Arbor at Berkeley

(e) All individuals subject to a criminal record review... shall prior to working... licensed facility: (3) Request a transfer of a criminal record clearance...This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having S3 associated to the facility which poses a potential health, safety, and personal risk to persons in care.

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement was not met as evidence by: Based on record review LPA observed ten personnel files were incomplete, which poses a potential health, safety, and person rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above by having disinfectants unlocked and unattended which poses/posed 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 by not associating staff (S2) to the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interviews and records reviewied, the licensee did not comply with the section cited above by not maintaining personnel records which poses/posed a potential health, safety or personal rights risk to persons in care.

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...unable to communicate his/her symptoms clearly, facility staff designated by the licensee... assist the resident with self-administration...-This requirement is not met as evidenced by:Based on interviews and records reviewed, Licensee did not assure residents received administration of medication(s).

1569.80 Care and services decision making; meeting; written record (b) Once prepared, the written record...to determine the care and services provided to the resident written record shall be sent by the facility to that physician.-This requirement is not met as evidenced by: Licensee/ED did not confirm contact information was correct for notifications of residents' services from physicians and pharmacies.

The licensee shall evaluate staffing needs to ensure that there is a sufficient number of direct care staff, as specified in Section 87411, Personnel Requirements – General, to support each resident's physical, social, emotional, safety and health care needs, as identified in their current appraisal. -This requirement is not met as evidenced by:Supervision was not present to assist R1 with exit seeking behaviors per R1's physician's report.

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: Licensee/ED presented two different fax cover sheets and could not confirm when fax number 510-788-XXXX was no longer working.

1569.80 Care and services decision making; meeting; written record (b) Once prepared, the written record...to determine the care and services provided to the resident written record shall be sent by the facility to that physician. Licensee/ED did not provide written record to R1's physician for the decision making for care and services.

87303 Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times. (3) Nothing in this section shall prohibit residents from adjusting individual thermostatic controls. -This requirement is not met as evidenced by: Licensee/ED did not ensure the facility maintained a comfortable temperature for all residents at all times.

87224 Eviction Procedures (f) A written report of any eviction shall be sent to the licensing agency within five (5) days.-This requirement is not met as evidenced by: Licensee did not provide the notice of eviction in a timely matter to CCLD. The notice provided to R1's RP was unlawful.

87203 Fire Safety All 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 is not met as evidenced by: Licensee to review the regulation, provide training to staff and submit proof to CCLD by POC. Locks removed from two gates during the visit to allow emergency exiting on both sides.

87468.2...Personal Rights of Residents in Privately Operated Facilities(a) ...Residents in All Facilities...shall have all of the following personal rights:(2) To have their records and personal information remain confidential...-This requirement is not met as evidenced by: Licensee/ED did not ensure that R1's and RP's records be presented and maintained with confidentiality.

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...unable to communicate his/her symptoms clearly, facility staff designated by the licensee... -This requirement is not met as evidenced by:Based on interviews and records reviewed, Licensee did not assure residents received administration of medication(s).

Personnel Requirements-General 87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.-This requirement is not met as evidenced by: Based on interviews and records reviewed, the license did not comply with the section above by not having sufficient and competent number of staff to meet bowel and incontinence care needs.

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency ... (1) A written report ... within seven days of the occurrence of any of the events specified in (A) through (D) below ... (A) Death of any resident-This requirement is not met as evidenced by: Based on interviews and records reviewed, the Interim ED did not comply with the section above by not providing a written report of death for R2 within seven (7) days which poses/posed a potential health and safety risk to persons in care.

(a) Residents of residential care facilities for the elderly shall have all of the following rights: (10) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section above by care staff screaming/yelling at residents which posed a potential health and safety risk to persons in care.

Personnel Requirements-General 87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.-This requirement is not met as evidenced by: Based on interviews and records reviewed, the licensee and ADM did not comply with the section above by not having sufficient and competent number of staff to meet R1, R2, R3, and R5’s incontinence care needs.

87411 Personnel Requirements – General (f) All personnel ... shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified…signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents…Personnel with evidence of physical illness ... relieved of their duties. -This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, S7 was asleep in the common area where other staff and residents could see. The incident did not result in injury; however, all staff should be capable or performing assigned task at the facility without cause for concern.

87217 Safeguards for Resident Cash, Personal Property, and Valuables(b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff.....-This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section above by not safeguarding R1's clothing items which poses/posed a potential health, safety or personal rights risk to persons in care.

87506 Resident Records (b) Each resident’s record shall contain at least the following information: (11) The documentation required by Section 87611 for residents with an allowable health condition.-This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section above by not safeguarding R1's clothing items which poses/posed a potential health, safety or personal rights risk to persons in care.

87628 Diabetes (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible...(2) Ensuring that sufficient amounts of medicines, testing equipment...other supplies...as specified in Section 87465(c)..-This requirement is not met as evidenced by: Based on interviews and records reviewed, the licensee did not comply with the section above by not testing R1's blood sugar and dispensing R1's medication as prescribed which poses/posed an immediate health, safety or personal rights risk to persons in care.

87465 Incidental Medical and Dental Care (a) A plan...shall be developed by each facility... encourage routine medical and dental care and provide for assistance...by compliance with...(4) The licensee shall assist residents with self-administered medications as needed,-This requirement is not met as evidenced by: Based on interviews and records reviewed, Licensee did not ensure R1's blood sugar and/or medications were documented which poses/posed a potential health, safety or personal rights risk to persons in care.

