Marbella Oroville

87303 (a) 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 was not met as evidenced by: LPA observed cockroaches in one resident room and cockroach traps in one office and one resident room area of the facility which poses a potential health, safety, and personal rights risk to residents in care.

87303(a) 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 evidenced by: Based on LPA obervation and interviews the licensee failed to ensure that the facility internet remained operational during a vendor transition, the memory care garden fence is in disrepair, the carpet in the memory care unit and assisted living common areas is stained and dirty which poses a potential health and safety risk to residents in care.

Based on LPA observation the licensee did not comply with the section cited above in 2 of 2 laundry rooms which poses a potential health, safety or personal rights risk to persons in care. LPA observed laundry detergent accessible to residents in 2 of 2 assisted living laundry rooms.

Based on LPA record review the licensee did not comply with the section cited above in 5 of 6 staff files which poses a potential health, safety or personal rights risk to persons in care.

If a resident council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response to those concerns or recommendations within 14 calendar days. This requirement was not met as evidenced by: Based on interviews and records reviewed, the previous administrator did not ensure that she responded to the concerns of the residents within 14 calendar days as required. This poses a potential risk to the residents.

Planned Activities - The licensee shall arrange for utilization of available community resources through contact with organizations and volunteers to promote resident participation in community-centered activities. This requirement was not met as evidenced by: Based on interviews and records reviewed, the administrator did not ensure that the staff had the appropriate license to operate the van. This poses a potential risk to the residents.

87705(a)(c)(4) Care of Persons with Dementia (a) This section applies to licensees who accept or retain residents diagnosed by a physician to have dementia. Mild cognitive impairment, as defined in Section 87101(m), is not considered to be dementia. (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is met as evidenced by: Based on interviews and records review, the licensee failed to ensure that there were sufficient staff present to provide supervision to residents to ensure that no residents eloped from the facility. As a result, R1 eloped from the facility and was found by a community member who called 911. R1 was transported to ER for evaluation. Staff were not aware that R1 had eloped until the ER called the facility and notified staff that R1 was ready to be discharged, This poses an immediate health, welfare and safety hazard to residents in care.

87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4)The licensee shall assist residents with self administered medications as needed. This requirements is not met as evidenced by: Based on record review the licensee did not provide resident with medication which poses an immediate health, safety risk to residents in care.

§1569.655 (b) Increase in fee rates for elderly residents; 60 days’ written notice stating amount of and reasons for increase; application of section. (b) No licensee shall charge nonrecurring lump-sum assessments. The notification requirements contained in subdivision (a) shall apply to increases specified in this subdivision. For purposes of this subdivision, "nonrecurring lump-sum assessments" mean rate increases due to unavoidable and unexpected costs that financially obligate the licensee. In lieu of the lump-sum payment, all increases in rates shall be to the monthly rate amortized over a 12-month period. This requirement was not met as evidenced by: Based on evidence obtained it was determined that the facility is charging all residents a lump-sum utility surcharge for the months of June, July, and August 2024. This poses a potential health and safety risk to residents in care.

87411(a) 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. This requirement is not met as evidenced by: Based on document review and interviews the licensee did not ensure that staffing was appropriate to meet the needs of residents in care on the dates of 04/01/2024 through 04/02/2024 when there was one med tech on the assisted living side and 1 PCA on the memory care side of the facility during the NOC shift. This poses a potential Health, Safety and Personal Rights risk to residents in care.

87506 (c) (1) Resident Records (c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. This requirement is not met as evidenced by: Based on document review the licensee did not ensure that resident confidential records were safeguarded when a large plastic bag that contained confidential resident records was located in the activity room. This poses a potential Health, Safety and Personal Rights risk to residents in care.

Health and Safety Code section 1569.2(c) provides: (c) "Care and supervision" means the facility assumes responsibility for, or provides… ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. This requirement was not met as evidenced by: Based on interviews and document review it was determined that staff did not ensure that Resident 1 is provided assistance in showering with the required number of showers as required in their care plan. This poses a potential health and safety risk to residents in care.

Program Flexibility - The use of alternate concepts, programs, services, procedures, techniques, equipment, space… This requirement was not met as evidenced by observation of the outdoor gate that was locked without a wavier in place. This poses a potential risk to residents in care.

Maintenance and Operation - The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by observation of the carpets. The licensee did not ensure that the carpets were sanitary and clean. This poses a potential risk to residents in care.

Infection Control Requirements - A licensee shall ensure that infection control practices are maintained as follows: All staff and volunteers shall perform hand hygiene. Hand hygiene shall be conducted before and after assisting with medications. This requirement was not met as evidenced by: Based on video feed observed by LPA Gurriere, the licensee did not ensure that infection control and hand hygiene were used when administering medication. This poses an immediate risk to residents in care.

§1569.269(a)(5) - (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 and records reviewed, the licensee failed to ensure that residents were allowed to have a camera in their apartment, which is a personal rights violation to residents in care. This poses a potential risk to residents in care.

87224(a) 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. This requirement was not met as evidenced by: Based on interviews and document review it was determined that the licensee failed to serve Resident 1 (R1) with a 30-day written eviction notice and refused to accept R1 back to the facility after R1 was released from jail. This poses a potential health and safety risk to residents in care.

87705(a)(c)(4) Care of Persons with Dementia (a) This section applies to licensees who accept or retain residents diagnosed by a physician to have dementia. Mild cognitive impairment, as defined in Section 87101(m), is not considered to be dementia. (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by: Based on staff interviews, the licensee failed to ensure that there were sufficient staff present to provide supervision to residents to ensure that no residents eloped from the facility. As a result, R1 eloped from the facility and was found a substantial distance from the facility by a community member and was returned to the facility. Staff were not aware that R1 had eloped until R1’s family came to visit them and R1 was not present at the facility. This poses an immediate health, welfare and safety hazard to residents in care.

87705(j) 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 LPA interviews and observation the gate to the memory care patio was left unsecured by the gardener and 1 resident eloped down the street and was returned to the facility by law enforcement 20 minutes after eloping. Staff were unaware that the resident had eloped. This poses an immediate health and safety risk to residents in care.

87465 (c)(2) Incidental Medical and Dental Care - ((c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for ... medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Based on interviews and document review it was determined that Resident 1’s supply of prescription pain medication ran out and R1 was without their prescribed pain medication for 1 week. This poses a potential health and safety risk to residents in care.

Basic Services – A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal… The licensee did not ensure that resident care was provided when a resident was given another resident’s medications.

Personal Rights of Residents in All Facilities – To have their representatives regularlyinformed by the licensee of activities related to care or services, including ongoingevaluations, as appropriate to their needs. The licensee did not ensure that the family of the resident was informed that theresident was offered to go to the hospital; however, the resident declined.

Based on LPA observation, the licensee did not comply with the section cited above in staff #2 does not have current First Aid Certificate which poses/posed a potential health, safety or personal rights risk to persons in care.

-Personal Rights-To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by: Interview and documentation. Licensee failed to protect 1 of 1 resident from physical abuse. This poses an immediate risk to residents in care

87468.2(a)(8)-Personal Rights-To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evidenced by: Interview and documentation. Licensee failed to protect 1 of 1 resident from physical abuse. This poses an immediate risk to residents in care