Mini Manor Home

Kitchen sanitation against contamination sources

Based on observation, the licensee did not comply with the section cited above which poses a potential health risk to persons in care. During record review, on two occassions, LPA observed vermin on the dining table and in the resident's file. LPA also observed dead vermin near the baseboard in the dining room. LPA and Administrator observed vermin on dining ceiling

Request transfer of criminal record exemption

Based onrecord review, the licensee did not comply with the section cited above for one (S3) out of five staff members, which poses a potential safety risk to persons in care. During record review, LPA did not see an eligble Guardian clearance for staff hired 12/04/2023. S3 is only cleared at the licensee's other facility. S3 was not on-site. At 12:54 PM, the House Manager notified LPA that the deficiency was corrected. LPA confirmed.

Admission agreement signing and dating deadline

Based on record review, LPA/LPM observed admission agreements not signed by R1 which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview. LPA /LPM were unable to review staff records due to them being unavailable. which poses/posed a potential health, safety or personal rights risk to persons in care.

Right to accept or decline care or services

Based on interview and record review, the licensee did not comply with the section cited above. Based on discharge paperwork for R1 their medical needs are not being met, nor does resident have access to their wheelchair. which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview. LPA /LPM were unable to review resident records due to them being unavailable. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above. LPA observed doors, a ladder, ply- wood, bed frame and dog feces in the back yard of the facility. which poses/posed 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. LPA observed toxins and sharp knives unlocked, 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 in due to Administaor not having a valid certifcation on file. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Resident care and supervision skills

Based on observation and record review, the licensee did not comply with the section cited above. LPA observed the caregivers were unable to effectively communicate with residents. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Resident care and supervision skills

87411 (d) (3) Personnel Requirements - General(d) 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 … (3) Skill and knowledge required to provide necessary resident care and supervision, including the ability ..This requirement was not met as evidence by: Based on observation and interviews conducted, staff cannot communicate with residents. On 9/10/21 LPA had a hard time communicating with staff #1 and Staff #2 could not speak English. This a potential health and safety risk to clients in care.

87468.1 Personal Rights of Residents in All Facilities(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement was not met as evidence by: Based on LPAs interviews and document reviews Staff #1 did not take temperature at entry. Residents #1-4 and staff #1-2 temperatures were not log.This poses a potential health and safety risk to all residents in care.

87211 Reporting Requirement:(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse...This requirement was not met as evidence by: During LPA's interviews conducted with administrator and resident #1. Administrator did not submit an incident report to LPA regarding R1's incident's at the facility.This poses a potential health and safety risk to all residents in care.

Personal rights of residents in all facilities

87468.1 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..This requirement was not met as evidence by: Based on LPAs interviews, R1 stated S1 yells all the time. Residents stated they have heard S1 yelling a them and other residents.This poses a potential health and safety risk to all residents in care.

Criminal Record Clearance:(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17...(1) Obtain a California clearance or a criminal record exemption as required by the Department..(2) Request a transfer of a criminal record clearance as specified in Section 87355(c)This requirement was not met as evidence by: LPA and LPM observed Caregivers #1-2 both workiing in the facility. CG #1 Djie Nio did not have finger print clearance and CG #2 Petrus Canssisus was not associated. LPA and LPM called the El Segundo office and confirmed. LPA/LPM also confirmed.This poses and immediate health and safety risk to all residence at the facility.

Dignity in personal relationships

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:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.This requirement was not met as evidence by: LPA/LPM observed during visit Administrator conducting a search in residents #1 room with no reasonable basis and confiscated a bat.This poses a potential health and safety risk to all residents in care.

Safe, healthful, comfortable accommodations

Personal rights of residents in all facilities:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement was not met as evidence by: LPA/LPM observed incontinent supplies being stored in residents #2's bedroom in a cabinet.This poses a potential health and safety risk to all residents in care.