Victor Royale, Llc

87468.1 Personal Rights... (a) Residents in all residential care facilities for the elderly shall... (1) ...be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by permitting Staff #1 (S1) to be disrespectful towards residents, which posed a potential Health, Safety, or Personal Rights risk to persons in care.

87468.1 Personal Rights of Residents in All Facilities (a) Residents... shall...(3) ...be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...This requirement was not met as evidenced by: Based on record review and interview, the licnesee did not comply witht he section cited above in allowing Staff #1 (S1) to hit Resident #1 (R1) which posed an immediate Health, Safety, or Personal Rights to persons in care.

Maintenance operation: (e) Water supplies and plumbing fixtures shall be maintained as follows:(2 Faucets used by residents for personal care such as shaving and grooming shall be...maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of... ... not less than 105 degree F...and not more than 120 degree F...This requirement was not met, evidenced by; based on water temperature ranged from 102.0 to 125.6 degrees. This is a potential health and safety risk to residents in care.

87468.1 Personal Rights of Residents in all Facilities (a) Residents in all residential care facilties for the elderly shall...(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.This requirement was not met as evidenced by:LPA observed S1 yelling at residents who were about to shower. Staff and R1 also stated the R1 yells at residents in care.This poses a potential health and safety risk to residents in care.

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 and interview the licensee failed to ensure complete safe walkway flooring with the facility for residents in care which poses a possible health and safety risk to residents in care.

87303(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 the observation, licensee failed to ensure that the outlets in room #6 and room #22 had a wall plates, wich poses a potential health, safety or personal rights risk to persons in care.

Incidental Medical and Dental Care (a) ...The plan...shall provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange...for medical care... appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on documents reviewed and interviews conducted, facility staff failed to call Emergency Medical Services (EMS) personnel in a timely manner. Staff called 911 EMS approximately 2 hours after 2nd fall was discovered. This poses an immediate health and safety risk to residents in care.

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.....the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met evidenced by: Based on record review on May 5, 2022, R1 had 2 falls, (one in incontinence care room & the other in their room); staff did not provide appropriate care and supervision after both falls. This poses a potential health and safety risk to residents in care.

87303-Maintenance & Operation (a) The facility shall be clean, safe sanitary and in good repair at all times. Maintence shall include provision of maintence services and procedures for the safety and well-being of residents, employees, and visitors. This requirement was not met as evidenced by: LPA observed many flies in resident room #14. LPA observed both flies that were dead and alive.This poses a potential health and safety risk to residents in care.

Personnel Requirements-General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.This requirement was not met by evidence of: Based on document review and interviews conducted, on May 5, 2022 facility staff failed to meet the needs of resident (R1) after 2 fall incidents; by not conducting body assessments or providing adequate supervision subsequent to falls. This posed an immediate safety risk to this resident in care.

87211 Reporting Requirements(c)Any suspected physical abuse that does not result in serious bodily injury... shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency...This requirement is not met as evidenced by: Based on interviews, observation and record review the licensee failed to ensure that suspected physical abuse was reported to the appropriate agencies in a timely manner.

Health and Safety Code section 1569.157 provides:(c)If a resident council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response to those concerns or recommendations within 14 calendar days. This requirement is not met as evidenced by; Based on interviews, the facility did not respond to resident council’s written recommendation within 14 days which poses a potential health, safety, and personal rights risk to residents in care.

Personnel Requirements – General(d)All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement is not met as evidenced by: observation, interviews conducted and record review. A resident that required supervision was able to elope from the facility unsupervised and remains missing. This poses a health and safety risk to residents in care.

Resident Participation in Decision-making: The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident’s condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. This requirement was not met as evidence by: Based on interviews conducted: Residents have not been participating in the needs and services plan assessments. This poses a potential risk to clients in care.

