Amy's Paradise Home of Angels Inc.

87309 Storage Space and Access(c) ... the licensee shall...ensure that ... other potentially toxic substances... are stored so as not to pose a hazard to residents.This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as a Clorox spray air freshener was unsecured and paints were stored in a resident's room who was at risk if allowed access to toxic substances which posed a potential health and safety risk to clients in care.

87468.1 Personal Rights of Residents...(a) Residents... 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 interviews and record review the licensee did not comply with the section cited above as S1 entered into an inappropriate relationship with R1 through their marriage and subsequent divorce which posed a potential personal rights risk to clients in care.

87705 Care of Persons with Dementia(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates...This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the side and front gates were missing properly functioning auditory alarms which poses a potential safety risk to clients in care.

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times....This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the closet doors in bedroom #1 and the shared tub were in disrepair which poses a potential safety or personal rights risk to clients in care.

87465 Incidental Medical and Dental Care(a) ...by compliance with the following:(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above as the facility did not seek timely medical attention for R1 following the presentation of symptoms of a medical emergency which posed an immediate health risk to clients in care.

87465 Incidental Medical and Dental Care(a) ... by compliance with the following:(8) ...The kit...shall contain at least the following:(A) A current edition of a first aid manual...This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above as the facility did not have a current edition of a first aid manual which poses a potential health or safety risk to clients in care.

Based on record review, the licensee did not comply with the section cited above as four staff members files contained expired first aid certifications which poses a potential health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above as one employee file was not maintained at the facility for review which poses 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 three residents files contained appraisal needs and services plans that were created more than 12 months prior which poses 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 R1 and R2's CSMDRs contained inaccurate records of their prescribed medications which poses a potential health risk to persons in care.

87465 Incidental Medical and Dental Care(a) ... by compliance with the following:(4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on observation, record review and interview the licensee did not comply with the section cited above as twenty three medications across six residents had errors in the medication count which poses an immediate health risk to persons in care.

Based on record review, the licensee did not comply with the section cited above as two resident admission agreements did not contain the amount charged for basic services which poses a potential personal rights risk to persons in care.

87458 Medical Assessment(c) The medical assessment shall include, but not be limited to:(1) A physical examination of the resident indicating...all of the following:(A) Communicable tuberculosis.This requirement is not met as evidenced by: Based on file review the Licensee did not comply with the section cited above as one resident file was observed to be missing proof of a negative TB test which poses an potential health risk to clients in care.

87463 Reappraisals(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition...This requirement is not met as evidenced by: Based on file review and observation the Licensee did not comply with the section cited above as R2 had a change of condition that was not reflected on their physician report which poses a potential health and safety risk to clients in care.

87465 Incidental Medical and Dental Care(h) The following... shall apply...(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained...This requirement is not met as evidenced by: Based on record review the licensee did not comply with the section cited above as one medication prescribed to R1 was not logged on R1's CSMDR which poses a potential health risk to clients in care.

87202 Fire Clearance(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...This requirement is not met as evidenced by: Based on observation and file review the Licensee did not comply with the section cited above as one resident was observed to be non-ambulatory for which the facility does not have an approved fire clearance which poses an immediate safety risk to clients in care.

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency...(1) A written report shall be submitted to the licensing agency... within seven days of the occurrence...This requirement is not met as evidenced by: Based on file review and interview the Licensee did not comply with the section cited above as incident reports for R1's hospitalization and R2's change of condition were not submitted to CCLD which poses a potential health, safety, or personal rights risk to clients in care.

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement is not met as evidenced by: Based on observation the Licensee did not comply with the section cited above as the flooring in the kitchen near the exit, the closet door in room # 2, and the light switch cover in the shared resident bathroom were in disrepair which poses a potential health and safety risk to clients in care.

Based on observation, the licensee did not comply with the section cited above as the facility's carbon monoxide detector was non-functional at the time of the visit which poses an immediate health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above as the facility's emergency disaster plan was not reviewed annually which poses a potential safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above as the facility was unable to provide a copy of un-expired liability insurance at the time of the inspection which poses 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 one resident's file was observed to be missing a negative TB test which poses a potential health risk to persons in care.

Based on record review, the licensee did not comply with the section cited above as one employees file was observed to be missing their LIC 508 and one additional employee's file was observed to be missing their LIC 503 and a negative TB test which poses 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 as the water temparature was measured between 138.2 and 140.4 degrees F which poses an immediate health risk to persons in care.

Based on observation, the licensee did not comply with the section cited above as three windows were observed to have screens missing or not properly installed which poses 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 in 2 out of six persons, did not have on file documenation of services provided by the Home Health/Hospice agency LVN/RN, which poses an immediate health, safety or personal rights risk to persons in care.

(4)Without violating ... Personal Rights, facility staff shall attempt to redirect a resident who attempts to leave the facility.(5)Residents who continue to indicate a desire to leave the facility following redirection shall be permitted to do so with staff supervision.Personal Rights, facility ... the continued safety of residents if they wander... facility. This requirement was not met as evidence by: Based on interviews, the licensee did not comply, R1 was able forcefully restrained while trying to leave the facility, which poses a potential safety risk to residents in care.

Based on observation the licensee did not comply with the section cited above as two out of two signal devices were not installed correctly for front door and outdoor gate, 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 as two out of two bottles of charcoal fluid were observed by the barbecue grill outdoors, 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 canned food was found to have expired on 2021 and 2022, 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 as one out of one fire extinguishers were found to have been serviced on 02/26/2021, which poses/posed a potential health, safety or personal rights risk to persons in care.

87458(b)(1) Medical AssessmentThe medical assessment, at a minimum, shall include: A physical exam of the resident containing a primary and secondary diagnosis, if any, results of a test for tuberculosis and any medical conditions which would preclude care of the person in an RCFE.

All residents’ records shall be maintained at the facility and shall be available to the licensing agency for review

A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response.