Golden Care Living, Inc.

Based on observation, the licensee did not comply with the section cited above in having fruit flies in the kitchen area which poses/posed 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 not having a TB test on file for one of the caregivers which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation record review, the licensee did not comply with the section cited above in not having a health screening for a care staff which poses/posed 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 not having Appraisal & Needs Services Plan completed for 2 residnets which poses/posed 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 not having an active TB test on file for one of the residents which poses/posed 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 not having personal rights completed for one of the residents which poses/posed 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 not having a SPV form completed for one of the residents which poses/posed 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 not having a CPR card on file from a care staff which poses/posed 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 having an extra hospice resident at the facility 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 having unlocked cleaning solutions on bathrrom sink and kitchen which poses an immediate health, safety or personal rights risk to persons in care.

80061 Reporting Requirements (b) Upon the occurrence, during the operation of the facility, (1) Events reported shall include the following:(E) Any unusual incident or client absence which threatens the physical or emotional health or safety of any client.This requirement was not met as evidence by: Licensee did not generate incident reports for resident refusal to shower, clean resident room or change the bed sheets. This poses an immediate health and safety risk to all

80069.2 Functional Capabilites Assessment (a) In order to determine whether the facility's program meets a client's services needs,(A) Does not bathe or shower self. This requirement was not met as evidence by: LIcensee did not ensure resident took a shower. This poses an immediate health and safety risk to all residents in care.

80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights...(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.This requirement was not met as evidence by: Licensee did not ensure that resident room was clean and free of odor.This poses an immediate health and safety risk to all residents in care.

80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights...(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.This requirement was not met as evidence by: LIcensee did not change the bed and sheets This poses an immediate health and safety risk to all residents in care. This requirement was not met as evidence by:

87307 Personal Accommodations and Services (E) Portable or permanent closets and drawer space in the bedrooms for clothing and personal belongings. A minimum of eight (8) cubic feet (.743 cubic meters) of drawer space per resident shall be provided. This requirement is not met as evidenced by: Resident #1 was not accorded a comfortable accomdations and did not have a closet space as required by Title 22 Sec 87307. This violation is a potential risks to resident in care.

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Resident #1 was not accorded a comfortable accomdations and did not have access to to personal clothing items. This violation is a potential risks to resident in care.

Section 87405(a)–(c) Administrator - Qualifications and Duties:(a) AllFacilities shall have a qualified and currently certified administrator...The administrator shall have sufficient freedomfrom other responsibilities and shall be on the premises a sufficient number of hours... to permit adequate attention to the management and administration of the facility as specified in this...have qualifications adequate to be responsible and accountable for management and administration... (b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. (c) Failure to comply with all licensing requirements... may constitute cause for revocation of thelicense of the facility. This requirement is not met as evidenced by: Resident #1 was transported to the hospital on 08/21/21 and hospital staff noted Stage II pressure injury to their right hip. By November 2020, Resident #1’s right hip developed from a Stage II to Unstageable/Stage III. This violation poses a potential health, safety or personal rights risk to persons in care.

Section 87411(a) Personnel Requirements – General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff... ensure provision of ...care as required in Section 87608, Postural Supports. This requirement is not met as evidenced by: There is no overnight staff to assist residents with personal hygiene (incontinence care) needs. This violation poses a potential health, safety or personal rights risk to persons in care.

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional, and social functioning and that appropriate assistance is provided when such observation reveals unmet needs...This requirement is not met as evidenced by: Home Health Agency skilled nurse was aware that Resident #1 was not being repositioned overnight because there was no nighttime caregiver available to do so and recommended Resident #1 to a higher level of care. This violation poses an immediate health, safety or personal rights risk to persons in care.

87609(c) Allowable Health Conditions and the Use of Home Health Agencies: (c) The use of home health agencies to care for a resident’s medical condition(s) does not expand the scope of care and supervision that the licensee is required to provide.This requirement is not met as evidenced by: Home Health Agency skilled nurse provided training to facility staff on how to turn and reposition resident every two (2) hours; of which, facility staff failed to turn and reposition Resident #1 every two (2) hours over night. This violation poses an immediatel health, safety or personal rights risk to persons in care.

Section 87615(a)(1) Prohibited Health Conditions: Persons who require health services or have a health condition including... shall not be... retained in a... care facililty sores (dermal ulcers).This requirement is not met as evidenced by: Resident #1 was diagnosed with Unstageable and Stage 3 dermal ulcers on 08/21/22 and Administrator retained Resident #1 at the facility following Resident #1’s discharge from the hospital on 08/24/22 with “Unstageable” and “Stage III” wounds. This violation poses an immediate health, safety or personal rights risk to persons in care.

Storage SpaceStorage areas for poisons, and firearms and other dangerous weapons shall be locked.This requirement is not met as evidenced by: Based on observation, 11:33 LPA observed unlocked drawer in the kitchen where knives are stored. At 12:02pm LPA observed lock to closet were toxins are stored was not locked. This is an immediate health and safety hazard for residents in care.

Medical AssessmentPrior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year...This requirement is not met as evidenced by: Based on observation, At 10:20am LPA Cifuentes noted that Physician's Report for Resident 1 (R1) is not signed by a physician. This is a potentail health and safety risk to residents in care.

Medical AssessmentA physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis...which would preclude care of the person by the facility.This requirement is not met as evidenced by: Based on observation, At 10:18am LPA Cifuentes observed that R1and R2 do not have a TB test. This is a potential heath and safety risk to residents in care.

Resident RecordsThe licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.This requirement is not met as evidenced by: Based on observation, at 11:56am LPA Cifuentes noted medication administration record was not marked for resident R3 from dates of 7/22/2022 until 7/28/2022.

Postural SupportsA written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.This requirement is not met as evidenced by: Based on observation, At 11:42 am and 11:44am LPA Cifuentes observed half-bed rails in bedrooms of R1, resident 2(R2) and resident 3 (R3) and a lap belt on R3 and no physicians order was found in residents files.

Storage SpaceDisinfectants, 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 was not met as evidenced by: Based on observation, at 11:33am LPA Cifuentes observed kinfe in container on kitchen counter and at 11:38am, 11:46am and 11:50am LPA Cifuentes observed toxins in two of the bathrooms and R1's room. This is an immediate health and safety hazard for residents in care.

Maintenance and OperationThe 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 visitorsTHis requirement is not met as evidenced by: Based on observation, at 11:18am LPA Cifuentes noted an assortment of empty boxes, boards and electrical parts around perimeter of facility. At 11:26am and 11:58am LPA noted that lights in bathroom 1 and 2 are in disrepair. At 11:30am LPA Cifuentes observed pests in facility kitchen. This is a potential health and safety risk for the clients in care.