197609604-5-16-2023-29-AS-JAPL-CRWRLW-20230517130745

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609604
Report Date: 05/16/2023
Date Signed: 05/16/2023 04:58:17 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2022 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20220113115003

FACILITY NAME:	HM SWEET HOME		FACILITY NUMBER:	197609604
ADMINISTRATOR:	NADRIAN, ASMIK		FACILITY TYPE:	740
ADDRESS:	6215 BLUEBELL AVENUE		TELEPHONE:	(818) 903-6302
CITY:	NORTH HOLLYWOOD	STATE: CA	ZIP CODE:	91606
CAPACITY:	6	CENSUS: 4	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	04:30 PM
MET WITH:	Marine Arshakyan		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident is sustaining multiple pressure injuries while in care
Staff are not properly positioning a resident while in care
Staff are not ensuring a resident is consuming the appropriate amount of fluids while in care
Resident is left soiled for extended periods of time

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to issue the findings for the above allegation. The LPA met with staff and explained the reason for the visit. The LPA notified the Administrator Asmik Nadrian via phone and staff Marine Arshakyan was authorized to sign the report.

On 01/13/2022, the Department received a complaint, alleging that Resident #1 (R1) sustained multiple pressure injuries while in care, was not repositioned by staff, was not properly hydrated, and was left soiled for an extended period of time. On 1/14/2022, LPA Salia Walker conducted a tour at 10:42 a.m., interviewed three (3) staff from 10:30 a.m. – 11:15 a.m., and interviewed four (4) residents from 12:07 p.m. – 1:30 p.m. On 1/24/2022, LPA Walker video conference R1 to identify if R1 could reposition themselves. On 12/20/2022, LPA Ashley Smith interviewed three (3) residents from 12:00 p.m. - 12:30 p.m. LPA Smith interviewed representatives from a home health agency on 3/16/2023 at 4:24, and on 5/12/2023 at 10:12 a.m., 3:51 p.m., and 4:48 p.m. The LPA attempted to speak to R1’s family member on multiple occasions but was unable to reach them. The LPA also requested and reviewed home health records.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 8

Control Number 29-AS-20220113115003

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HM SWEET HOME	FACILITY NUMBER: 197609604
	VISIT DATE: 05/16/2023

NARRATIVE

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Regarding the allegation: Due to lack of care, resident wounds progressed to pressure injuries while in care
The investigation revealed that prior to residing at this facility, R1 was at a skilled nursing facility (SNF) from 12/09/2021 – 12/25/2021, with the admitting diagnosis of hemiplegia and hemiparesis following cerebral infarction affecting the left dominant side. Medical records from R1’s stay at the SNF indicated that R1 required wound care for ‘multiple trauma wounds’ on the left elbow, left knee, left lower chest, right knee, right elbow, and left dorsal foot trauma wound. The above-mentioned wounds were not documented as pressure injuries. R1 was discharged from the SNF with an order for physical therapy and wound care.

R1 began to receive home health services on 12/25/2021, which was the same day that R1 was admitted to this facility. At the start of care, R1’s wounds were noted as follows: left chest wound (11x3cm), left elbow wound (4x3.2 cm), left knee wound (2x1.5x0.2cm), left medial knee (2x1.7cm). However, these were considered trauma wounds and were not documented as pressure injuries. On 12/25/2021, home health staff completed the “Braden Scale for Predicting Pressure Sore Risk in Home Care”, and R1 had a total score of 12, which was indicated as “high risk” for pressure injuries. At the start of R1’s home health services, R1 was visited by a home health nurse daily to care for R1’s wounds. A nursing visit from home health conducted 12/27/2021 reported that R1 also had a stage 2 pressure injury on the left buttocks.

