Glen Park at Valley Village

(a) Each licensee shall furnish to the licensing agency... (1) A written report shall be submitted to the licensing agency... within seven days of the occurrence … (D) Any incident which threatens the welfare, safety or health of any resident, …, or unexplained absence of any resident.This requirement was not met as evidenced by: Based on interview and record review, the Licensee did not comply with the section cited above as the Licensee did not provide CCL notification of the incident which posed/poses a potential health, safety, and/or personal rights risk to residents in care.

(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: Based on interview and record review, the Licensee did not comply with the section cited above as the Licensee did not meet R1’s care and supervision needs that resulted in an elopement which posed/poses an immediate health, safety, and/or personal rights risk to residents in care.

87464 Basic Services (f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident ... pre-admission appraisal, with those activities of daily living such as ... bathing ...This requirement was not met as evidenced by: Based on interviews and record review, the Licensee did not comply with the section cited above as the licensee did not assist residents with showers which posed/poses an immediate health, safety, and personal rights risk to residents in care.

Personal Rights of Residents in All Facilities:Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Staff #4 responded back to Resident #1 when they requested their medication by cursing at them and this poses a possible risk to the rights of the resident

87465(c)(2) Incidental and Medical Care: ....Once ordered by the physician the medication is given according to the physician's directions.This requirement has not been met as evidenced by: The facility was short staffed and the residents were not being given their medications in a timely manner and this poses an immediate risk to the health of the residents.

87615Prohibited Health Conditions (a) Persons who require health services for or have a health condition...shall not be admitted or retained in a residential care facility for the elderly: (5) Residents who depend on others to perform...This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Facility admitted and retained R1 who had no capacity for self-care, without submitting an exception request for the prohibited health condition, which posed an immediate health and safety risk to residents in care.

87609(b)(3) Allowable Health Conditions and the Use of Home Health Agencies (b) Incidental medical care... (3) The licensee informs the home health agency of any duties the regulations prohibit facility staff from performing...This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. Facility staff performed wound care treatment to R1’s pressure injury, which posed an immediate health and safety risk to residents in care.

87631Healing Wounds(a) Except... the licensee shall be permitted... a resident who has a healing wound...(3) Residents with a stage 1 or 2 pressure injury...an appropriately skilled... (B) All aspects... documented in the resident's file.This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. There were no home health logs or staff notes available for R1 at the facility, which posed an immediate health and safety risk to residents in care.

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement is not met as evidenced by: Based on interviews and observation, the facility did not provide residents a safe, healthful and comfortable accommodations, as bed bugs were observed and interviews confirmed bed bugs. This posed a potential health, safety, and personal rights risk to residents in care.

Safeguards for Resident Cash, Personal Property, and Valuables Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above as it related to former administrator storing/leaving resident's belongings outside in the parking lot to get rid of bed bugs. This posed a potential personal rights risk to residents in care.

§1569.312(a)Basic services requirements. Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above as the licensee failed to provide adequate supervision to R1 who signed out of the facility and never returned, which posed an immediate health and safety risk to residents in care.

87412 Personnel Records(h) All personnel records shall be retained for at least three (3) years following termination of employment.This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above as the licensee failed to keep personnel records for S1 and S2, which posed a potential health and safety risk to residents in care.

87465 Incidental Medical and Dental 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... This requirement is not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above as the licensee failed to keep medication records for R1, which posed a potential health and safety risk to residents 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 …This requirement is not met as evidence by: Based on information obtained through interviews, the administrator searched R1’s dresser and nightstand drawers without prior permission, which poses a potential health, safety and personal rights risk to resident in care.

Eviction Procedures. (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement is not met as evidenced by: Based on interviews, and record review, licensee did not meet with the section above by not including date, place, witnesses, and circumstances surrounding the concerns of the eviction, which causes a potential personal rights violation to residents in care.

Personal Rights: Except for children’s..., each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations...and equipment to meet his/her needs.This requirement is not met as evidenced by: Based on record review and interviews, licensee did not comply with section above. R1's prescription order dated on 12/14/2023 and _____ for new wheelchair was not processed in a timely manner. This poses a potential risk to residents in care.

Storage Space: 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 observations, licensee did not comply with section above by not ensuring detergents, cleaning solutions and scissors are kept inaccessible to residents. This poses an immediate risk to residents in care.

(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 Per record review, Virginia Sumulong, aslo known as Virginia De Los Reyes, hired on 9/18/23, has been employed and present at the facility and has not been associated to the facility until it was brought to the Admnistrator's attention today-10/5/23. CIVIL PENALTIES of $500 were assessed

387217 (c) (1) Safeguards for Resident Cash, Personal Property, and Valuables-Every facility shall account for any cash resources entrusted to the care or control of the licensee or facility staff, (1) Cash resources include … and personal and incidental need allowances from funding sources such as SSI/SSP. This requirement was not met. Based on record review, the withdrawals are not supported, and the facility is to refund the residents accordingly. The documentation submitted and reviewed disclosed that the facility mishandled some of the residents’ funds.

