Royal Vista San Gabriel

Based on observation, the licensee did not comply with the section cited above in that the 3-door refrigerator had a temperature of 52 degrees, above the 40 degrees maximum temperature, 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 in that the 2nd floor ceiling has multiple openings exposing wiring; the ceiling is not painted; wall paper is in disrepair and 3rd floor hallway ceiling has water damage that requires repair and painting, 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 in that the mobile kitchen food steamer ignition knobs are in disrepair and only maintains food in high temperature and staff must disconnect on/off of the steamer when it gets too hot, 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 in that (R10) is not enrolled in hospice and their bed had two half rails converting it to a full bed rail, which poses an immediate health, safety or personal rights risk to persons in care.

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 was not met evidenced by: Based on investigation findings staff (S1 & S2) were found to be treating residents in a disrespectful manner by yelling and ignoring the residents. This poses a potential health and safety risk to persons in care.

Personnel Administrator Recertification Requirements. Whenever a certified administrator assumes or relinquishes responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days, to: (1) The local licensing office .....This requirement was not met evidenced by: Based on observation, the facility has a new Administrator. Licensee failed to report changes to CCL within 30 days. Administrator Sarah Rafael was hired on 6/3/24. This poses a potential health and safety risk to persons in care.

Personal Rihgts 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...................sleeping, or elimination. This requirement was not met evidenced by:The findings indicate that caregiver staff (S1) physically abused residents while providing assistance. S1 was suspended on 3/1/24, and is pending termination. This poses a potential health and safety risk ro persons in care.

Additional Personal Rights of Residents in Privately Operated Facilities. (a) In addition to the rights listed in Section 87468.1, ....:(8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met evidenced by: Based on interviews conducted the findings indicate that S1 handled R1, R3, & R5 in a rough manner while providing incontinence and ADL care. This poses a potential health and safety risk to persons in care.

Postural Supports. Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. This requirement was not met as evidenced by: Based on interviews conducted, statements obtained corroborated with the allegation that S1 restrained R2 on their wheelchair by tying the reisdents hands in order to prevent the resident from putting their hands on diaper. This poses a potential health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in that on 4/23/2024 10 out 17 resident rooms inspected recorded water temperatures ranging from 83.8 DF - 125.0 Degrees Fahrenheit, 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 that on 4/23/2024, LPA observed the large freezers are not in working condition. Per Dietary Supervisor, licensee was notified of non-operable freezers in January 2024, which poses a potential health, safety or personal rights risk to persons in care.

Additional Personal Rights of Residents in Privately Operated Facilities: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met evidenced by: Based on record review and interviews conducted, the findings indicate that S1 made unauthorized charges totaling approximately $800.00 by using R1's bank card/PIN for online purchases that were never received by R1, and charging concert tickets on R4's card. This poses an immediate and health and safety risk to persons in care.

Care and supervision of residents shall be provided without physical or verbal abuse, exploitation or prejudice.This requirement was not met by evidence of: Per reviews of staff record, staff interview and video footage (dated 8/15/23), the administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

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: On 8/8/23 & 8/15/2023 Dementia resident (R1) eloped out of the facility. During the 8/15/23 elopement the resident fell and sustained a facial injury resulting in hospitalization. Due to a recent fire Dementia residents are not in a locked perimeter. This poses an immediate safety risk to this residenst in care.

Reporting Requirements. Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: 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..... Based on record review and interviews conducted, staff failed to notify R1's responsible party and CCL within 7 days of the incident; which poses a potential health and safety risk to persons 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 have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. Based on record review and interviews conducted staff did not notify R1's responsible party of 911 incident (4/25/23) and bill received pertaining to the incident; which poses a potential health and safety risks to persons in care.

Based on record review, the licensee did not comply with the section cited above in that annual assessments for Dementia two (2) Dementia residents are older than 1 year; which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, the hot water temperature readings today a total of 7 rooms had hot water temperatures above 120 D; which poses an immediate health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in that the majority of the rooms inspected had beds without mattress pads; 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 that resident in room 218 had full bed rails and is not enrolled in hospice; which poses an immediate health, safety or personal rights risk to persons in care.

Administrator - Qualifications and Duties.All facilities shall have a qualified and currently certified administrator....The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. On 3/31/23, incomplete Administrator change documents were submitted. The Interim Administrator appointed is not at the facility sufficient number of hours.