To supplement such care, facility staff were expected to ensure that R1 was hydrated and regularly repositioned to aid in the treatment of wounds. Yet, a home health visit dated 1/8/2022 indicated that R1’s wounds had progressed to the following: stage 3 pressure injury to the right knee (2x1.7x0.3) with a moderate amount of drainage, stage 2 pressure injury to the sacral (3.8x1.2x0.3cm), stage 3 pressure injury on the buttocks (3.2x1.3cm), stage 4 pressure injury to the left elbow (3.0x3.0x0.4cm) with a moderate amount of drainage. It was further noted that R1 required skilled nursing for wound treatment. Interviews and records review confirmed that on 1/9/2022, witnesses observed a sealed bag of disposable bed pads being used to prop R1 up instead of pillows. Home health records indicated that staff ‘refused to assist to turn the patient’ in claims that they had already performed wound care. Records from 1/21/2022 stated that R1’s pressure injury at the sacral had progressed to a stage 3, and the wound on R1’s elbow was progressing to a stage 4 pressure injury. It was documented in records on 1/10/2022 that R1’s wounds worsened despite communicating the rotating schedule to staff and demonstrating proper positioning.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 8

Control Number 29-AS-20220113115003

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HM SWEET HOME	FACILITY NUMBER: 197609604
	VISIT DATE: 05/16/2023

NARRATIVE

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Staff interviews from 1/14/2022 claimed that R1 required repositioning and staff insisted that they regularly repositioned R1. Yet, during a virtual conference call with R1 on 1/24/2022, LPA Walker spoke to R1, who stated and demonstrated that they were unable to reposition in the bed. R1 also indicated that staff did not reposition them throughout the day and stated that they could not reposition in bed without assistance.
Home health records from 1/25/2022 documented that the facility was unable to care for R1 and required the services of a skilled nursing facility. It was written that the facility did not have a hoyer lift, which made it impossible for R1 to go to medical appointments without contacting emergency services. While there was a wheelchair in R1’s room, there was no way to get R1 in it, and R1 required the assistance of two people to perform physical therapy exercises. Witnesses indicated that staff in the facility were either unwilling or capable to provide the care that R1 needed. It was again documented in home health notes on 02/07/2022 that R1 required skilled nursing interventions for wound care.

Interviews with representatives from the home health agency indicated that R1 required total assistance for bed mobility. As a result, the worsening of R1’s wounds could have been due to lack of repositioning, lack of protein intake, and/or lack of hydration. Additionally, records and interviews with home health reported that R1 needed total assistance with performing physical therapy exercises and notated that facility staff either were unaware or unwilling to assist. It was communicated that the facility staff, despite the education provided, weren’t skilled or capable to provide the care that R1 needed.

Based on information obtained in interviews and records review, there is sufficient evidence to support the claim that due to lack of care from the facility staff, R1’s wounds progressed to pressure injuries while in care. This allegation is deemed Substantiated at this time.

Regarding the allegation: Staff are not properly positioning a resident while in care
It was alleged that staff were not repositioning R1. According to the physical therapy evaluation conducted on 12/27/2021, R1’s left side was significantly limited in movement due to paralysis of the left side and wounds. As such, R1 required maximum assistance with transfers. Physical therapists who assisted R1 indicated that R1 would require continued practice with transfers and mobility techniques in between sessions.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 8

Control Number 29-AS-20220113115003

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HM SWEET HOME	FACILITY NUMBER: 197609604
	VISIT DATE: 05/16/2023

NARRATIVE

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On 1/03/2022, it was documented in home health records that the home health staff advised and demonstrated the proper repositioning schedule and pressure relief for R1 to both R1 and the facility staff. On 1/11/2022, facility staff were again educated on repositioning R1 every two hours and assisted R1 in a better position for meals. It was documented that R1 required two persons to assist for bed mobility. R1’s appraisal, dated 1/12/2022 and signed by the Administrator, indicated that R1 was unable to walk without any assistance, and required help in transferring and moving about the facility. Lastly, R1’s physician’s report dated 1/12/2022 indicated that R1 was bedridden, which meant that R1 required assistance with turning or repositioning. Staff interviews conducted on 1/14/2022 supported claims that staff were aware that R1 required assistance with repositioning every two hours and staff claimed they followed orders as prescribed.

