Santa Anita Assisted Living

Plan of Operation 87208 (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…(5) Staffing plan, qualifications and duties. This requirement was not met as evidenced by: based on interviews and record review, the facility has staffing shortages which have delayed wellness checks, bathing and incontinent care for residents which poses a potential risk for persons in care.

General Food Service Requirements(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.This requirement is not met as evidenced by: Based on observation on 7/17/25, the licensee did not comply with the section cited above in that several live cockroaches were observed in the dishwashing area of the kitchen during visit, which poses a potential health, safety or personal rights risk to persons in care.

Admission Agreements (g) Admission agreements shall specify the following:(3) Payment provisions, including the following: (G) A comprehensive description of billing and payment procedures. This requirement is not met as evidenced by: Based on record review, Resident 1's admission agreement does not indicate rent payment provisions for payment procedures and proper notification to resident for outstanding balances if it applies, which poses a potential personal rights risk to residents in care.

87303(a)(1) Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met as evidenced by: during inspection of (2) resident dining rooms, missing floor tiles/panels were observed in the main dining room by kitchen door under table and between doorway to secondary resident dining room. Both affected areas have lifted edges and grime accumulated on the surface creating a trip hazard, which poses a potential health and safety risk for persons in care.

87208(a) 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... This requirement was not met as evidenced by: R1's Care Plan indicates safety checks to be conducted 4 times per shift; however, staff indicated that staff conduct safety checks 2 to 3 times per 7.5 hour shift

87303(a) Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: inspection and observation of the two dining rooms during and after meal services revealed that several walls and baseboards have splattered stains from drinks and other food particles. Also observed dirt and grime stains around the corners of the floor by the grand piano and doorways in both dining rooms.

Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs.This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by not having the warning sign posted by the kitchen dishwashing sink for water delivered at 125 degrees F. during inspection which poses a potential safety risk for kitchen staff/empoyees.

General Food Service Requirements b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips.This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above in that two dry food containers for rice and oatmeal had broken lids and content was exposed during time of visit, which poses an immediate health, safety or personal rights risk to persons in care.

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.This requirement was not met as evidenced by: Based on observation, interview, and record review, the licensee did not comply with the section cited above as on 12/12/2025, there was two (2) caregivers on duty in the AM shift to provide incontinence care for 40 to 48 residents out of the facility census of 147 residents. Resident #1 (R1’s) incontinence needs was not met as incontinence service was provided by staff at 9:15am which was two hours and fifteen minutes passed the scheduled time of 7am. LPA also observed a strong urine odor in Resident #14 (R14’s) room. This poses a potential health and safety risk to persons in care.

Personal Rights of Residents in All Facilities (a) Residents...shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...This requirement was not met as evidenced by: Interviews conducted with staff and resident indicate that staff member acknowledged raising their voice at resident and making inappropriate statement to resident in care.

(a) In addition to the rights listed in Section 87468.1, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (25) To protection of their property from theft or loss according to Health and Safety Code sections 1569.152, 1569.153, and 1569.154. This requirement was not met as evidenced by: 6 out of 10 residents did not have property protected from theft or loss. This poses a potential risk to the health, safety, or personal rights of persons in care.

(a) In addition to the rights listed in Section 87468.1, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (25) To protection of their property from theft or loss according to Health and Safety Code sections 1569.152, 1569.153, and 1569.154. This requirement was not met as evidenced by: 6 out of 10 residents did not have property protected from theft or loss. This poses an immediate risk to the health, safety, or personal rights of persons in care.

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement was not met evidenced by: Based on observation, there is one (1) indoor surveillance camera located in the hallway by the lobby, and multiple cameras in the exterior of the building. The main office camera monitors only show 3 operable cameras. The indoor camera is not operable. This poses a potential health, safety, and personal rights risk to residents in care.

False Claims. No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.This requirement was not met evidenced by: Based on record review of Medication Release form dated 12/24/24 and multiple other forms on different dates it was observed that form dated 12/24/24's signature is different and inconsistent with the majority of signatures on record. Therefore, there is a signature mismatch. This poses a potential health, safety, and personal rights risk to residents in care.

87468.2 (a)(4) Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidence by:Based on interviews conducted and documents reviewed, licensee did not ensure that R1 received their medication at the correct times and thus, received excessive medication within a six-hour period. Medication was administered too soon between doses which poses an immediate risk to the health, safety, or personal rights to residents in care.

Maintenance and OperationFacilities shall have signal systems which shall meet the following criteria:(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall:(A) Operate from each resident's living unit.(B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff.(C) Identify the specific resident living unit. This requirement is not met as evidenced by:Facility failed to have a signal system operable in R7 and R9's room which poses an immediate health and safety risk to residents in care.

Incidental Medical and Dental Care 87465(c)(3): (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, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement was not met as evidenced by: at the time of visit on 8/11/25, the facility was unable to provide a record of each dose including date and time the PRN medication was taken, the dosage taken, and teh resident's response for May 2, 4 and 5, 2025 for R1.

87303 (i)(A) Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (A) Operate from each resident’s living unit.This requirement is not met as evidence by: During inspection, (4) out of (24) call buttons were inoperable. Four (4) buttons located in (2) resident rooms, did not trigger an alert to front desk staff.

87411 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.This requirement is not met as evidenced by: Based on interview, Staff could not find R1's PRN medication which poses an immediate health and safety risk to residents in care.

