Leisure Garden Senior Assisted Living Facility

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary... at all times. Maintenance shall include...for the safety and well-being of residents...This requirement is not met as evidenced by: LPA observed a bed bug on the mattress of one of the thirteen rooms toured which poses a potential Health, Safety, or Personal Rights risk to persons in care.

87468.1 (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement is not met as evidenced by; Based on observations and interviews, the licensee is using the office as entrance and exit for residents and door has locking mechanism for residents trying to EXIT the building which poses a potential health, safety and personal rights risk to residents in care.

Maintenance and Operation: 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 inspection, and observation the Licensee did not ensure that the facility is safe and sanitary for wellbeing of residents and others. LPA observed cockroachesin the hallway. This poses a potential health, safety risk and personal rights violation to residents in care.

87457 Pre-Admission Appraisal (c)Prior to admission... (1)The appraisal shall document, at a minimum:(A) An evaluation of the prospective resident's functional capabilities,... as specified in Sections 87459, Functional Capabilities... This requirement is not met as evidenced by: Based on interviews and resident records review the licensee failed to conduct a proper preplacement evaluation with R1 to make sure the facility was suitable for R1 which is an immediate health and safety risk to resident in care.

(a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (3) Fires... which occur in... the premises shall be reported no later than the next working day to the licensing agency. This requirement is not met as evidenced by: According to record reviews the facility failed to report a facility fire to CCL the next working day which poses an potential health, safety, or personal rights risk to persons in care.

All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.This requirement is not met as evidenced by: Based on LPAs' observation and interviews, the facility keep one (1) of (2) two exit doors on the second floor locked, which poses an immediate health, safety, or personal rights risk to persons in care.

87464 Basic Services (f) Basic services shall at a minimum include: (6) Arrangements to meet health needs, including arranging transportation as specified in Section 87465… This requirement is evidenced by: The facility staff did not provide R1 transportation to their doctor's appointment which poses an immediate health and safety risk to residents in care.

87468.1 (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 was not met by evidence of: Based on interviews conducted with residents and staff, the facility did not take appropriate action to mitigate treatment of R1 by other residents' increasing aggressive behavior towards R1, which poses a potential health, safety, or personal rights risk to persons in care.

87466 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... This requirement is not met as evidenced by: Based on interviews conducted, the facility did not take appropriate action to mitigate R1 from sustaining an unexplained injury although facility was aware of R1's change in condition 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...This was evidenced by: LPA observed one of the two elevators was not working which poses an immediate health, safety or personal rights risk to person in care.

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(5)Each resident with dementia shall have an annual medical assessment... and a reappraisal done at least annually... This requirement was not met by evidence of: Based on interviews conducted with staff and residents and record review conducted by LPA, the licensee failed to have R1 receive an annual medical assessment which poses a potential health, safety, or personal rights risk to persons in care.

87303 Maintenance & Operation (a) The facility shall be clean, safe, sanitary at all times. Maintenance shall include...mainte- nance services & procedures for the safety and well-being of residents, ....This is evidenced by: Based on LPAs observations and staff interview, the licensee did not comply with the section cited above by not ensuring the facility is free of bed bugs. This poses 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: (2) To be accorded safe, healthful and ….furnishings and equipment. This requirement is not met as evidenced by: Based on LPAs interviews, the licensee did not comply with the section cited above by not ensuring the storage room door was locked. The door was unlocked and R1 left the facility unassisted by staff. This poses a potential health, safety or personal rights risk to persons in care.

Maintenance and Operation: 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 LPAs observation licensee did not comply with the section cited above, by not ensuring that three (3) out of five (5) resident rooms are in good repair. This poses/posed a potential health, safety or personal rights risk to persons in care.

