Activcare at Mission Bay.

(Cont. from LIC 9099) Regarding the above-mentioned allegation, staff members and outside sources were interviewed. LPA attempted to interview several residents, however due to their major neurocognitive disorders, they were not considered reliable historians for the purpose of this investigation. Resident Power of Attorney(POA) interviews were conducted as all residents in the facility have some diagnosis of major neurocognitive disorder and reside in a secured memory care unit. Staff interviews did not corroborate the allegation, as staff consistently reported that infection control protocols were followed during the time of the outbreak, including the use of PPE, multiple in-service trainings on identifying and managing scabies, proper use of gowns and gloves, and handling contaminated clothing. During the interview with the Executive Director(ED), it was stated that the same 3–4 residents who were initially infected experienced recurring cases of scabies. However, all other residents who contracted the disease were treated successfully and did not experience reinfection. The ED stated the facility consulted multiple physicians and specialists, followed public health guidance, and repeatedly treated and monitored affected residents. Outside source interviews (Resident 1 and 2's POA's) did not corroborate the allegation, as Outside Source 1 and Outside Source 2 (OS1 and OS2) consistently stated that the facility had consistent communication during the outbreak and that they had no concerns. Outside sources consistently stated that the outbreak was addressed professionally and that the facility did an excellent job at monitoring and communicating the status of the outbreak at the time. (Cont. on LIC 9099-C pg. 2) 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 (Cont. from LIC 9099-C pg. 1) Outside source 3 (OS3)(Previous resident 3's POA) stated that the facility did attempt to call about the rash on their resident and that once OS3 agreed to use the facility’s dermatologist, the treatment finally worked and OS3 was satisfied with the care. While OS3 felt communication could have been clearer, OS3’s own account shows the facility tried to notify them and provided effective medical support. Review of the facility records did not corroborate the allegation as documentation showed that staff received in-service training on contact precautions, scabies, and PPE station maintenance supported by email correspondence and caregiver sign-in sheets. Progress notes for R1, R2, R3, and R4 reflected multiple instances of rash-related medication administration and POA notification, with additional records confirming that residents received physician-prescribed treatment and were evaluated by a dermatology specialist who ordered multiple medication treatments. Email correspondence from the Department of Public Health revealed that the facility reported the scabies outbreak and was provided guidance materials for prevention and control. The facility’s infection control plan additionally outlined comprehensive precautionary measures consistent with the practices staff described during interviews. During the facility visit, the LPA observed residents well-groomed and clean. LPA observed storage areas which contained adequate and appropriate Personal Protective Equipment (PPE), including masks, gloves, gowns, and test kits. Based on interviews, direct LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Marketing Director Jeremy Przybylek , to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided and their signature on this report confirms receipt of the Licensee Rights.

Licensing Program Analyst (LPA) Janet Ngallo conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Executive Director Dawn DeStefani. According to the facility’s license, the facility has a maximum capacity of sixty (60) residents, of whom fourty-five(45) can be non-ambulatory, and fifteen (15)may be bedridden. The facility has a hospice waiver for fifteen(15) residents and is approved for locked perimeters. LPA Ngallo, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and resident activities. There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled, as required, and stored in locked areas. (Continued on LIC809-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 The facility's ambient internal temperature as well as hot water temperature at taps accessible to residents were all compliant. No pools or bodies of water on the premises. Per Executive Director DeStefani, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were present. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. LPA Ngallo reviewed multiple staff and resident records/files. LPA records review did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in locked areas. No deficiencies were observed or cited during today's annual inspection. An exit interview was conducted with Executive Director Dawn DeStefani to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

Licensing Program Analyst (LPA) Amy Rodgers conducted a 1-year Required Annual Licensing inspection. Upon displaying her identification and explaining the purpose of the visit, LPA was granted entry into the facility. LPA was greeted and escorted during the tour by Jeremy Przybylek, Family Advisor. Executive Director Dawn DeStefani later joined the visit. The facility serves sixty (60) elderly residents; approved for forty-five (45) non-ambulatory; fifteen (15) bedridden; hospice waivers for fifteen (15) and is also approved for locked perimeters. A tour of the facility was conducted which included a sample of resident units, the dining area, recreation rooms, and food storage areas. There are four wings on site connected by one central room. Signal systems are in place and operational. PPE supplies are onsite. Passageways were free from obstructions. Facility does feature delayed egress doors or a locked perimeter. Each resident had clean and sufficient bed linens. All residents’ rooms were equipped with required furnishings. Lighting was present in the bedrooms. Residents’ bathrooms were observed to be sanitary and operational. Toilets and showers were equipped with grab bars. Hot water temperature in residents’ bathrooms were compliant. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were in working order. First aid kit(s) were complete and readily accessible. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-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 Facility has a two-day supply of perishable food and a seven-day supply of nonperishable food items. Food supply is replenished frequently by outside vendors. Food was observed to be properly stored and labeled. The food service area was observed to be neat and clean. Food menus and activities schedule were posted. Chemicals and cleaning supplies were stored in a locked closed room not assessable to residents. Centrally stored medications were properly stored and locked in cabinets. Medication logs and medications reviewed were current and medications appear to be administered according to the label instructions. Staff records review verified that all staff records were complete and compliant. Resident records were reviewed and confirmed compliant. Administrator’s certification is current. LPA reviewed the theft and loss policy and procedures. LPAs conducted a review of In-service training procedures. LPA observed that residents were being treated with dignity by staff, and there were sufficient staff on duty to meet resident’s needs. No deficiencies were cited during today's annual inspection; however, technical violation was issued. An exit interview was conducted with Executive Director DeStefani, to whom a copy of this report, the LIC 9102TVs, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.