Jasmin Terrace at El Molino

Basic Services. A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. Based on interviews, observation, and record review resident (R1) was not escorted to exercise class on 7/25/25 and today (7/31/25). Per home health orders R1 requires daily exercise participation. The Appraisal/Needs and Services Plan states R1 is to be escorted to activities. This poses a potentila health, safety, and personal rights risk.

Based on observation and record review, the licensee did not comply with the section cited above in 3 out of 10 residents have a full bed rail on their beds and a full bed rail physician's order and are not under hospice care which poses/posed a potential health, safety or personal rights risk to persons in care.

87468.2...Personal Rights...: (a)...shall have all...: (4) To care, supervision, and services that meet their individual needs ... that are sufficient..., qualifications, and competency to meet their needs.This requirement is not met as evidence by: Based on observations, interviews, and documents reviewed licensee failed to ensure R1 was injured by R2 while in care which poses an immediate health, safety, or personal rights risk to the persons in care.*Immediate $500 civil penalty is being assess*

87468.2 Additional Personal Rights... (a) ...residents...shall...: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.This requirement is not met as evidence by: Based on documents review and interviews conducted facility did not ensure R1 left the facility unattended which poses an immediate risk to the health, safety, or personal rights of the persons in care.

Based on record review, the licensee did not comply with the section cited above in staff training did not include training on postural support, hospice care, restricted conditions or health services 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 Appraisal Needs and Service Plan for resident #6 (R6) was last updated on 9/1/22 and #9 (R9) was last updated 1/6/23. 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 exit gate to El Molino street on the left of the building egress system is not working and was observed tied with a rope 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 water temperature in the following room tested as follow: room#114 at 103.8 F., room #119 at 89.7 F., room #134 at 100.5 F. room #259 at 100.4 F., room #240 at 104.1 F., room #204 at 90.3 F., which is not within 105-120 degrees F. 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 disinfectant spray was observed in room #107's bathroom cabinet accessible to the resident which poses an immediate health, safety or personal rights risk to persons in care.

87468.2 Additional Personal Rights of Residents...: a)...residential care facilities ...shall ...: 4)..., supervision,... that meet... and are delivered by staff that are sufficient in..., qualifications, and competency to meet their needs.This requirement is not met as evidence by: Based on interviews and documents reviewed licensee did not ensure R1 left the faciltiy unassisted and R1 obtained a fall while unsupervised which poses an immediate risk to the health, safety, or personal rights of the persons in care.

87705 Care of Persons with Dementia(k) The following...must be met...: (8) Delayed egress devices shall not substitute for trained staff... to meet... supervision needs of all residents and to escort residents who leave the facility.This requirement is not met as evidence by: Based on interviews and documents reviewed licensee did not ensure R1 left the facility unassisted through the front door while a staff was at the front desk which poses an immediate risk to the health, safety, or personal rights of the persons in care.

87211 Reporting Requirements: (a) Each licensee shall furnish... (1) A written report ... within seven days of the occurrence of any of the events... (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse...This requirement is not met as evidence by: Based on document review licensee did not ensure a copy of incident report was provided during the visit or submitted to the department within 7 seven of incident occured on 8/27/23 which poses a potential risk to the health, safety, or personal rights of the persons in care.

(c) An Infection Control Plan...shall be included in the Plan of Operation required by Section 87208.(1)... shall includ e...:(F) Staff shall demonstrate knowledge of and skill in infection control, as appropriate to the job assigned and as evidenced by safe and effective job performance.This requirement is not met as evidence by: Based on interviews conducted Licensee did not ensure staff are following COVID 19 guidelines and supplies are replenish over night which poses a potential risk to the health, safety, or personal rights of the persons in care.

Based on observation, the licensee did not comply with the section cited above in bathroom in room #130 water temperature tested at 100.0 degrees F., and bathroom in room #239 water temperature tested at 101.6 degrees F., which poses/posed a potential health, safety or personal rights risk to persons in care.

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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.This requirement is not met as evidence by: Based on documents review licensee did not ensure S2 follow residents rights by using R1's private bathroom which poses a potential health, safety, or personal rights risk to the persons in care.

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities shall...:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement is not met as evidence by: Based on interviews, and documents reviewed the licensee failed to ensure R1 did not sustained a hip fracture while in care which poses an immediate health, safety, or personal rights to the 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 evidence by: Based on interviews and documents review licensee failed to provide adequate direct care staff to support R1's needs identify in physician's report which poses a potential risk to the health, safety, or personal rights of persons in care.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: (a) ... Section 87468.1, Personal Rights of Residents...(4) To care, supervision,... meet their individual needs...by staff that are sufficient in numbers, qualifications, and competency to meet their needs.This requirement is not met as evidence by: Based on documents review facility did not ensure R1 did not leave the facility unattended which is an immediate risk to the health, safety, or personal rights to the persons in care.

