Roseleaf Gardens

Based on record review, the licensee did not comply with the section cited above in one (1) out ofsix (6) resident files did not have record of a negative tuberculosis exam which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above in one (1) out of six (6) staff files did not contain proof of a negative tuberculosis test 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 in that (1) one exterior exit was blocked by a hoyer life and a resident wheelchair which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in that LPA observed (2) two resdient beds positioned away from room pull cords so that residents were unable to reach them in case of an emergency which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in that two (2) bathrooms were dirty with dirt in unused showers, visable dirty floors in walk-in showers, and dirty fingerprints on doors/doorjams. Additionally, one (1) exterior door alarm was not sounding and needed the batteries to be replaced, which poses/posed a potential health, safety or personal rights risk to persons in care.

87468.1 Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(14) To have reasonable access to telephones, to both make and receive confidential calls.This is evidenced by: Based on observation and record review, the licensee failed to ensure that the facility had reliable and correctly functioning telephone service which prevented families from being able to contact residents. This poses a potential health, safety, and/or personal rights risk to residents in care.

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….The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This is evidenced by: Based on observation and interview, the licensee did not ensure that facility staff was sufficient in numbers in that (2) two of (2) residents interviewed stated they had been left unattended after requesting assistance from staff. Additionally, (5) of five (5) staff agreed that the facility did not have enough staff on each shift to properly care for residents, which poses a potential health, safety, or personal rights risk to residents in care.

87211 Reporting Requirements (a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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….(A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This is evidenced by: Based on observation and record review, the licensee did not comply with the regulation stated in that one (1) resident passed away and the facility failed to inform CCL within seven (7) days, which poses a potential health, safety, or personal rights risk to residents in care.

87411 Personnel Requirements – General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This is evidenced by: Based on observation and record review, the licensee did not comply with the regulation stated in that one (1) of three (3) staff files reviewed did not have current First Aid training, which poses a potential health, safety, or personal rights risk to residents in care.

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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 events specified in (A) through (D) below (D) Any incident which threatens the welfare, safety or health of any resident.This is evidenced by: Based on Observation, Interview, and Record Review, the licensee/administrator failed to report an incident in which R1's welfare was threatened, which poses a potential health, safety, or personal rights risk to persons in care

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.This violation is evidenced by: Based on interview and record review, the licensee failed to meet the residents needs in that they did not follow the resident's care plan to provide hands on toileting asisitance and they left the resident unattended for approximately 1.5 hours, resulting in R1 sustaining a fall and injury, which poses a potential health, safety, or personal rights risk to resident's in care.

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This is evidenced by: Based on observation, interview, and record review, the licensee failed to provide safe accomodations for the resident in that staff did not follow the resident's care plan to have only bed baths resulting in a fall while in the care of staff, which poses a potential health, safety, or personal rights risk to persons in care

87625 Managed Incontinence (b) In addition to Section 87611... the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.This is evidenced by: Based on observation, record review, and interviews, the licensee did not ensure that incontinence needs of residents were being met in that resdients were found soaked through their bedding at shift changes on more than one occasion and the facility has been observed to smell of urine which poses a potential health, safety, or personal rights risk to persons in care.

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health...This is evidenced by: Based on observation, interview, and record review, the licensee failed to seek medical assistance for the resdient after a fall and sustained injury,

87303 Maintenance and Operation(i) Facilities shall have signal systems which shall meet the following criteria:(1) All facilities licensed for 16 or more... shall have a signal system which shall:(B)Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. Based on observations and interviews conducted, the licensee did not ensure the facility's emergency signal system was operable, which poses an immediate health, safety or personal rights violation.

87303 Maintenance and Operation - (a) The facility shall be clean, safe, sanitary and in good repair at all times.This requirement was not met as evidenced by: Based on observations and interviews conducted, the licensee did not ensure that R1's room was clean, safe, and sanitary on at least three (3) seperate dates, which poses a potential health, safety or personal rights violation.

87312 Motor Vehicles Used in Transporting Residents....Any vehicle used by the facility to transport residents shall be maintained in a safe operating condition. This requirement was not met as evidenced by: Based on observation, interviews, and records reviewed, the licensee did not ensure that the facility transportation vehicle was in working order which poses a potential health, safety or personal rights violation.

Basic Services - 87464(f)(4) Basic services shall at a minimum include:(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications Based on observation and interview, the licensee did not comply with the section cited above as three residents in the facility are refusing showers, causing specific wings of the facility to be maloderous, which poses an immediate health, safety or personal rights risk to persons in care.

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions... which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.This is evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that 1 of 1 cleaning solutions was left in a bathroom cabinet accessible to residents which poses an immediate health, safety or personll rights risk to persons in care.

Residents in all residential care facilities for the elderly shall have all of the following personal rights...To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night.This is not evidence by: Based on observation and interview, the licensee did not comply with the section cited above as the exit doors are all locked with codes rendering them inoperable which poses an immediate health, safety or personll rights risk to persons in care.

The facility shall be clean, safe, sanitary and in good repair at all times...Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. Based on observations the licensee did not comply with the section as there were multiple rooms that smelled bad.

(a) The facility shall be clean, safe, sanitary and in good repair at all times...(d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility.This is not evidenced by: Based on observation and interview, the licensee did not comply with the section cited above in that 1 of 1 lamp was missing a lightbulb and lampshade. the missing lightbulb poses an immediate health, safety or personll rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above in one out of five files which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above in one out of five files 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 in 2 out of 5 rooms which poses/posed a potential health, safety or personal rights risk to persons in care.