Maintenance and Operation. Water supplies and plumbing fixtures shall be maintained as follows: Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs.This requirement was not met evidenced by: Based on observation and interviews conducted on April 23, 2023, room # 230's bathtub water fixtures could not be turned off. Security guard shut off the water supply without notifiying Administration staff and residents. Room #230's issue was repaired the same day.

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 was not met evidenced by: Based on physical plant observation, the Dementia unit's laminate flooring is in disrepair, resident rooms have stained carpets, and there are room doors that need repair on the bottom half caused by wheelchairs; which poses a potential health and safety risk to persons in care.

Incidental Medical and Dental Care. If the resident's physician has stated in writing that the resident is unable to determine his/her own need ........ facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: Once ordered by the physician the medication is given according to the physician's directions. Based on records review, R1 had in place a physician order for Rexulti 4 mg and it got changed to 3mg on 10/11/22 by a different unathorized doctor. This poses an immediate health and safety risk to persons in care.

Personal Rights of Residents in All Facilities. Residents in residential care facilities for the elderly shall have personal rights which include.....8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. Based on record review, facility staff did not obtain R1's responsible party's consent to change doctor; which poses a potential health and safety risk to persons in care.

Administrator - Qualifications and Duties.All facilities shall have a qualified and currently certified administrator....The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. Administrator last worked at the facility on Feb. 17, 2023, and no designee has been appointed, nor was CCL notified.

Personnel Requirements - General(d) All personnel shall be given on the job training or have related experience in the job assigned to them.... (4) Knowledge required to safely assist with prescribed medications which are self-administered. This requirement was not met evidenced by: Based on interviews and record review, med-tech staff and Administration staff did not do their due diligence in reviewing all medication records and physician orders. In addition, MAR documentation errors were observed during today's visit; which poses a potential health and safety risk to persons in care.

Incidental Medical and Dental Care. If the resident's physician has stated in writing that the resident is unable to determine his/her own need ........ facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: Once ordered by the physician the medication is given according to the physician's directions. Based on records review, on Jan. 22, 2023 med-tech staff gave resident (R1) resident (R2's) Velphoro 500 mg medication in error. R1 immediately reported the error, and the medication was not taken. This poses an immediate health and safety risk to persons 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 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. Based on interviews conducted and document review, registry staff (S1) abused resident (R1) by not dressing the resident appropriately when taking it to the dining room, and force feeding the Dementia resident without regard to choking or apiration. This poses an immediate health and safety risk to persons in care.

Enumerated rights; severability. Residents of residential care facilities for the elderly shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard for photocopies. This requirement was not met evidenced by: Based on record review, the facility received a formal medical records request on 10/22/2020, and failed to provide the records within 2 business days, as required per regulation; which poses a potential health and safety risk to persons in care.

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: (2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours..... This requirement was not met evidenced by:On 1/5/2023, the facility had 21 COVID-19 positive cases that were not reported to CCL or Dep. of Public Health (DPH) within 24 hours. They were reported to CCL until 1/10/23, and to DPH until 1/17/23; which poses an immediate health and safety risks to persons in care.

Personnel Administrator Recertification Requirements. Whenever a certified administrator assumes or relinquishes responsibility for administering a residential care facility for the elderly, he or she shall provide written notice, within thirty (30) days, to: (1) The local licensing office .....This requirement was not met evidenced by: On 1/17/2023, LPA was informed by current Administrator that former Administrator stopped working at the facility. The former Administrator was discharged on Aug. 1, 2022. Licensee & Administrator failed to report to CCL of the change within 30 days. This poses a potential health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in rooms 104, 107, 112, 121, 307, & 312 had sheer curtains and/or were missing curtains or blinds, which poses a potential health, safety or personal rights risk to persons in care.

Based on observation during medication review, the licensee did not comply with the section cited above in that six (6) out of seven (7) residents were missing 30-day supply of medications and/or physician ordered cycle medications. Resident (R1's) medications [total of 9] have not been filled since mid April 2022; which poses an immediate health, safety or personal rights risk to persons in care.

Incidental Medical and Dental Care. 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: The licensee shall assist residents with self-administered medications as needed. This requirement was not met evidenced by:Based on record review, R1's Medication Administration Record showed evidence of no medication administration beginning March 1, 2022, due to non-payment. This poses an immediate health, safety or personal rights risk to persons in care.

