A Ohana Home for Seniors, Llc

Upon the death of a resident, all cash resources, personal property, and valuables of that resident shall immediately be safeguarded.-This requirement is not met as evidenced by: Based on record review and staff interviews, the resident's belongings were thrown away two days after the resident's passing.

To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days...- This requirement is not met as evidenced by: Based on interviews and record review, the authorized representative has not received records in two months since the initial request.

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)...or neglect by, the licensee or its employees. -This requirement is not met as evidenced by:Based on records review, the liability insurance was outdated.

87303(a) Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement is not met as evidenced by: The licensee did not comply with the section cited above by having items such as mattress, furniture, carpet, boxes, window panel, and other items in the backyard, the kitchen drawer in disrepair, and multiple bugs such as spiders found in the kitchen pantry, which poses a potential safety risk to persons in care.

87309(a) Storage Space and Access(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects... locked storage and are not left unattended if outside the locked storage.This requirement is not met as evidenced by: The licensee did not comply with the section cited above by having unlocked items such as paint, ladder, drill, screwdriver, disinfectant deodrozier, dayquill, laxaclear, and knives all around the kitchen which poses an immediate health and safety risk to person in care.

87411(d)(3)Personnel Requirements - General (3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents.This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above when S1 was left alone in the facility with a language barrier which posed a potential safety risk to persons in care.

87405 Administrator - Qualifications and Duties(a) All facilities shall have a qualified and currently certified administrator...This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as the facility does not have a certified administrator, which poses a potential health, safety, or personal rights risk to persons in care.

87464 Basic Services(f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).-This requirement is not met as evidenced by: -Based on record review and interviews, the licensee did not comply with the section cited above by leaving the residents unattended.

87355 Criminal Record Clearance(e) All individuals...shall prior to working, residing or volunteering in a licensed facility:(2) Obtain a California clearance or a criminal record exemption as required by the DepartmentThis requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as there is a staff member working while the background check is still in process, which poses an immediate health, safety, or personal rights risk to persons in care.

87405 Administrator - Qualifications and Duties(a) All facilities shall have a qualified and currently certified administrator...This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as the facility does not have a certified administrator, 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 complete resident files, which poses/posed 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 complete staff files, which poses/posed 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 as none of the staff have up to date CPR/First Aid training, 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 not conducting quarterly emergency drills, which poses/posed 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 due to doors heavily shutting themselves, window screens missing, a window being broken, and the freezer on the fridge not opening, 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 as a backyard passageway was obstructed by furniture and debris, 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 failing to renew their administrator certificate, 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 due to Pepto Bismol found unlocked in a bathroom and paint primer found unlocked in a closet, 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 with the issue of the language barrier between care staff and residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

87412 Personnel Records(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:-This requirement is not met as evidenced by; -Based on interview, the licensee did not comply with the section in not having file/record for staff, S1, which poses a potential health, safety and/or personal rights risks to persons in care.This is a repeat violation. A citation was issued on 9/23/24.

87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required..... -This requirement is not met as evidenced by:-Based on record review and interviews, the licensee did not comply with section above in allowing S1 worked without exemption which posed an immediate risk to persons in care.This is a repeat violation. A citation was issued on

87506 Resident Records(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff....... -This requirement is not met as evidenced by:-Based on records review and interview, the licensee did not comply with the section for not having Pre-placement Appraisals and LIC621 for residents which pose a potential personal rights risks to persons in care.

87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required.. .....by the Department...-This requirement is not met as evidenced by:-Based on record review and interviews, the licensee did not comply with section above in allowing S1 worked without fingerprint clearance which posed an immediate risk to persons in care.