Personal Rights At the request of the Department, and immediately if the request is made during an inspection, a licensee shall provide the Department with a confidential list of residents that includes the language(s) read by each resident, which is to be kept confidential to the extent permitted by law. This list shall be maintained in an accurate and current status at all times. This requirement was not met as evidence by: based on record review, sections of the LIC 602 was completed by the facility that should have been completed by the resident or physician. This poses a potential risk to clients in care

Based on observation and iinterview, the licensee did not comply with the section cited above in several cans of food located in the kitchen, emergency supplies, and in the basement were expired, were inflated, and some were popped and spilling, which poses a potential health, safety or personal rights risk to persons in care.

87411 (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 evidenced by: Based on interviews, Staff did not report R-1's aggressive behavior to the Administrator which poses a potential health and safety and personal rights to residents in care.

Personnel Requirement - General (d) All personnel shall be given on the job training...(3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents.This requirement is not met as evidenced by: Based on interviews, Staff did not report R-1's aggressive behavior to the Administrator which poses a potential health and safety and personal rights to residents 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 standard is not met as evidence by: (4) ouf of (6) interviewed staff indicated they have either witnessed or have received reports in regards to S-6 yelling at residents. (4) out of (5) interviewed residents indicated S-6 yells at residents.

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 interviews and documents reviewed, bed bugs and cockroaches were recently observed at the facility, which poses a potential health and safety risk to residents in care. LPA observed cockroaches in Room #2 bathroom on today's visit.

The department may deny an application for a license or may suspend or revoke a license issued under this chapter upon any of the following grounds and in the manner provided in this chapter: Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California This standard is not met as evidence by: During facility tour, LPA observed all hand sanitizer stations to be empty in cottages 1511 and 1515.

Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. This standard is not met as evidence by:At approximately 11 A.M,, LPA toured cottages 1511 and 1515. In cottage 1511, room#1, the room temperature measured 89.2* and in room #4 the temperature measured at 89.6*. In cottage 1515, room #5, the temperature measured at 89.2*.

(a)Residents in all residential care facilities for the elderly shall ....have personal rights: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons.This requirement was not met by evidence of: Per interviews conducted, staff did not treat resident with respect and dignity.Based on interviews and observation, the Administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public.(1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities shall be posted as applicable to the facility.This requirement was not met as evidenced by: LPA Rea observed that the personal rights, nondiscrimination notices, and complaint information were not posted on today's visit.

Posting of licensing reports; disclosure to new residents (a) Each residential care facility for the elderly shall place in a conspicuous place copies of all licensing reports issued by the department within the preceding 12 months, and all licensing reports issued by the department resulting from the most recent annual visit of the department to the facility.... shall provide the telephone number and address of the appropriate district office.This requirement was not met as evidenced by: LPA Rea observed that Community Care licensing reports were not posted as required during today's visit.

(2) The licensee shall conspicuously post in a location accessible to public view in the facility a complete copy of the approved admission agreement, modifications and attachments, or notice of their availability from the facility.This requirement was not met as evidenced by: LPA Rea observed that the facility did not have admission agreement posted or notice of availability on today's visit.

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (7) To fully participate in planning their care, including the right to attend and participate in meetings or communications regarding care and services to be provided, according to Health and Safety Code section 1569.80 and involve persons of their choice in this planning... make informed decisions and choices.This requirement was not met as evidenced by: LPA observed that resident council meeting information was not posted on today's visit.

87303 Maintenance and Operation (e)(2) Faucets used by residents for personal care ..... the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). The requirement is not met as evidenced by: based on LPAs observation, LPA observed the hot water temperature was measured at Rm#1, #4 and #11 are beyond the required 105-120 degrees F which poses an immediate Health and Safety risk to residents in care.

87625 Managed Incontinence (b)the licensee shall be responsible for the following:(3)(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. The requirement is not met as evidenced by: LPA interviews and 4/7 residents reported they always got soiled or wet diaper and record review. Some residents only got changed twice a day

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) residents in…shall have all of the following personal rights: ... The licensee shall post the telephone numbers and addresses for the local offices of the … ombudsman program,...This requirement is not met as evidenced by Based on observations, interviews the licensee did not comply with the section cited above by not having the Obudsman poster posted, which poses anpontiential health, safety, or Personal rightsrisk to persons in care.

