Simply Caring Angels Llc

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in facility staff not logging response from R1 after administering PRN, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on (interview) (record review)], the licensee did not comply with the section cited above in not centrally storing or administering a medication for R3 that was prescribed on June, 18, 2025, which poses an immediate health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in R3 removing R3's restricted health condition and facility not obtaining a reappraisal regarding the change in condition, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in staff not having training for R3's hoyer lift, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Administrator receiving numerous repeated citations, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in staff not having training for, R2 and R3's restricted health conditions, which poses/posed a potential health, safety or personal rights risk to persons in care.

Additional Personal Rights of Residents in Privately Operated Facilities (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: (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement was not met as evidenced by all residents in care being montiored by a baby monitor in residents rooms and baby monitors for staff to listen on kitchen counter which poses an immediate health safety and or personal rights risk to residents in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in not having current home health care plans for R1, R2 and R3 and not having a Home Health Care Plan for R4, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in administering an expired over the counter supplement to R1 that was not prescribed by a physician 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 2 out of 4 residents observed with full bed rails with no physicians orders, which poses an immediate health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee does not have current and complete hospice care plans for 3 out of 4 residents in care, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have hospice training for each residents specific needs, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have medications locked when LPA's arrived at the facility and medications were left unattended on the kitchen counter, which poses an immediate health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee does not have a qualified Administrator, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have a care plan for R3 or home health notes of care being provided, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not update the medical reappraisal for 3 out of 4 residents who's condition changed which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not keep an accurate centrally stored log for R1 by logging a future start date of 10/18/24, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not administer R1's medication every 12 hours as prescribed, which poses an immediate health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have a personnel file for Administrator and stated it was lost, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have a primary or secondary diagnosis for R3 on the physician report, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have prescriptions with labels for R1's medications, which poses an immediate health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have any milk or eggs and was very low on other perishable items, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee did not have bedridden in the facility's plan of operation, which poses/posed 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 Licensee did not have a written order for R2's medication which Licensee stated is a PRN however it states to be administered daily, which poses/posed 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 Licensee did not have any documentation from the physician or from home health regarding the stage of R1's wounds, which poses/posed 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 Licensee did not have a plan of care or physician care documentation for R1, R2, or R3 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 by having the cleaning supplies cabinet unlocked and accessible to residents with dementia, 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 by not having R1's reappraisal complete with change in condition which poses/posed 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 by Licensee did not administer R1's medications correctly after conducting a pill count and comparing to centrally stored log R1s medication should have started on 10/17/23 not 10/20/23, which poses an immediate health, safety or personal rights risk to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above in Licensee does not have a hospice care plan for R2 which poses/posed 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 Licensee did not have any documentation of staff training from hospice for R2, which poses/posed a potential health, safety or personal rights risk to persons in care.

5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet.(A) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.**This was not met as evidenced by R1 has full bed rails and not on hospice

Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly. (1)Stage 3 and 4 pressure injuries. **This was not met as evidenced by R1 has a Stage 3 pressure injury being treated by Home Health.

5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet.(A) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails.**This was not met as evidenced by 5 of 6 residents have full bed rails and not on hospice

Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly. (1)Stage 3 and 4 pressure injuries.**This was not met as evidenced by R5 has a Stage 3 pressure injury being treated by Home Health.

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (5) The licensee shall assist residents with self-administered medications as needed.This requirement was not met as evidenced by: Based on records review and observation Licensee did not administer R1's medications for 12/9/21 which poses an immediate health, safety or personal rights risk to persons in care.

87705 Care of Persons with Dementia(d) In addition to requirements specified in Section 87303, Maintenance and Operation, safety modifications shall include, but not be limited to, inaccessibility of ranges, heaters, wood stoves, inserts, and other heating devices to residents with dementia. This requirement was not met as evidenced by: Based on observation Licensee did not have the stove knobs locked which were accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's This requirement was not met as evidenced by: Based on records review and observation R1 did not have a completed LIC 602 Physicians Report or TB test in the residents file which poses a potential health, safety or personal rights risk to persons in care.