Plan of Operation. Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility.....This requirement was not met evidenced by: Based on record review during complaint control #: 28-AS-20220303150219, LPA requested a copy of the Plan of Operation and staff job descriptions, but Administrator was not able to find copies in facility record files. 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...personal rights:(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: 1/11/2022 11:20 a.m. LPA was not screened for COVID-19 symptoms or temperature check by security guard or staff. This is a repeat violation from 5/12/2021. Based on observation and interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

87555 General Food Service Requirements. In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist, a dietitian ... shall be made for regular consultation from a person so qualified. Based on observation and interviews conducted the facility has not had a dietary supervisor or dietician consultant in years. Currently the dishwasher is is responsible for creating the food menu, cooking, ordering food inventory supplies, cleaning, and serving. There are residents that require special diets. Staff confirmed no special diets are being cooked.

87411(a) Personnel Requirements - General.(a) 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 and interviews conducted the facility failed to ensure there is sufficient personnel to meet the needs of residents in care. On 7/22/2021 only 1 caregiver staff worked in the PM shift [memory care]. No caregiver was available for Assisted living residents. Staffing shortages have not been addressed by Licensee. This poses and immediate health and safety risk to persons in care.

87405(a) Administrator - Qualifications and Duties. All facilities shall have a qualified and currently certified administrator....there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. Based on interviews, observation, and record review the facility failed to appoint an Administrator after Administrator on record's extended absence. Designee Marina Galaviz assummed Administrator responsibilities in May 2021.

87303(a) 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 was not met by evidence of: Based on observation during physical plant inspection in the Memory Care Unit the laminate flooring was observed to be in major disrepair. The laminate flooring was raised and sticking out. The floors has a temporary fix of duct tape in some areas. This poses a potential health and safety risk to residents in care.

87411(a)Personnel Requirements-General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care The requirement is not met as evidenced by conducting interiew. Staff reported they are currently under staffing and residents reported they did not get their medication sometimes or showering due to short staff which impose a potenital risk to resident in care

87465(c)(2)Incidental Medical and Dental Care if the resident's physician has stated in writing that the resident is unable to determine his/her own need ........ facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: Once ordered by the physician the medication is given according to the physician's directions. The requirement is not met as evidenced by reviewing record, LPA observed all R1's morning medication on the bubble pack on day 15th was taken out in error and then put them back on the original package. Also R2's day 15th medication was missing due to staff accidently dropped which posed an immediate risk to residents

87465)(c)(2) Incidental Medical and Dental Care. If the resident's physician has stated in writing that the resident is unable to determine his/her own need ........ facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: Once ordered by the physician the medication is given according to the physician's directions. Based on records review the facility failed to obtain medication refills for resident (R1) and not administered medications as directed until June 26, 2021. During today's visit, medication errors were observed for residents (R2-R4).This poses an immediate health and safety risk to residents in care.

87507(e). The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative, if any, immediately upon signing the admission agreement or modification. The licensee shall provide additional copies to the resident or resident’s representative upon request. Based on record review and interviews conducted the facility failed to provide R1's responsible party a copy of the admission agreement upon signing it on April 1, 2021. Resident (R1) moved in on April 3, 2021. As of April 19, 2021, responsible party had not received the copies.

87468(d). Personal Rights. Licensees shall post the personal rights, nondiscrimination notice, and complaint information specified above in English, and, in any other language in which at least five (5) percent of the residents can only read that other language.This requirement was not met by evidence of: Based observation and interviews conducted the facility has failed to post required documents i.e. Personal Rights, complaint information, and non-discrimination notice in any other language such as Mandarin. Approximately 30 -40 % of the resident population is of Asian descent and does not speak English. This poses a potential health and safety risk.

87465)(c)(2) Incidental Medical and Dental Care. If the resident's physician has stated in writing that the resident is unable to determine his/her own need ........ facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: Once ordered by the physician the medication is given according to the physician's directions. Based on records review facility staff did not verify medication list with R1's MD after moving in. Per Medication Administration Records (MAR) residents (R1-R4) were not administered medications as directed per physicians.

Based on observation resident room 317 did not have hand washing soap in the bathroom which poses/posed a potential health, safety or personal rights risk to persons in care. In addition, hand sanitizer stations were not observed in the 2nd floor hallways.