week, because R1 had an accident. S1 further stated that FM came one time and said something about R1's hair being dirty and that was day after R1 was given the scheduled bathing, so S1 gave R1 a shower that day. S2 stated all residents get a bath Wednesdays and Saturdays but R1 sometimes refused but at the end of the day, R1 still get bathe. She and S1 give bath to R1 because of R1’s medical condition and cannot take care of own bathing needs. R1 stated not remembering how many times staff gave R1 a bath, however, R1 told LPA regarding R1's medical condition. S1 stated R1 loves wearing dress sleep wear and that she changed R1's dress every day. S1 further stated she cleaned and wiped R1’s underarm and body with warm cloth every single day. S2 stated she changes all residents clothes every day. R1 stated that it never happened that R1 wore the same clothing for days. Licensee stated residents are changed everyday when they get up and before they go to bed ...continued 9099C (page 3) 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 Page 3 During inspection, LPA observed R2 wearing clean clothing; however, due to R2’s medical condition, LPA was not able to obtain information regarding the allegations. Therefore, the allegations are unsubstantiated. Allegation: Resident did not receive medication as prescribed. FM stated that licensee, told FM that the Milk of Magnesia had not been stated and gave the FM the medication to administer to R1. Licensee denied the allegation and that she and ADM are the one who administers medications to residents. S1 stated she does know if licensee asked FM to administer the said medication. S2 stated not hearing the licensee asked FM to administer the said medication. R1 stated she does not believe she was taking Milk of Magnesia while at the facility, but list of medications showed R1 has order for this medication. Therefore, the allegation is unsubstantiated. Allegation: Staff did not meet resident's (R1) hygiene needs. FM stated that R1 would be bathe twice a week per contract which facility failed to provide. FM further stated that R1 was lacking proper hygiene with greasy, matted hair. Review of Admission Agreement for R1 showed bathing twice a week. S1 and S2, stated they gave R1 bath two times a week. S1 also stated she R1 a bath 3x a week when R1 had accident while S1 stated R1 sometimes refused but at the end of the day, R1 gets bathe. S1 further stated that when FM came and observed R1’s hair, R1 was given a bathe day prior. Licensee stated residents are given bath 2 to 3 times a week as agreed and given sponge bath on days residents are not scheduled for bathing; however, residents are given bath when they have accidents. R1 was not able to provide information regarding the frequency of bathing provided to R1. Due to R2’s medical diagnosis, LPA was not able to obtain information. Therefore, the allegation is unsubstantiated. Allegation: Staff did not properly dress a resident (R1) while in care. FM stated that R1’s lower half was not dressed for facility’s convenience and instead wrap a pad and blanket around R1’s lower extremities. S1 stated R1 loves wearing pajama. Both S1 and S2 stated they change residents’ clothes every day. Licensee denied the allegation and stated the residents' clothing are changed when they get up and before they are put to bed. ....continued on 9099C (page 4) 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 Page 4 R1 stated care staff has taken good care of her. W1 stated observing R1 has blanket from waist down when she assessed R1, however, W1 was not able to tell if R1 was wearing something from waist down or if R1 was wearing a full dress. Due to R2’s medical diagnosis, LPA was not able to obtain information whether R2 observed R1 not dressed from waist down. Therefore, the allegation is unsubstantiated. Allegation: Staff made an unauthorized diagnosis of a resident (R1) while in care. FM stated the licensee repeatedly described R1 as having dementia. Review of LIC602A did not show R1 has dementia diagnosis. The licensee denied the allegation and stated that she never told the FM that R1 has dementia but mentioned that it could be mild cognitive impairment. S1 and S2 stated not hearing the licensee saying R1 has dementia. Due to R2’s medical diagnosis, LPA was not able to obtain information pertaining to the allegation. Therefore, the allegation is unsubstantiated. Allegation: Staff denied visits to resident (R1) while in care. FM stated that licensee told R1’s family leave R1 there for some time after admission meaning not visiting regularly R1 so R1 would fall into line with the house rules. The licensee …… . S1 and S2 stated R1’s family member came to the facility every day and was allowed to visit R1 and the visitation took place in the backyard. Residents’ visitations were allowed inside the facility after weeks and visitors wore mask. R1 was not able to provide information. Due to R2’s medical diagnosis, LPA was not able to obtain information. Therefore, the allegation is unsubstantiated. Based on interviews, observation and records review, there is not a preponderance of evidence standard to prove that violation occurred. No deficiency cited. Exit interview conducted and copy of this report provided.