Colonial Acres Residential Care Home

Based on record review, the licensee did not comply with the section cited above in not having one of R5's prescribed medications which poses an immediate health and/or personal rights risks to persons in care.

Based on observation, the licensee did not comply with the section cited above inunlocked utility room where cleaning supplies are kep which poses an immediate safety and/or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in Installing a door hardware operable with code in 2 entrance/exit doors and having dowels in the other entrance/exit doorwhich poses an immediate health, safety or personal rights risk to persons in care.A $500.00 civil penalty is assessed.

Based on record review, the licensee did not comply with the section cited above in not conducting drills every quarter which poses a potential safety and/or personal rights risks to persons in care.THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD.

Based on records review, the licensee did not comply with the section cited above in S3 & S4 not have the required total 40 hours required training which pose a potential health, safety and/or personal rights risks to persons in care.

Based on records review, the licensee did not comply with the section cited above in staff (S2 and S5) certificates expired which pose a potential health, safety and/or personal rights risks to persons in care.

Based on records review, the licensee did not comply with the section cited above in R2 and R3's medical assessments (Physician's Report) over a year old which pose a potential health and/or personal rights risks to persons in care.

Based on record review)], the licensee did not comply with the section cited above in R4's LIC625 Appraisal/Needs and Services Plan more than 2 years old which poses a potential health and/or personal rights risks to persons in care.

Based on observation, the licensee did not comply with the section cited above in medication on the kitchen counter and resident's medications unlocked in the refrigerator which pose an immediate health, safety and/or personal rights risk to persons in care.

Based on records review, the licensee did not comply with the section cited above for not having LIC622 Centrally Stored Medication and Destruction for all the medications received by the facility nor have complete record for medications administered for R5 which pose a potential health and/or personal rights risks to persons in care.

Based on records review, the licensee did not comply with the section cited above in not having doctor's orders for R1 and R2's half bed rails which pose a potential health, safety andor personal rights risks to persons in care.THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD.

Based on records review, the licensee did not comply with the section cited above in S3 and S4 not having TB test and LIC503 Health Screening on file which pose a potential health and/or personal rights risks to persons in care.

Based on observation, the licensee did not comply with the section cited above in carbon monoxide not working due to no battery which poses an immediate safety and/or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in loose light switch cover in resident's room which poses a potential safety and/or personal rights risks to persons in care.THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD.

Based on observation, the licensee did not comply with the section cited above in hot water temperature at 121.3 degrees Fahrenheit which poses a potential health and/or personal rights risks to persons in care.THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD.

Based on observation, the licensee did not comply with the section cited above in the following which pose an immediate safety and/or personal rights risk to persons in care: unlocked knives, kitchen shears, lighter, razor, cleaning agents in the kitchen.THIS IS A REPEAT VIOLATION WITHIN 12 MONTH PERIOD.

87615 Prohibited Health Conditions(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:(5) Residents who depend on others to perform all.... ... activities of daily living for them....-This requirement is not met as evidenced by:-Based on record review and interviews, the licensee did not comply with the section above when R1 who is dependent on others will all ADLs was admitted which posed a potential health risks to person in care.

87506 Resident Records(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.-This requirement is not met as evidenced by: -Based on records review, the licensee did not comply with the section in R1's incomplete LIC9172 which posed a potential health, safety and/or personal rights risks to person in care.

87202 Fire Clearance: (a) All facilities shall maintain a fire clearance approved by...... Prior to accepting or retaining any of the following types of persons.... licensee shall .... obtain an appropriate fire clearance approved by city, county, tor district.........(2) Bedridden persons. -This requirement is not met as evidenced by:-Based on record review and interviews, the licensee did not comply with the section above when R1 who is bedridden was admitted and facility does not have bedridden fire clearance.

87464 Basic Services(f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).-This requirement is not met as evidenced by: -Based on records review and interviews, the licensee did not comply with the section above in not meeting R1's needs for allowing R1 get dehydrated which posed immediate health risk to person in care.

