Angel Care Home

(a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing... and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement was not met as evidence by: Based on interviews the Licensee did not comply with the section cited above in having a skilled professional conduct glucose testing and administering insulin, which poses a potential health and safety risk to persons in care

(a) ... (b), the licensee shall ensure that disinfectants, cleaning solutions... knives, matches, tools, sharp objects... are in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having sharps inaccessible to residents, which poses a safety risk to persons in care.

(h) The following requirements shall apply to medications which are centrally stored: This requirement is not met as evidence by: Based on observation licensee did not comply with the section cited above in having refrigerated medication for R2, R3, and R4 locked and inaccessible, which poses a possible health and safety risk to persons in care.

1569.652 Termination of admission agreement upon death of resident; removal of resident’s property... (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed... shall be issued to the individual... responsible for the fees... within 15 days after the personal property is removed. This requirement was not met as evidence by:Based on interviews the Licensee did not comply with the section cited above in refunding responsible party, which poses a potential risk.

(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement was not met as evidence by:Based on interview and record review the Licensee did not comply with the section cited above in have a MAR for R1, which poses a potential health risk to persons in care.

(c) If a resident who has an... request regarding resuscitative measures form on file experiences a medical emergency, facility staff shall do one of the following: (1) Immediately telephone 9-1-1, present... form to the responding emergency medical personnel... This requirement was not met as evidence by:Based on interviews and record review the Licensee did not comply with the section cited above in presenting documents to emergency personnel, which poses a potential health risk to persons in care.

(g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis...This requirement was not met as evidence by: Based on interviews the Licensee did not comply with the section cited above in immediately contacting 9-1-1, which poses a potential health risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in having all required furniture in residents bedrooms which poses personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in having exit gate unlocked. LPA observed locked padlock 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 in having diabetic medication unlocked in refrigerator 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 in having outdoor passageways cleared which poses a potential health or safety risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in having a fire clearance for five (5) non-ambulatory residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above in conducting a quarterly fire drill which poses a potential health, or safety risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in having training for all staff which poses a potential health, safety or personal rights risk to persons in care.

(g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidence by: Based on interviews and record review the Licensee did not comply with the section cited above in contacting 9-1-1 after R1 sustained an injury which poses an immediate health and safety risk to persons in care.

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided... This requirement was not met as evidence by: Based on observation and record review the Licensee did not comply with the section cited above in obtaining and administering prescriptions as ordered, which poses a potential health and safety risk to persons in care.

(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 evidence by: Based on observation the Licensee did not comply with the section cited above in having the tub in the shared bathroom in repair, which poses a potential health and safety risk to person in care.

(3) Equipment and supplies necessary for personal care... shall be readily available to each resident. (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often... clean linen is in use by residents at all times. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having suffiencient linen for residents, which poses a potential health and safety risk to persons in care.

(a) Each licensee shall furnish to the licensing agency such reports... (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... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section above in reporting incidents for R1 and R2 to CCLD, which poses a potential health and safety risk to persons in care.

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Slip-resistant mats, strips, or flooring shall be used in all bathtub and shower floors. This requirement was not met as evidence by: Based on observation the Licensee did not comply wiht the section cited above in having a non slip mat in the shared bathroom tub, which poses a potential health and safety risk to persons in care.

(d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. This requirement was not met as evidence by: Based on record review and interview the Licensee did not comply with the section cited above in have a S4 residing in facility with a clearance, which poses an immediate health and safety risk to persons in care.

(b) Each resident’s record shall contain at least the following information: Based on LPA record review the licensee did not comply with the section cited above in having R1's file completed, which poses a potential health and safety risk for persons in care.

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(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 specified in (A) through (D) below... This requirement was not met as evidence by: Based on record review and interview the Licensee did not comply with the section cited above in report R1's hospitalization, which poses a potential health and safety risk to persons in care.

