Garden Manor Inc.

Maintain records of centrally stored medication dosages

Incidental Medical Care (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement was not met as evidenced by Staff dispensed medication without signing the documentation to indicate when the dosage was administered. This poses an immediate risk to the health and safety of the resident in care.

Maintain records of centrally stored medication dosages

Based on observation and record review it was found that staff were not always marking when medication was dispensed. It was also noted that no initials are used only an "X" which provides no indication of who dispensed medication. This practice poses an immediate health, safety or personal rights risk to persons in care.

Food quality controls and rejected damaged goods

Based on observation, LPA was not able to ascertain the freshness of the non-perishable food as expiration dates are not present. This practiced poses a potential risk to the health, safety or personal rights risk to persons in care.

Maintain fire clearance before retaining specified persons

Based on record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA reviewed Fire Alarm System Service Report dated 8/14/2023 which states this facility did not pass inspection.

Provide resident hot water for personal care

Based on observation the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA tested the water temperature in the resident bathrooms, two were found to be too hot at 144 and 127.1 degrees F.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above a square container of knives was observed accessible to residents in care on the kitchen counter which poses an immediate health, safety or personal rights risk to persons in care.

Report specified resident events within seven days

87211 Reporting Requirements (a) (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: On 08/12/2021 and 08/13/2021, the facility did not submit an incident report to the Fresno CCL office when R1 had witnessed falls and on 08/12/2021 when R1 sustained 1st and 2nd degree burns. Which poses a potential health and safety risk to persons in care.

87356(i) Criminal Record Exemption: The Department has the authority to grant a criminal record exemption that places conditions on the individual's continued licensure, and employment or presence in a licensed facility. This requirement was not met as evidenced by: S1 was granted a criminal record exemption to work at this facility under the condition that S1 would not be left unsupervised with residents in care. During the course of the investigation, it was reported that S1 resides at the facility and provides unsupervised assistance to residents with showering, activities, and transportation. Which poses an immediate health and safety risk to persons in care.

Facility personnel sufficiency and competence

87411(a) Personnel Requirements - GeneralFacility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.This requirement was not met as evidenced by Based on records review R1, who cannot leave the facility unassisted, AWOL from the facility without facility staff’s knowledge, which posed an immediate health and safety risk to the resident. Immediate penalty was also assessed.