Elder Creek Villa Iii

Personnel RecordsPersonnel records: (a)Th e licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11)A health screening as specified in Section 87411, Personnel Requirements - General. This requirement was not met, evidenced by, based on, staff Allen, did not have a current health screening during today's visit, which is a health and safety risk to residents and staff in care.

Based on today's observations and recored review, the facility has a hospice waiver for (2); but has accepted an additonal (2) residents without requesting for an exception or hospice waiver increase; which poses a potential health, safety or personal rights risk to persons in care.

Based on observations and record review (2) residents incomplete Licensing documents in files; which poses a potential health, safety or personal rights risk to persons in care.

Administrator Recertification Requirements: (k) Whenever a certified administrator assumes or relinquishes responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days, to: This requirement was not met, evidenced by, during today's annual inspection, LPA observed the current Administrator's certificate expired 01/16/2025. LPA was informed the son will be taking over as Administrator for the facility.

Based on today's observations and recored review, the facility has a hospice waiver for (2); but has accepted an additonal (2) residents without requesting for an exception or hospice waiver increase; which poses a potential health, safety or personal rights risk to persons in care.

(c) No resident shall be accepted or retained if any of the following apply: This requirement was not met, evidenced by, during today's annual inspection, LPA observed the facility retained (2) residents that were bedridden and one had a prohibited health condition (colostomy) bag, resident#1. This is an immediate health and safety risk to residents in care and an immediate civil penalty will be assessed and an immediate $500.00 civil penalty will be assessed.

Based on today's annual inspection and record review, all residents 1-5, per LIC858, were missing important and required licensing documents, such as physician reports, re and pre-appraisal, needs and service plan, functional capabilities documents. This is a potential health and safety risk to residents in care.

Based on today's annual inspection and record review, all residents 1-5, per LIC858, were missing important and required licensing documents, such as physician reports, re and pre-appraisal, needs and service plan, functional capabilities documents. This is a potential health and safety risk to residents in care.

Based on today's annual inspection for the facility's food supply, LPA observed food to be not properly wrapped, opened, old and freezer burned. This is a immediate health and safety risk to residents in care. POC cleared, food was discarded.

Based on today's annual inspection for the facility's food supply, LPA observed food to be not properly wrapped, opened, old and freezer burned. This is a immediate health and safety risk to residents in care. POC cleared, food was discarded

Based on annual inspection, the Administrator's son's family, wife visited the facility, and according to the personnel summary, the wife did not have a fingerprint clearance or was associated to the facility. This poses an immediate health, safety or personal rights risk to persons in care.

Based on today's annual inspection and observation and record review for resident # 1 and 4, both are bedridden, and the facility did not have a fire clearance for bedridden clients. This poses an immediate health, safety or personal rights risk to persons in care. An immediate civil penalty in the amount of $500 will be fined.

Based on today's annual inspection and observation and record review for resident # 1 and 4, both are bedridden, and the facility did not have a fire clearance for bedridden clients. This poses an immediate health, safety or personal rights risk to persons in care.

Based on today's annual inspection and observation and record review for resident # 1 and 4, both are bedridden, and the facility does not have a fire clearance for bedridden clients. This poses an immediate health and safety risk to resident in care.

This requirement is not met as evidenced by: Based on today's physical plant inspection, LPA observed the facility built an additional sleeping room in the garage for staff. LPA reviewed the original facility sketch, and the additional room was not included when the application was submitted. This is a potential health and safety risk to residents in care.

Based on record review, LPA observed staff #1 (S1) not to have current first aid or CPR training. Certifcate had expired 2/2021. This poses as a potential health, safety or personal rights risk to persons in care.

Based on resident record review, LPA observed resident #1 (R1) not having a current physician report, who is diagnosed with dementia. The last report observed was date 07/2019. This poses as a potential health, safety or personal rights risk to persons in care.

Based on today's physical plant inspection, LPA observed the facility built an additional sleeping room in the garage for staff. LPA reviewed the original facility sketch, and the additonal room was not included when the application was submitted. This is a potential health and safey risk to residents in care. This poses as a potential health, safety or personal rights risk to persons 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 has not been met as evidenced by a report (S223) received stating that during a visit on 3/17/21 the reporting party observed Clorox, glass cleaner, dishwasher pod and sharp kitchen tools acceessible to the residents. This posses an immediate health and safety risk to the residents in care.