Alta Loma Gardens Residential Care #2

Facility personnel sufficiency and competence

Based on observation, interview and record review, staff were unaware R1 required all foods to be mechanical soft and meats chopped, LPA Ramirez observed R1 eating a whole sausage patty and orange slices during breakfast, the licensee did not comply with the section cited above in 1 out of 5 residents requires mechanical soft foods, chopped meats, which poses/posed a potential health, safety or personal rights risk to persons in care.

Document required staff training and orientation

Based on record review, LPA Ranirez did not observe verification of required staff training and orientation in personnel records, the licensee did not comply with the section cited above in 2 out of 2 personnel records, which poses/posed a potential health, safety or personal rights risk to persons in care.

Include medical assessment and special precautions

Based on resident record review, LPA Ramirez did not observe a medical assessment for R3 in their resident record, 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.

Maintain separate complete record for each resident

Based on observation, R3 file was not located by staff during inspection, the licensee did not comply with the section cited above in 1 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation & record review, Administrator certificate for Ana Stark Pleitez has been exipred since 2021, the licensee did not comply with the section cited above in 6 out of 6 residents, and/or staff and visitors, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on record review, R1 & R2 did not have annual medical assessments, the licensee did not comply with the section cited above in 2 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

87705 Care of Persons with Dementia(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. All exit doors did not have an auditory device.

Limit operations to licensed capacity

87204 Limitations - Capacity and Ambulatory Status.(a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time….This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses an immediate health, safety, or personal rights risk to persons in care. Facility was over capacity due to having a 7th resident.

87208 Plan of Operation.(a) 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 and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (7) Sketches, showing dimensions, of the following: (A) Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for nonambulatory residents and for bedridden residents, other than for a temporary illness or recovery from surgery as specified in Sections 87606(d) and (e).This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. The garage is being used as a sleeping area for staff and there is no permits allowing this. Also, the garage was not licensed as a living/sleeping area for staff.

Prohibition on using other rooms as bedrooms

87307 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. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (B) No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building.This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. Resident 6 was residing in a room licensed as "Office".

Hazardous areas restricted from residents

87307 Personal Accommodations and Services(d) The following space and safety provisions shall apply to all facilities: (4) Stairways, inclines, ramps and open porches and areas of potential hazard to residents with poor balance or eyesight shall be made inaccessible to residents unless equipped with sturdy hand railings and unless well-lighted.This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above, which poses a potential health, safety or personal rights risk to persons in care. There is a step down when opening a door in the kitchen area leading to a hallway that leads to the garage. This step down is not noticeable and can be a tripping hazard. This door was unlocked when LPA visited the facility.

Provide resident hot water for personal care

Based on observation and file review, it poses/posed an immediate health, safety or personal rights risk to persons in care.

Obtain required California clearance or exemption

Based on observation and file review, it poses/posed an immediate health, safety or personal rights risk to persons in care.

Allow licensing inspection and controlled record removal

Based on observation and file review, it poses/posed a potential health, safety or personal rights risk to persons in care.

Records available to licensing agency for inspection

Based on observation and file review, it poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain admission agreement and appraisal

Based on record review, the licensee did not comply with the section cited above in 2 out of 4 resident records which poses a potential health, safety or personal rights risk to persons in care.Resident #1 (R1) and Resident (R2) did not have a pre-admission appraisal on file. R1 also did not have an admission agreement on file.

Health screening and fitness requirements

Based on records reviewed, the licensee did not comply with the section cited above in 2 out of 2 staff files which poses a potential health, safety or personal rights risk to persons in care.S1 and S2 did not have a health screening on file.

Maintain separate complete record for each resident

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 staffThis requirement was not met as evidenced by: Staff did not provide complete resident or staff files during a complaint visit.

Obtain California clearance or exemption

Personnel requirements:Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall:Obtain a California clearance or a criminal record exemption as required by law or Department regulations This requirement was not met as evidenced by: The following staff was not associated to the facility (Oliver Velasco hired in January 2021).Immediate Civil Penalties were assessed.

Give PRN medication by physician order

87465 Incidental Medical and Dental Care(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, ......provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidence by:Licensee failed to give resident #1, 10 and 11 their medication as prescribed by their physcians orders.

Record centrally stored prescriptions and refill data

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 prescription medications for each resident is maintained for at least one year and includes: (A)-(F) This requirement was not met as evidence by:The licensee was giving resident #1 a multi-vitamin and Stool softener (DOCUSATE SODIUM 100mg) with out a physcians order.

Based on observation and record review, the licensee did not comply with the section cited above in 2 out of 3 residents medications which poses 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 in 2 out of 3 residnets which poses a potential health, safety or personal rights risk to persons in care.

Store disinfectants separately from food supplies

Based on observation, the licensee did not comply with the section cited above due to having debris out in the back yard along with cans and tools which poses a potential health, safety or personal rights risk to persons in care.

Keep bathing and hygiene facilities in operating condition

Based on observation, the licensee did not comply with the section cited above in 2 out of 3 bathrooms 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 3 out of 3 bathrooms which poses an immediate health, safety or personal rights risk to persons in care.

Record dose details and resident medication response

Based on observation and record review, the licensee did not comply with the section cited above in 3 out of 3 residents medication administration logs were not completed which poses a potential health, safety or personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above by not keeping the cleaning solutions locked which poses a potential health, safety or personal rights risk to persons in care.

Obtain required California clearance or exemption

87355 Criminal Record Clearance. (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c).... This requirement was not met as evidence by: LPA observed staff Gerardo S. Alfonso DOB: 10/13/1968 and Glenda P. Alfonso DOB: 4/6/1966 are not associated to this facility but was fingerprint cleared. They both stated they started working at the facility on 6/25/21

Facility maintenance and healthful environment

Based on observation, the licensee did not comply with the section cited above in 2 out of 3 bathrooms had a puddle of water on the floor from a leak in the bathrooms which poses a potential health, safety or personal rights risk to persons in care.

Obtain California clearance or exemption

Personnel requirements:Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall:Obtain a California clearance or a criminal record exemption as required by law or Department regulations This requirement was not met as evidenced by: The following individual was present at the facility supervising the Licensee's child. LPA was informed telephonically by Licensee he watches the child when she is not present. LPA witnessed William Verner come in through a side door, stay at the facility and change before leaving the facility. LPA also observed Caregiver Lavonne Brinkly DOH: 1/2020 present at the facility. Both individuals are not associated to the facilityas today.Immediate Civil Penalties were assessed.