Kingston Bay Senior Living

87312 Motor Vehicles Used in Transporting ResidentsOnly drivers licensed... Any vehicle used by the facility to transport residents shall be maintained in a safe operating condition.This requirement was not met as evidenced by: Licensee did not ensure the facility van used to transport residents on outings and to appointments is maintained in a safe operating condition.The van air conditioning has not been maintained. 6/27/25 R1 became ill related to heat on a facility outong on the van. This is a potential health and safety risk to persons in care.

Dignity in personal relationships

Personal Rights of Residents in All Facilities 87468.1 (a) Residents in all residential care facilities... (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by Licensee did not ensure R1 was accorded dignity in their personal relationships with staff. After R1 reported to DON, S1 admitted to an inappropriate interaction of body exposure to R1 during care. This poses a potential health and safety risk to persons in care.

Store centrally held medications in locked secure place

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. Medications were observed unsecured in the following resident apartments by LPA and AD on 7/29/25. The resident Physician Reports state that the resident cannot store or administer own medications.R3 (136), R5 (110), R6 (119B), R7 (124)

Based on observation], the licensee did not comply with the section cited abovewhich poses/posed a potential health, safety or personal rights risk to persons in care. On 7/29 LPA observed full bed rails on R1's hospital bed and they were removed. On 8/18/25, LPA again observed full bedrails placed on R1's hospital bed. R1 does not have Physician orders for any bed rails at this time.

Document required significant condition changes

Based on interview and record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. It was disclosed that R2 has a change in skin condition. Staff have documented the status of the condition as healing in facility notes. The facility has not conducted a reappraisal of the change of condition or obtained a obtained an updated Medical Assessment to document the skin condition or treatment.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited abovewhich poses/posed a potential health, safety or personal rights risk to persons in care. LPA found rooms 309 and 311 (share a bathroom) to have sticky floors appearing to have dried liquid. The bathroom floor was sticky and wet with urine, covered with groupings and trails of ants. Room 311 laundry basket linens contained ants. The room has a strons musty stench.

Document each PRN medication dose taken

Based on record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care. LPA and DON conducted a medication Audit. R1's Tylenol 325mg PRN medication documents 7/31/25 on the back of the card. 9 pouches have been used. The MAR only notes on 8/16/25 documentation of the medication dose given to R1. Medications not logged for R1.

Assist residents with self-administered medication

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. Per med audit with DON: R1 - Cymbalta -Start date (SD) 7/23/25, there should be 6 pills left in the card, there are 4. R2 -Magnesium Oxide SD 7/30/25, there are 11 pills in the med card, there should be 10. MAR not documented for 8/18/25 am dose. These medications were not given as ordered by physician.

Ensure hazardous items are locked and not unattended

87309 Storage Space and Access (a)Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances,... in locked storage and are not left unattended if outside the locked storage. This requirement was not met as evidenced by: Licensee did not ensure items which could pose danger to R1 were locked and inaccessible. Per Physicians Report, R1 is at risk is allowed access to Hygiene items. R2's report is blank on #14j of the Physician report. Shampo, hairspray, cleansing spray and peri wash were left unlocked and accessible to residents.

Protection from punishment and intimidation

87468.1 Personal Rights... (a) Residents .....shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... This requirement was not met as evidenced by: Licensee did not ensure R1's personal rights were met. S1 pulled R1 by the legs and then by the arms to move R1 away from R2 which caused R1 to sustain a skin tear on the right arm. This poses an immediate health and safety risk to residents in care.

Staff training in personal care activities

87411 Personnel Requirements... (c) All RCFE staff... who assist residents with personal activities of daily living shall receive initial and annual training... This requirement was not met as evidenced by: S3 worked as a caregiver without completing RCFE requirements and without First Aid/CPR Certification. This is a potential health & safety risk to persons in care.

Personal rights of residents in all facilities

87468.1 Personal Rights...(a)...shall have the following personal rights (1)... .accorded dignity in their personal relationships with staff, residents, and other persons.This requirement was not met as evidenced by: Residents confirm S1 speaks in a demeaning manner and is rough causing discomfort during care. This is a potential health & safety risk to persons in care.

87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes ... The reappraisals shall document changes in the resident's physical, medical,(3) Any illness, injury, trauma, or change in the health care needs… This requirement was not met as evidenced by: R1 was accepted back to the facility with significant changes of condition. The facility did not conduct an assessment prior to discharge from the hospital. This poses a potential health & safety risk to persons in care.

87211 Reporting Requirements (a) Each licensee shall furnish... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident... of the occurrence of any of (D) Any incident which threatens the welfare, safety or health of any resident… This requirement was not met as evidenced by: Licensee did not ensure that a written report was provided to the Responsible Person of R1 after a medication error and fall resulting in hospitalization.This poses a potential health & safety risk to persons in care.

Comply with all admission agreement terms

87507 Admission Agreements (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by: Licensee did not ensure compliance with all applicable terms of the Admission Agreement. R1 was not billed accurately according to the agreement after vacating the facility on 8/13/24.This is a potential health & safety risk to persons in care.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care... by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Licensee did not ensure that the facility Med Tech assisted R1 and R2 with self-administered medications as ordered by their Physicians. R1 and R2 were given other resident's medications by facility Med Techs. R2 fell and required medical care.This poses an immediate health & safety risk to residents in care.

Maintain facility in clean, safe, sanitary condition

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 was not met as evidenced by: Licensee did not ensure that R5's bed linens were clean. Dry brown smears were observed on the sheets and floor. A damaged nightstand was observed ias well as damaged bathroom door frame in R7's room. This poses a potential health and safety risk to persons in care.

