Ayanna Home 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) Obtain a California clearance or a criminal record exemption as required by the Department This requirement was not met as evidenced by: S3 did not have record of criminal clearance . This poses an immediate risk to the health, safety, or personal rights of persons in care.

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) 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.(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. Based on record review Admiistrator did not report to CCLD when resident was in hospital which poses a potential risk to the persons safety, health, or personal rights of the persons in care.

Maintain and operate facility under definitive plan

87208 Plan of Operation(a)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. 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: Based on record review facility does not have a dementia care plan and currently has three residets with dementia which poses a potential risk to the persons safety, health, or personal rights of the persons in care.

Give PRN medication by physician order

Based on record review, the licensee did not comply with the section cited above two (2) residents R1 R4 did not have all prescribed medication 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 any drill ready for review 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 #1 and staff #2 had no training in file 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 during physical plant tour LPA observed a large knife on kitchen counter drying rack which poses an immediate health, safety or personal rights risk to persons in care.

Require fire clearance before non-temporary bedridden admission

Based on record review, the licensee did not comply with the section cited above two (2) out of the five (5) residents physicians reports stated they were both bedridden which poses an immediate health, safety or personal rights risk to persons in care.

Maintain physician order documentation in resident record

Based on observation and record review, the licensee did not comply with the section cited above in four out of five residents had bed rails and no orders from physician. which poses an immediate health, safety or personal rights risk to persons in care.

Allow licensing inspection and controlled record removal

Based on observation, the licensee did not comply with the section cited above Administrator file was not available during time of visit. Administrator could not provide personnel records in a timely manner which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain personnel records at facility location

Based on record review, the licensee did not comply with the section cited above in 4 out of 4 staff 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 1 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care. Resident 1 (R1)'s Physician Report (LIC 602) did not have a TB exam results.

Based on record review, 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. Resident 1 (R1) had blank Identification and Emergency Information form (LIC 601).

RCFE complaint poster posting requirements

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. LPA did not observe the Complaint Poster (PUB 475) posted at the facility.

Based on observation and record review, 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. Resident 3 and Resident 4 are not hospice and have a full bed rail.

Based on record review, the licensee did not comply with the section cited above in 6 out 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care. All 6 residents did not have a Functional Capabilities form (LIC 9172) in their file

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. There is a caregiver's bed and belogings in an area in the facility that is labeled as an "Open Area" on the facility floor plan sketch. This area should not be use as a caregiver sleeping or living area.

Maintain physician order documentation in resident record

Based on record review, the licensee did not comply with the section cited above in 5 out 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care. Resident 1 (R1) through Resident 5 (R5) all had a bed rail and LPA did not observe a doctor's order for the bed rails on file. The staff could not find the orders either.

Assist residents with self-administered medication

Based on observation and record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. During medication review, LPA observed discrepencies in Resident 1 (R1), Resident 2 (R2), and Resident 3 (R3). There were empty medication containers/bubble packs, some bubble packs were full even though it is the 5th of the month, some bubble packs had more than 5 pills missing, pills were taken out of the bubble pack in an out of order way (dates are on the bubble pack for each pill) which made it difficult to verify if residents are getting their medication daily, and staff stated for some residents medication was discontinued, but medication is still in their basket. LPA is unable to determine if medication is being given as prescribed because staff could not provide an explaination for some of the discrepencies, did not have a list with all the medicaiton for each resident written by a doctor, and there was no doctor's discontinuation orders for the medication that staff claimed where discontinued.

Store centrally held medications in locked secure place

Based on observation and record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Resident 6 (R6) has medication unlocked in the bedroom. R6's Physician Report states that R6 can manage own medication, but R6 shares the bedroom with Resident 5 (R5) and R5's physician report states that R5 cannot manage own medication. Therefore, medication needs to be locked for the safety of Resident 5.

Require physician-written PRN medication directions

Based on record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. During the visit, staff were unable to provide the LPA with a current/updated medication list for all residents written by the residents' physician. Due to this and not having a Medication Administration Record (MAR), the LPA could not verify if residents had all their medication at the facility and which medications were discontinued.

Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. During the visit, the staff could not provide the LPA with a copy of the liability insurance.

Maintain required personnel records for staff

Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. During the visit, the staff did not know the whereabouts of all staff files and therefore LPA was unable to review any staff files.

Complete admission suitability appraisal

Based on record review, 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. Resident 5 (R5) did not have a Resident Appraisal (LIC 603A) on file during the visit.

Obtain baseline medical assessment before resident admission

Based on record review, 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. Resident 1 (R1)'s Physician Report (LIC 602) did not have a physician's signature and Resident 2 (R2) had a blank Physician Report (LIC 602) on file.