Inspection visit

complaintNovember 4, 2021

SACRED HANDS LIVING IILicense 0792008161 citation on this visit

1 citation recorded

Inspector’s narrative

What the inspector wrote

Allegation: Insufficient Staff Investigation Finding: Unsubstantiated Upon records review and interviews, the RP asserted that during visits there was only 1 staff person present. The facility produced the staff schedule for the subject time period which illustrated a sufficient number of staff per the Appraisal Needs and Services available for the residents in care at the time. Neutral witnesses, including those who visited the facility in an official capacity, were unable to confirm the number of staff present during the subject time period. Although it was not possible to determine the sufficiency of staff present during the subject time period, during visit to the facility on 10/27/21 the Department found only 1 staff person present, which was not sufficient to meet the needs and services per the appraisals and Physician assessments for the residents in care. The facility is cited under a Case Management report dated 11/04/21. Allegation: Staff do not provide activities for residents Investigation Finding: Unsubstantiated Per interviews, S1 stated that residents are encouraged by staff to engage in activities including gardening, walking around the inside of the facility & the backyard, watching television, reading, and games. This was corroborated by a resident who was identified as being mentally capable. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are unsubstantiated. Exit Interview conducted and a copy of this report provided to Administrator.

Citations

8 citations recorded^*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

87457(c)(1)Type B
Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455... This requirement was not met as evidenced by failure of staff to complete a needs/services/appraisal for R1prior to admission which posed a potential health & safety risk to resident in care
87466Type B
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... This requirement was not met as evidenced by R2 and R4’s physicians reports were more than a year old dated 10/15/2019 and 06/15/2019 which posed a potential health & safety risk to residents in care.
87468.2(4)Type B
(4) 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 staff not exhibiting understanding of providing proper dementia care which posed a potential health & safety risk to residents in care
87705(c)(4)Type B
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 was not met as evidenced by insufficient staff to meet the needs of current residents which posed a potential health & safety risk to residents in care
87405(a)Type B
(a) The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section... This requirement was not met as evidenced by administrator not being at the facility for sufficient amount of hours which posed a potential health & safety risk to residents in care.
87458(a)Type B
Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year... This requirement was not met as evidenced by facility failing to secure a medical assessment for R1 prior to admission which posed a potential health & safety risk to residents in care.
87465(e)Type B
For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information... This requirement was not met as evidenced by R1's medical records not matching the centrally stored logs which posed a potential health & safety risk to residents in care.
87555(b)(26)Type B
(26) 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 insufficient food supplies at the facility which posed a potential health & safety risk to residents in care

FAQ · About this visit

Common questions about this visit

What happened during the November 4, 2021 inspection of SACRED HANDS LIVING II?

This was a complaint inspection of SACRED HANDS LIVING II on November 4, 2021. 1 citation were issued: 1 Type B.

Were any citations issued to SACRED HANDS LIVING II on November 4, 2021?

Yes, 1 citation was issued (0 Type A, 1 Type B). The first citation was for: "Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall ..."

What type of inspection was this?

This was a complaint inspection. Complaint inspections are triggered when someone reports a concern about the facility to CCLD.

SourceView on CCLD View original report

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Data from CCLD public records. Last updated May 25, 2026. If you believe any information is inaccurate, report it here.

complaint·November 4, 2021