87309 Storage Space and Access(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger residents.... -This requirement is not met as evidenced by:-Based on observation, the licensee did not comply with the section above which posed an immediate health, safety and/or personal rights risks to persons in care: shovels; unlocked storage; pails of paint

87303 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 is not met as evidenced by:-Based on observation, the licensee did not comply with the section above for the following in the yard: soiled mattress; foam; hospital bed and board; hole in the kitchen door

Based on observation, the licensee did not comply with the section cited above by having chemicals unlocked in the laundry room and bathroom which poses/posed 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 R4 did not have an admissions agreement in his file which poses/posed 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 by not having a record of residents Personal Property, and Valuables 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 not having signs for the oxygen tank that is stored in R1's room which poses/posed 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 by not having an updated medical assessment for R1 and R2 which poses/posed 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 by having all staff records mixed together in one binder which poses/posed a potential health, safety or personal rights risk to persons in care.

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record ....exemption as required by the Department.-This requirement is not met as evidenced by:-Based on review of roster, checking of Guardian Portal and interviews, the licensee did not comply with the section in FM1 and FM2 not fingerprinted and cleared which pose an immediate safety risks to persons in care.

87307 Personal Accommodations and Services: (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. -This requirement is not met as evidenced by:-Based on interviews, the licensee did not comply with the section above in FM1 sleeping in the common area of the facilty which poses a potential personal rights risk to persons in care.

§1569.269 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 is not met as evidenced by:-Based on interviews, the licensee did not comply with the section above in not providing meals to residents in timely manner which poses a potential health and/or personal rights risks to persons in care.

87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance... -This requirement is not met as evidenced by:-Based on review of staff roster, checking of Guardian Portal and interviews, the licensee did not comply with the section above for not having S1 and S2 associated to this faciltiy which poses a potential safety and/or personal right risks to persons in care.

87468.2(a)(4)(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall..(4)To care, supervision, and services that meet their individual needs ... Based on interview, the licensee did respond to R1's verbal call for help after they sustained a fall which poses/posed an immediate Health, Safety or Personal Rights risk to persons in care

Care of Persons with Dementia(f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in staff failed to lock a gallon of bleach, LPA observed a gallon of bleach at the kitchen counter 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 failure to have fire extinguishers serviced on an annual basis which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed that fire extinguishers were last serviced April 2021.

Hospice Care of Terminally ill residents (d) The licensee shall ensure that the hospice care plan is current, accurately matches the services being provided, and that the client’s care needs are being met at all times. This requirement was not met as evidenced by resident sustaining injury while in care which posed a potential health & safety risk to resident in care

Reporting Requirements (a) (1) 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… This requirement was not met as evidenced by failure of staff to submit incident report to CCLD which posed a potential health & safety risk to residents in care.

Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. This requirement was not met as evidenced by missing resident roster (LIC 9020) for inspection which posed a potential health & safety risk to residents in care.

87705 Care of Persons with Dementia. The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances...This requirement is not met as evidence by: Based on observation, facility failed to keep cleaning supplies and disinfectant inaccessible to residents in care, This possess an immediate health and safety risk of residents.

General Food Service RequirementsSupplies of nonperishable foods for a minimum of one week.. shall be maintained on the premisesThis requirement was not met as evidenced by Based on observation and interview, 1.5 Gallon of milk and ¾ bag loaf of bread during the visit, LPA asked Adminsitrator if there are more perishable food for resident, Adminsitrator only showed eggs observed at the counter. This possess a potential health and safety risk of residents.

Criminal Record Clearance. All individuals subject to a criminal record review...prior to working, residing or volunteering in a licensed facility: Obtain a California clearance...This requirement is not met as evidence by: Based on observation and interview 5 adults visitors has been staying at the facility with no fingerprint clearance, this possess immediate health and safety risk for residents in care.

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 observation LPA observed facility sitting area (per facility sketch) is cluttered with clothes, shoes on the floor, bedroom #3 & bedroom #5 was observed to have a lot of unorganized clothes, shoes on the floor, pantry which is located at the dining area is unorganized with food supplies observed to be on the floor. This possess a potential health and safety risk of residents.

Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include...To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.This requirement is not met as evidence by: Based on observation LPA observed staff not wearing mask this possess potentia health and safety risk for residents in care.

Criminal Record ClearanceObtain a California clearance or a criminal record exemption as required by the Department...This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by having S2 who do not have fingerprint exemption clearance work at the facility which poses an immediate health and safety risk to the clients in care.