Carlton Plaza of San Leandro

87309 Storage Space and Access(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items...This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having McKesson Perineal & Skin Cleanser fluid unlocked and accessible to R1's room which poses an immediate health and safety risk to persons in care.

(b)In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3)Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.This requirement was not met as evidence by: Based on interviews and observations made by LPAs, the licensee did not comply with the section cited above in R17s room smelling of urine which posed a potential personal rights risk to persons in care.

(f)All waste shall be located, stored, and disposed of in a manner that will not transmit communicable diseases or odors, pose a risk to health and safety, or provide a breeding place or food source for insects or rodents.This requirement was not met as evidence by: Based on observations made by LPAs, the licensee did not comply with the section cited above in R4s room having moldy and expired foods while R4 was on full care and bed bound which posed a potential personal rights risk to persons in care.

(a)In each facility:(2)Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice.This requirement was not met as evidence by: Based on interviews and photos, the licensee did not comply with the section cited above in R2 sustaining bruises on both arms while being showered by W3 which posed an immediate personal rights risk to persons in care.

(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8)To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.This requirement was not met as evidence by: Based on interviews and record review, the licensee did not comply with the section cited above in R4 being financially abused by previous staff member (W2) which posed an immediate personal rights risk to persons in care.

(a) The facility shall be clean, safe, sanitary and in good repair at all times....This requirement was not met as evidence by: Based on interviews and record review the licensee did not comply with the section cited above in having a malfunctioning broiler which posed a personal rights and potential health and safety risk to persons in care.

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities,...:(4) To care, supervision, and services...This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in not having sufficient in numbers to meet the needs of residents care. which poses a personal rights and potential health and safety risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in that the call button was not signaling on the second floor common restroom and having damaged floors in residents room which poses a potential health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in that the facility did not update R6's appraisal needs and services plan based on a change of condition which poses a potential health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in that the facility not ensuring proper food storage which poses a potential health risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in that resident records were not readily avaiable upon demand and were observed to be incomplete which poses a potential health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in having a filled gasoline tank in an unlocked shed outside assessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in that the personnel records were not readily available upon demand and were incomplete which poses a potential health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in that three (3) staff members had expired first aid certificates which poses a potential health and safety risk to persons in care.

The licensee shall ensure that residents are regularly observed for changes...that appropriate assistance is provided when such observation reveals unmet needs…..This requirement is not met as evidenced by… Based on records review and interview, the licensee did not comply with the section cited above by not calling medical attention for the resident until an hour after the error had occurred and did not call for transported until two hours after the error had occurred which posed an health and safety risk to the resident.

(b)The following...shall apply: (9) Procedures which protect the safety, ...of food shall be observed in food storage, preparation and service.This requirement was not met as evidence by Based on observation the Licensee did not comply with the section cited above with having improperly stored food in the kitchen refridgerators which poses a potential health and safety risk to residents in care.

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by...fire protection services...Prior to accepting or retaining any of the following types of persons...licensee shall...obtain an appropriate fire clearance... (1) Nonambulatory persons.-This requirement is not met as evidenced by:Based in interviews and records reviewed, the facility has 8 non-ambulatory residing on the 3rd floor but only 6 are approved which poses a potential health, safety, or personal rights risk to persons in care.

(a) The facility shall be clean, ... for...residents, employees and visitors.(1)Floor surfaces in ...kitchen areas shall be... clean....This requirement is not met as evidenced by: Based on observation of the kitchen the Facility did not comply with the section above by the kitchen having a dirty/sticky floor which poses a potential health and personal rights risk to residents in care.

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of ... insects.This requirement is not met as evidenced by: Based on observation of the kitchen the Facility did not comply with the section above by the kitchen having small flying insects which poses a potential health and personal rights risk to residents in care.

87204 Limitations - Capacity and Ambulatory Status (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license . . .This requirement is not met as evidenced by: Based on observation, the Licensee did not comply with the section cited above as 12 and not 6 non-ambulatory residents are living on the third floor of the facility, which poses a potential health, safety, or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in two (2) of two (2) fountains which poses a potential health, safety or personal rights risk to persons in care.

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by … fire protection services … Prior to accepting or retaining any of the following types of persons, … licensee shall … obtain an appropriate fire clearance …. (1) Nonambulatory persons.This requirement is not met as evidenced by: Based on review of facility records, there are 19 nonambulatory residents living on the 3rd floor, but the facility is licensed for a capacity of only 6 nonambulatory residents for the 3rd floor, which poses a potential health, safety, or personal rights risk to persons in care.

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. Based on record review the Licensee did not comply with the section cited above in administering medication to the correct resident, which poses a potential health and safety risk to persons in care.

Administrator - Qualifications and Duties. Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not testing resident with symptoms which poses a potential health and safety risk to the persons in care.

Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not administering PRN medication which poses an immediate health and safety risk to the persons in care.

Personal Rights of Residents in All Facilities. To have their representatives regularly informed by the licensee of activities related to care or services... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not notifying R1's family when R1 had a change in condition which poses a potential health and safety risk to the persons in care.

Enumerated rights; severability.To be free from neglect,..., intimidation, and verbal, mental, physical, or sexual abuse.This This requirement is not met as evidenced by: Based on interviews conducted, records and video footage reviewed, on 6/20/2020 facility staff failed to assist R1 when R1 woke up, got up from the chair and walked which resulted to R1 falling and sustained fracture of right femoral neck. R1 underwent right hip hemiarthroplasty and has moved out of the facility.