California State Health Group Llc

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: Based on LPAs observation that the facility tap worker was not working. This poses a potential health, safety risk and personal rights violation to residents in care.

Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement is not met as evidenced by: Based on LPAs interview that staff was sleeping in the living room couch. This poses a potential health, safety risk and personal rights violation to residents in care.

When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have the qualifications adequate to be responsible and accountable for management and administration of the facility. Based on LPA’s observations and interaction with the administrator, the administrator refused to respond to the facility to provide records to the LPA and had no Designee to act in his stead. This resulted in a potential risk to the health and safety of residents in care.

The facility shall be clean, safe, sanitary 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 mold in residents’ bedroom # 3. This poses a potential health, safety risk and personal rights violation to residents in care.

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.

Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.

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: This was observed with LPM and LPA R1 used a white shoelace like rope to tie the handles of the cabinet to safeguard belongings. The allegation is substantiated and is an immediate health and safety risk to residents in care.

Storage Space: 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: During a physical plant inspection, LPAs observed laundry detergent and toxins, in the laundry area, unattended and accessible to residents in care, which can pose an immediate health and safety risk to the 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:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.This requirement is not met as evidenced by: Based on interviews conducted, licensee failed to ensure that residents have access to the food/snacks at any time. This poses a potential health and safety or personal rights risk to the resident in care.

1569.73(a) (5) An agreement has been executed between the facility and the hospice regarding the care plan for the terminally ill resident or terminally ill person to be accepted as a resident. The care plan shall designate the primary caregiver, identify other caregivers, and outline the tasks the facility is responsible for performing and the approximate frequency with which they shall be performed. The care plan shall specifically limit the facility’s role for care and supervision to those tasks allowed under this chapter."This requirement is not met as evidenced by: Based on record review, LPAs did not observe a written plan care outlining R1's hospice care, specifically wound care. This posses an immediate health and safety risk to residents in care.

87224(f) Eviction Procedures.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: Based on interviews and record review the licensee did not comply with the section cited above by not notifying the licensing of R1's eviction. This poses a potential Health and Safety and Personal Right risk to residents in care.

87465(h)(6)(A)-(F)87465 Incidental Medical and Dental Care(h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescriptions... (A)...(F)...This requirement is not met as evidenced by: Based on record reviews and interviews, licensee did not comply with the section above, as facility staff handling medications were not properly documenting prescribed medications on CSMDR, which poses an immediate health and safety risk to residents in care.

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. Based on observation, the Administrator did not comply with the section cited above in which LPA observed medicati near the kitchen, accessible to residents in care. This poses an immediate health and safety risk or personal rights risk to resdients in care.

Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: 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 has not been met as evidenced by the LPAs observing the sidegate being locked with a padlock. Although this gate doesn't serve as a direct exit, this may pose an immediate health and safety risk for the residents in care.

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirment has not been met as evidenced by the administrator's admission that an Incident Report was not filed with the Licesing Agency. This may pose a potential health and safety risk for the residents in care.

1569.657(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. This requirement is not met as evidenced by:Based on the interviews conducted and records reviewed, the facility did not ensure that an appropriately detailed rate increase letter was provided to R1's RP, which poses a potential risk to the personal rights of residents in care.

87224(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 (5(1) Nonpayment of the rate for basic services within ten days of the due date. This requirement is not met as evidenced by:The facility did not ensure that R1 was given 10 days to pay their rent nor was R1 given 30 days notice of eviction which poses a potential risk to the health, safety or personal rights of residents in care.