Jbm Residence Home, Inc.

(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 requirement is not met as evidenced by: Based on record review and interviews the licensee did not comply with the section cited above by retaining R1 who is not receiving hospice services and has a unstageable wound which poses an immediate health, safety or personal rights risk to persons in care.

(a) Based on the individual's ... appraisal... Postural supports may be used under the following conditions. (3)A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. This requirement is not met as evidenced by: Licensee did not comply with the section cited above by not obtaining a written order from a physician indicating the need for bed rail that extends from the head half the length of the bed which poses an immediate health, safety personal rights risk.

(a) All facilities shall maintain a fire clearance...Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance...(2)Bedridden persons. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above in that the facility has fire clearance for one bedridden resident and the facility currently has two bedridden residents which poses an immediate health, safety or personal rights risk to persons in care.

...all residential care facilities for the elderly,... shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, ... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in not maintaining liability insurance which poses a potential health, safety or personal rights risk to persons in care.

(a) ...Postural supports may be used under the following conditions. (5)... (B)Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care...This requirement is not met as evidenced by: Licensee did not comply with the section cited above by utilizing full bed rails for R1 who does not receive hospice care services which poses an immediate health, safety personal rights risk .

(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 requirement is not met as evidenced by: Based on record review and interviews the licensee did not comply with the section cited above by retaining R1 who is not receiving hospice services and has a unstageable wound which poses an immediate health, safety or personal rights risk to persons in care.

(a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department... and any future residents who may request acceptance, ... This requirement is not met as evidenced by: Based on record review and interviews the licensee did not comply with the section cited above in accepting a second resident receiving hospice services when the facility has a hospice waiver for only one resident which posed an immediate health, safety or personal rights risk to persons in care.

...all residential care facilities for the elderly,... shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, ... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in not maintaining liability insurance which poses a potential health, safety or personal rights risk to persons in care.

(a) All facilities shall maintain a fire clearance...Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance...(2)Bedridden persons. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above in that the facility has fire clearance for one bedridden resident and the facility currently has two bedridden residents which poses an immediate health, safety or personal rights risk to persons in care.

No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. Based on interviews the licensee did not comply with the section cited above in false or misleading statements on two different days regarding the same question about the number of residents receiving Hospice services in the facility which posed an potential health, safety or personal rights 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... This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above in four (04) out of four (04) residents' centrally stored medication not being properly recorded which poses a potential health, safety or personal rights risk to persons in care

(b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range... or in areas of extreme heat to 30 degrees F less than the outside temperature. This requirement is not met as evidenced by: Based on LPA's interviews and observation the facility's air conditioning system was observed to be inoperable which poses an potential Health, Safety or Personal Rights risks to persons in care.

Based on interviews and record review, the licensee did not comply with the section cited above in one (01) out of four (04) resident who do not have a reappraisal and were identified as having a wound which poses a potential health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above in three (03) out of four (04) residents' medication not being properly recorded with required information which poses a potential health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in the back exterior door leading to the backyard was missing a door knob 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 in not maintaining liability insurance which poses a potential health, safety or personal rights risk to persons in care.

(a) 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: Based on observation the licensee did not comply with the section cited above in that LPA smelled a urine odor in bedroom #1 and the section of the facility where the bedroom is located by the formal dining area smelled of urine which poses a potential health, safety or personal rights risk to persons in care.

(a) The licensee shall ensure that personnel records are maintained on... each employee. Each personnel record shall contain the following information:(11)A health screenings specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above in that staff #1's (S1's) record was incomplete missing health screening and TB test result which poses a potential health, safety or personal rights risk to persons in care.

(c) Prior to admission a determination of the prospective resident's suitability...(1) The appraisal shall document, at a minimum:(A)An evaluation of the prospective resident's functional capabilities...This requirement is not met as evidenced by: Licensee did not comply with the section cited above in two out of five resdients had no preplacement appraisal on file which poses a potential health, safety or personal rights risk to persons in care.

87458(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above in that the facility did not obtain a medical assessment with TB test for R1 prior to admittance which poses an immediate health, safety or personal rights risk to persons in care.

