California Mission Inn

87355(e)(2)(3)(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)Obtain a California clearance or a criminal record exemption as required by the Department or (3)Request a transfer of a criminal record clearance as specified in Section 87355(c).This requirement was not met as evidenced by: Contractor #1 was present in facility without a criminal record clearance and was not associated to facility.

Managed Incontinence. The licensee shall be permitted to accept or retain a resident who has a manageable bowel and/or bladder incontinence condition under the following circumstances:(1) The condition can be managed with any of the following: A program of scheduled toileting at regular intervals.This requirement was not met evidenced by: Statement obtained from staff and resident stated R1 was left in soiled diaper for unreasonable time.

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....for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance...This requirement is not met as evidenced by: Statements from staff and residents in care, revealed that staff are not responding to the call light assistance within a reasonable time frame which poses a potential health and safety risk to residents in care.

Prohibited Health Conditions. Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: Stage 3 and 4 pressure injuries. This requirement was not met evidenced by: Based on record review, the licensee did not comply with the section cited above in that staff did not follow Plan of Care, were doing wound care, and retained the resident with a Stage 3 pressure injury; which poses an immediate health, safety or personal rights risk to persons in care.

Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs.....the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement has not been met as evidenced by: Based on medical record review and investigation report, staff failed to provide routine and MD order repositioning of R1 to prevent to prevent the advancement of pressure injuries. This poses an immediate a health and safety risk to the residents in care.

Personnel Requirements - General. All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following....(3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met evidenced by: Based on investigation report, medical records, and interviews conducted staff failed to do reposition/rotation care as needed, and resident had to call front desk staff to reposition and assist with incontinence care; 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 that signs were not observed posted in all public bathrooms and hallways that promote handwashing, cough/sneeze etiquette, and physical distancing. Four (4) out of 23 resident rooms inspected did not have either hand sanitizer or hand soap in the rooms. In addition, the latest Provider Information Notice (PIN) 21-44 was not posted where persons in care can easily access it and distribute the PIN Summary for Persons in Care which poses an immediate health, safety or personal rights risk to persons in care.

87211(a)(1). Reporting Requirements. 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 and interviews conducted the facility failed to report a fall incident involving resident (R1). The incident occurred on 12/26/2020. The facility did not submit the incident report to Licensing or furnish a copy when requested for complaint control #: 28-AS-20210105160055. This poses a potential health and safety risk to residents in care.

87705(f)(1). Care of Persons with Dementia. The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).This requirement was not met by evidence of: Based on records review and interviews conducted on 12/19/2020 the facility failed to store hand sanitizer in a locked PPE cart and resident (R1) drank the hand sanitizer bottle. Items that could constitue a danger to Dementia residents must be inaccessible.This poses an immediate healthy & safety risk.

87303(i)(1). Maintenance and Operation. Facilities licensed for 16 or more and/or facilities that have separate floors or buildings shall have a signal system which meets specified requirements.Operate from each resident's living unit.This requirement was not met by evidence of: Based on physical plant observations on 5/14/21 the facility failed to have an operable call signal system in all resident rooms. Five (5) out of 11 rooms that had the signal system tested were missing the system and/or the signal pendants were not accessible to non-ambulatory residents. This poses an immediate health and safety risk.

87464(f)(4) Basic Services. Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports. Based on record review and interviews conducted resident (R1) requires incontinence care and bathing assistance that was not provided as needed and in a timely manner. Resident requires two-person assist due to body size, but a a result of staff shortages reported during Summer 2020 assistance was not provided per care plan and as needed.

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/audit of randomly selected resident's medications on 5/14/2021, LPA observed a medication error. Resident (R8) was missing medication Furosemide 80 mg. The two med-tech staff (S9 & S10) that assisted during the medication review did not find the missing medication, and later that day confirmed the facility failed to order the medication refill in a timely manner or administered as directed.

1569.153(e) Theft and loss program; standards, property inventories and surrender of personal effects; secured areas. Inventory and surrender of the resident's personal effects and valuables upon discharge to the resident or authorized representative in exchange for a signed receipt.This requirement was not met by evidence of: Based on interviews conducted and document review, resident (R1) requested the original COVID-19 vaccination card in Feb. 2021, and was only provided a copy. Resident was discharged on 3/1/21. Staff stated due to Administration changes the whereabouts of the cards were unknown for at least one day. R1 later returned to pick-up the card, and was again not given the CDC COVID-19 vaccine index card.