The Residences at Royal Bellingham

(f) basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c)This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section in R1 developed 2 Stage II pressure injuries which poses an immediate health, safety, and personal rights risk to persons in care.

(a)Except as specified in Section 87611(a), the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances: (3) Residents with a stage one or two pressure injury must have the condition diagnosed by a physician or an appropriately skilled professional.This requirement was not met as evidenced by: Based on interview and record review, the licensee did not comply with the above cited section in R1 developed 2 Stage II pressure injuries that were not treated which poses an immediate health, safety, and personal rights risk to persons in care.

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents... Hot water temperature controls shall be maintained to... a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in 6 resident restroom sinks measured above the required range which poses an immediate health, safety or personal rights risk to persons in care.

(a) In addition to the rights listed in Section 87468.1... residents... shall have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions...This requirement was not met as evidenced by: Based on interview and record review the Licensee did not comply with the section cited above in the facility refused R1's readmission upon hospital discharge which poses/posed an immediate health, safety, and personal rights risk to persons in care.

(d) …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… and providing the other basic services specified below, either directly or through outside resources.This requirement was not met as evidenced by: Based on interview and record review, the Licensee did not comply with the above cited section as the facility did not follow R1's care plan which poses/posed a potential health, safety, and personal rights risk to persons in care.

Deficiency rescinded - intentionally left blank.

(a) The services provided by the facility shall be conducted… to continue and promote, to the extent possible, independence and self-direction.... Such persons shall be encouraged to participate… as their conditions permit in daily living activities both in the facility and in the community.This requirement was not met as evidence by: Based on interview and record review, the Licensee did not comply with the above cited section as R1 was not assisted with daily living activities in the community which poses/posed a potential health, safety, and personal rights risk to persons in care.

(d) A written resident personal property inventory is established upon admission and retained during the resident's stay in the residential care facility for the elderly. Inventories shall be written in ink, witnessed by the facility and the resident or resident's representative, and dated. …This requirement was not met as evidenced by: Based on interview and record review the Licensee did not comply with above cited section in the facility did not complete a personal property inventory written in ink upon admission which poses a potential health, safety, or personal rights risk to persons in care.

(a) Each licensee shall furnish to the licensing agency such reports…including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency… within seven days of the occurrence of any of the events specified in (A) through (D) …This requirement was not met as evidenced by: Based on interview and record review the Licensee did not comply with the above cited section as CCL did not receive a report/notification of an unwitnessed fall which poses a potential health, safety, or personal rights risk to persons in care.

Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition ...(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by: Based on interviews, facility video footage, and records review, the licensee did not comply with the section cited above. S1 sexually abused R1 and R2, which posed an immediate health and safety risk to residents in care.

Additional Personal Rights of Residents in Privately Operated Facilities (a) (a) In addition ...(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement is not met as evidenced by: Based on interviews, facility video footage, and records review, the licensee did not comply with the section cited above. S2 sexually assaulted R1, which posed an immediate health and safety risk to residents in care.

87405(d)(2)(5) Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)...(5) Good character and a continuing reputation of personal integrity.This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above. Administrator did not follow the reporting requirements for suspected abuse which posed an immediate health and safety risk to residents in care.

87307(a) Personal Accommodations and Services (a)Living accommodations and grounds shall ...comfortable living accommodations and privacy for the residents, staff... (1) There shall be ...prevent such activities from interfering with other functions. This requirement is not met as evidenced by: Based on interviews and observation, the licensee did not comply with the section cited above. Staff are sleeping in the basement room which also serves as a lounge for employees, which poses a potential health and safety risk to residents in care.

87211 Reporting Requirements (c) Any suspected physical abuse... shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours ... This requirement is not met as evidenced by: Based on records review and interviews, the licensee did not comply with the section cited above. Administrator submitted the incident report late and with incorrect information, which posed an immediate health and safety risk to residents in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in one (1) out of five (5) residents did not have a TB which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above in two (2) out of six (6) staff did not have a completed health screening signed by a physician, and one (1) out of six (6) staff did not have a TB test which poses/posed a potential health, safety or personal rights risk to persons in care.

