FAX Date: | 08/24/2020 Pages including cover sheet: [5 To: Division of Pubic and Behavioral From: | eninst Reno Reno Retirement Center ee 1 AL Phone Phone _| (775) 323-1911" 3 Fax Phone| (775) 684-4211 Fax Phone | 17753231911, Termination of license appealsue? ENTRUST SENIOR LIVING isa Sheyeh, Administrator Division f Public end Behavioral Health 450‘Technalogy Way Sie 300 Carson City, NV 9706 Dear Ms. Sheryeh 1am requesting an appeal ofboth the immediate suspension of Reno Valley's license to operate and the [Immediate Jepoardy determination ofthe surprise Extended Survey beginning August 13,2020. To date, we have received no information supporting the decision to force closure ofthe facility; however, ‘the ovmers of the building were told tht Las the Executive Director was to “be relieved of duty" (Oumership has declined to da so as no details were given other than “serious concerns about me asthe Administrator, and intimation that Y had abused a resident Also of note: of the stated violations attributed tothe close, NOT ONE conceras physical. verbal, psychological, financial or sexual abuse commited by me, asthe Executive Director, nor anyone else on Staff at Reno Valley. As such, Tam left without an opportunity to defend zy good name, knowing tht the license I worked hard for and earned isin jeopardy. What I know for certain is that Iam entitled 10 ‘know who made the allegations, and what the specific allegations were, Lalso know, also for absolute ‘erin, that the allegations are false. Given thatthe facility received an “A” rating on our most recent previous survey (which we requested), up Rom a“D", my staff and [are that much more flummoxed. ‘We can only assume that there is someone, somewhere, witha vendetta against Reno Valley. and ‘against me a ts Executive Director. What other reasonable explanation could there be to go from the highest rating Reno Valley has ever earned in its history, to an order to close in less than seven weeks? [No one on this end has one. (Of the indicated violations: (016 food on the floor: The Dining room and Activities areas ofthe building are cleaned regularly and at Teast daily. As we were not informed as to where this food was located, I cannot answer for other areas ofthe building, only that, per our admissions contract, we provide weekly cleaning of Fesident rooms and, as we are an Assisted Living facility residents are equited to maintain the cleanliness of their own living spaces in the interim, Debris and dirty laundry on the oor: Again, and in the matter of debs, there was no indication as to ‘hat the debris ishas. Residents are provided laundry baskets on move-in, but are not required ‘o maintain their dity laundry ina specific manner in their private space, Residents in shared Toms are required to keep their personal space clean so as not to cause unde hardship on thei Foornmates however, otherwise none ofthe residents has any specific manner in which they are required to maintain ther dirty laundey. Feces on the flor: Again, there is no indication of where this was located, Was tis ina resident's roost, orn a common ares? As this isa fecility for elders, we do have several residents who ace 1155 Beech St, Reno, NV 89512 775-323-1911/775-323-1925 FAX80. Its especially concerning then, that it appears this action isthe result of frequent calls to “State” ‘ade by this group, {and my team have put an enormous amount of effort into moving this building forward, making ‘improvements to the exterior and upgrading interior spaces as our budget will allow. However, as we ace partially dependent on Medicaid for income on a larger scale than other facilities that still accep the Waiver, we are no always able to make big-budget changes as are othe facilities thet may not participate. Nonetheless, we do everything in our power to make living here comfortable and safe. However, and having said this, Ihave for months requested that Washoe County Health District, o anyone willing to do so, come into the facility and tes all our residents for COVID-19. To date. only ne resident has shown syrnptoms related to the virus, Thad to make multiple calls to gether tested, and ‘was forced to quarantine all residents to thele apartments for 17 days while I waited for someone to come to the butiding and swab her and subsequently receive her resus. Fortunately, al she had was a stomach bug orf, However, had she been infected withthe vieus, she could have potentially ‘decimated our resident population, and caused Reno Valley to be yet another statistic and/or ad pandemic story {Other than this one person, however, and as no other residents have shown symptoms, I can only assume we are one of the few facilities inthe State of Nevada tat can state we are “COVID Free". Given that there are several Reno Valley residents with severe respiratory illnesses (asthma, COPD, emphysema, etc) who have not become il I strongly believe this 0 be ‘rue. However and until SOMEONE assists us in testing the entire resident population, Ica nly speculate and tel those wi challenge this belie that, instead of pointing out the obvious, they could be working to help us get what we need to prove that belie corrector incorrect} {have been assured with almost every cal that “someone” would be in contact to made arrangements for facility wide testing o, inthe alternative, would cal back for details about the numberof test kits we needed to test the residents ourselves. To date, [have received no return call, no followup, no test kts, nothing. Given that the highest rate of infection, and the highest fatality percentage, has occurred in the ‘Long. Term Care setting I ind this to be extremely concerning and point of great stress fr the residents and my team. ‘Thank you ‘Audrey F. Liggins, LNHA, RCAL, RFA, Executive Director Entrust Reno (formerly Reno Valley Assisted Living) 1155 Beech St, Reno, NV 89512 775-323-1911/775-323-1925 FAXsve ENTRUST incom bowel and lt, over. any ney ese nde ving acide fr ups) eee ns or aff wae ae eno ed and Sienna hye ae Vabeyis opera ae ‘Bugs on the windowsill: To which rooms does this refer? There are several unoccupied rooms in the