Interviews with R1’s home health agency indicated that they educated facility staff on how to best reposition R1 to prevent further skin breakdown. Yet, on 01/09/2022, witnesses observed a ‘sealed bag’ of disposable bed pads being used to prop up R1 instead of a pillow. Also, home health records documented that during a visit on 1/17/2022, staff refused to assist the home health aide with turning R1. In addition, during a virtual conference call with R1 on 1/24/2022, LPA Walker spoke to R1, who stated and demonstrated that they were unable to reposition in the bed. R1 also indicated that staff did not reposition them throughout the day and stated that they could not reposition in bed without assistance. Yet, the Administrator claimed during an interview on 1/24/2022 that R1 was able to rotate on their own without assistance.

Home health documentation from on 1/25/2022 revealed that due to the worsening of R1’s wounds, the agency believed the facility was unable to care for R1 and required the services of a skilled nursing facility. It was written that the facility did not have a hoyer lift, which made it impossible for R1 to go to appointments without contacting emergency services. While there was a wheelchair in R1’s room, there was no way to get R1 in it, and R1 required the assistance of two people to perform exercises. Witnesses indicated that staff in the facility were either unwilling or capable to provide the care that R1 needed. On 2/9/2022, home health records noted that R1’s progress in physical therapy was minimal and claimed that home health staff began educating R1’s family member on assisting R1 with physical therapy exercises, as “the board and care facility where [R1] resides will likely not do this … likely will not perform these interventions with the patient.” Concerns were also raised that R1 suffered a significant decline since coming to the facility on 12/25/2021.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 8

Control Number 29-AS-20220113115003

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HM SWEET HOME	FACILITY NUMBER: 197609604
	VISIT DATE: 05/16/2023

NARRATIVE

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Based on the information obtained in interviews and record review, there is sufficient evidence to support the claim that staff failed to properly position R1 while in care. This allegation is deemed Substantiated at this time.

Regarding the allegation: Staff are not ensuring a resident is consuming the appropriate amount of fluids while in care
It was alleged that R1 was not receiving the appropriate amount of fluids. Home health records documented that on 1/5/2022 and 1/10/2022, R1 claimed that they had not had any water on those days. Home health staff also indicated that on 1/10/2022, R1 had begun showing signs of dehydration. On 1/11/2022, home health staff indicated that R1’s ability to move in bed and alertness had declined. While additional resident interviews supported claims that they received liquids from facility staff on a regular basis, staff interviews stated that R1 required assistance with consuming liquids due to their paralysis. Yet staff also indicated that they check on the residents ‘regularly’ to assess if the residents require any assistance.

Interviews with representatives from the home health agency indicated that R1 required total assistance for bed mobility. As a result, the worsening of R1’s wounds could have been due to lack of repositioning, lack of protein intake, and/or lack of hydration. A review of home health notes from 1/5/2022 and 1/10/2022 indicated that R1 informed home health that they had not received any water. Interviews with residents conducted on 1/14/2022 at 12/20/2022 revealed no concerns as it related to receiving water from facility staff. Yet, at the time of those interviews, residents denied needing physical assistance with consuming liquids and were not bedridden. However, interviews with home health representatives supported claims that given R1’s paralysis, staff needed to assist R1 with drinking water.

R1 was not able to reposition themselves in the bed given their physical condition. As such, leaving water by R1’s bedside is insufficient, as R1 would not have been able to consume the liquids independently. Home health records indicated that R1’s condition worsened and at a certain point, R1 was unable to sit up on their own without proper equipment or a two-person assist. Hence, R1 was unable to consume liquids without the assistance of another person.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 8

Control Number 29-AS-20220113115003

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HM SWEET HOME	FACILITY NUMBER: 197609604
	VISIT DATE: 05/16/2023

NARRATIVE

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Based on the information obtained in interviews and record review, there is sufficient evidence to support the claim that staff failed to ensure that R1 was consuming the appropriate amount of fluids. This allegation is deemed Substantiated at this time.

