Ivy Park at Hayward

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 is not met as evidenced by:-Based on observation, the licensee did not comply with the section above in 3 out of 7 apartments inspected with soiled/dirty carpet flooring which pose a potential personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

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 which could pose a danger to residents are in locked storage...... ....and are not left unattended if outside the locked storage.-This requirement is not met as evidenced by:-Based on observation, the licensee did not comply with the section above in unlocked scissors, Lysol, Neosporin and wound cleanser which pose an immediate risks to persons in care.

Facility personnel sufficiency and competence

87411 Personnel Requirements - General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed as necessary........... -This requirement is not met as evidenced by:-Based on interviews and record review, the licensee did not comply with section above when R1 was able to leave the facility unnoticed which posed an immediate 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 by staff that are sufficient in numbers, qualifications, and competency to meet their needs.-This requirement is not met as evidenced by:-Based on records review and interviews, the licensee did not comply with the section when staff did not respond to residents' call timely which posed a potential health, safety and/or personal right risks to persons in care.

Auditory exit monitoring for elopement risk

87705 Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement......... -This requirement is not met as evidence by:-Based on observation and interviews, the licensee did not comply with the section above in front/exit door not having auditory signal and R1 was able to leave the facility unnoticed.

87463 Reappraisals: (b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition....(1)..(C) Behavioral expression, as defined in Section 87101, Definitions, that may result in harm to self or others, such as unsafe wandering, elopement, hallucinations.....-This requirement is not met as evidence by:-Based on record review, the licensee did not comply with the section when R1's assessmrent was completed but not consistent with the current need which poses a potential satety risk to person in care.

Based on observation and record review, the licensee did not comply with the section cited above in having Tylenol in the medication cabinet in the apartment of a resident who can not administer and store own medications which poses an immediate health, safety and/or personal rights risks to persons in care.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above in having a razor in one of the apartments in memory care unit which poses an immediate safety and/or personal rights risk to persons in care.

§1568.03 License requirements; levels of care; application of chapters; multiple licenses; enjoining violations: (b) A facility may accept or retain residents requiring varying levels of care. However, a facility shall not accept or retain residents who require a higher level of care than the facility is authorized to provide. …….. -This requirement is not met as evidenced by;-Based on interviews and record review, the licensee did not comply with the section above in retaining a resident who needed higher level of care which posed an immediate health, safety and/or personal rights risks 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 by staff..........-This requirement is not met as evidenced by: -Based on records reviews and interviews, the licensee did not comply with the section above in not meeting R1’s needs of being non-ambulatory by walking R1 to the bathroom causing R1 to fall and sustained injury which posed an immediate health, safety and/or personal rights risks 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:(5) To be accorded safe, healthful, and comfortable accommodations.......-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 safely meeting R1’s needs resulting to R1's constant falls which posed an immediate health, safety and/or personal rights risks to person in care.

87464 Basic Services(f) Basic services shall at a minimum include: (2) Safe and healthful living accommodations and services, as specified in Section 87307, Personal Accommodations and Services.-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 transferring needs by walking R1 to the bathroom which posed an immediate health, safety and/or personal rights risks to person in care.

Prompt responses to resident communications

87468.1 Personal Rights of Residents in All Facilities(a) .......(9) To have communications to the licensee from their representatives answered promptly and appropriately.-This requirement is not met as evidenced by --Based on document review and interviews, the licensee did not comply with the section above in not responding to R1's responsible person.

§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 by staff that are sufficient in numbers.... -This requirement is not met as evidenced by:-Based on interviews and record review, the licensee did not comply with the section above in R1 having overgrown toenails which posed a potential personal rights risk to person in care.

Provide assistance for residents medical needs

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. ...(2) The licensee shall provide assistance in meeting necessary medical and dental needs. .....-This requirement is not met as evidenced by: -Based on record review and interview, the licensee did not comply with the section in not checking R1 blood pressure as ordered on particular dates which posed a potential health risk to resident 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 is not met as evidenced by:-Based on interviews and observation, the licensee did not comply with the section above in residents aparments not kept cleaned and free of insects which pose a potential health, safety and personal rights risks to persons in care. This is a repeat vioation

Allowing diabetic residents based on self-management ability

87628 Diabetes : (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through .. ..injection, or has it administered by an appropriately skilled professional.-This requirement is not met as evidenced by:-Based on records review and interviews, the licensee did not comply with the section above in having non-medical staff administers insulin injection to residents,

Based on observation and records review, the licensee did not comply with the section cited above in R2 and R4 not having doctor’s order for the postural support which pose a potential safety and/or personal rights risks to persons in care.

