Heritage Haven

(c)(1)(A) Subsequent to initial licensure, a person.. (b) who is not exempted from fingerprinting shall obtain.. (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment..This requirement is not met as evidenced by: Based on observation, interview, the licensee did not comply with the section cited above in not having S1 fingerprinted and associated to the facility which poses an immediate health and safety risk to persons in care

Report specified resident events within seven days

Document required significant condition changes

Based on records review, the licensee did not comply with section above in R1, R3, and R4 did not have updated Appraisal Needs and Services Plans which poses a potential health and safety risks to persons in care.

Maintain facilities for fire and panic safety

Based on observation, the licensee did not comply with the section cited above in that 2 out of 2 fire extinguishers were expired, which poses a potential safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in that S2, S3, S4, and S5 had missing required 20 hr annual training which poses a potential health and safety risk to persons in care.

Include required health screening documents

Based on record review, the licensee did not comply with the section cited above in by not having health screening and negative TB results for S3 on file 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. 0 of 5 staff had a record of 8 hours of training on medications within the past 12 months, which poses a potential health, safety or personal rights risk to persons in care.

Regular observation and documentation of resident changes

87466 Observation of the Resident..The licensee shall ensure that residents are regularly observed...the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section above for not doing an updated reappraisal with the changes in R1 getting lost when leaving the facility. This posed a potential health and safety risk to person in care.

Keep bathing and hygiene facilities in operating condition

Based on observation, the licensee did not comply with the section cited above with bathroom #12 sink broken and leaking faucets in Administrator room, Staff room, and Basement, which poses a potential health, safety or personal rights risk to persons in care.

Maintain facilities for fire and panic safety

Based on observation, the licensee did not comply with the section cited above with non-operational smoke detectors, 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 throughout the facility, with flooring that is in disrepair: the vinyl and/or linoleum flooring is chipped, the carpeting has holes, dirty, frayed on the edges, and littered with gum and/or other substances stuck to it, which poses a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above with a window cracked in room 21, kitchen cabinets and drawers in disrepair, broken garbage disposal in kitchen sink, a broken sink in room #2, which pose a potential health, safety or personal rights risk to persons in care.

Keep window screens clean and in repair

Based on observation, the licensee did not comply with the section cited above the window screens in rooms 2 and 10 in disrepair, 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 with washer in disrepair, which poses a potential health, safety or personal rights risk to persons in care.

Facility maintenance and healthful environment

Based on observation, the licensee did not comply with the section cited above with second floor patio in disrepair, which poses a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

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 was not met as evidence by: Based on LPA observation the Licensee did not comply with the section cited above in having the in good repair and free of unexplainable amount of flies, which poses a potential health and safety risk to persons in care.

1569.625 (2) In addition to paragraph (1), training requirements shall also include... 20 hours annually, eight hours of... dementia care training... and four hours.. to postural supports, restricted health conditions, and hospice car.... This training shall be... on the job, or in a classroom, and may include online training. This requirement was not met as evidence by: Based on LPAs record review the Licensee did not comply with the section cited above in having staff currently trained, which poses a potential health and safety risk to persons in care.

Onsite food stock levels for nonperishables and perishables

87555 (b)... food service requirements shall apply: (26)...of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidence by: Based on LPAs observation the Licensee did not comply with the section cited above in having 1 week of nonperishables and 2 days of perishable foods in facility, which poses a potential health and safety risk for persons in care.

First aid training requirements

87411 Personnel Requirements - General (c)All RCFE staff... shall receive initial and annual training...(1) Staff... shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirment was not met as evidence by: Based on LPAs record review the LIcensee did not comply with the section cited above in having all staff firs aid certified and at least 1 staff per shift CPR certified, which poses a potential health and safety risk for persons in care.

Document behavioral expression and related causes

87463 Reappraisals (c) The licensee shall arrange a meeting with the resident, the resident’s representative, if any,... when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first, This requirement is not met as evidence by: Based on LPAs record review the Licensee did not comply with the section cited above in having current appraisal needs and services or physician's report, which poses potential health and safety risk to persons in care.

Maintain facilities for fire and panic safety

87203 Fire SafetyAll facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidence by: Based on LPA observation the Licensee did not comply with the section cited above in having the fire extinguishers currently serviced or purchased, which poses a potential health and safety risk to persons in care.

Onsite food stock levels for nonperishables and perishables

Based on observation, the licensee did not comply with the section cited above by not having a minimum of 7-day non-perishable and 2-day perishable foods available for residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintenance and operation requirements for facilities

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. Based on interviews conducted, Administrator failed to maintain facility for the safety and well-being of residents and staff. Residents and staff were infested with bed bugs which poses a potential risk to the health and safety of residents, staff and visitors.