§1569.269 Enumerated rights; severability: (a) Residents of residential care facilities for the elderly shall have all of the following rights:(6) To care, supervision, and services that meet their individual needs and are delivered.-This requirement is not met as evidenced by: -Based on records review and interviews, the licensee did not comply with the section above for R1 who developed stage 4 and unstageable pressure injuries which posed immediate health risk to person in care. Civil penalty is assessed.

§1569.269 Enumerated rights; severability: (a) Residents of residential care facilities for the elderly shall have all of the following rights: (5) To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. -This requirement is not met as evidenced by:-Based on interviews, the licensee did not comply with the section above for having R1 left soiled in urine which posed potential health and/or personal rights risks to person in care.

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility. ...... by compliance with the following(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. -This requirement is not met as evidenced by-Based on records review and interviews, the licensee did not comply with section above for not seeking medical attention for R1 when R1’s pressure injuries progressed which posed an immediate health risk to person in care.

Based on record review, the licensee did not comply with the section cited above in R2's LIC602A indicating R2 needs assistance with all ADLs but R2 can feed self. This poses a potential personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in not conducting the disaster drill every quarter which poses a potential safety risk to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above in not notifying the Department when a new administrator was hired poses a potential health and/ or personal rights risks to persons in care.

Based on observation, the licensee did not comply with the section cited above in broken drawer in resident's room which poses a potential safety and/or personal rights risks to persons in care.

Based on observation, the licensee did not comply with the section cited above in hot water at 127.4 degrees Fahrenheit which poses an immediate health and/or personal rights risks to persons in care.

Based on observation, the licensee did not comply with the section cited above in the following which pose an immediate safety and/or personal right risks to persons in care: unlocked kitchen cabinet where cleaning supplies are kept; insect killer, laundry soap, Clorox spray, wound cleanser, staff's medications in unlocked staff room

Based on observation and records review, the licensee did not comply with the section cited above in R1 and R5 not having the right medication dosages, not having certain medications, and facility not administering the dosage as precribed which pose an immediate health and/or personal rights risk to persons in care.

Based on records review, the licensee did not comply with the section cited above in 5 out of 5 residents' half bed rails not having doctor's orders on file which pose a potential safety and/or personal rights risks to persons in care.

Based on records review, the licensee did not comply with the section cited above In R2 who has stage 3 pressure injury was admitted back to the facility. which poses a potential health and/or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in the following which pose an immediate health, safety and/or personal rights risk to persons in care: residents medications unlocked in the refrigerator; saline solution, wound and peritoneal cleansers, grooming kit in residents' rooms

Based on observation, the licensee did not comply with the section cited above in all 3 entrance/exit doors' auditory signals/device turned off & not working which pose an immediate safety and/or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in R2 who had change in condition and admitted back to the facility and LIC625 not updated which poses a potential health, safety and/ or personal rights risks to persons in care.

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator.... The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours topermit adequate attention to the management and administration of the .facility as specified in this section.........-This requirement is not met as evidenced by:-Based on interviews, the licensee did not comply with the section abuve for not having administrator in January 2024 and the new administrator working only at most 4 hours per week.

§1569.269 Enumerated rights; severability (a) .....(3) To confidential treatment of their records and personal information and to approve their release, except as authorized by law.-This requirement is not met as evidenced by: -Based on interviews, the licensee did not comply with the section above for not releasing the requested documents.

Based on record review, the licensee did not comply with the section cited above for not having doctor's order on R1's file for half bed rails which poses a potential safety and/or personal rights risks to person in care.

Based on observation, the licensee did not comply with the section cited above for the expired sour cream which poses an immediate health risk to persons in care.

Based on record review, the licensee did not comply with the section cited above for R1's LIC622 not recording the dates medications were filled and started which pose a potential health, safety or personal rights risk to person in care.