§1569.269 Enumerated rights; severability: (a) Residents of residential care facilities for the elderly shall have all of the following rights: (16) To reasonable accommodation of individual needs and preferences in all aspects of life in the facility, except when the health or safety of the individual or other residents would be endangered.-This requirement is not met as evidenced by:-Based on interviews and records review, the licensee did not comply with the section above in giving the resident alcohol more that the permitted amount.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above in the following which poses an immediate s afety or personal rights risks to persons in care: razor, hair developer, perming agent, waving lotion, anti fungal wash and screw driver in unlocked drawers in unlocked salon; cleaning supplies in unlocked housekeeping room on the 5th floor.This is a repeat violation within 12-month period. A citation was issued on 10/04/23.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above in stained/soiled carpet flooring 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 S5 not having the require total initial hours of medication training which poses a potential health and/or personal rights risk to persons in care.

Fire approval and staff access to unlock systems

Based on observation, the licensee did not comply with the section cited above in R3 having medications in the room and Peritoneal cleanser in another resident's room which poses 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 inS1, S3 and S5 not completing the required numbers of hours of training which poses a potential health, safety or personal rights risks to persons in care.

Ensure hazardous items are locked and not unattended

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 at evidence by: - Based on observation, the licensee did not comply with the section above for the following which poses immediate risk to persons in care: housekeeping room and salon unlocked; hazardous materials and debris in the garage.

87555 General Food Service Requirements: (b)(15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination.-This requirement is not met at evidence by: -Based on observation, the licensee did not comply with the section above in 2 kitchen staff not wearing hair nets which pose potential health and/or personal rights risk to persons in care.

87211 Reporting Requirements(a)(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the event.(D)Any incident which threatens the welfare, safety or health of any resident,... -This requirement is not met as evidenced by:- Based on records review and interview, the licensee did not comply with the section above for not submitting incident report for R2 which poses a potential health, safety and/or personal rights risks to person in care,

Update reappraisal at required intervals

87463 Reappraisals(a) The 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 review and interview, the licensee did not comply with the section above for not doing a re-appraisal or updating Care Plan after R1 had multiple falls in few months.

First aid training requirements

Based on record review, the licensee did not comply with the section cited above for staff (S2) not having first aid training and/or certificate on file which poses a potential 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 staff (S5) not having the required 8 hours of medication training for 2022 which poses a potential health risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above for blade and scissors in the drawer without lock in unlocked salon, and professional strength glue, paint spray, fabric and vinyl adhesive spray in cabinets without lock in unlocked art room. These pose an immediate health and/or safety risks to persons in care.This is a repeat violation within 12 months period. First citation was issued on 8/03/23. A $250.00 civil penalty is assessed.

Ensure hazardous items are locked and not unattended

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 having cabinets, drawers, storage without lock and/or unlocked where cleaning, art and salon supplies and scissors are kept which pose immediate safety risks to persons in care.

Complete admission suitability appraisal

87457 Pre-Admission Appraisal - General (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria... -This requirement is not met as evidenced by:-Based on records review, the licensee did not comply with the section above for R1 without pre-admission appraisal which poses oses potential health and/or safety risks to person in care.

87458 Medical Assessment(c) The licensee shall obtain an updated medical assessment when required by the Department.-This requirement is not met as evidenced by -Based on records review, the licensee did not comply with the section above for R2's medical assessment indicating R2 has dementia but can administer medications which is not consistent with doctor's note indicating R2 can not determine need for medications,

87618 Oxygen Administration - Gas and Liquid (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. -Based on observation, the licensee did not comply with the section above for not having the sign posted in appropriate place which poses a potential risk to persons in care,

Obtain baseline medical assessment before resident admission

87458 Medical Assessment(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 within the last year.....-This requirement is not met as evidenced by: -Based on records review, the licensee did not comply with the section above for not having medical assessment and/or LIC602A for R1 which poses potential health and/or safety risks to person in care.

Night supervision when dementia residents require it

87705 Care of Persons with Dementia(b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (2) Safety measures to address behaviors such as wandering...... -This requirement is not met as evidenced by:-Based on records review, the licensee did not comply with the section above for R1 who has dementia was able to leave the facility unnoticed which posed immediate safety risk to person 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 llicensee did not comply with the section above.for the auditory device on the front door not working which poses immediate safety risks to persons in care.

Notify agency before locking doors or gates

Based on observation and record review, the licensee did not comply with the section cited above. Facility has residents with dementia and the room with construction tools/equipments and chemicals was unlocked which poses an immediate safety 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 is not met as evidenced by: -Based on observation, the licensee did not comply with the section cited above. LPA observed the following which pose immediate health and safety risks to persons in care: frayed carper flooring in resident's room; bathroom doors in one of resident's bedroom; insect killers, uneven pavement and pieces of metal in the patio

87461 Mental Condition: (a) The facility shall determine the amount of supervision necessary by assessing the mental status of the prospective resident to determine if the individual: (1) tends to wanderThis requirement is not met as evidenced by -Based on records review, 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.