Jefferson Care Home

Based on observation, and interview, the licensee did not comply with the section cited above in by the administrator not going to the facility for a suffucent number of hours or preforming the dutys of administrator 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 by not having the fire extinguishers serviced or replaced annually 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 by not fixing the broken fence in the yard or keeping the yard maintenanced which poses/posed a potential 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 by only having one staff member which poses an immediate health, safety or personal rights risk to persons in care.

Licensee has not applied to have Administrator's Certificate renewed prior to expiration date which poses a potential health and safety risk to resident in care.

Based on interview and record review, the licensee did not comply with the section cited above by not having a current liability insurance which poses an immediate health, safety or personal rights risk to persons in care.

87407 Administrator Recertification Requirement (d) To apply for recertification prior to the expiration date of the certificate, ...post-marked on, or up to ninety (90) days before, the certificate expiration date. This requirement is not met as evidenced by: Based on observation and interviews, Licensee failed to have Administrator's Certificate renewed prior to expiration date which poses a potential health and safety risk to resident in care.

To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above by yell and curse in front of and at residents in care which poses/posed a potential health, safety or personal rights risk to persons in care.

An application fee adjusted by facility and capacity shall be charged by... After initial licensure, a fee shall be charged by the department annually on each anniversary of the effective date of the license.This requirement was not met as evidenced by: LPA conducted records check via LIS which revealed outstanding annual fees due to the department which poses a potential risk to the health and safety of residents in care.

A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. This requirement was not met as evidenced by: Staff not known what to do or where to go during a multi day power outage at the facility.

A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. This requirement was not met as evidenced by: Not having an updated emergency disaster plan at the facility.

Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by: Based on observations, the licensee did not comply with the section cited above by not having two days of perishable foods in the refrigerators which poses/posed a potential health, safety or personal rights risk to persons in care.

The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council...This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above by not having fresh fruit or vegetables for residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Plans for the facility to be self-reliant for a period of not less than 72 hours immediately following ... a short-term or long-term power failure. If the facility plans to shelter in place ... Shall have a plan and supplies available to provide alternative resources during an outage. This requirement was not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above by not having a plan and supplies available to provide alternative resources during an outage which poses/posed 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 by not having tags on the Fire extinguishers 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 having a wood board blocking the back door 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 having expired foods in the dry foods pantry 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 having the laundry room door unlocked with cleaning chemicals inside which poses an immediate health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above by not having pre-admission appraisal for each resident which poses/posed a potential health, safety or personal rights risk to persons in care.

87411(c) 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 This requirement is not met as evidenced by: Based on record review, LPAs observed S2 did not meet training requirements upon being hired in October of 2022 which poses a potential health and safety risk to persons in care.

87608(a)(1) POSTURAL SUPPORTS(1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position....This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the regulation cited above. LPA observed a belt on R2's wheel chair strapped around R2's waist. R2 was not able to remove buckle independently which poses a potential personal rights to persons in care.

No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.This requirement was not met as evidence by: Based on observation, interview, and record review, the licensee did not comply with the section cited above: By claiming that they would submit documentation that proves they still have control of property.

87465 Incidental Medical and Dental Care(h) The following requirements shall apply to medications which are centrally stored:(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees..This requirement is not met as evidenced by: Based on observation and interview, Licensee did not comply with the regulation cited above, LPAs observed unlocked medication inside office drawer, which poses an immediate health and safety risk to residents in care.

87202 FIRE CLEARANCE(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services....This requirement is not met as evidenced by: Based on observation and record review, Licensee did not comply with the regulations cited above. LPAs observed additional bedroom is not cleared by Fire Department which poses an immediate health and safety risk to residents in care.

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review.....1) Obtain a California clearance or a criminal record exemption as required by the Department…This requirement was not met as evidence by: Based on interview and record review, the licensee did not comply with regulation above. S1 confirmed S2 was left alone with a resident on 10/11/2021 which poses an immediate health and safety risk to residents in care.

***This is an amended report from visit on 10/15/2021***87305 ALTERATIONS TO EXISTING BUILDING...(a) Prior to construction or alterations, all facilities shall obtain a building permit.This requirement is not met as evidenced by: Based on observation and record review, Licensee did not comply with the regulation above. LPA observed walls were added to the living room to be converted into a bedroom which poses a potential health and safety risk to residents in care.

***This is an amended report from visit on 10/15/2021***87411(c) 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 This requirement is not met as evidenced by: Based on record review, Licensee did not comply with the regulation cited above not meeting the training requirements for S2 which poses a potential health and safety risk to persons in care.

87465 Incidental Medical and Dental Care(h) The following requirements shall apply to medications which are centrally stored:(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees.. This requirement is not met as evidenced by:Based on observation and interview, Licensee did not comply with the regulation cited above. On 10/11/21, W1 observed unlocked medication inside office drawer. LPAs observed unlocked medication in staff's room which poses an immediate health and safety risk to residents in care.

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review.....1) Obtain a California clearance or a criminal record exemption as required by the Department…This requirement was not met as evidence by: Based on observation, interview, and record review, the licensee did not comply with the section cited above S2 started working at the facility for about a month , LPA conducted records review using guardian system and S2 is not finger print cleared which poses an immediate health, safety or personal rights risk to persons in care.