Based on record review, the licensee did not comply with the section cited above for R3's LIC602A over a year old which poses a potential health and/or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above for shave cream, shaver, glucose lancets, and ointment unlocked in resident's room which pose an immediate safety and/or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above for mediications in the storage box with broken lock and Albuterol soltuon in one of ther residents' rooms which pose an immediate health, safety and/or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above for facility not having the 4 medications for resident (R1) which were on the list of order which poses an immediate health risk to person in care.

Based on record review, the licensee did not comply with the section cited above in 5 out of 5 residents' LIC625 with no signatures of residents' responsible person; it's not clear whether or not the assessment been discussed which pose a potential personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above for S3 not having LIC503 Health Screening and TB test on file which pose a potential health risk to persons in care.

Based on record review, the licensee did not comply with the section cited above for S1, S4 and S5 expired first aid certificates which pose a potential safety and/or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above for unlocked utility room and storage where bleach and cleaning supplies are kept which pose an immediate health and safety risks to persons in care.

Based on observation, the licensee did not comply with the section cited above for the shower area in the 2 bathrooms with not non-skid mats or strips which pose an immediate safety and/or personal rights risk to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above for not conducting disaster drills which poses a potential safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above for S3 not having the required annual training on file which poses/posed a potential safety and/orpersonal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above for R1 who is dependent on staff with all activities of daily living which poses a potential safety and/or personal rights risk to persons in care.

87705 Care of Persons with Dementia(c) (5) (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 evidence:by:-Based on, records review, the licensee did not comply with the section above for not updating the Appraisal/Needs and Services to meet R1's current needs which poses potential health and safety risks to person in care,

CONTINUATION:-Licensee did not comply with the section above for not submitting the requested documents which poses potential personal rights risks to persons in care.

87211 Reporting Requirements(g) The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator. The notification shall include the following:(1) Name and residence and mailing addresses of the new administrator. (2) Date he/she assumed his/her position.(3) Description of his/her background and qualifications, including documentation of required education and administrator certification.-This requirement is not met as evidenced by:

87705 Care of Persons with Dementia(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.This requirement is not met as evidence -Based on inspection, records review and interview, the licensee did not comply with the section cited above. R1 was able to leave the facility unnoticed which posed immediate health and safety risks to person in care. LPA observed the auditory signal not properly working.

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following:(3) Ensuring that the use of oxygen equipment meets the following requirements:(B) "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas. -This requirement is not met as evidenced by:-Based on observation, records review and interview, the licensee did not comply with the section above for not having the poster posted which poses potential safety risk to persons in care.

87309 Storage Space(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 the unlocked utility room which poses immediate safety risk to persons in care.

87705 Care of Persons with Dementia(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.-This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above for having the auditory signal on the entrance door disabled which poses immediate safety risk to persons in care.

87506 Resident Records(e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident.-This requirement is not met as evidenced by: -Based on interviews, the licensee did not comply with the section above for not keeping/retaining R1's record which poses potential personal rights risk to person in care.

87705 Care of Persons with Dementia(f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. -This requirement is not met as evidenced by:-Based on observation, the licensee did not comply with the section above for having unlocked medications, knives and cleaning supplies in unlocked kitchen which pose immediate safety 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, the licensee did not comply with the section above. Facility had roaches which posed potential health and personal rights risks to persons in care.

87506 Resident Records(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.This requirement is not met as evidenced by: -Based on interviews, the licensee did not comply with the section above. R1's document was not located when staff tried to find it which posed potential health and personal rights risks to person in care,

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(a).... elderly shall have all of the following personal rights: (4) 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:-Based on interviews, the licensee did not comply with the section above. R1 was in distress and pain and staff failed to call emergency in timely manner which posed personal rights risk to person in care.

Based on observation, the licensee did not comply with the section cited above by adding 3 bedrooms inside the staff rooms. License failed to submit updated facility sketch so CCL can request for fire safety inspection. This poses an immediate safety risk to persons in care.A $500.00 civil penalty is assessed.