facility. Occupied rooms ate cleaned weekly, and exterminator services follow a similar schedule. As this i the warmer season, there ae an abundance of insects around the building, \which is surounded by tres and faces a public pari. The Environmental Services department ‘makes every effort to remove insect carcasses in and around the building, however given the time of year this isan uphill battle atthe best of times ‘Thick, orange substances on windows: [assume this is old glue, however, without any specificity on \where this was located cannot give a thorough response to this. Resident sink separating from the wall: Where? While there is ongoing maintenance in the facility, I ‘cannot answer a5 to why or where this was discovered, and can only assume the sink was, awaiting replacement. However, no one asked if this was the case. Food debris on the floor in the Rebecca Room: This room is wed frequently by staff and residents, ‘Without knowing when the food was found and what it consisted of, cannot answer to this except to state thet specificity is required inorder for a complete, honest answer to this isu. Canmot state when the food was dropped (That morning? The night before?) or by whom, Brow sticky substance on the Activities floor. ‘This space is constantly in use, at all hours of the day Ang night. There are several residents who drink coffee all day and, as there was no substance on ‘the floor outside the mediation room at poin’s when T passed though the Activities room (frequently, I can only imagine that the substance was indeed cleaned shortly after it was, noticed. The Activites floor is mapped tice per day Ms, Sherych, it appears several of the violations noted had to do with medications, Of particular noteis| the question of whether a medication was onsite, self-administered medications kept ina locked Container, and medications kept in a bottle clearly labeled with contenis. For each ofthese, Ican only state this 1, Resident medications are ordered and refilled as indicated by the prescribing provider. We hhave frequently found that some agencies that dispense medications ae slot to do so, and Reno Valley is at their mercy. Refills are requested a least three days in advance, however, \when these arive at the facility Is beyond our contro 2. Self-administered medications are kept by the resident, each having been provided a lockbox to be kept ether inthis rooms or in the med room as each resident chooses. Every resident ‘deemed capable of sel-administration s given a lackbox for their personal use. 1155 Beech St, Reno, NV 89512 775-323-1911/775-323-1925 FAXiw ENTRUST SENIOR LIVING 3. Las notified by one resident that she has kept one of her medications in a botle labeled ‘Vitamin D", because she feared it would be stolen or tampered with If she Rep tin the ‘original container. Residents are encouraged to keep their apartment doors lacked when they exit their rooms to prevent this occurrence, however we cannot force them toda so. also ind it necessary to note that Reno Valley was said to have not ensured a resent complied with the policy to signin and out when exiting and returning t the facility. As we were tagged for this Violation while under lockdown due to COVID- 19 it hasbeen our policy that all exterior doors be locked at allies to ensure residents leave only by the Front Desk entrance, where they are require to sign in and out, ‘This was indicated in the Plan of Correction far May. and was accepted by the inspector issuing the Statement of Deficiency. ‘The only doors that remain open to egress-at-will are the fre doors a the ends ofeach hall which are locked from the outside, but fully accessible from within the building. Since the building has been in lockdown in response to statewide mandates due to the COVID-19 pandemic, five residents have eloped ‘overnight using these exits. Each was placed on quarantine asa precaution against COVID-19 infection pon return, Prior to lockdown one particular resident adamantly refuse to signin or out, stating he was “a grown, ‘man’, that he “can do what I want and go where I want” and that nobody at Reno Valley “has the right tomake me do anything I don’t want to. I'm an American.” Eventually he let the feciity once mace and never returned. Other residents who have exited the facility for overnight stays have done so having notified the Executive Director and staff of their intent. Each Was provided witha mask and instructions ‘o prevent exposure to COVID-19 prior co Teaving, as were the farly member they were with atthe Lume of exit ‘Ms. Sherych, Reno Valley has been placed in an untenable positon, and we are completely in the dark 810 why. Several Reno Valley resens,all fom Norhem Nevada Adult Menal Health Seviees {NNAMIS), most with severe psychological nesses, were pulled fom the fatty without nice the "ght of August 18, nor was at easton of the families of thes esdens noted ofthis action. One of those familie came tothe facility n person to ask what happened to thee brother. All hey knew es ‘hat head left a message stating he was frcod to leave, and didn’t know where he was Residents remaining inthe facility ae now under a high level of undue stress as their long-term: home is ‘now threatened with closure, duting a pandemic. Many have sated they like it here, andor have nowhere else to go. My staff conducted an informal survey beginning August 17. All but two, and all ‘of the NNAMIIS residents interviewed, sated they felt safe in our care Reno Valley has accommodated placement agencies, especially ADSD and the VA. by opening our doors to Medicaid Waiver recipients, despite receiving litle in the way af monetary suppor for this Cohext. AS more and more facilities have closed their doors to these individuals, many Medicald Waiver "recipients in the building are frightened that Reno Valley's closure means they ae potentially homeless during a pandemic and, withthe exception of a small group (total of 4), state they love living here and do not want to leave. The members ofthis small group have also indicated they have nowhere else to 1155 Beech St, Reno, NV 89512 775-323-1911/775-323-1925 FAX