87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: On 12/15/21 LPA observed window screen in room 3 of cottage 1511 in disrepair and bent out of shape, window screen in bathroom of room 1 of cottage 1515 with a tear window screen in room 6 of cottage 1515 with a tear, window screens in main facility in rooms 6,8,15,16,19,23, 29, 27, and bathroom window in room 2 with tears in screen. Based on observation, interview, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to persons in care.

87307 Personal Accommodations and Services (d)The following space and safety provisions shall apply to all facilities:(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. On 12/15/21 LPA observed open paint cans outside of cottage 1511 closed paint cans in patio common area by vending machines, which poses an immediate Health and Safety risk to persons in care

87307 Personal Accommodations and Services (d)The following space and safety provisions shall apply to all facilities:(6)All outdoor and indoor passageways and stairways shall be kept free of obstruction.This requirement is not met as evidenced by On 12/15/21 LPA observed planks of wood, metal chair, plastic chair, concrete, dry wall, plastic bucket and plastic boxes blocking walkway on side of facility, bags of sand blocking walkway to patio area, which poses an immediate Health and Safety risk to persons in care.

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities ...personal rights:(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: On 12/15/2021 LPA observed no screenings of COVID-19 for temperature or symptoms were done for visitors of the facility. Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights 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 is not met as evidenced by: On 12/15/2021 LPA observed white picket fence on side of facility, adjacent to a walkway, with detached pieces of fence and broken pieces of fencewooden fence on side of facility, adjacent to a walkway, with broken pieces of wooden fence, a wooden bench located in the back yard area with back support detached on one side, a wooden bench located in the back yard area with metal support in disrepair. window on door leading to back area with cracks in glass, utility door on side of facility, adjacent to walkway and wooden fence, off door hinge, water pipe on side of facility building, with a missing screw to secure water pipe in place, bathroom fixture in room 1 of cottage 1511 in disrepair, missing base and bar of towel rack, door of room 1 in cottage 1511 with a crack, missing bathroom tile inside shower of shared bathroom in cottage 1511, wall in room 4 of cottage 1511 with a crack, window in room 3 of cottage 1511 with a crack. window of shower area with mold Based on observation, interview, the licensee did not comply with the section cited above, which poses/posed a potential health, safety or personal rights risk to 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: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... . This requirement was not met as evidence by:Staff #1 grabbed Resident #1 by the arm and shoved the resident away from the reception area causing the resident to hit the table/dresser and it falling towards the resident. Staff #1 also grabbed a walking cane from Resident #4 and swung the cane towards Resident #5.

Emergency Plans(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter... Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by:Based on interview with Administrator, last drill was conducted on 04/23/21. However there was no documentation available of said drill.This poses a potential Health, Safety, and/or Personal Rights risk to the residents in care.

Reappraisals: The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency,if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making.This standard is not met as evidence by: Please refer to page (2) of the LIC 9099 report for details.

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(10)To be informed of the licensee’s policy concerning visits and other communications with residents, according to Health and Safety Code section 1569.313.This requirement is not met as evidenced by: Based on physical plant tour of the facility, LPA did not observe Statewide Waiver related to coronavirus disease 2019 (covid-19)(PIN 21-17.2-ASC) not posted anywhere in the facility. This poses a potential, health,safety, and or personal rights risk to the residents in care.

(e) Water supplies and plumbing fixtures shall be maintained as follows:(4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents.This requirement is not met as evidenced by: During physical plant tour of the facility, LPA oberved the bathrooms located in the main building and the bathroom next to room #1 do not have grab bars next to the toilets. This poses a potential health, safety, and or/personal rights risk to the residents 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 tour of physical plant, LPAs observed the handrail coming in on the entry side of 1515 Glenn Ave is loose and unstable. This poses a potential health, safety, and/or personal rights risk to the residents in care.

87224(f) A written report of any eviction shall be sent to the licensing agency within five (5) days.This requirement is not met as evidenced by: The facility did not provide a copy of the eviction notice for R1 within 5 days based on the administrator's admission, which poses a potential risk to the personal rights of residents in care.