87411 Personnel Requirements - (a) 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 evidence by:

Reporting Requirements: Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This This requirement is not met as evidenced by:Dermatologist reported "suspected scabies just based on clinical presentation - did not do biopsy to confirm"; therefore, facility did not report it to the Public Health Department.

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... for assistance in obtaining such care, by compliance with the following:(2) The licensee shall provide assistance in meeting necessary medical and dental needs.This requirement is not met as evidence by: Based on interviews and documents reviewed licensee failed to ensure R1 did not have food intake in the morning prior to surgery which poses a potential health, safety or personal rights risk to the persons in care.

Based on observation, the licensee did not comply with the section cited above in 3 out 11 resident's bathroom observed did not have a skid mat in the shower 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 5 out of 11 resident's bathroom were water temperature was tested was at: room #138 tested 104.7 degrees F., #248 tested at 103.7 degrees F., #252 tested 102 degrees F., #259 tested at 99.1 degrees F., and #263 tested at 103.2 degrees F., 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 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 and record review, the licensee did not comply with the section cited above in 6 out of 11 residents did not have staff's initials in medication sheet which poses an immediate health, safety or personal rights risk to persons in care.

87303 Maintenance and Operation: (a) (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 evidence by: Based on interviews conducted Licensee did not ensure facility was free of bed bugs in 9 rooms, which poses an immediate Health, Safety, or Personal rights risk to person in care.*Immediate Civil Penalties assess for repeat violation of $250.*

87705 Care of Persons with Dementia: (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.This requirement is not met as evidence by: Based on interviews Licensee did not ensure exit door's (to courtyard) alarm batteries were working properly which poses an immediate Health, Safety, or Personal risk to the persons 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 evidence by: Based on documents review and interview conducted Licensee did not ensure to maintain one entrance point at the facility which poses an immediate health, safety, or personal rights risk for persons in care.

Based on record review, the licensee did not comply with the section cited above in 1 out of 9 staff does not have a health screening and TB test on file 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 4 out of 9 staff files (S1,S2,S5,S9) reviewed did not have a current CPR training 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 9 out of 9 staff files reviewed did not have 20 hours of training in the topics above 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 4 out of 12 resident's PRN medication reviewed did not have a label on them 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 LPAs tested call signal in rooms #134, 239, and 217 and staff did not respond as staff at front desk were not able to visually see light was on to let staff know to assist 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 2 out of 13 rooms observed nail polish under the sink in room #223 and all purpose cleaner in room #122 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 LPAs observed water temperature as follow in rooms #256 tested at 103.0; #122 tested at 102.3; #130 tested 102.4; #134 tested at 98.5; #136 tested at 102.1; and water temperature in sink area in dinning room tested at 100.4 degrees F which poses/posed a potential health, safety or personal rights risk to persons in care.

87411 Personnel Requirements-General: a) Facility personnel shall at all times be sufficient in numbers,...In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care .... for the provision of adequate services.This requirement is not met as evidenced by: Based on interviews and documents reviewed, licensee did not ensure there is sufficient staffing as 1 caregiver may be assigned between 13- 18 residents and 1 housekeeper may be cleaning up to 36 rooms in a day, which poses a potential Health, Safety, or Personal Rights risk for persons in care.

87211 Reporting Requirements: (a) Each licensee shall furnish...such reports as the Department may require,...: (2) Occurrences,... which threaten the welfare, safety or health of residents, ... within 24 hours either ... to the licensing agency and to the local health officer... This requirement is not met as evidence by: Based on documents reviewed Administrator failed to submit required documentation for 7 new admissions to the facility based on PDPH evaluation which poses a potential Health, Safety, or Personal Rights risk to persons in care.

87411 Personnel Requirements-General: a) Facility personnel shall at all times be sufficient in numbers,...In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care .... for the provision of adequate services.This requirement is not met as evidence by: Based on interviews and documents reviewed licensee did not ensure there is sufficient staff at the facility to provide assistance with resident care as 1 staff is assigned 16 - 18 residents when a caregiver is out this poses a potential Health, Safety, or Personal Rights risk for persons in care.

87303 Maintenance and Operation: (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 evidence by: Based on observation, and document review Licensee did not ensure facility is free of cockroaches as LPA(s) observed cockroach in room #204 and 8 out 8 staff stated to have observed roaches in the facility which poses a potential Health, Safety, and/or Personal rights risk to persons in care.