(a) Residents... shall have all of the following personal rights: (6) To... not be locked into any room... by day or night. This does not prohibit a licensee... locking doors at night to protect residents... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in R1 having a reversed door knob and being locked inside bedroom, which poses a potential health and safety risk for persons in cae.

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription... and is unable to communicate... facility staff ... shall be permitted to assist the resident with self-administration provided all of the following requirements are met: This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having 3 prescribed medications available for R1 for administration which poses a potential health and safety risk to persons 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:(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 evidence by: Based on interviews and record review the Licensee did not comply with the section cited above in providing care and services to meet the resident needs, which poses an immediate health and safety risk to persons in care.

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 was not met as evidence by:Based on observation, interview, and record review the Licensee did not comply with the section cited above in having R1's file available for review, which poses a potential health and safety risk to persons in care.

87468.2 (a) In addition to the rights listed in Section 87468.1... residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (2) To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement was not as evidence by:Based on interview and record review the Licensee did not comply with the section cited above in preventing resident from having pressure injury, which poses an immediate health and safety risk to persons in care.

87466 Observation of the ResidentThe 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. When changes... or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met as evidence by:

87211 (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (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...This requirement was not met as evidence by: Based on observation and record review the Licensee did not comply with the section cited above in submitting an incident report for R1, which poses a potential health and safety risk for persons in care.

87412 Personnel Records (f) All personnel 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 evidence by: Based on observation and record review the Licensee did not comply with the section cited above in having S3's file available for review, which poses a potential health and safety risk to persons in care..

(3) ...supplies necessary for personal care and maintenance... shall be readily available to each resident. ...if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall... at least once per week or more often... This requirement was not met as evidence by:Based on observation the Licensee did not comply with the section cited above in having sufficent linen for residents, which poses a possible health and safety risk to persons in care.

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having knives locked and inacessible to residents, which poses a health and safety risk to persons in care.

87506 Resident Records (e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This requirement was not met as evidence by: Based on observartion the Licensee did not comply with the section cited above in having R1's records available for review, which poses a potential health and safety risk to persons in care.

(a) Each licensee shall furnish to the licensing agency such reports... including, but not limited to... (1)A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven day... This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment... A) Death of any resident from any cause regardless of where the death occurred...This requirement was not met as evidence by: Based on observation the Licensee did not comply with the seciton cited above in reporting R1's death to CCLD, which poses a potential health and safety risk to person in care.

87465 Incidental Medical and Dental Care (c) 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 with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. Based on observation and record review the Licensee did not comply with the section cited above in having an accurate MAR for each resident, which poses a potential health and safety risk for persons in care.

Based on observation, the licensee did not comply with the section cited above in having a resident with dementia in a ambulatory room only per fire clearance 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 in having knives and scissors inaccessible to residents 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 in having outdoor passageways clear of obstruction 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 having cleaning supplies accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above in having an administrator employed at facility which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in having a full bedrail for R4 and no doctor's order which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in having only 2 residents residing in facility on hospice which poses an immediate health, safety or personal rights risk to persons in care.

87465 (h) The following requirements shall apply to medications which are centrally stored: (6)The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having the medication administrator record (MAR) current and aligned with resident's medication, which poses a potential health and safety risk to persons in care.

87202(a) All facilities shall maintain a fire clearance approved by the city, county... department, or district providing fire protection services... Prior to accepting or retaining... licensee shall notify the licensing agency and obtain an appropriate fire clearance...(1) Non ambulatory persons.This requirement was not met as evidence by: Based on observation and record review the Licensee did not comply with the section cited above in have 3 non-ambulatory residents in ambulatory rooms, which poses a potential health and safety risk to persons in care.

87211 (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (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 specified in (A) through (D) below... This requirement was not met as evidence by: Based on interview and record review the Licensee did not comply with the section cited above in reporting incidents to CCLD, which poses a potential health and safety risk to persons in care.