87303 Maintenance and Operation (d) The following space and safety provisions shall apply to all facilities:(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.-This requirement is not met as evidenced by: Based on interviews and records reviewed, the licensee did not comply with the section above by not properly maintaining R1’s bedroom which poses/posed a potential health, safety or personal rights risk to persons in care.

87705 Care of Persons with Dementia(c) Licensees who...retain residents with dementia shall be...ensuring the following:(5) ...annual medical assessment...reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. -This requirement is not met as evidenced by Based on observation, interviews and record review, the licensee did not comply with the section cited above by R1 not having reappraisal by the POC which poses an immediate health, safety, or personal rights risk to persons in care.

87705 Care of Persons with Dementia(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. Based on observation, interviews and record review, the licensee did not comply with the section cited above by person, Resident (R1) not an update annual medical assessment and reappraisal which poses an immediate health, safety or personal rights risk to persons in care.

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...unable to communicate his/her symptoms clearly, facility staff designated by the licensee... assist the resident with self-administration...-This requirement is not met as evidenced by:Based on interviews and records reviewed, Licensee did not assure residents received administration of medication(s).

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(2) Occurrences, such as epidemic outbreaks, shall be reported within 24 hours either by telephone or facsimile to the licensing...-This requirement is not met as evidenced by Based on observation, interviews and record review, the Licensee did not comply with the section cited above by not reporting R1’s UIR's to CCLD.

87705 Care of Persons with Dementia(b) In addition...specified in Section 87208…(2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials.-This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section above when R1 in Assisted Living was able to leave unassisted and unnoticed which posed an immediate safety risk to persons in care.

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(2) Occurrences, such as epidemic outbreaks, shall be reported within 24 hours either by telephone or facsimile to the licensing...-This requirement is not met as evidenced by Based on observation and record review, the Licensee did not comply with the section cited above in

87506 Resident Records(b) Each resident’s record shall contain at least the following information:(10) Reports of the medical assessment specified in Section 87458, Medical Assessment, and of any special problems or precautions.-This requirement is not met as evidenced by Based on interviews and records reviewed, the licensee did not comply with the section above when R1's refusals, blood pressure, and medication administered with all three dates and times were not documented posed an immediate safety risk to persons in care.

87705 Care of Persons with Dementia(c) Licensees who...retain residents with dementia shall be...ensuring the following:(5) ...annual medical assessment...reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs.-This requirement is not met as evidenced by Based on observation, interviews and record review, the licensee did not comply with the section cited above by person, Resident (R1) not having an updated annual medical assessment and reappraisal which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interviews and record review, the licensee did not comply with the section cited above by person, Executive Director (ED) not having criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.

87506 Resident Records (c) All information and records obtained from or regarding residents shall be confidential...(1) The licensee shall...reveal or make available...upon the resident's written consent or that of his designated representative. -This requirement is not met as evidenced by-Based on interviews and observation, the Licensee did not comply with the section above by not providing R1’s RP with the resident’s records.

87705 Care of Persons with Dementia(b) In addition to the requirements as specified in Section 87208.........(2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials.-This requirement is not met as evidenced by: -Based on interviews and records review, the licensee did not comply with the section above when 3 residents in Memory Care Unit were able to leave unassisted/unnoticed which posed an 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 in interviews and observation, the licensee did not comply with the section above in facilty having strong smell of urine which pose personal rights risk to persons in care.

87217 Safeguards for Resident Cash, Personal Property, and Valuables(b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff..... -This requirement is not met as evidenced by:-Based in interviews, the licensee did not comply with the section above in not safeguarding R1's personal belogings whiich posed personal rights risk to person in care.

87468.1 Personal Rights of Residents in All Facilities: (a)..... (12) To wear their own clothes; to keep and use their own personal possessions, including their toilet articles; and to keep and be allowed to spend their own money. -This requirement is not met as evidenced by:-Based in interviews, the licensee did not comply with the section above when staff removed R1's hygiene items which posed a potential personal rights risk to person in care.

87625 Managed Incontinence(b) .... the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. -This requirement is not met as evidenced by:-Based on interviews and records review, the licensee did not comply with the section above in R1 being left in urine soaked clothing for extended period of time which posed a potential health and/or personal rights risks to person in care.

87468.1 Personal Rights of Residents in All Facilities: (a)....... (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.-This requirement is not met as evidenced by: -Based on interviews and records review, the licensee did not comply with the section above in not properly upkeeping R1’s bedroom.which posed a potential personal rights risks to person in care.

87468.1 Personal Rights of Residents in All Facilities: (a)...... (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.-This requirement is not met as evidenced by -Based in interviews, the licensee did not comply with the section above in not meeting R1's incontinence care needs which posed personal rights risk to person in care.

87507 Admission Agreements (g) Admission agreements shall specify the following: (8) General facility policies that are for the purpose of making it possible for residents to live together.This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above because the Resident Handbook is missing from the Admissions Agreement as an Addendum and no copy was sent to the POA, which poses a potential health, safety or personal rights risk to persons in care.

87224 Eviction Procedures (f) A written report of any eviction shall be sent to the licensing agency within five (5) days.This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above because no copy of the letter to evict dated 3/7/2024 was sent to the licensing agency, which poses a potential health, safety or personal rights risk to persons in care.

87307 Personal Accommodations and Services...safety provisions shall apply to all facilities:(2) The premises shall be maintained in...good repair...-This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above by the kitchen electrical outlet being in disrepair which poses a potential health and safety or personal rights risk to persons in care.

Based on observation, interviews and record review, the licensee did not comply with the section cited above by person, Interim-Executive Director (ED) not having criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.