Regarding the allegation: Resident is left soiled for extended periods of time
Regarding the allegation, it was alleged that R1 had been left soiled potentially for hours due to the inflexible incontinent care changing schedule from facility staff. Staff stated that residents were change ‘three times’ throughout the day. Per that schedule, residents that used pull-ups and depend on facility staff to change them may be soiled for several hours between changes. Resident interviews conducted on 1/14/2022 in general supported claims that they were only changed by staff approximately two (2) times a day.

Information obtained from interviews with home health staff and a review of home health records revealed that R1 was oftentimes soiled. On 12/25/2021, home health staff completed the “Braden Scale for Predicting Pressure Sore Risk in Home Care”, and R1 had a total score of 12, which was indicated as “high risk” for pressure injuries. On this scale, R1 was rated a ‘2’ on the scale of moisture, which is documented as “often moist – skin is often but not always moist. Linen must be changed as often as 3 times in 24 hours”. With such an infrequent changing schedule, one can allege that R1’s exposure to moisture (urine), coupled with an infrequent repositioning schedule, aided in the worsening of pressure injuries. A representative from R1’s home health agency documented their concerns on 1/9/2022, where they indicated that R1 had been left soiled for ‘potentially hours’ due to an inflexible changing schedule from the caregivers’. Records indicated that the pressure injury on R1’s sacral progressed to a stage 2 pressure injury, and the pressure injury on R1’s buttocks progressed to a stage 3 pressure injury. Based on the information obtained from interviews, there is sufficient evidence to support the claim that R1 is left soiled for extended periods of time. This allegation is deemed Substantiated at this time.

Per California Code of Regulations (CCR), Title 22, see LIC 9099-D for deficiencies cited. An immediate civil penalty of $500 is also assessed. The licensee was informed that a civil penalty might be assessed based on the Health and Safety Code 1569,49(e) or (f), or 1548(e) or (f), 1568.0822(e) or (f). Exit interview conducted. A copy of the report was issued, along with appeal rights.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 6 of 8

Control Number 29-AS-20220113115003

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HM SWEET HOME	FACILITY NUMBER: 197609604
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/19/2023 Section Cited CCR 87615(a)(1)	1 2 3 4 5 6 7	87615(a)(1) Prohibited Health Conditions. (a) Persons who require ... those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agreed to do the following: 1. Schedule a training regarding Prohibited Health Conditions and Pressure Injuries. Verification of scheduled training with the trainers credentials will need to be submitted by 5/19/2023 and completion of training must be submitted no later than 5/31/2023
	8 9 10 11 12 13 14	Based on interview and record review, the licensee did not comply with the section cited above, as R1’s trauma wounds progressed to stage 3 and stage 4 pressure injuries, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14	A civil penalty in the amount of $500 has been issued due to the worsening of R1's pressure injuries, and further retaining a resident with a prohibited health condition.
Type A 05/19/2023 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	87468.2(a)(4) Additional Personal Rights of Residents.. To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agreed to do the following: 1. Review Regulation 87468.2. Once reviewed, submit a Plan of Action, indicating how the facility will maintain compliance with the regulation. Submit Plan of Action no later than 5/19/2023, end of day.
	8 9 10 11 12 13 14	Based on interviews and record review, licensee did not comply with the section cited above, as R1 did not receive the appropriate care and supervision as it relates to repositioning R1 and ensuring R1 is properly hydrated, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 7 of 8

Control Number 29-AS-20220113115003

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HM SWEET HOME	FACILITY NUMBER: 197609604
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/19/2023 Section Cited CCR 87625(b)(7)	1 2 3 4 5 6 7	87625(b)(7) Managed Incontinence. … The licensee shall be responsible for the following: Ensuring that the condition of the skin exposed to urine and stool is evaluated regularly to ensure that skin breakdown is not occurring. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator has agreed to do the following: 1. Review Regulation 87625 and submit a Statement of Understanding by the end of the day, discussing how the facility will maintain compliance.
	8 9 10 11 12 13 14	Based on interviews and record review, licensee did not comply with the section cited above, as staff did not ensure all residents were regularly changed and R1 was observed to be soiled for extended periods of time, which poses an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Jeralyn Ann Pfannenstiel
LICENSING EVALUATOR NAME: Ashley Smith
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

Page: 8 of 8