Incidental Medical and Dental Care (b) If resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication.(3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement was not met as evidenced by: QuickMAR has multiple medication errors regarding a medication dose for pain relief for May 2, 4 and 5, 2025 for R1.

87411(d)(4) 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 of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance:(4) Knowledge required to safely assist with prescribed medications which are self-administered. This requirement was not met as evidenced by: based on observation, staff and resident interviews and record review, licensee did not ensure that caregiving staff who are not qualified to administer medication to residents refrain from administering medication to a resident.

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility.(4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on record review, Resident #3 did not take the medication Alendronate Sodium 70 MG once a week in June which poses an immediate health and safety risk to resident in care.

Based on observation and record review, the licensee did not comply with the section cited above in that LPA observed a medication present in the bubble pack and not given to a resident which should have been administered on 7/8/25 to R1 (Famotidine 20 mg). Staff interview indicated, they forgot to give the resident (R1) the medication at the time it was due for administration. Also, an evening medication was administered too early on 7/17/25 to R4. LPA observed missing medication in the evening slot for 7/17/25 (Quetiapine Fumarate 25 mg), 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 that two dry food containers for rice and oatmeal had broken lids and content was exposed during time of visit, 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 that grab bar in shower breaking off the wall in resident bathroom, 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 that several live cockroaches were observed in the dishwashing area of the kitchen during visit, 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 by not having the warning sign posted by the kitchen dishwashing sink for water delivered at 125 degrees F. during inspection, which poses an immediate health, safety or personal rights risk to persons in care.

Incidental Medical and Dental Care. For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. This requirement was not met evidenced by: Based on record review and interviews conducted, on June 14m, 2025 R1 ran out of 2 medications [ Furosemide 20 mg or Hydrochlorothiazide 25 mg]. Facility does not have a current physician order for the medications and they have not been filled as of today. This poses an immediate health and safety risk.

87211(a)(1) 87211 Reporting Requirements: (a) Each licensee shall furnish..: (1)A written report shall be submitted to the licensing agency... within seven days of the occurrence...(D)Any incident which threatens the welfare, safety or health of any resident.... This requirement is not met as evidence by:LPA observed that the facility did not submit an incident report for Resident #1 (R1) who fell on 04/25/2025 and sustained an injury which poses a potential health and safety risk to the residents in care.

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, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. Title 22, Division 6Chapter 8This requirement was not met as evidenced by: On 08/08/24, staff #21 gave R#20 the afternoon blood pressure medication, a dosage of 10 mg in the morning.

Admission Agreements 87507(5) Refund conditions.(c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility... the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. This requirement not met as evidence by:Based on interviews and record review, licensee failed to refund monies with 15 days after R1's belonging were removed and after R1's death. California Code of Regulations, (Title 22, Division 6 & Chapter 8), are being cited.

87224 Eviction Procedures...(a) The licensee may evict a resident.. Thirty (30) days written notice to the resident is required.... This requirement is not met as evidenced by:The facility did not comply with regulation of evictions procedures. R1 is ready to be discharged from the hospital however facility does not have room available for R1, facility gave away room to other resident. R1 did not given 30 day notice to facility about leaving.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities- (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights.

(d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons.This requirement was not met as evidence by: Licensee did not provide R1 in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons.

87506Resident Records(b) Each resident’s record shall contain at least the following information:(13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or needed services. This requirement is not met as evidence by: R1 physican ordered R1 have blood sugar monitored and recorded 3x a day, R8 physican ordered R8 have blood pressure monitored and recorded. Staff only recorded 1 day of R1's blood sugar and no proof of monitoring or logging of R8 blood pressure.

87468.1 (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (16) To receive or reject medical care or other services.This requirement is not met evidenced by: Based on interviews, LPA determined that facility staff noticed R1's health was declining on 7/26/2022, however medical care was not obtained until 7/31/2022 after R1's family called for an ambulance, which poses an immediate health and safety risk.

87303Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by:Resident accommodation carpet is disrepair and not clean. Room 129 bathroom tub and floor was observed to be dirty.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(8)To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. The requirement was not met as evidenced by interviews conducted and records reviewed which indicated the facility failed to obtain additional medical care for R1 as required which resulted in the advancement of her scabies diagnosis which posed a potential risk tor resident in care.

87465(a)(1) Incidental Medical and Dental Care:(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. (2)The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidence by:R1 physican ordered R1 have blood sugar monitored and recorded 3x a day, R8 physican ordered R8 have blood pressure monitored and recorded. Facility staff only recorded 1 day of R1's blood sugar and no proof of monitoring or logging of R8 blood pressure.

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by:Seven out of the seven residents interviewed do not have keys to lock their rooms. 3 out of the seven residents are have been at the facility less than 60 days and never received a key to their room.

87466 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 requirement was not met as evidenced by LPA contacted the medical professional and confirmed the faciltiy had scabies infection two to three months ago. And faciltiy had about 7 residents infected which pose an potenial risk to residents in care.

87224 Eviction Procedures...(a) The licensee may evict a resident.. Thirty (30) days written notice to the resident is required....(4)If, after admission, has a need and a reappraisal has been conducted ... the licensee and the person who performs the reappraisal....not appropriate for the resident.This requirement is not met as evidenced by: The Administrator did not issue/provide the required thirty (30) days eviction written notice to the family or the resident's responsible party and CCLD.