Kingsley Manor

Facility personnel sufficiency and competence

87411 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 shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.This requirement is not met as evidenced by: Based on observation, interview, record review, the licensee did not comply with the section cited above in R1 was able to leave facility unassisted even though R1's physician's report stated that R1 was not to be allowed to go out of the facility, which poses/posed a potential health, safety or personal rights risk to persons in care.

ReappraisalThe pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition and significant including those required to be documented as specified in Section 87466, Observation of the Resident. Definitions, include, but are not limited, to:(D) A mental or social trauma, such as the loss of a loved one.”This requirement is not met as evidenced by: Appraisal wasn't updated and Resident R1 not being provided safety checks, proper assessment, which caused a potential risk to residents in care.

Care and supervision as defined by statute and rules

Basic ServicesBasic 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 is not met as evidenced by: Facility did not monitor Resident R1's blood pressure and didn't conduct room checkswhich caused a potential risk to residents in care.

87464 Basic Services: (a) The services provided by the facility shall be conducted so as to continue and promote ,... independence and self-direction for all persons... shall be encouraged to participate as fully... in daily living activities...This requirement is not met as evidence by: Based on interviews and observations licensee did not ensure staff were promoting resident's independence and self-direction by allowing choices during meal service which is a potential risk to the health, safety, or personal rights of the persons in care.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(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:(3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(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:(3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights.

Protection from punishment and intimidation

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.. Based on record review and interviews that S2 grabbed R2’s arm while in the elevator which poses an immediate personal rights risks to residents in care.

Grounds for eviction listed for residents

87224 Eviction Procedures (a)The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph... This requirement is not met as evidenced by: Based on LPA interviews and record review, Facility / administrator refusal to accept R1 back to the facility upon discharge from hospital and not providing R1 with the 30 day eviction notice which poses a potential health, safety or personal rights risk to the residents in care.

Facility personnel sufficiency and competence

87411 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... Based on record review and interviews, the licensee did not ensure staff are providing the required needs and supervision to Resident #1 which poses an immediate health, safety, and personal rights risk to residents in care.

Maintenance and Operation. Facilities shall have signal systems which shall meet the following criteria: All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall:Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement was not met evidenced by: Four (4) out of (6) staff stated at times they respond within 30 minutes, because the staff pendants at times take 5-15 minutes to register/summons the call on staff pagers, and then it may take an additional 10 minutes to reach the resident. This poses an immediate health and safety risk.

Require physician order and label for PRN medication

Incidental Medical and Dental Care. For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. Based on observation, R1 has multiple over the counter medications in the room that are not listed on medication records, and the resident is self-administering without a physician's order. According to the MD report, R1 cannot administer their own medications; this poses an immediate health and safety risk.

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. (9) A statement whether or not the applicant will handle residents' money and/or valuables. If money or valuables will be handled, the method for safeguarding pursuant to Sections 87215, Commingling of Money, 87216, Bonding and 87217, Safeguards for Resident Cash, Personal Property and Valuables. This requirement is not met as evidenced by: Facility is now classifying employee appreciation funds as tips and taxable and requiring the resident council to cut a check to corporate to distribute the funds. the plan of operation is not up to date and is missing a statement on how resident's cash will be safeguarded.

Limit staff assistance with self-administered drugs

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(5) Facility staff, except those authorized by law, shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. This requirement was not being met as evidenced by : staff #1 dropped a medication pill belonging to another resident in resident #1's room. Staff then left the medication in the room. This poses a health and safety risk to residents in care.

Provide resident hot water for personal care

Based onobservation, the licensee did not comply with the section cited above in 2 out of 179 residents, which poses an immediate health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

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 required by: Based on interviews, the licensee did not ensure that both elevators in the LH building were working properly which poses a potential health, safety, and personal rights risk to residents in care.

Maintain facility in clean, safe, sanitary condition

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 licensee did not ensure facility was free of bed bugs which is a potential health, safety, or personal rights risk to the persons in care.

Maintenance and operation requirements for facilities

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 interviews conducted, and pest control document review, at least 3 rooms (AD-217, AD-210, MH-103) were under pest control treatment for bed bugs. Per pest control record review, a service date of 09/17/2020, found roaches in resident rooms LH-308 through LH-310. This pose(s) a potiential risk to the health, safety or personal rights of residents in care.

Personal assistance and care for required daily activities

Basic Services. Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports.This requirement was not met by evidence of: Based on interviews and records reviewed, R1 has not been receiving assistance with showering which poses a potential risk to the health, safety, or personal right of the persons in care.

Basic Services. Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports.This requirement was not met by evidence of: Based on interviews and records reviewed, R1 has not been receiving assistance with showering which poses a potential risk to the health, safety, or personal right of the persons in care.

Report serious outbreaks and major accidents

Reporting Requirements: Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents .... shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement was not met evidenced by: On June 9, 2022 R1 tested positive for COVID-19 virus. The facility did not call CCL to report the case, and has not submitted an incident report to CCL; which poses a potential health and safety risk to persons in care.

Dignity in personal relationships

(a) Personal Rights of Residents in All Facilities(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.This requirement was not met as evidenced by: Based on interviews with residents and facility staff that revealed that R4 has screamed at, intimidated and harassed facility resident 6, which a potential risk to residents in care.

Ensure hazardous items are locked and not unattended

Storage Space(a) Disinfectants, 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 interviews with residents and facility staff and LPA observations that revealed that R4 poured bleach onto R6's room door, which poses an immediate health and safety risk to the residents in care.

Kitchen sanitation against contamination sources

General Food Service Requirements. All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. LPA observed 2 rat trap in kitchen area.This requirement was not met as evidenced by: Based on interviews and review of documents that confirmed that facility had an inspection conducted by LA County DPH and during visit the Environmental Health Specialist observed rat droppings and dead cockroaches in different areas of the facility kitchen. Facility kitchen operations were suspended for 48 hrs, which poses an immediate risk of residents in care.