No Place Like Home for Golden Ages 2 Llc

Based on [(observation) and record review licensee did not comply with the section cited above in [2] out of [5] record review for residents 1 and 2, who were missing an needs and service plan in there which pose a potential health, safety or personal rights risk to persons in care.

Based on [(observation) and record review, the licensee did not comply with the section cited above in [1] out of [4] [staff did not have criminal record clearance. Which poses an immediate health, safety or personal rights risk to persons in care.Administrator has the paperwork at another facility and will email the document to LPA.

Based on (record review)], the licensee did not comply with the section cited above in [2] out of [total 2] , both staff on duty did not have copy of first aid/CPR certificates available to be reviewed. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) and record review, the licensee did not comply with the section cited above in [1] out of [4] [staff did not have criminal record clearance. 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 [5] out of [5] residents had full bed rails. 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 [5] out of [5] residents had full bed rails. 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 [total 2] , both staff on duty did not have copy of first aid/CPR certificates available to be reviewed. Which poses/posed a potential health, safety or personal rights risk to persons in care.

§1569.73 Terminally ill residents... (b) At any time that… the facility... determines that the resident's condition has changed ... the facility may initiate procedures for a transfer.This requirement was not met as evidenced by:This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by retaining Resident #1 (R1) with a worsening prohibited health condition and not applying for an exception which posed a potential Health, Safety, or Personal Rights risk to persons in care.

87211(a)(B) Reporting Requirements-(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(1) A written report shall be submitted to the licensing agency for (B) any serious injury as determined by the attending physician and occurring while the resident is under facility supervision.This requirement was not met as evidenced by: The Licensee did not notify the Department that residents had entered hospice care and did not submit incident reports for residents. This poses a potential health and safety risk for residents in care.

87705(c)(5) Care of Persons with Dementia-Each resident with dementia shall have an annual medical assessment...and a reappraisal done at least annually both of which shall include a reassessment of the resident's dementia care needs.This requirement was not met as evidenced by:Based on records review, the Licensee did not have a resident with dementia annually medically assessed. R1's last medical assessment was conducted in 2019. This posses a potential health and safety risk to residents in care.

87633(h)(3) Hospice Care of Terminally Ill Residents (h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record (3) A copy of the written certification statement of the resident's terminal illness from the medical director of hospice...This requirement was not met as evidenced by:The licensee did not provide the Department representative with this documentation. This poses a potential health and safety risk to residents in care.

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 the licensing agency staff.This requirement was not met as evidenced by:The Licensee did not present to Licensing agent complete resident records for R2. This poses a potential health and safety risk to residents in care.

87405(d)(1)(2) Administrator Qualifications and Duties-The Administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). (2) Knowledge of the ability to conform to the applicable laws, rules, and regulations...This requirement was not met as evidenced by: Licensee did not ensure that the Administrator has enough knowledge to comply with Title 22 Regulations. Based on interviews and record review, the facility is not in compliance with Title 22 Regulations. This poses a potential health and safety risk to residents in care.

87217(d)(2)(f) Safeguards for Resident Cash, Personal Property, and Valuables (d)(2)...no licensee or employee of a facility shall; accept any general or special power of attorney for any resident.This requirement was not met as evidenced by: Based on interviews and records review the Licensee became R1's POA. This poses an immediate health and safety risk to residents in care.

1569.58 Persons prohibited from being a licensee, owning beneficial interest in licensed facility-(a) The Department may prohibit any person from being a licensee...or being an administrator, member, or manager of a licensee...and my further prohibit any licensee from employing, or continuing the employment of...or allowing contact with clients of a licensed facility...who has done any of the following: (5) Engaged in acts of financial malfeasance concerning the operaton of a facility, including but not limited to, improper use or embezzlement of client moneys and property or fraudulent appropiattion for personal gain of facility moneys and property. This requirement was not met as evidenced by:Based on interviews and records review, the Licensee became R1's health care and financial power of attorney. This posses an immidiate health and safety risk to resident in care.

Based on observation, the licensee did not comply with the section cited above in B1 shower floor was observed damaged and in disrepair, lightbulbs out in R1, boxes in the backyard piled, large toys hanging by the pool gate, and grass was umkept, 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 in B1 water temperature tested at 133.5, B2 water temperature tested at 133.2 and B3 water temperature tested at 133.3 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 LPA observed knives and cleaning solutions cabinet unlocked, bleach solution on top of toilet in B2 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 staff files were not available for review during the visit which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPA observation, the licensee did not comply with the section cited above as Water temperature read 138.9 which is not within Title 22 regulations which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA observation, the licensee did not comply with the section cited above in that fire extinguisher had not been serviced and did not have a tab indicating when it was last serviced which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA observation, the licensee did not comply with the section cited above in that knives were observed in the stove oven unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPAs observation the licensee did not comply with the section cited above as when LPA's were completing annual visit, a live cockroach was observed crawling n the facility kitchen window which is located near were the kitchen table is located which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPA observation, the licensee did not comply with the section cited above as all facility residents medications were observed in an unlocked file cabinet located in the facility living room, which poses an immediate health, safety or personal rights risk to persons in care.

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) or This requirement is not met as evidence by: Based on observation and documents reviewed facility did not ensure a criminal background transfer request for S2 and S3 was obtain which poses an immediate Health, Safety, or Personal Rights risk to persons in care.*Civil Penalties were asses at $1000.*

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) or This requirement is not met as evidence by: Based on observation and documents reviewed facility did not ensure a criminal background transfer request for S2 and S3 was obtain which poses an immediate Health, Safety, or Personal Rights risk to persons in care.*Civil Penalties were asses at $1000.*

87468.1(a)(2) 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:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirements is not met as evidence by: Based on observation on 5/19/21 licensee failed to protect the personal rights of clients in care to receive safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of clients in care, in the facility staff #2 faided to wear face coverings while providing care and supervision to residents in care in violation of