Section 87216 (1) Bonding- Each licensee, other..., shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. The amount of the bond shall be in accordance with the …schedule. This reuirement was not met. Based on record review, the facility failed to maintain sufficient surety bond coverage to safeguard the residents’ resources. The current $11,000 surety bond coverage is not sufficient and needs to be increased for the amount that is being safeguarded. which poses a potential health and safety danger to persons in care.

87217 (g)(1) 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...the resident's signature or mark, or responsible party's full signature...This requirement was not met. Based on record review, no residents’ signatures were observed on the LIC 405 ledgers, which is inconsistent with the facility's policies and procedures. The licensee failed to maintain adequate safeguards and accurate records of cash resources and valuables entrusted to their care, which poses a potential health and safety danger to persons in care.

87465 Incidental Medical and Dental Care (a)(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. Based on evidence gathered through a medication audit, the licensee did not comply with the section cited above as R1 did not have their medication centrally stored which poses a potential health, safety and personal rights risk to person in care.

87468.1 Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement is not met as evidenced by: Based on interviews and observation, the facility did not provide R1 a safe, healthful and comfortable accommodations, as bed bugs were observed and interviews confirmed bed bugs which poses a potential health, safety, and personal rights risk to residents in care.

87465(h)(2)Incidental Medical and Dental CareThe following requirements shall apply to medications which are centrally stored: ...shall be kept in a safe and locked place that is not accessible to persons other than employees …centrally stored medication. This requirement is not metas evidenced by: Based on interviews and observation the licensee did not comply with the section cited above, as R2’s medication was mixed with R1’s medication, which poses a potential health and safety risk for residents in care.

87211(a)(1)(D) Reporting Requirements. A written report shall be submitted … within seven days of the occurrence of any of the events specified ... (D) Any incident which threatens the welfare, safety or health of any resident ...This requirement is not met as evidenced by: Based on record review, and interviews, the licensee did not comply with the section cited above, as R1’s POA and CCLD were not informed of R1’s hospitalization, which poses a potential health and safety risk for residents in care.

87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities. Residents shall have all of the following....: (4)To care, supervision, and services that meet their individual needs...and are delivered by staff that are sufficient in numbers,.This requirement is not met as evidenced by: Based on the investigation, licensee did not comply with the section cited above, as staff did not provide adequate supervision, resulting in a resident falling, which poses an immediate health and safety risk to residents in care.

87211(a)(1)(D) Reporting Requirements. A written report shall be submitted … within seven days of the occurrence of any of the events specified ... (D) Any incident which threatens the welfare, safety or health of any resident ...This requirement is not met as evidenced by: Based on record review, and interviews, the licensee did not comply with the section cited above, as family members and CCLD were not informed of R1’s hospitalization, which poses a potential health and safety risk for residents in care.

87468.1 Personal Rights of Residents in All Facilities (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement is not met as evidence by: Based on interviews, the licensee did notcomply with the section cited above asthe facility abandoned R1 for 2 days at the hospital which poses an immediate health, safety and personal rights risk to resident in care.

87211(a)(1)(D) Reporting Requirements. A written report shall be submitted … within seven days of the occurrence of any of the events specified ... (D) Any incident which threatens the welfare, safety or health of any resident ...This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, as reports were not submitted for incidents to both CCL and Regional Center, which poses a potential health and safety risk for residents in care.

Based on observation, the licensee did not comply with the section cited above, as the laundry room flooring on the 2nd floor was unclean, which poses a potential health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in two (2) out of five (5) restrooms where the hot water temperature measured above 120 degree F, which poses an immediate health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above, as the laundry rooms on the 1st and 2nd floor were unlocked and there were cleaning supplies and laundry detergent accessible to clients in care, which poses an immediate health, safety or personal rights risk to persons in care.

87211(a)(1)(D) Reporting Requirements. A written report shall be submitted … within seven days of the occurrence of any of the events specified ... (D) Any incident which threatens the welfare, safety or health of any resident ...This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, as reports were not submitted for all of R1’s incidents to both CCL and Regional Center, which poses a potential health and safety risk for residents in care.

87411(a) Personnel requirements – General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by: Based on information received, the licensee did not comply with the section cited above, as the facility experienced an incident where there were no staff present in the facility for approximately one-hour, if not longer, which posed an immediate health and safety risk to residents in care.