Fingerprints and criminal records of individuals in contact with clients; exemptions; criminal records clearances(b) In addition to the applicant, the provisions of this section shall apply to criminal record clearances and exemptions for the following persons: (1)(A) Adults responsible for administration or direct supervision of staff. This requirement was not met as evidenced by: Based on observation, interviews and record review staff 1 (S1) was not fingerprinted while caring for residents in the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply.(1) Knowledge of the requirements for providing care and supervision appropriate to the residents. This requirement was not met as evidenced by: Based interview, record review and observation Licensee did not hire qualified staff (not fingerprinted, no evidence of training or staff records), which poses an immediate health, safety or personal rights risk to persons in care.

Personal Accommodations and Services apply:(d) The following space and safety provisions shall apply to all facilities:(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by: Based on obervation on 6/2/21 Licensee did not keep passageways clear of obstruction in the enclosed covered patio located off of the family room and master bedroom 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 by having a unlocked kitchen cabinet containing knives and cleaning supplies for 5 out of 5 dementia residents in care 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 5 out of 5 persons 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. Licensee was unable to provide documentation of quarterly fire drills 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 5 out of 5 which poses/posed a potential health, safety or personal rights risk to persons in care.

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (5) Ensuring that facility staff have knowledge of, and ability in the operation of the oxygen equipment. This requirement was not met evidenced by Licensee not having trained staff to operate all oxygen equiptment for residents in care. Based on review of records and interview with Licensee, Licensee did not not have training for staff to operate oxygen equiptment, which poses an immediate health and safety risk to residents in care.

Admission Agreement(b) Each resident’s record shall contain at least the following information:(17) Documents and information required by the following:(A) Section 87457, Pre-Admission Appraisal; This requirement was not met as evidenced by LPA's review of all residents records. No pre-appraisal has been completed or maintained in the resident files.

87613 General Requirements for Restricted Health Conditions(a) Prior to admission of a resident with a restricted health condition, the licensee shall:(2) Ensure that facility staff who will participate in meeting the resident’s specialized care needs complete training provided by a licensed professional sufficient to meet those needs.(B) Training shall be completed prior to the staff providing services to the resident. This requirement was not met as evidenced by interviews with licensee and the lack of documentation( no care plans) received from the licensee. Based on review of records, Licensee did not have training for staff to care for hospice residents, which poses an immediate health and safety risk for residents in care.

Reporting Requirements Reporting Requirments: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence.other death reports were not submitted.This requirement was not met as evidenced by late reporting date stamped from CCL on 3/19/21 for a death that occured on 3/1/21 and while reviewing records it was found other death reports were not submitted. Based on interview and review of records Licensee did not have death reports for residents that were in care

1569.73 Terminally ill residents; or terminally ill persons to be accepted as a resident; transferring hospice care and waivers; resident care and supervision (h) Nothing in this section shall be construed to relieve a licensed residential care facility for the elderly of its responsibility to notify the appropriate fire authority of the presence of a bedridden resident in the facility as required under subdivision (f) of Section 1569.72, and to obtain and maintain a fire clearance as required under Section 1569.149. This requirement was not met as evidenced by Licensee not notifying the local fire department of admitting 5 bedridden residents. Based on review of records and interview with Licensee, Licensee did not notify the local fire departmet of admitting 5 bedridden residents and obtaining the proper fire clearance.

87618 Oxygen Administration - Gas and Liquid (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. This requirement was not met as evidenced by Licensee not notifying the local fire department of oxygen dependent residents. Based on review of records and interview with Licensee, Licensee did not notify the local fire department of oxygen dependent residents, which poses an immediate health and safety risk for residents in care.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by Licensee not having a current medical assessment for R1. Based on review of records and interview with Licensee, Licensee did not have a current assessment for R1 since 2017, which poses an immediate health and safety risk for residents in care.