Alondra Guest Home

Maintain facilities for fire and panic safety

Based on observation, the licensee did not comply with the section cited above in that bedroom #3/ R2's bed is blocking the room exit door that leads to the exterior of the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Maintain separate complete record for each resident

Based on observation, the licensee did not comply with the section cited above in that R3 is a family member of licensee and is being cared for by staff but does licensee does not have a file for the resident with required Title 22 documents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain and operate facility under definitive plan

Based on observation, the licensee did not comply with the section cited above in that bedroom #1 is being used by licensee but the facility sketch states it is resident bedroom #1, which poses/posed a potential health, safety or personal rights risk to persons in care.

Store centrally held medications in locked secure place

Based on observation, the licensee did not comply with the section cited above in that R3's medications [ Hydrocodone 5 mg, bisacodyl 5mg, Acetaminophen, and allergy medications] were observed unlocked on top of the table next to the bed, as well as S3's medications were observed unlocked in a pill box in the garage, which poses an immediate health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on observation, the licensee did not comply with the section cited above in that kitchen sink measured 125.7 and bathrooms measured 126.6, 124.1, and 123.7, which poses an immediate health, safety or personal rights risk to persons in care.

Diet quality and preparation in safe healthful manner

87555 General Food Service Requirements(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. Based on observation LPA observed Administrator serve R1 Three month expired sour cream for lunch. This poses an immediate health and safety risk to residents in care.

Food quality controls and rejected damaged goods

87555 General Food Service Requirements(b) The following food service requirements shall apply:(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. Based on observation facility had expired sour cream, milk, cheese, bread and vegetables in refrigerator.LPA observed gnats on food. This poses an immediate health and safety risk to residents in care.

Right to accept or decline care or services

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:(16) To receive or reject medical care or other services. Based on record review R1 was given two referrals for ophthalmologist and urologist appointments were never made which poses a potential risk to residents in care.

Maintain separate complete record for each resident

87506 Resident Records(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Based on record review R1 has not had an updated physician’s (602) report since 2020. R1’s appraisal needs, and service plan is incomplete.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Carea) 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:(4) The licensee shall assist residents with self-administered medications as needed. Based on record review R1 di not have Atrovent NFA Inhaler 2 puffs by mouth every 4 hours with spacer (routinely). This poses an immediate health and safety risk to residents in care.

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. Based on record review R1 refuses to take Famotidine 40 MG one tablet daily, Docusate 250 MG once daily, and Constulose twice a day and Facility has never reported to licensing or to R1’s physician. which poses a potential risk to resident in care.

Call 9-1-1 for imminent health threats

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis...This requirement is not met as evidence by: R1 had a fall on the September 24, 2024 and S1 did not call 911 until 3 days later. The resident was not given immediate medical attention for the injuries which poses/posed health and safety hazard to people in care.

Maintain facility in clean, safe, sanitary condition

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidenced by;LPA and Administrator observed ants, spiders and spider webs in residents room which pose/poses a health and safety hazard to people in care.

Document behavioral expression and related causes

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in (3) of (3) resident files reviewed had appraisails over a year old which poses/posed a potential health, safety or personal rights risk to persons in care.

Safe, healthful, comfortable accommodations

Residents in all residential care facilities for the elderly shall have all of the following personal rights:To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement was not met as evidenced by During the tour of the facilty, LPA observed a camera with audio in resident #2's room, which pose a personal rights violation to persons in care.

First aid training requirements

Based on record review, the licensee did not comply with the section cited above in 2 out of 5 staff members because 2 staff member's CPR/AED/First Aid Training certificates expired on 2/7/2023, which poses a potential health, safety or personal rights risk to persons in care.

Maintain fire clearance before retaining specified persons

Based on observations, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on observations, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

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 evidence by: During the visit on 09/02/21 and 09/30/21 LPA observed bedroom #1 bedroom #4 to be in need of cleaning/organizing, the window seals in the bedroom windows to be dirty and in need of cleaning which poses a potential health and safety risk for the residents in care.