San Leandro Senior Living

87465 Incidental Medical and Dental Care (d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication... assist the resident with self-administration..This requirement is not met as evidenced by: Based on Interview and record review, the licensee did not comply with the section cited above in administering the incorrect dosage of medication to R1 which poses an immediate health and safety risk to persons in care.

(h) The following requirements shall apply to medications which are centrally stored (1)Medications shall be centrally stored..(3) Each container shall carry all of the information.. (E) below plus expiration date and number of refills.This requirement is not met as evidenced by: Based on Interview and record review, the licensee did not comply with the section cited above in administering expired medication to R1 which poses an immediate health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in that S1, S3, S4, and S5 files were incomplete which poses a potential safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in that comet bleach powder and Endust Dust & Clean multi-surface spray was found unlocked in a residents room which poses an immediate safety risk to persons in care.

The licensee did not comply with the section cited above by having the residents shower with debris, resident’s room with a strong odor of feces, and the handicapped button in the front door in disrepair, which poses a potential safety risk to persons in care.

Additional Personal Rights of Residents in Privately Operated Facilities. To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in...competency to meet their needs. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by staff not properly care for resident's pressure injury which poses a potential health and safety risk to the persons in care.

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made...m LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. Based on observation, interview, record review, the licensee did not comply with the section cited above in having current medical assessment for R1 which poses a potential health and safety or personal rights risk to persons in care.

87224 Eviction Procedures(5) Change of use of the facility.(A)The licensee may, upon no less than sixty (60) days written notice, evict a resident due to change of use of the facility.1. In addition to written notice to quit requirements specified in Section 87224(d),...notice shall include all requirements specified in Section 1569.682(a)(2)(A) through (F) of the HSC. This requirement is not met as evidenced by the 60-day notice letter given to residents was not in compliance with regulation which poses a potential health, safety or personal rights risk to persons in care.

“…Any significant changes in the plan of operation…shall be submitted to the licensing agency for approval."This requirement is not met as evidenced by: Based on observations, interviews and record review, the licensee did not comply with the section cited above in by changing the plan of operation without CCLD approval which poses a potential health, safety or personal rights risk to persons in care.

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. Based on interviews conducted the licensee did not comply with the section cited above. Medications were found under R3's bed which poses an potential health, safety or personal rights risk to persons in care.

Criminal Record Clearance. All individuals subject to a criminal record review ...Request a transfer of a criminal record clearance as specified in Section 87355(c)... This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not associating S1 to the facility which poses a potential health and safety risk to the persons in care.

87307 Personal Accommodations and Services: (a).....The following provisions shall apply: (3).....if the resident is unable or chooses not to provide them, the licensee shall assure provision of:(F) Basic laundry service (washing, drying, and ironing of personal clothing). -This requirement is not met as evidenced by:-Based on records review and interviews, the licensee did not comply with the section above for charging the residents for laundry of personal clothing which poses a potential personal rights risk to persons in care.

87309 (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.-This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above for unlocked laundry room which posed an immediate health and safety risks to persons in care.

Based on record review, the licensee did not comply with the section cited above by having a staff member not fingerprint cleared which poses an immediate health, safety or personal rights risk to persons in care.

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency....(1) A written report shall be submitted to the licensing agency ... within seven days of the occurrence of any of the events......(A) Death of any resident from any cause regardless of where death occured This requirement is not met evidenced by:Based on record review, the Administrator did not comply with the section above for not submitting the death report within 7 days which posed potential personal rights risk to person in care.

(h) The following requirements... centrally stored: (2) Centrally stored medicines... to persons... the... medication. This requirement was not met as evidence by: Based on LPAs observation licensee did not comply with the section cited above by not securing medication when being delivered to resident’s apartment which poses and immediate health and safety risk to residents in care.

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: based on interviews and inspection. the licensee did not comply with the section above. LPA observed water damage in the walls and ceiling of Apt 12 which poses potential safety risk to person in care.

87303 Maintenance and Operation(b) A comfortable temperature for residents shall be maintained at all times.-This requirement is not met as evidenced by:-Based on interviews and records review, the licensee did not comply with the section above. The temperature at the dining area was not at comfortable level and heaters in residents apartments not working. These pose potential health and personal right risks to persons in care.

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.-This requirement is not met as evidenced by: -Based on interviews and inspection. the licensee did not comply with the section above. LPA observed the following: (1) water leaking from the bathroom ceiling and sign of water leak in the bedroom ceiling in one of the residents' apartment; (2) sink faucet leaking in another resident apartment; (3) water damage in the ceiling on the third floor hallway which pose potential safety and personal rights risks to persons in care.

87303 Maintenance and Operation(e) ...(4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents.-This requirement is not met as evidenced by: -Based on inspection, the licensee did not comply with the section above. LPA observed one of the shower room of the resident's apartment without grab bar which poses potential safety risk to person in care.

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...-This requirement is not met as evidenced by: -Based on interview and review of record, the licensee did not comply with the section cited above by not reporting the positive case of COVID-19 to CCL and LPH.

87463(a) ReappraisalsThe pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition.This requirement is not met as evidenced by: Based on records obtained by the Department, R1 has fallen multiple times between 09/2019 and 02/2020. There is no documentation to show that the facility conducted a reassessment of the resident and updated the resident’s Needs and Services Plan for changes in condition following these falls which poses a potential risk to the health and safety of clients under care.

87705(c) (5) (A) Care of Persons with Dementia(A) When any medical assessment, appraisal, or observation indicates that the resident’s dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. This requirement is not met as evidenced by: Based on investigation conducted by the Department, R1 had fallen multiple times between 9/2019 and 2/2020. There is no documentation to show that the facility conducted a reassessment of R1. On 2/26/2020, R1 fell in the bathroom which resulted in a fractured spine. Medical records show R1 diagnosed with Dementia on 02/07/2017.

87224 (a) (4) Eviction Procedures(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)(4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident. This requirement is not met as evidenced by: Based on interview and records review, facility failed to issue R1 a 30-day notice of eviction. Facility refused to take back R1 when R1 was ready for discharge back to the facility from the skilled nursing facility (SNF).

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations....This requirement was not met as evidence by: Based on LPA's interview and records review , resident was diagnosed with DEMENTIA, based on interview, facility is not designed to have dementia residents in care, facility did not comply with the section cited above which poses an immediate health and safety risk to persons in care.