Golden Leaf Manor

87755 Inspection Authority of the Licensing Agency (a) Any duly authorized officer, employee or agent of the licensing agency ...enter and inspect the entire premise of any place providing services at any time...This requirement is not met as evidenced by: Based on observation, LPA did not have access to the staff office and 2 staff rooms, which poses a potential health and safety risk to residents in care.

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying.This requirement is not met as evidenced by: Based on observation, the staff office was locked and staff did not have the key to access files which poses a potential health and safety risk to residents in care.

87405 Administrator - Qualifications and Duties (a) All facilities shall have qualified and currently certified administrator. When the administrator is not in the facility, there shall be coverage by a designated substitute...This requirement is not met as evidenced by: Based on interview and record review, there is no qualified administrator for this facility and there is no designated substitute in place while the administrator is not in the facility which poses a potential health and safety risk to residents in care.

CCR 87465(h)The following requirements shall apply to medications which are centrally stored:(5)Each resident's medication shall be stored in its origally recieved container.No medications shall be transferred between containers. This above requirement was not met as evidenced by Based on observation,3 out of 3 residents, Residents #1-#3, medication was pre prepared and stored in pillboxes to be dispensed outside of their original container.

Based on observation and record review the licensee did not comply with the section cited and this affected 3 out 3 residents in care 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 and this affected 3 out of 3 residents 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 as the left side of the house passageway was not free of obstruction which poses an immediate health, safety or personal rights risk to persons in care. This affects 3 out 3 residents in care and poses an immediate health and safety risk to residents in care.

Based on observation, interview and record review], the licensee did not comply with section above as there was no documentation of a qualified and certified administrator this affects 3 out of 3 residents 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 1 out of 3 resident files (R1) did not contain a TB test which poses/posed a potential health, safety or personal rights risk to 3 out 3 persons in care.

Based on record review, the licensee did not comply with the section cited above in1 out of 3 residents, R1 which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation and interview with licensee and staff, the licensee did not comply with the section cited above in that medication were left accessiable to 3 out of 3 resident 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 in 3 out of 3 residents medication supply. This affects 3 out of 3 residents 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 as carbon monoxide detector was not observed to be operable and sercured which poses an immediate health, safety or personal rights risk 3 out of 3 persons in care.

Based on record review, the licensee did not comply with the section cited above has 2 out 3 Staff , Staff 2 and 3, did not have a current CPR training on file and 3 out 3 Staff ( S1, S2 and S3) did not have current First Aid training on file. This affects 3 out of 3 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on a record review, the licensee did not comply with the section cited above in 1 out of 3 staff , S3, did not have a TB test in their file which which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on a record review, the licensee did not comply as LPA observed Licensee's Liablilty Insurance to not meet the required amount which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on interview and observation the licensee did not comply with the section cited above in 1 out of 3 residents rooms were not used by residents but by S3. This affects 3 out 3 residents 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 in [count] out of [total count] [(objects) (persons)] [identifiers] 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 in 1 out of 1 resident bathrooms this affects 3 out of 3 residents 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 as administrator certificates are expired for both staff files reviewed 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 as there is no active liability insurance for the facility 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 (1) of (2) resident files reviewed did not have a medical assessment on file 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 as the emergency disaster plan is not updated to the curent form for the LIC 610D 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 as there is no record on file of last emergency drill completed 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 as Administrator certificates are expired, 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 as several medications have not been ordered from the pharmacy and added to the centrally stored medications list for resident #1, 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 as staff Jocelyne Serra does not have proof of trainings completed on file 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 as the licensee could not provide a copy of their insurance at the time of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.

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: (1) Obtain a California clearance or a criminal record exemption as required by the Department or...: This requirement is not met as evidenced by: Staff #1 does not have a criminal record clearance or association to the facility and resides on the property, this poses an immediate health and safety risk to resident(s) in care.

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.... This was not met as evidenced by: LPA was unable to access staff files as the staff files were locked in an office and no staff had a key. Licensee had the key but could not be present during visit, this poses a potential health and safety risk to residents in care.

87307 Personal Accommodations and Services(a) (1) There shall be common rooms such as living rooms, dining rooms, dens or other recreation/activity rooms. They shall be of sufficient space and/or separation to promote and facilitate the program of activities and to prevent such activities from interfering with other functions. This requirement is not met as evidenced by: Individual residing in a room erected without a permit in the covered patio area was designated for Resident use.

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: (1) Obtain a California clearance or a criminal record exemption as required by the Department or...: This requirement is not met as evidenced by: Staff #1 does not have a criminal record clearance. Individual residing in a non-permitted room in the covered patio area does not have a criminal record clearance.

Based on record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Based on LPA observation and record review, LPA observed R1's medication for Divalprpex Sodium is in a different container and not the original container.

Based on LPA's observation, LPA observed the bathroom#1 has a lot of ants around the sink area and toilet bowl and the floor which imposed an potenital risk of the residents in care.