Spyglass Senior Villa Iii

Based on record review, the licensee did not comply with the section cited above.2 of the 5 resident files had no Personal Rights (LIC 613C) in them, which poses a potential personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in no physician's orders for 2 of the 5 residents which posed a potential safety risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above. Shahid Siddiqui is not conducting administrative duties at the facility a minimum of 20 hours per week during normal working hours, which poses a potential health, safety and personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above. 0 of 2 staff completed 20 hours of training. Medication training is a separate requirement and is not included in the 20 hours, 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. 1 staff assisting residents with medication never had medication training, 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 2025, which poses a potential safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above. No Plan of Operation at facility, so no description of the ways in which the Licensee will address resident behavioral expression as defined in Section 87101 and no infection control plan LIC 9282 at facility, which poses a potential health, safety and personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in 5 out of 5 residents, which poses a potential health risk to persons in care.

Based on record review, the licensee did not comply with the section cited above. The posted LIC 500 has hours for Administrator who is not at the facility during those times and prospective caregiver who has not yet been cleared to care for residents, which poses a potential health, safety and personal rights risk to persons in care.

Based on interview, the licensee did not comply with the section cited above with a staff shortage for more than two weeks, 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 5 out of 5 residents by using the wrong form. He needs to use LIC 603A RESIDENT APPRAISAL and LIC 9172 FUNCTIONAL CAPABILITY ASSESSMENT instead to conduct Pre-Admission Appraisals, 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. 2 of 3 residents living at facility more than 12 months did not have their annual reappraisal, 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. 2 of 3 residents living at facility more than 12 months did not have their annual routine visits, which poses a potential health risk to persons in care.

Based on record review, the licensee did not comply with the section cited above. A majority of the required resident documents are missing: LIC 621 2 of 5 missing, LIC 601 5 of 5 missing, LIC 627C 5 of 5 missing, and LIC 613C-2 2 of 5 missing, 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. The maximum hot water temperature was measured at 125.4 degrees Fahrenheit, which poses an immediate safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above. 4 of 30 cans checked beyond best buy date, which 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. Cheese Whiz that had been opened was left in cabinet and not refrigerated, which 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. Centrally stored medication cabinet was unlocked, 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. Cabinet with cleaning products under kitchen sink not locked, which poses an immediate safety risk to persons in care.

(e) All individuals subject to a criminal record review... shall prior to working.. in a 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 S1 associated to the facility, which poses an immediate health and safety risk to person in care.

Based on record review, licensee did not comply with the section cited above by not associating S1 to the facility which poses a potential health and safety risk to the persons in care.

Based on record review, the licensee did not comply with the section cited above in not having S4 health screening 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 having five (5) out five (5) residents in hospital beds with bed rails without orders 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 having 5 out of 5 resident records being incomplete 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 not having three (3) staff members complete annual training which poses a potential health, safety or personal rights risk to persons in care.

87465 (h) The following requirements shall apply to medications which are centrally stored: (2) ...medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement was not met as evidence by: Based on LPAs observation the Licensee did not comply with the section cited above in having medication inaccessible to residents, which poses an immediate health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in the water temprature measuring at 125.2 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 in 5 out of 5 resident records being incomplete which poses a potential health, safety or personal rights risk to persons in care.

(a)Each licensee shall furnish to the licensing agency such reports...including, but not limited to, the following: (2) Occurrences, such as...which threaten the welfare, safety or health of residents....This requirement is not met as evidenced by… Based on interview the licensee did not comply with the section cited above. Facility failed to report incident to CCL when incident occurred which poses a potential health, safety or personal rights risk to persons in care.

(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 cited above by having unlocked disinfectants and cleaning products in the which poses an immediate health and safety risk to persons in care.

(k) The following requirements shall apply to medications which are centrally stored: (1) Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having unlocked medications in the refrigerator which poses an immediate health and safety risk to persons in care.

Fire Clearance All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons...(2) Bedridden persons Based on observation and interviews, Licensee failed to obtain fire clearance for two (2) (R2 & R3) bedridden residents. LPA observed and records review revealed that R2 & R3 is bedridden. However, facility does not have bedridden clearance which poses an immediate health and safety risk to residents in care.