87705 Care of Persons with Dementia (g)As required residents with dementia shall be allowed to keep personal grooming and hygiene items,. unless there is evidence… (1) Evidence means documentation from the resident’s physician... This requirement was not met as evidenced by: Licensee did not ensure hygiene supplies were inaccessable to residents. On 8/12/24 shampoo, conditioner, moulth wash were accessible in the bathrooms of R3 and R7. 9/5/25, conditioner was accessable in the bathroom of R7. R7's Physicians Report says R7 is at risk if accessible.

Care and supervision as defined by statute and rules

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 was not met as evidenced by: Licensee did not ensure R1's physical health, mental health, safety, or welfare once aware of the intimate sexual relationship between R1 and R2. The facility did not prevent multiple incidents of inappropriate interactions between R1 and R2. This poses an immediate health and safety risk to persons in care.

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency... (1) A written report shall be submitted to the licensing agency... within seven days…(D) Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by: Licensee did not ensure that Incident reports were submitted as required after incidents occurred which threatens the welfare, safety or health of R1.

Care and supervision as defined by statute and rules

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 was not met as evidenced by: Licensee did not ensure R1's physical health, mental health, safety, or welfare once aware of the behaviors of R2. The facility did not prevent multiple incidents of innapropriate interactions between R1 and R2.This poses an immediate health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care. Residents R1 and R3 do not have a current (certification period) Hospice Plan of Care maintained in their files.

Certified administrator requirements and substitute coverage

Based on interview and record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care. AD's Administrator Certification is not current. The certificate expired 5/31/24. Required renewal documents has not been submitted for recertification.

Based on interview and record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care. Resident (R4) Physician Report (PR) has not been updated as required. R4 is also Diabetic. The PR states that R4 cannot Administer Glucose testing or insulin injections. R4 has orders for both.

Based on [(observation and record review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care. Resident (R2) stated to LPA and AD to be having trouble breathing. The oxygen was on and the tubing was on the floor. R2 thought the oxygen was off. Physician Report states R2 cannot self administer Oxygen. R2 resides in memory care.

Store centrally held medications in locked secure place

87465 Incidental Medical and Dental Care (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.... This requirement was not met as evidenced by: Licensee did not ensure that resident medications were centrally stored and locked. LPA observed unsecured medications in the following apartmentts:125, 105, 110, 127, 137, 202, 242 and 231, 313.

Store centrally held medications in locked secure place

87465 Incidental Medical and Dental Care (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.... This requirement was not met as evidenced by: Licensee did not ensure that resident medications were centrally stored and locked. LPA observed unsecured medications in the apartmentts of R1, R2 and R3.

87470 Infection Control Requirements (c) An Infection Control Plan shall be developed…by the licensee and shall(1) The Infection Control Plan shall include all of the following: (C) An Infection Control Training Plan.This requirement was not met as evidenced by: Licensee did not ensure all staff are trained as required in the area of Infection Control. Five staff training logs were reviewed during the visit.This poses a potential health, safety or personal rights risk to persona in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times... 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: Licensee did not ensure the facility van was maintained in a clean, safe and sanitary condition. Trash was observed and personal items are not properly stored.This poses a potential health, safety or personal rights risk to persons in care.

Central store medicines that create safety hazards

87465 Incidental Medical and Dental Care (h) The following requirements... (1) Medications shall be centrally stored under the following circumstances: (C) Because of potential dangers... facility and the condition or the habits of other persons in the facility, the medications are determined,… or Department to be a safety hazard to others. This requirement was not met as evidenced by: Licensee did not ensure that medications were inaccessible to R2. R1's medications were observed on the counter of the room shared by R1 and R2. R1's medications were not locked. This poses an immediate health & safety risk to persons in care.

Maintain separate complete record for each resident

Based on record review, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Record review revealed that required documents are not included in resident files and not all documents are complete.

Based on interview andrecord review, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care. File reviews were conducted for 3 staff. Facility was not able to provide evidence of all required initial or annual training.

87705 Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (2) Safety measures to address behaviors such as wandering…..This requirement was not met as evidenced by: Licensee did not ensure that the needs of R1s known wandering and exit seeking behaviors were met. R1 was able to jump over the facility wall and walk away without facility staff knowing R1's whereabouts.This poses an immediate health, safety or presonal rights risk to persons in care.

Dignity in personal relationships

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.This requirement was not met as evidenced by: Licensee did not ensure that residents in care were acaorded dignity in their personal relationships with staff... On multiple documented and reported occasions, R1 has demonstrated innapropriate behavior and verbal outbursts which were disruptive and disrespectful to residents and staff. Outbursts often consist of yelling, cussing or throwing items at others.

Store disinfectants separately from food supplies

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked.This requirement was not met as evidenced by: Licensee did not ensure that disinfectants and cleaning solutions were locked and inaccessible to residents. LPA observed cleaning products under bathroom sinks that were unlocked in Memory Support rooms 330, 307 and 301.This violation poses an immediate health and safety risk to persons in care.

87211 Reporting Requirements(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.This requirement was not met as evidenced by: Licensee did not submit complete Special Incident Reports to to CCLD within 7 days. Incident dates include 11/12/21, 11/13/21, 11/15/21, 11/28/21 and 9/14/21.This poses a potential health and safety risk to persons in care.

Limit staff assistance with self-administered drugs

87465(a)(5) Incidental Medical and Dental Care. A plan for incidental medical and dental care shall be developed by each facility...The licensee shall assist residents with self-administered medications as needed.This requirement was not met as evidenced by: Licensee did not ensure that Resident (R1) was assisted in taking the correct medication.This is an immediate health and safety risk to persons in care.