(4) All facility staff and volunteers shall use gloves...(A)Gloves shall always be worn when: 3...assisting with incontinence when there is a risk of contact with blood, body fluids or other potentially infectious material. This requirement is not met as evidenced by: Based on observation LPA Rios observed the Licensee change a resident without using gloves, which poses an immediate health, safety or personal rights risk to persons in care.

(a) ...Postural supports may be used under the following conditions. (5)Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B)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 requirement is not met as evidenced by: Licensee did not comply with the section cited above by utilizing full bed rails for R1 and R5 who are no longer on hospice which indicates the need which poses an immediate health, safety personal rights risk .

(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 requirement is not met as evidenced by: Based on record review and interviews the licensee did not comply with the section cited above by retaining R3 who is not receiving hospice services and has a stage 4 wound which poses an immediate health, safety or personal rights risk to persons in care.

(a) All facilities shall maintain a fire clearance...Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance...(2)Bedridden persons. This requirement is not met as evidenced by: Based on observation and record review the licensee did not comply with the section cited above in that the facility has fire clearance for one bedridden resident and the facility currently has two bedridden resdients which poses an immediate health, safety or personal rights risk to persons in care.

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 the LPA's record review and interviews, the licensee did not comply with the section cited above in 2 staff not having on going training on file and S1 and administrator who was also working other shifts providing care for 5 residents which posed an immediate health, safety or personal rights risk to persons in care.

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training...(1) 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 the LPA's record review and interviews, the licensee did not comply with the section cited above in 6 staff not having active 1st aid and CPR certification which poses an potential health, safety or personal rights risk to persons in care.

87407 (e)To apply for recertification after the expiration date of the certificate, but within four (4) years of the certificate expiration date, the certificate holder shall submit to the Department’s Administrator Certification Section: (1) A completed Application for Administrator Certification form LIC 9214. (2)Evidence of completion of the required continuing education hours…(3)Payment of a non-refundable delinquency fee…This requirement is not met as evidenced by: During today's inspection, the Administrator has failed to renew Administrator's certificate, or provide proof payment or training submission has been sent to Sacramento which poses an potential health, safety or personal rights risk to persons in care.

Based interview and record review, the licensee did not comply with the section cited above in not making themselves available to provide records upon request which poses a potential 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 not providing the department notice of a designated manager when they were not aviable which posed a potential health, safety or personal rights risk to persons in care.

(a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department...This requirement is not met as evidenced by: Based on interview and record review, Administrator did not comply with the above section by failing to obtain a hospice care waiver and accepted or retained two (2) terminally ill residents, which poses an immediate health, safety and personal rights risk to residents in care.

87211(a)(1)(A) Reporting Requirements. The licensee shall send a written report to the licensing agency and the person responsible for the resident when a resident dies, regardless of cause or where death occurred, within seven days of the death. This requirement was not met as evidenced by: Based on interview conducted with the administrator, revealed that they failed to submit a death report for R3 to CCL which poses a potential health, safety and personal rights risk to residents in care.

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs...(A)The licensee shall be permitted to use the form LIC 603 (Rev. 6/87), Preplacement Appraisal Information, to document the appraisal. This requirement was not met as evidenced by:Based on interview and record review conducted with the administrator, they failed to complete an appraisal for R2 which poses a potential health, safety and personal rights risk to residents in care.

(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...and a reappraisal done at least annually... This requirement is not met as evidenced by: Based on record reviews, the licensee did not comply with the section cited above by not ensuring a annual medical assessment for three(3) out of four(4) residents with dementia which poses a potential health, safety and personal rights risk to persons in care.

87625(b) ... the licensee shall be responsible for the following:(2)Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night.This requirement is not met as evidenced by: Based on interview and record review, Administrator did not comply with the above section by failing to check R1 incontinent resident in regular intervals including during the night, which poses an immediate health, safety and personal rights risk to residents in care.

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 requirement is not met as evidenced by: Based on observations made and record review, the licensee did not comply with the section cited above by utilizing full bedrails for R2 who is not on hospice which poses an immediate health, safety and personal rights risk to persons in care.

Based on observation, the administrator did not comply with the section cited as the fire extinguisher was purchased on 2/24/2020 and has not been serviced since which poses an immediate health, safety and personal rights risk to persons in care.