Izene's Haven Assisted Living

Certified administrator requirements and substitute coverage

87405(a) Administrator - Qualifications and Duties - All facilities shall have a qualified and currently certified administrator.This requirement is not met as evidenced by: Based on record review, Administrator/ Licensee does not have a valid and current Administrator certificate and has not have one since 2023. Administrator/Licensee appointed S1 who do not have current Administrator certificate, which poses a potential health, safety or personal rights risk to persons in care.

Certified administrator requirements and substitute coverage

87405(a) Administrator - Qualifications and Duties - All facilities shall have a qualified and currently certified administrator. Based on records reviewed and interviews conducted, the licensee does not have a valid and current Administrator certificate and has not have one since 2023.This requirement is not met as evidenced by: Based on records reviewed and documentation provided by Licensee, the facility has not had an certified Administrator in the facility since 2023.

Prohibit false or misleading facility statements

87207 False Claims - No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. Based on records reviewed and interviews conducted, the licensee provided an invalid Administrator Certificate to the Department.This requirement is not met as evidenced by: Based on records reviewed and documentation provided by Licensee Marguerite Bruton submitted an Administrator Certificate that was not issued by the Department with altered dates.

Eviction report must be filed within five days

87224 (f) A written report of any eviction shall be sent to the licensing agency within five (5) days.This requirement was not met as evidenced by: Based on record review and interview, the department was not notified of R1's 30 days eviction notice that was given to the resident on 05/12/25, this poses a potential health and safety risk to residents in care.

Report specified resident events within seven days

87211(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 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: Based on record review and interview, Licensee did not submit a written report to the department within 7 days of incident when R1 had went to the hospital on 01/06/25, 01/24/25, and 04/08/25, this poses a potential health and safety risk to residents in care.

Based on records reviewed and interview conducted, the Facility has overdue Annual and Late Fees, this is poses/posed potential health and safety risk to residents in care.

Ensure hazardous items are locked and not unattended

Based on observation, the Licensee did not comply with the section cited above when LPA and S1 observed chemicals unlock in the garage accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.

Give PRN medication by physician order

Based on observation and records reviewed, R1’s medications Lisinopril 20 mg and Clonidine Hcl 0.1 were not administered as directed by physician, which poses/posed an immediate health and safety risk for the person in care

Conformance with applicable laws and regulations

Based on observation, Fire Extinguisher has a purchase date of 06/06/23, which poses an immediate health and safety risk to the residents.

Give PRN medication by physician order

Based on records reviewed and observation, all residents' MARS were reviewed, and all medications were audit, medications were not administered as directed by physician to 4 out of 5 resident, which poses an immediate health and safety risk for the person in care.

Maintain facility in clean, safe, sanitary condition

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 has not been met: Based on interviews conducted and records reviewed, Licensee confirmed bed bug have been seen in the facility and no pest control service is in place for bed bug which poses a potential health, safety or personal rights risk to persons in care.

Document each PRN medication dose taken

Based on observation, LPA reviewed all residents’ MARS and observed MARS was not initialed after medications was administered to residents. MARS was observed not initialed after medication administered for date 05/30/23 for 2 residents, date 05/31/23 for 4 residents, and date 06/06/23 AM for 4 residents. This is a potential health and safety risk for the residents in care.

Conformance with applicable laws and regulations

Based on observation, Fire extinguisher was observed with purchased date 04/10/22, which poses an immediate health and safety risk to the residents.

HSC 1569.652 (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued to the individual... contractually responsible for the fees... within 15 days after the personal property is removed.This requirement was not met as evidenced by: Based on interviews conducted and record review, Resident 1 passed away on 10/02/22 and was not issued a refund for the remaining unused days to the resident’s responsible party. Licensee mailed the check late December 2022 early January 2023. The responsibility party have not received the check that was mailed. Responsible have not received a copy of the Admission Agreement as requested.This poses a potential health and safety risk to persons in care.

Health screening and fitness requirements

Based on interview and record review, the licensee did not comply with the section cited above when 1 out of 1 personnel did not have a health screen within in 7 days after employment which poses a potential health, safety or personal rights risk to persons in care.

Maintain required personnel records for staff

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:(4) Written verification that the employee is at least 18 years of age, including, but not necessarily limited to, a copy of his/her birth certificate or driver's license. This requirement was not met as evidenced by LPA's request for resident records and Licensee was unable to provide the required documents in the LIC 311F.

87506(a) Resident Records. A separate, complete, and current record shall be maintained for each resident in the facility, readily available to facility staff and to licensing agency staff and shall contained specified information. This requirement was not met as evidenced by LPA observation of resident records. Required LIC forms are in the file, however, they are not completed in their entirety.

(g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review.THis requirement was not met as evidenced by LPAs' observation at the time the complaint was opened, staff records were not complete and available.

Maintain separate complete record for each resident

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 evidenced by LPA's request for resident records and Licensee was unable to provide the required documents in the LIC 311F.

General Requirements for Allowable Health Conditions(b) The licensee shall complete and maintain a current, written record of care for each resident that includes, but is not limited to, the following: (1)Documentation from the physician of the following:(A) Stability of the medical condition(s); (B) Medical condition(s) which require incidental medical services;(C) Method of intervention;(D) Resident's ability to perform the procedure; and (E) An appropriately skilled professional shall be identified who will perform the procedure if the resident needs assistance.(2) The names, address and telephone number of vendors, if any, and all appropriately skilled professionals providing services.(3) Emergency contacts.**R2 was observed to have a colostomy bag and catheter and no plan of care for these were on file. Immediate risk to resident in care.

Authority to audit and copy facility records

Inspection Authority of the Licensing Agency (c) The Licensee shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours..**This requirement was not met as evidenced by Licensee not responding to a request for audit from Licensing. This poses a potential risk to residents in care.

Administrator Recertification Requirements (a) Administrators shall complete at least forty (40 classroom hours of continuing education during each two (2)-year ceritication period...**This requirement was not met as evidenced by Licensee not having a current Administrator certificate. This poses a potential risk to residents in care.

Maintain physician order documentation in resident record

Postural Supports.A written order from a physician indicating the need for postural support shall be maintained in the resident’s record. **There is no Physician's order on file for R1's full bedrails. Immediate risk to resident in care.

Authority to audit and copy facility records

87755 Inspection Authority of the Licensing Agency (c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b). This requirement was not met evidenced by: Licensee did not respond to request for audit from Licensing which poses a potential health, safety and personal rights risk to residents in care.

87407 Administrator Recertification Requirements (a) Administrators shall complete at least forty (40) classroom hours of continuing education during each two (2)-year certification period, including. This requirement was not met as evidenced by: Licensee does not have a current Administrator certificate which poses a potential health, safety and personal rights risk to residents in care.

Facility must clear fire safety for bedridden persons

(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. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by Resident R1's LIC 602 and review of facility file in Regional Office.*Civil Penalty Assessed*

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:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by interviews and observation of videos taken of Resident on the ground after sliding out of bed. Resident R1 was on the ground for up to 10 hours. Licensee does not have written consent to video Resident.

87468 Personal Rights (c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public.This requirement was not met as evidenced by: Licensee did not have personal rights posted in the facility which poses a potential health, safety and personal rights risk to residents in care.

Obtain required California clearance or exemption

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 as specified in Section 87355(c) or which poses an immediate health, safety and personal rights risk to residents in care. This requirement was not met as evidenced by Facility Roster in the Guardian system. *Civil Penalty Assessed*