(f) A facility shall have both of the following in place: (1) An evacuation chair at each stairwell, on or before July 1, 2019.This requirement is not met as evidenced by: Based on LPAs observation, the licensee did not comply with the section cited above by not having the evacuation chair in their stairwell, which poses/posed a potential health, safety or personal rights risk to persons in care

87465 Incidental Medical & Dental Care (g) The licensee shall immediately telephone 911 if an injury,... has resulted in an imminent threat to a resident’s health including,.. an apparent life-threatening medical crisis...This requirement was not met as evidenced by: Based upon staff interviews, staff failed to call 911 when staff observed the resident had experienced pain and discomfort which poses an immediate health & safety risk to residents in care.

87466 Observation of the Resident.The licensee shall ensure that residents are regularly observed for changes in... physical,..functioning &...assistance is provided... When changes...are observed, the licensee shall ensure that changes are brought to attention of resident's physician... This requirement was not met as evidenced by: Staff interviews revealed the changes in R1's health were not brought to the physician's attention in a timely manner, which poses an immediate health & safety risk to residents in care.

87217(b)Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff...This requirement was not met by evidence of: Based on interviews conducted with staff and residents the licensee failed to take appropriate measures to return residents' personal property after laundry service which poses a potential health, safety, or personal rights risk to persons in care.

87615(a)(1) Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, ... those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 pressure injuries. This requirement is not met as evidenced by: Facility staff failed to adequately address the resident’s pressure injuries which poses an immediate health risk to persons in care.

87211(a) Each licensee shall furnish to the licensing agency... the following:(1)A written report shall be submitted to the licensing agency...(D) Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidenced by: Based on interview and record review the Licensee did not comply with the section cited above as evidence by a special incident report for R1 was not submitted to CCL which poses a potential health, safety or personal rights risk to persons in care.

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: To written notice of any room changes at least 30 days in advance ... This requirement has not been met as evidenced by interviews the facility failed to provide written notices to residents which poses a potential safety risk to this resident 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 has not been met as evidenced by observation the facility has broken tiles which poses a potential safety risk to this resident in care.

(a) Living accommodations and grounds shall be related to the facility's function... The following provisions shall apply:(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: based on LPAs obervation the facility failed to provide hygine items to residents.

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 has not been met as evidenced by:

87705(k)(2)The following initial and continuing requirements must be met for the licensee to utilize delayed egres devices on exterior doors or perimeter fence gates: The licensee shall ensure that the fire clearance includes approval of delayed egress devices. This requirement has not been met as evidence by LPA's observation. Facility failed to notify CCLD and provide a complete LIC 200 form within the appropriate time frame

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 observation, record review and interviews conducted, facility staff failed to meet the needs of resident (R1) and (R2) who required incontinant care and S1 was the only staff observed in the memory care unit to provide assistance which poses an immediate safety risk to this resident in care.

87705(f)(2) Care of persons with Dementia Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Based on LPA's observation chemicals used for cleaning where left unattended in a hallway in the designated memory care unit accessible to residents in care which poses/posed 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 is evidenced by LPA's observed the floor panels had been removed making the floor uneven. The toilet tank cover was missing in bathroom #1. In the kitchen there was a large puddle of water on the floor coming from a leak in the industrial dishwasher. This poses an immediate health, safety, or personal rights risk to persons in care.

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. This was evidenced by: LPA observed eight resident files and observed the Physician's Report for Residential Care Facilities for the Elderly were missing from the residents; files which poses an immediate health, safety, or personal rights risk to persons in care.

(b) the following food service requirements shall apply: (26) Supplies of nonperishable food for a minimum of one week & perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met as evidenced by: Based on observations by LPA the Licensee did not comply with the section cited above by not ensuring the required minimum of 7-days nonperishable and 2 days perishable supply of food was maintained on the premises. This poses an immediate health and safety or personal rights risk to clients 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 was not met as evidenced by: Based on interviews and observation, conducted by LPA the licensee did not comply with the section cited above by failing to maintain resident's #2 (R2) room in good repair. Ceiling tile in R2's room 117 is drooping.