General Food Service Requirements(b)The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Based on LPA and witness observation, interviews, file review and pictures obtained, the licensee did not comply with the section cited above as roaches were observed in kitchen areas. This poses a potentail health and safety risk to persons in care.

87463(a)(3) Reappraisals(a)The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: (3) Any illness, injury, trauma, or change in the health care needs of the resident that results in a…This requirement is not met as evidenced by: Based on record review, R1’s Reappraisal was not updated when R1 began drinking alcohol, smoking marijuana and had a change of mental condition, which posed a potential health and safety risk to residents in care.

87211(c) Reporting Requirements. Any suspected physical abuse that does not result in serious bodily injury... shall be reported to the local ombudsman, the licensing agency, and the local law enforcement agency within twenty-four (24) hours.This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above, as facility staff did not fulfill reporting requirements to appropriate parties, including Mandated Reporter requirements by reporting suspected abuse, which poses an immediate health and safety risk to residents in care.

A written report shall be submitted to licensing agency and to the person reponsible for the resident within seven days of the occurrence of any of the events ...if any; and disposition of the case.This requirement is not met as evidenced by: Based on interviews and record review, license did not comply with the section cited above as R1’s responsible party was not notified about an unwitnessed fall, which poses a potential health and safety risk to residents in care.

87224 Eviction Procedures (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. (1) The notice to quit shall include the following information: (B) Resources available to assist in identifying alternative housing and care options which include, but are not limited to, the following: 1. Referral services that will aid in finding alternative housing. 2. Case management organizations which help manage individual care and service needs.

87463(a)(3) Reappraisals. (a) Thepre-admission appraisal shall be updated, inwriting as frequently as necessary to notesignificant changes...(3) Any illness, injury,trauma, or change in the health care needs ofthe resident that results in a circumstance or condition...This requirement is not met as evidenced by: Based on interviews and record review, licensee did not comply with the section cited above as R1's reappraisal was not updated to reflect change of condition after being discharged from the hospital, which poses a potential health and safety risk to residents in care.

87468.1 Personal Rights (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: Based on interviews with staff and R1, R1 was not bathed for at least a week and did not have a change of socks in at least a week, which poses a potential health and safety risk to residents in care.

Based on observation, the licensee did not comply with the section cited above, as staff were observed without the appropriate face covering, which poses a potential personal rights risk to residents in care.

Based on observation, the licensee did not comply in the section cited above due to accessible tools and sharps in the courtyard, which poses an immediate health and safety risk to residents in care.

87615(a)(1) Prohibited Health Conditions. (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...: (1) Stage 3 and 4 pressure injuries.This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as R1 was retained with an unstageable pressure injury and was hospitalized with multiple deep tissue pressure injuries, which poses an immediate health and safety risk to residents in care.

87355(e)(2) 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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement is not met as evidenced by:Based on record review, the licensee did not comply with the section cited above, as S1 was not associated to the facility until 12/23/21, however S1 has been working at the facility since approximately 11/16/21, which which poses an immediate health and safety risk to residents in care.

87411(f) Personnel Requirements - General. All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician...This requirement is not met as evidenced by: S1 was missing a health screening, which poses an immediate health and safety risk to residents 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 was not met as evidenced by: Licensee failed to keep the carpet in the unit of R1 clean and well kept. During the investigation LPA observed the carpet to have multiple stains in various areas. This poses as a potential health and safety riske to the residents in care.

Based on observation, the licensee did not comply with the section cited above, as there were accessible disinfectants and cleaning solutions observed during the visit, which poses an immediate health and safety risk to 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 was not met as evidenced by: Based on records review, the licensee failed to ensure that R1's bedroom was free of bedbugs, which posed a potential health risk to residents in care.