87303-Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times.This requirement is not met as evidence by: Based on observation, and interviews: During the physical plant inspection, LPA Urena observed holes in the hallways’ walls and ceilings, as well in residents’ rooms 23 and 20, with some wiring exposed. which poses a potential Health, Safety, and Personal rights risk for persons in care.

87411(f) Personnel Requirements - General. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure.This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in four out of ten staff (S1, S2, S4, S5), which poses a potential health and safety risk to residents in care.

87411(c)(1) Personnel Requirements - General. Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in three out of ten staff (S2, S3, S5), which poses a potential health and safety risk to residents in care.

87463(c) Reappraisals. The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff ... when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first ...This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in four out of nine residents (R1, R2, R3, R4), which poses a potential health and safety risk to residents in care.

87465(a)(4) Incidental Medical and Dental Care. The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in one out of nine residents (R5), which poses an immediate health and safety risk to residents in care.

87211(c) Reporting Requirements. Any suspected physical abuse that does not result in serious bodily injury... shall be reported to the local ombudsman, the licensing agency, and the local law enforcement agency within twenty-four (24) hours.This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, as facility staff did not fulfill reporting requirements to appropriate parties, including Mandated Reporter requirements by reporting suspected abuse, which poses an immediate health and safety risk to residents in care.

Based on LPAs observation, the licensee did not comply with the section cited above, as the facility does not currently have a sufficient 30-Day supply of PPE gear, which poses a potential personal rights risk to persons in care.

Based on interviews and LPAs observation, the Licensee did not comply with the section cited above, as the facility failed to ensure that residents in residential care where allowed to have their visitors with restrictions in accordance with PIN 22-040-ASC, which poses a potential health and safety risk to residents in care.

Based on interviews, the licensee did not comply with the section cited above, as the facility failed to report between five (5) to six (6) COVID cases within 24 hours to the licensing agency, which poses a potential health and safety risk to residents in care.

Based on LPAs observation and interviews, the licensee failed to ensure hot water temperature measured within 105 to 120 degrees Fahrenheit to residents in care due to the facility’s water heater being in need of repairs, 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, as S3 and S4 have not been associated to the facility, which poses an immediate health and safety risk to residents in care.

87355(e)(2) 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) This requirement is not met as evidenced by:Based on record review, the licensee did not comply with the section cited above, as S1 and S2 have not been associated to the facility, which which poses an immediate health and safety risk to residents in care.

874069A) Administrator Certification Requirements. (a) All individuals shall be residential care facility for the elderly certificate holders prior to being employed as an administrator.This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above, as the current Administrator Certificate for the current Administrator on file is expired, which poses a potential health and safety risk to residents in care.

87224(a) Eviction Procedures. The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required…This requirement is not met as evidenced: Based on interview and record review, the licensee did not comply with the section cited above, as the issued eviction notice to R1 was invalid, which poses an immediate health and safety risk to residents in care.

87355(e)(2) 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) This requirement is not met as evidenced by:Based on record review, the licensee did not comply with the section cited above, as S1 and S2 have not been associated to the facility since 08/04/21 (S1) and 04/10/20 (S2), which which poses an immediate health and safety risk to residents in care.

1569.69(a)(1) Employees assisting residents with self-administration of medication; training requirements. ... The employee shall complete 24 hours of initial training. ...16 hours of hands-on shadowing training... and 8 hours of other training or instruction ...This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as staff failed to complete all required medication training prior to assisting residents with the self-administration of medication for R1, which poses an immediate health and safety risk to residents in care.

Additional Personal Rights of Residents in Privately Operated Facilities. (19) To have prompt access to review all of their records and... photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies. This requirement was not met as evidenced by: Based on interviews, and record review, the licensee did not meet the above section by failing to produce requested records resulting in a potential risk to the personal rights of residents in care.

(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). (2) Safe and healthful living accommodations and services, as specified in Section 87307, Personal Accommodations Services (4) Personal assistance and care as needed by the resident as indicated in the pre-admission appraisal...This requirement is not met as evidenced by: Based on investigation, the facility failed to ensure that R1 was properly provided care and supervision resulting to R1 contracting communicable (continued to right)

To be accorded safe, healthful and comfortable accommodations, furnishings and equipmentThis requirement is not met as evidenced by:Based on IB investigation, the facility failed to ensure that health and safety of R1 resulting to R1 contracting communicable disease while in the care of the facility. This poses an immediate health and safety risk to the residents in care.

(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). (4) Personal assistance and care as needed by the resident as indicated in the pre-admission appraisal...(5) Regular observation of the resident's physical and mental condition as specified in Section 87466, Observation of the Resident. This requirement is not met as evidenced by: Based on IB investigation, the facility failed to ensure that R1 was properly provided care and supervision resulting to R1 sustaining pressure injury while in the facility, which poses (see right)