Ivy Park at San Ramon

(a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. 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 requirement is not met as evidence by: Based on interviews the licensee did not comply with the section cited above by not having adequete staffing in memory care which allowed R2 to wander into R1's room unbeknownst to staff which posed a potential personal rights violation to residents in care

(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 have all of the following personal rights:(16)To written notice of any room changes at least 30 days in advance unless a room change is agreed to by the resident, required to fill a vacant bed, or necessary due to an emergency.This requirement was not met as evidence by: Based on record review and interview R1 did not receive a written 30 day notice of room change prior to the change which poses a potential personal rights risk to resident in care

87465(h)(2)Incidental Medical and Dental Care“Once ordered by the physician, medications shall be given according to the physician’s directions.”Residents’ medications must be safeguarded to ensure they are administered only to the prescribed individual and strictly in accordance with the physician’s directions.This requirement is not met as evidenced by: Based on observation and record review, the licensee did not ensure the safeguarding of residents’ medications. Medications were found unsecured and accessible, creating a risk that residents may receive medications not prescribed to them or that doses may not be administered as directed. This poses an immediate health and safety risk to residents in care.

87468.2(a)(4) – Personal Rights of Residents in All Residential Care Facilities for the Elderly“To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.”Residents shall be provided with safe, healthful, and comfortable accommodations, which includes the proper administration of prescribed medications to ensure resident health and safety.This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not ensure that medications were administered as prescribed. Documentation confirmed that staff failed to follow physician’s orders regarding medication administration, resulting in missed and/or delayed doses. This posed a potential health and safety risk to residents in care.

(d) The following shall apply... to all facilities:(2)The premises shall be maintained in a state of good repair...This requirment was not met as evidence by: Based on observations and interview the facility did not comply with the following by R1's call button being in disrepair which poses a potential safety and personal rights violation to residents in care

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above inhot water temprature measuring at 126.1 which poses an immediate safety risk to persons in care.

(a) In addition...the elderly shall have all of the following personal rights:(4) To care, supervision... that meet their individual needs ...This requirement was not met as evidence by: Based on interviews the facility did not meet the requirement above staff neglecting to ensure that the memory care door fully closed behind them which led to R1s elopement which posed an immediate safety risk to residents in care

(6) For each incident of elopement..(B)The licensing agency...no later than the next working day ...This requirment is not met as evidence by: Based on interviews the facility did not meet the requirement above by not reporting the elopement of R1 within 24hrs to CCLD which poses a potential safety risk to residents in care

(a) Each licensee shall furnish ... reports...but not limited to, the following:this requirement was not met as evidence by: Based on interview the facility did not comply with the following by not reporting incidents as required which poses a potential safety and personal rights violation to residents in care

(e) Water supplies and plumbing fixtures shall be maintained as follows:(2)Faucets...Hot water temperatur ... not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C)....This requirement was not met as evidence by: Based on interview the facility did not comply with the following by not having hot water in 1 of 2 of R1's showers which poses an immediate safety and personal rights violation to residents in care.

(d) The following shall apply... to all facilities:(2)The premises shall be maintained in a state of good repair... Based on observations and interview the facility did not comply with the following by the call buttons being in disrepair which poses a potential safety and personal rights violation to residents in care

(a) A plan ...by compliance with the following:this requirement was not met as evidence by: Based on record review the facility did not comply with the following by having an inaccurate MAR which put into question the validity of the entries which poses a potential safety and personal rights violation to residents in care.

(d) The following shall apply... to all facilities:(2)The premises shall be maintained in a state of good repair... Based on observations and interview the facility did not comply with the following by the elevator, fireplace, and other utilities being in disrepair which poses a potential safety and personal rights violation to residents in care.

(a) A plan ...by compliance with the following:this requirement was not met as evidence by: Based on record review the facility did not comply with the following by having an inaccurate MAR which put into question the validity of the entries which poses a potential safety and personal rights violation to residents in care.

(a) Each licensee shall furnish ... reports...but not limited to, the following:this requirement was not met as evidence by: Based on interview the facility did not comply with the following by not reporting incidents as required which poses a potential safety and personal rights violation to residents in care

(f) The licensee shall .., communicate ... any significant change ...Documentation...shall be added to the resident’s record.this requirement was not met as evidence by: Based on record review and interview the facility did not comply with the following by previous HWD updating residents care plan and not notifying the appropriate parties and not providing the care specified which poses a potential personal rights violation to residents in care.

Based on observation, the licensee did not comply with the section cited above inhot water temprature measuring at 133.6 which poses an immediate safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in 6 out of 6 staff files reviewed not having first aid which posesa potential health and safety or personal rightsrisk to persons in care.

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panicThis requirement is not met as evidence by: Based on observation the fire exit in stairwell behind door six was blocked by an industrial shampoo machine which posed an immediate health and safety risk to residents in care.

Based on record review, the licensee did not comply with the section cited above by having R1 in room 194 which is not an approved bedridden room 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 2 out of 5 staff files reviewed not having valid first aid training or card on 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 2 out of 5 staff records reviewed not having health screens and TB results which poses a potential health, safety or personal rights risk to persons in care.

To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.This requirement was not met as evidenced by: Based on interviews and reports S1 pushed R1 thereby physically abusing them.

87202(a) 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, or the State Fire Marshal... Based on interview, the licensee did not comply with the fire clearance. The facility has an approved fire clearance for a capacity of 140, however the facilities current census is 143 which poses/posed an immediate Health, Safety or Personal Rights risk to persons in care

General Food Service Requirements. Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not providing R1 with diet prescribed by physician which poses a potential health and safety risk to the persons in care.

If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident…(2) Once ordered by the physician the medication is given according to the physician's directions.This requirement was not met as evidence by: Based on observation and record review, the licensee did not comply with the section cited above by not following doctor's order for R6's medication which poses an immediate health and safety risk to persons in care.

87203 FIRE SAFETYAll facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. Based on record review and interview, Licensee did not comply with the regulation cited above by not having smoke detectors monitored by fire alarm company which poses a potential health and safety risk to residents in care.