Valerio Rcfe

Annual routine visit with medical professional

Based on record review, the licensee did not comply with the section cited above ias records reviewed reviewed, Resident #1, Resident #2 and Resident #4 have not had an annual routine visit with a licensed medical professional since 2023 which poses/posed a potential health, safety or personal rights risk to persons in care.

Permit PRN self-administration with written ability

Based on record review, the licensee did not comply with the section cited above as Resident #3 and Resident #4 take PRN medications but there is no completed PRN Authorization Letters observed in the residents' files which poses/posed a potential health, safety or personal rights risk to persons in care.

Give PRN medication by physician order

Based on observation and record review, the licensee did not comply with the section cited above as medications reviewed show that the facility is not dispensing the medications as prescribed by the physician. MAR LOGS indicate medications are dispensed and is still in the bubble pack and medications are dispensed in amounts not indicated on the medication label] which poses an immediate health, safety or personal rights risk to persons in care.

Require physician order and label for PRN medication

Based on record review, the licensee did not comply with the section cited above as per record review, the facility does not have any physicians orders in the residents' files for all the centrally stored medications ] which poses an immediate health, safety or personal rights risk to persons in care.

Mark taps at high-temperature threshold

Based on observation, the licensee did not comply with the section cited above by having hot water temperature above regulation range which poses an immediate health, safety or personal rights risk to persons in care.

Give PRN medication by physician order

Based on observation, interview and record review, the licensee did not comply with the section cited above by having discrepancies in 4 out of 4 resident's medication which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interviews and record review, the licensee did not comply with the section cited above by have discontinued medication for former and current residents inside a staff room which poses an immediate health, safety or personal rights risk to persons in care.

Kitchen sanitation against contamination sources

General Food Service Requirements(b) The following food service requirements shall apply:(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.This requirement is not met as evidenced by: Based on LPA observation, the Licensee did not comply in the section cited above in that vermin was observed in the kitchen / dining room area on 12/04/2024 visit. This posed an immediate health and safety risk to persons in care.

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.(1) Disinfectants, cleaning solutions, and poisonous substances shall be stored in areas separate from food supplies as specified in Section 87555, General Food Service Requirements. Based on LPA observation, the Licensee did not comply in the section cited above in that a knife was left out in the kitchen area accessible to residents in care. This posed an immediate health and safety risk to persons in care.

General Food Service Requirements(b) The following food service requirements shall apply:(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.(28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. Based on LPA observation, the Licensee did not comply in the section cited above in that multiple food items in the kitchen did not have proper dates and lables. This posed an immediate health and safety risk to persons in care.

(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.... Based on records review, and medication audit the licensee did not comply with section cited above as in six (6) out of six (6) residents did not have the start dates documented on the centrally stored log.

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 is not met as evidenced by: facility roof awning was in disrepair. The Facility floor was in disrepair.

Food handling safeguards during storage and service

General Food Service Requirements. Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. Based on observation the licensee did not comply with section cited above as Food items observed in refrigerator were in containers and bags with no lable or date to esure the nutritive values of food.

Dignity in personal relationships

(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 is not met as evidenced by: Based on observation and interviews, the Licensee did not comply with the section cited above in that cameras in the common areas have an audio component which poses a potential personal rights risk to persons in care.

Solid waste shall be stored, located and disposed of in a manner that will not...provide a breeding place or food source for insects or rodents. (1)All containers, including movable bins, used for storage of solid wastes....shall have tight fitted lids...This requirement is not met as evidenced by: Based on LPA observation, the Licensee did not comply in the section cited above in that resident bedrooms were observed to contain trash bins without lids. This poses a potential health, safety, and personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

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.This requirement is not met as evidenced by: Based on LPA observation, the Licensee did not comply with the section cited above in that cleaning solutions were stored accessible in the visitor bathroom which posed a potential health and safety risk to persons in care.

Kitchen sanitation against contamination sources

General Food Service Requirements (b)The following food service requirements shall apply: (27)All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.This requirement is not met as evidenced by: Based on LPA/credible witness observation and pictures obtained, the licensee did not comply with the section cited above as roaches and flies were observed in kitchen areas. This poses a potentail health and safety risk to persons in care.

Food quality controls and rejected damaged goods

(b) The following food service requirements shall apply: (8)All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.This requirement is not met as evidenced by: Based on LPA observation, the Licensee did not comply with the section cited above. LPA observed expired food items in pantry and refrigerator dating back to 11/17/2022. This posed a potential health and safety risk to persons in care.

Food handling safeguards during storage and service

(b) The following food service requirements shall apply: (9)Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.This requirement is not met as evidenced by: Based on LPA observation, the Licensee did not comply with the section cited above. LPA observed food items stored without original packaging and labels detailing nutrtitive values and expiration dates. This poses a potental health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above per file review, Resident #5's file does not contain a copy of a medical assessment and it is unknown if the resident is ambulatory or non-ambulatory and if the resident is appropriately placed in the correct fire cleared room which poses/posed a potential health, safety or personal rights risk to persons in care.

Obtain baseline medical assessment before resident admission

Based on record review, the licensee did not comply with the section cited above per review of Resident #5's file that there was no medical assessment(LIC602)Physician's Report obtained or maintained in Resident #5's file. It is unknown at this time what the resident's medical condition is or whether the resident has a contagious disease, which poses/posed a potential health, safety or personal rights risk to persons in care.

Restrict nonambulatory residents from ambulatory rooms

Based on observation and record review, the licensee did not comply with the section cited above as Resident #1 who is determined to be non-ambulatory per physician, needs alot of assistance in transferring to a wheelchair and turning every 2 hours was observed in a hospital bed placed in bedroom #5, which poses an immediate health, safety or personal rights risk to persons in care. Immediate civil penalties were assessed.

Require physician order and label for PRN medication

Incidental Dental and Medical Care -For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. 1)The specific symptoms which indicate the need for the use of the medication.(2) The exact dosage.(3) The minimum number of hours between doses.(4)The maximum number of doses allowed in each 24-hour period. The facility does not have any physician's orders on file

Safeguards for Resident Cash, Personal Property, and Valuables:Each licensee shall maintain adequate safeguards and accurate records of cash resources and valuables entrusted to his care, including, but not limited to the following: Records of residents' cash resources maintainedas a drawing account shall include a ledger accounting (columns for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. Facility records are unclear as to the P &I balances for R2, R5 & R6.

Employees assisting residents with self-administration of medication; training requirements: a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets the following training requirements ) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete six hours of initial training. This training shall consist of two hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and four hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. Lorna Montemayor has not been provided with any medication training.

Maintain records of centrally stored medication dosages

Incidental Medical and Dental Care: 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: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. LPA observed that the MAR logs for August 2023 were not completed from 8/7/23-8/11/23. Per staff, medications were dispensed.

Require physician-written PRN medication directions

Incidental Medical and Dental Care: 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 if following conditions are met: (1) There is written direction from a physician, on a prescription blank, specifying the name of the resident, the name of the medication, all of the information in Section 87465(e), instructions regarding a time or circumstance (if any) when it should be discontinued, and an indication when the physician should be contacted for a medication reevaluation. All residents are prescribed PRNs and no PRN authorization letters were on file. This poses a danger to residents in care