D & L Residential Care Home 1

874129(a)(11)Personnel Records The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: A health screening as specified in Section 87411, Personnel Requirements - General.This requirement is not met as evidenced by: Based on record review one (1) out of three (3) staff records, S2 staff file did not contain a completed Health Screening with TB clearance which poses a potential health and safety risk to residents in care.

87458 Medical Assessment (c)(1)(A) The medical assessment shall include, but not be limited to:A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following:Communicable tuberculosis.This requirement is not met as evidenced by: Based on record review 3 out of 5 resident records did not contain TB clearance which poses/posed a potential health, safety or personal rights risk to persons in care.

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order.This requirement is not met as evidenced by: Based on observation and record review, the licensee did not comply with the section cited above R1, R4 and R5 did not have a order for bed rails which poses/posed a potential health, safety or personal rights risk to persons in care.

87208(a)Plan of Operation. The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49…Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval.This requirement is not met as evidenced by: Based on observation construction of an additional structure in the backyard has begun without prior notification and approval from licensing, which may affect services to residents and which may pose a health and safety risk to residents in care.

Based on observation, the licensee did not comply with the section cited above R1 had full bed rails 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 bottles of pills and vitamins were found in unlocked drawer in kitchen which poses an immediate health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above residents did not have a record of any kind of what medications were stored which poses an immediate health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above Administrator did not have file at facility which poses/posed 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 last drill was conducted in June of 2024 which poses/posed 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 two staff did not have current CPR 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 one (1) out of two (2) bathrooms water was at 122.1 which poses an immediate health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above five (5) out of five (5) residents files were missing documents 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 R3, and R4 did not have a order for bed rails which poses/posed 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 staff did not have annual training which poses/posed 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 facility has hospice waiver for two (2) residents but have three (3) residents under care which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, dresser in bedrooms#2 and 3 were in disrepair, 7inX12in tear on loveseat in living room, the licensee did not comply with the section cited above in 5 out of 5 residents, staff or visitors which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation and record review, R2 does not have a bed in their room, the licensee did not comply with the section cited above in 1 out of 5 residnets which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, LPA observed a double-key deadbolt which can only be unlocked by staff with a key from the outside and inside, the licensee did not comply with the section cited above in 5 out of 5 residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and record review, R5 is not on hospice, the licensee did not comply with the section cited above in 1 out of 5 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on record review, S1 and S2 did not have required annual training documented in personnel file, the licensee did not comply with the section cited above in 2 out of 4 staff 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. Staff are not trained in how to shut off gas or other utilities which poses/posed 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. Facility did not have plan of operation on file 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. One smoke alarm needs replacement, small oven on counter is not functioning and needs to be discarded. Outside umbrella for shade needs to be repaired or replaced 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. Water measured 144.3 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Based on interview, record review, the licensee did not comply with the section cited above. No staff have current training in facility emergency procedures which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above. No resident has appraisal or reappraisals which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above All resident files are missing PRN authorization letters 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. LET US KNOW and personal rights poster is not posted at facility which poses/posed 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 facility had no documentation that personal rights training was conducted with staff which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above 4 of 5 residents did not have labels on over the counter or PRN which poses/posed 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. Facility did not have evidence of liability insurance 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 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 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 which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation LPAs observed the auditory chimes on the front door and back door are missing which is required with dementia residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation LPAs observed that Residents #1; #2 ;#3 (R1; R2; R3) did not have complete record at the facility. which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation LPAs observed that Staff #1 did not have complete record at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation LPAs observed chemicals and cleaning supplies under the sink in the kitchen area left unlocked and accessible to the residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPAs observation and record reviews Resident #1 (R1) has prescribed daily eye drops (Brinzolamide Ophthalmic Suspension 1% and Combigan 0.2%-0.5% solution. LPAs observed bottles were sealed therefore R1 is not receiving the daily medication which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation water temperature was 132.8 degree which poses an immediate health, safety or personal rights risk to persons in care.