87303 (e)Water supplies and plumbing fixtures shall be maintained as follows: (2)Faucets used by residents... Hot water temperature controls shall be maintained... to attain a temperature of not less than 105 degree F and not more than 120 degree F. This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in have hot water between 105-120, which poses/posed an immediate health and safety risk to persons in care.

87355 (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement... (3) The licensee shall submit these fingerprints... for the purpose of searching the records... prior to the individual's employment, residence, or initial presence in the facility. This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having S3 fingerprinted before working at facility which poses a potential immediate health and safety risk to persons in care.

87411 (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 was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having annual training for staff, which poses a potential health and safety 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 was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having all personnel records complete and current, which poses a potential health and safety risk to persons in care.

87465 (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 was not met as evidence by: Based on observation the Licensee did not comply with the section cited in have medications locked and inaccessible, which poses/posed a potential health and safety risk to persons in care.

87405 (a) All facilities shall have a qualified and currently certified administrator...The administrator shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility... When the administrator is not in the facility, there shall be coverage by a designated substitute... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above by not having adequate attention to the management and administration of the facility , which poses a potential health and safety risk to persons in care.

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1)Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having knives and scissors accessible to residents, which poses/posed an immediate health and safety risk to persons in care.

87633 (a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon... to reside in the facility and receive hospice services from a hospice agency... (4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having a hospice plan for R3 and R4, which poses a potential health and safety risk for persons in care.

87632 (d) ...a hospice care waiver it shall stipulate terms and conditions of the waiver... to ensure the well-being of terminally ill residents... which shall include..., the following requirements: (2)The licensee shall notify the Department in writing within five working days of the initiation of hospice care... or within five working days of admitting a resident already receiving hospice care services... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in notifying CCLD about hospice residents, which poses a potential health and safety risk to persons in care.

87555 (b) The following food service requirements shall apply: (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 evidence by:Based on observation the Licensee did not comply with the section cited above in have 1 week perishable and 2-day non perishable foods for residents, which poses a potential health and safety risk to persons in care

87506 (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 was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in have complete and current records for residents, which poses a potential health and safety risk to persons in care.

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility... This requirement was not met as evidence by: Based on record review and interview the licensee did not comply with the section cited above in having complete records for residents, which poses a potential health and safety risk for persons in care.

87465 (h)... 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 responsible for the supervision... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having medication inaccessible which poses an immediate health and safety 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 observation the Licensee did not comply with the section cited above in having medicine inaccessible to residents, which posed an immediate health and safety 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 was not met as evidence by: Based on record review and interview the Licensee did not comply with the section cited above in having a complete file for S2 which poses a potential health and safety risk to persons in care.

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidence by: Based on observation and record review the Licensee did not comply with the section cited above in obtaining a permit which poses a potential health and safety risk to persons in care.

87211 (a) 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 specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. Based on interview and record review, the Licensee did not comply with the section cited above in submitting and death report and incident report for residents, which poses a potential health and safety risk to residents in care.

87303 Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. Based on observation the Licensee did not comply with the section cited above in having a comfortable temperature in the bedrooms, which poses a potential health and safety risk to persons in care.

87303 Maintenance and Operation(a) The facility shall be...in good repair at all times. ...maintenance services and procedures for the safety and well-being of residents... This requirement was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having the air conditioning unit operable which posed a potential health and safety risk for persons in care.

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility... This requirement was not met as evidence by: Based on record review and interview the licensee did not comply with the section cited above in having complete records for residents, which poses a potential health and safety risk for persons in care.

Based on observation, the licensee did not comply with the section cited above in having disinfectants and cleaning supplies accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in being present during normal working hours 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 passageways free of obstruction which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in not obtaining a fire clearance or contacting CCLD regarding alterations which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in reporting incidents of residents to CCLD which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in having resident files complete which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in having the Administrator file at the facility and the staff file complete which poses a potential health, safety or personal rights risk to persons in care.