(a) Each licensee shall furnish...(1)A written report...(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents...This requirement was not met as evidenced by: Based on interview and record review the Administrator did not comply with the section cited above as evidence by the administrator's own admission an incident report was not submitted to Community Care Licensing Division (CCLD) when R1 shoved her and R1 was taken to the hospital.

87555 General Food Service Requirements (b) the following food service requirements shall apply: (26) Supplies of nonperishable food for a minimum of one week & perishable foods for a minimum of two days shall be maintained on the prmises. This requireement is not met as evidenced by: Based on LPA's observations, the facility has a shortage of both perishable and non-perishable food items which poses an immediate health, safety, or personal rights risk to persons in care.

When a facility is cited for a deficiency and violates the same regulation subsection within a 12-month period, the facility shall be cited and an immediate penalty of $250 per cited violation shall be assessed for one day only. Thereafter a penalty of $50 per day, per cited violation, shall be assessed until the deficiency is corrected. Immediate Civil Penalty of $250.00 was assessed on 8/20/2015.

87470(b)(2)-Infection control requirements - All staff and volunteers providing direct care to a resident....shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents...This requirement was not met as evidenced by: Upon touring the facility, LPA observed five staff members were not wearing a mask which poses an immediate health and safety risk to residents in care.

Personal Accommodations and Services (d) The following space & safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair & shall provide a safe & healthful environment. This requirement was not met as evidenced by: Based upon LPA's interview of a staff member and observation of two resident room keys were actual master keys, the allegation is substantiated and is an immediate health and safety risk to residents in care.

All staff and volunteers providing direct care to a resident....shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents...This requirement was not met as evidenced by: Upon touring the facility, LPA observed four staff members were not wearing a mask which poses an immediate health and safety risk to residents in care.

(a) In addition to the rights listed in Section 87468.1, ... residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, ...This requierment was not met as evidenced by: Based upon LPA's interviews of the Administrator and Caregiver, Caregivers were not aware the resident had left the building without an escort, which is an immediate health and safety risk to residents in care.

Incidental Medical and Dental Care Services. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Los Angeles County Department of Health LVN professionals witnessed the medication was left out and accessible to anyone who walked into the room. Facility staff did not insure the medication was properly taken by a resident to which is an immediate health and safety risk to residents in care.

All staff and volunteers providing direct care to a resident who has a communicable disease shall wear appropriate Personal Protective Equipment (PPE) to prevent exposure to infectious agents... PPE may include gloves, gowns, masks, etc. This requirement was not met as evidenced by: Los Angeles County Dept. of Health LVN professionals witnessed caregiver did not wear full PPE.

87411(a) Personnel Requirements - (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 upon LPA's interviews of ten residents, licensee failed to ensure the care of residents was met. Six of the ten residents interviewed stated had to wait over thirty minutes for a diaper change. Three residents stated only checked two times a day during the 7:00 am until 7:00 pm shift and one resident stated had to wait over two hours for a assistance.

87555(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents & shall meet the Recommended Dietary Allowances of the Food & Nutrition Board of the National Research Council. This requiement was not met based upon: LPA Spaeth interviewed ten residents regarding quantity of food received. Six of the ten stated facility had run out of food and did not offer aadditional food choices. to the residents.

87555(b)(6) The following food service requirements shall apply: In facilities for sixteen (16) persons or more, menus shall be written at least one week in advance and copies of the menus.. shall be dated & on file for at least 30 days. This requirement was not met based upon: LPA toured the facility and did not see the menu posted or copies available for residents. Administrator Designee, Tanya Quezada confirmed a copy was not posted & not given to residents.

87303 Maintenance & Operation (a) The facility shall be clean, safe, sanitary . at all times. Maintenance shall include..maintenance services & procedures for the safety and well-being of residents, .... This was not met based upon: LPA Spaeth observed bed bugs on the bed of a resident within the facility.