The Cottages of Lake Balboa 3

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in two out of five personnel files were not available for review, 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 as one out of six residents bed had full bed rails without a doctor's order, 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 four staff out of four staff did not have CPR training, 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 one room it was detected a strong smell of urine, 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 as four out of staff didnot have on file the 20 hours of annual training, 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 thwo out of three medications were not dispensed correctly, 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 cleaning solutions were observed unlcked in a cabinet under the sink, which poses an immediate health, safety or personal rights risk to persons in care.

87465(h)(5) Incidental Medical and Dental Care - Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.This requirement was not met as evidenced by: Based on observations and interview, LPA the licensee did not comply with the section cited above as (6) residents had medications pre-poured and out of their original containers for more than 24 hours which poses a potential health risk to persons in care.

87411(a) Personnel Requirements Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... of adequate services.This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the regulation cited above in that staffing was not sufficient in numbers to provide needed services to R1 who required 2 person assist which poses a potential health, safety or personal rights risk to residents in care.

Admission Agreement: (a)The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement was not met as evidenced by: The facility failed to complete an Admission Agreement for Resident #1.

Postural Supports:(A)A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed.This requirement is not met as evidenced by: Based on observation by Investigator Santana, the licensee did not comply with the section cited above. Half bed rails are engaged on R1’s bed at night, which posed a potiential health and safety risk to residents in care.

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: (1)Obtain a California clearance or a criminal record exemption as required by the Department or (f) Violation of Section 87355(e) shall result in an immediate assessment of civil penalties of one hundred dollars ($100) per violation per day for a maximum of five (5) days by the department.This requirement is not met as evidenced by:

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... This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. R1 Needs and Services Plan dated 06/01/2021 did not contain accurate, current information, which posed a potential health and safety risk to residents in care.

87464 Basic Services(f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident...dressing...bathing and assistance with taking prescribed medications, as specified in Section 87608...This requirement is not met as evidenced by: Based on interview and record review, the licensee did not ensure R1's skin remained clean and dry, and incontinece needs were met, which poses a potential health risk to residents in care.

87464 Basic Services(f) Basic services shall at a minimum include:(2) Safe and healthful living accommodations and services, as specified in Section 87307, Personal Accommodations and Services.This requirement is not met as evidenced by: Based on interview and record review, the licensee did not ensure R1's sheets were regularly changed, which poses a potential health risk to residents 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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.This requirement is not met as evidenced by: Based on observation and interviews, facility staff have raised their voice with R1 and do not respond timely to R1's requests for assistance, which poses an immediate personal rights risk to residents in care.

87464 Basic Services (f) Basic services shall at a minimum include: (4) 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...in Section 87608, Postural Supports.This requirement is not met as evidenced by: Based on observation and interviews, R1's hair had not been washed or brushed regularly, which poses an immediate health and personal rights risk to residents in care.