Bayshire San Dimas

Based on record review, the licensee did not comply with the section cited above as 5 out of 5 staff files did not have valid first-aid certificates with training provided by such agencies as the American Red Cross, 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 as 2 out of 8 resident files reviewed were missing their negative TB tests, which poses a potential health, safety or personal rights risk to persons in care.

(a) Each licensee shall furnish to the licensing agency such reports (...) including, but not limited to, the following: (1) A written report (...) within seven days of occurance (...) (D) Any incident which threatens the welfare, safety or health (...) of any resident.This regulation is not met as evidenced by: Based on interview and record review, LPA determined that an incident report was not submitted to the licensing agency within the required timeframe, which poses a potential health and safety risk to residents in care.

87303 Maintenance and Operation (g) Facilities which have machines and do their own laundry shall: (1) Have adequate supplies available and equipment maintained in good repair.This requirement is not met as evidenced by: Based on interviews and observation, the washing machine in the memory care unit is not operable which poses a potential health and safety and personal rights to residents in care.

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:(b) (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. Based on interviews/record review, R1’s call pendent was taken away due to excessive pushing. This posed an immediate health, safety, and personal rights risk to the resident.

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 standard is not met at evidence by:Interviewed staff indicated that ceiling leaks occur frequently during the Summer time as the HVAC (air conditioner) is being used. LPA observed water damage on ceiling tiles.

General Food Service Requirements. The following food service requirements shall apply: Modified diets prescribed by a resident's physician as a medical necessity shall be provided.This requirement was not met evidenced by: Based on interviews/record review, on 6/15/25 Memory Care Unit resident (R1) choked on a piece of sausage during breakfast time. Staff (S1) gave the resident a regular diet food plate instead of mechanical soft diet plate. Hospice orders (3/2/25) state R1 requires a mechanical soft diet. This posed an immediate health, safety, and personal rights risk to the resient.

Advanced Directives and Requests Regarding Resuscitative Measures. Immediately telephone 9-1-1, present the advance directive and/or request regarding resuscitative measures form to the responding emergency medical personnel and identify the resident as the person to whom the order refers. Based on record review, on 6/15/25 staff called 911 regarding R1's choking incident. However, med-tech staff did not provide emergency personnel POLST or indentifying forms. This posed a potential health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above LPA observed cleaning supplies and scissors left in unlocked drawers in kitchen area in activity room which poses an immediate 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 two (2) out of five (5) residents were missing LIC 603 Pre admission needs and service plans which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] 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 LPA observed broken bathroom sink faucet in room #151 which poses/posed a potential health, safety or personal rights risk to persons in care.

The licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: At the time of visit LPA toured the facility, MCU and observed a spray bottle of cleaning supply and Heavy Duty Construction Caulk Gun in the kitchen cabinet unlocked and accessible to the residents, which poses an immediate health, safety or personal rights risk to persons in care.

87705 Care of Persons withDementia(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal.This requirement is not met as evidenced by: Based on interviews, observations, records reviews, the Administrator did not ensure that R1 was supervised properly which resulted to R1 wandering into the traffic which poses an immediate risk to residents in care.

87705 Care of Persons with Dementia:(f) 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 is not met as evidence by: Based on observation licensee did not ensure knife and scissors were stored inaccessible to the residents in the dementia kitchennete which poses an immediate risk to the health, safety, or personal rights of the persons in care.

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: Based on observations licensee did not ensure dementia's unit kitchennete cabinet was in good repair, and that water temperature was within the required 105-120 degrees F., water temperature tested as follow in room #167- 102.8, room #234- 86.8, room #224 - 71.5 degrees F. (Cont)

87461 Mental Condition..(a) The facility shall determine the amount of supervision necessary by assessing the mental status of the prospective resident to determine if the individual: (1) tends to wander;This requirement is not met as evidenced by: Based on interviews, observations, records reviews, the Administrator did not ensure that R1 was supervised properly which resulted to R1 wandering into the traffic which poses a potential risk to residents in care.

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. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. This standard is not met as evidence by: At times, staff are taking more than (30) minutes to respond to residents’ pendant calls and to meet residents’ oral care and/or toileting needs in a timely manner.

87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees...shall: (1) Obtain a California clearance....as required by law or Department regulationsThis requirement is not met as evidenced by: Based on record review, Staff #3 started working prior to obtaining verification of background clearance which poses an immediate health and safety concern to residents in care.

87555 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 ......This requirement is not met as evidenced by: Based on LPA's observations, interviews and records review, the refrigerator in the main kitchen has been broken since July 2024, currently not yet scheduled to be fixed and being used as storage which posed a potential risk for residents in care.

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: (1) Principles of good nutrition, good food preparation and storage, and menu planning.This requirement is not met as evidenced by: Based on interviews, observation and records, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Memory care caregivers do not have the training in regards to preparing and handling food.

Admission Agreements. Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any, and the licensee or the licensee’s designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. This requirement was not met evidenced by:Based on record review and interviews conducted findings indicate R1 moved in on May 14, 2024, and as of today the facility has not obtained a signed admission agreement, which poses a potential health, safety, or personal rights risk to persons in care.

87405 Administrator - Qualifications and Duties(a)The administrator...shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section.This requirement was not met as evidenced by: Based on interviews conducted, the Licensee failed to ensure the administrator is at the facility a sufficient amount of hours to address operational concerns of the facility, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

87355 Criminal Record Clearance(e) All individuals subject to a criminal record review...shall prior to working...in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department...This requirement was not met as evidenced by: Based on interview and record review, the Licensee failed to ensure that S2 had appropriate criminal record clearance prior to working at the facility, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

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:(14)To have reasonable access to telephones, to both make and receive confidential calls...This requirement was not met as evidenced by: Based on interviews conducted, the Licensee failed to ensure the facility telephone is answered during normal business hours so that residents may be contacted, which poses a potential Health, Saftey, or Personal Rights risk to persons in care.

87405 Administrator - Qualifications and Duties(f) The administrator in facilities licensed for fifty (50) or more shall have two years of college; at least three years experience providing residential care to the elderly; or equivalent education and experience as approved by the licensing agency.This requirement was not met as evidenced by: Based in interview and record review, the Licensee failed to ensure the listed administrator has appropriate qualifications to manage the facility, which poses a potential Health, Safety, or Personal Rights risk to persons in care.