87464 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 specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. This requirement was not met as evidenced by: Based on interviews and a review of the resident’s observation log the licensee/administrator did not send the resident out for emergency services. This poses an immediate risk to residents in care.

Observation of the Resident - The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are 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 was not met as evidenced by: Based on interviews and a review of the resident’s observation log the licensee/administrator did not notify the resident’s responsible party, as required. This poses a immediate risk to residents in care.

Basic Services - Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code Section 1569.2(c). This requirement was not met as evidenced by: Based on interviews and a review of the records, the licensee/administrator did not ensure that residents were receiving their showers as required. 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. 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 interviews, the licensee/administrator did not ensure that the facility was without clogged toilets and an odor throughout the facility. This poses a potential risk to residents in care.

87466 Observation of the Resident:The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are 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 was not met as evidenced by: Based on observation of records and interviews that were conducted by the Department of Social Services-Community Care Licensing Division-Investigations Branch, Investigator Blatnick, the facility did not seek any other medical options or communicate with the doctor regarding the resident’s condition which presents an immediate health, safety, and personal rights risk to the residents in care.

Health and Safety Code §1569.2(c) “Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, 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 an observation of facility records and an interview with the Administrator, the facility Care Notes reflected that the bathing was not documented as being completed with no proof that the resident ever denied the showers. LPA conducted an interview with the Administrator via email and learned that the facility has no corroborating evidence to support that the resident denied the showers during said dates which is an immeidate health, safety and personal rights risk to the residents in care.

Personnel Requirements – Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs or the physical arrangements of the facility require such additional staff for the provision of adequate services. The requirement is not met as evidence by: Based on record review, the licensee did not provide adequate care and supervision by leaving a dementia resident unsupervised outside for an extended period which poses an immediate Health, Safety, Personal Rights risk to persons in care.

Care of Persons with Dementia – Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: In addition to the on-the-job training requirements in Section 87411(d), staff who provide direct care to residents with dementia shall receive the following training as appropriate for the job assigned and as evidenced by safe and effective job performance: Dementia care including, but not limited to, knowledge about hydration, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living. Based on record review, the licensee did not provide adequate care and supervision by leaving a dementia resident unsupervised outside for an extended period which poses an immediate Health, Safety, Personal Rights risk to persons in care.

If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to 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: Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication. The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record. This requirement was not met as evidenced by: Based on interviews and records reviewed, the licensee did not ensure that a document indicating the date and time of each contact with the physician (hospice) and the physician’s (hospice) directions were documented and maintained in the resident’s file.

Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: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.The requirement is not met as evidence by: Based on record review, the licensee did not provide provide an updated medical assessment for a dementia resident which poses a potential Health, Safety, Personal Rights risk to persons in care.

87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs or the physical arrangements of the facility require such additional staff for the provision of adequate services. The requirement is not met as evidence by: Based on record review, the licensee did not provide adequate care and supervision by leaving a dementia resident unsupervised outside for an extended period of time which poses an immediate Health, Safety, Personal Rights risk to persons in care.

Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, 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: The resident was not assisted with dressing as an expressed need outlined in residents medical assessment, preapprasial and care plan from 3/11-3/15/2024, four days without assistance with dressing.

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 was not met as evidenced by interviews and documentation review. The licensee failed to comply with the Health and Safety code cited above. A fall risk care plan was not in place. This poses an immediate health and safety risk to residents in care.

Incidental Medical - 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: When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement was not met as evidenced by interviews and documentation review. The licensee failed to ensure that a prescription order was in place to crush a resident’s medication. This poses an immediate health and safety risk to residents in care.

Based on observation, the licensee did not comply with the section cited above in that a resident who had oxygen in their room but did not have the "No Smoking- Oxygen in Use" sign posted which poses a potential health, safety or personal rights risk to persons in care.

Based on observation record review, the licensee did not comply with the section cited above in two of the three files reviewed of residents to have observed to have bed rails did not have an medical order in the file which poses a potential health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in six of six staff files reviewed did not have the above requirement documented in the file which poses a potential health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in six of the six staff files reviewed did not have the above mentioned requirement within the file 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 in that urine was found in a bucket in the room of a resident with dementia which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in two out of eight bathrooms in which the water was tested it was above the required 120 degree maximum which poses an immediate health, safety or personal rights risk to persons in care.

Based onobservation, the licensee did not comply with the section cited above in one of the eight bathtubs observed was not in working order which poses/posed a potential health, safety or personal righ ts risk to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above in no fire drills were conducted in the last 12 months, which poses a potential health, safety or personal rights risk to persons in care.

87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs or the physical arrangements of the facility require such additional staff for the provision of adequate services. The requirement is not met as evidence by: Based on observation, interviews and record review, the licensee did not provide adequate care and supervision by leaving a dementia resident unsupervised outside for an extended period of time which poses an immediate Health, Safety, Personal Rights risk to persons in care.

Liability Insurance - On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. The licensee did not maintain liability insurance per the Health and Safety Code.

Accountability of Licensee Governing Body - The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves.If the licensee is a corporation or an association, the governing body shall be active, and functioning in order to assure accountability. The licensees did not exercise general supervision over the affairs of their licensed facilities.

Finances - The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency… The licensee did not ensure that there were sufficient resources to meet operating costs for the care of residents.

87705(f)(2)-Care of Persons with Dementia-The following shall be stored inaccessible to residents with dementia:cleaning supplies and disinfectants.This requirement is not met as evidenced by: Based upon interview and review of documents the Licensee failed to- Keep cleaning supplies from 1 of 1 residents in care.This poses an immediate Health, Safety and/or Personal Rights risk to residents in care.