Cedar Creek Senior Living

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 was not observed as evidenced by: Based on records reviews, resident 1 (R1) with diagnose of dementia walked out of the facility unassisted on 3/25/26, later, the same day was located by law enforcement and returned to the facility which poses health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in that packages of food were left open and exposed in the pantry and the refrigerator, with no dates or labeling of containers 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 inside the Memory Care kitchen cabinet a dead beetle was observed 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 cleaning products and sterno-burner fuel was in an unlocked cabinet in the main dining rooom 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 dining room drawer needs repair, water puddle by ice machine, dirty cabinets, appliances and walls in Memory Care, cabinets contained trash and other items, refrigerator was dirty, leaky sink plumbing in dining room and Memory Care, kitchen needs declutter and degrease which poses/posed a potential health, safety or personal rights risk to persons in care.

Personal Rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.(3) To be free from punishment, humiliation, intimidation, abuse, ...This requirement was not met as evidenced by R1 was photographed while using the restroom by caregiver S1. The picture was subsequently shared with a former employee.This poses an immediate risk to the health and safety of residents in care.

87211 Reporting Requirements(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.This requirement is not met as evidenced by: Based on observation, interview, & record review the licensee did not comply with the regulations listed above. This poses a potential health, safety, or personal rights risk to residents in care. The Administrator did not comply with the regulation listed above due to R2's death report not being submitted to the Dept within the required 7 days.

Based on observation & interview, 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 tour LPA observed a room listed as a exit that was locked with a key and the door exiting to outside was obstructed by multiple chairs.

Based on observation, 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. LPAs observed the following: Puddle of water next to the ice machine, mildew inside of the Ice machine, kitchen floors near the stove have debris and oil, window sills in the dining area have debris, cabinets in various areas are unclean and have debris

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. LPAs observed the following: Waste bag with gloves left outside of resident's room on the second floor.

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. During the tour LPAs observed the following: Kitchen has meat defrosting with blood leaking from package and not properly stored, freezer has multiple items opened and not stored/closed properly, food items not labeled, and 1 Strawberry pack was rotting

Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. In the card room LPAs observed cleaning items and a broken glass jar under the sink unlocked and accessible to residents. In the coffee and tea area next to the entrance/exit of the facility LPAs observed scissors to be unlocked and accessible to residents in care.

87211 Reporting Requirements(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.This requirement is not met as evidenced by: Based on observation, interview, & record review the licensee did not comply with the regulations listed above. Responsible party was notified verbally and not in writing.

87205 Accountability of Licensee Governing Body(a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves.This requirement is not met as evidenced by: Based on the Department's review of records and information gathered the licensee failed to maintain financial position. Overall, the licensee is not in a good financial position. The licensee had insufficient and negative cash reserves at bank, during the review period from June 2022 to May 2023.Based on documentation and information provided, licensee does not have an adequate financial plan required by law and is not in a good financial position.This poses an immediate health, safety, or personal rights risk to residents in care.

Based on observation, interview, record review, 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 reviewed a sample of resident's charts which do not have current physician's report for residents with dementia.

Based on observation, interview, record review, 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 any modification to admission agreements when rent is increased or if change of status creates an increase.

Based on observation & interview, 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 observed storage closet with cleaning supplies was not able to close properly.

Based on observation & interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Meat was not properly stored in the refrigerator with other food.

Based on observation, interview, & 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. After reviewing a sample of the staff records facility was unable to provide current/valid First Aid/CPR cards for staff members.

Based on observation, interview, record review, 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. During the visit on 7/25/23 facility was not able to provide a roster of residents readily available in case of an emergency.

Based on observation, interview, & record review, 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. Facility did not have on file Plan of Operations located at the facility.

Based on observation, interview, & record review, 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 observed cabinets in the Madera Room needing to be cleaned and the kitchen/cabinets in Generations needing to be cleaned.

Based on observation & interview, 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 tour of the facility LPA found cleaning supplies and scissors to be not be locked and accessible to residents in the Generation area of the facility.

Based on observation, interview, & record review, 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 observed a sample of the resident's charts which did not have current emergency contact information.

Based on observation, interview, record review, 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 observed various areas of the kitchen to not be cleaned, sanitized, and to have debris buildup.

Based on observation & interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed food not being properly stored and staff not using gloves when handling food on 7/27/23.

87507 Admission Agreements(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments.This requirement is not met as evidenced by: Based on observation, interview, & record review the licensee failed to follow the notice agreement listed in the admission agreement when making changes to resident in care.This poses a potential health, safety, or personal rights risk to residents in care

87465 Incidental Medical and Dental Care(h) The following requirements shall apply to medications which are centrally stored:(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.This requirement is not met as evidenced by: Based on observation, interview, & record review the licensee failed to keep medication inaccessible to residents in care.This poses an immediate health, safety, or personal rights risk to residents in care.

§1569.655 Increase in fee rates for elderly residents; 60 days’ written notice stating amount of and reasons for increase; application of section(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. This subdivision shall not apply to optional services that are provided by individuals, professionals, or organizations under a separate fee-for-service arrangement with residents.This requirement is not met as evidenced by: Based on observation, interview, & record review the licensee failed to give responsible party the proper 60-days notice in writing of fee increase.This poses a potential health, safety, or personal rights risk to residents in care.

87213 FinancesThe licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency. Such request shall explain the need for disclosure. The licensing agency reserves the right to reject any financial report and to request additional information or examination including interim financial statements.This requirement is not met as evidenced by: Based on observation, interview, & record review the licensee failed to maintain finances due to unpaid bills which stopped services from vendors and received potential shut-off notices from utility company.This poses an immediate health, safety, or personal rights risk 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:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement is not met as evidenced by: Based on observation interview, the licensee did not comply with the section cited above Poses a potential health, safety, or personal rights risk to residents in care.LPA reviewed records which indicated there was an extended amount of time before R1's pendant call was responded to.

87623 Indwelling Urinary Catheter(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (2) Ensuring that the bag and tubing are changed by an appropriately skilled professional should the resident require assistance. (B) There shall be written documentation by an appropriately skilled professional outlining the instruction of the procedures delegated and the names of the facility staff who have been instructed.This requirement is not met as evidenced by: Based on observation interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Staff at the facility was not adequate to care for R1 and send to hospital when needed. Interviewees stated facility was short staff and unable to meet resident's needs.

87609 Allowable Health Conditions and the Use of Home Health Agencies (b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (2) The licensee provides the supporting care and supervision needed to meet the needs of the resident receiving home health care.This requirement is not met as evidenced by: Based on observation interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Facility did not take the proper steps to ensure R1's medical needs were being met with Home Health, and no completed health plan was on file.

87211 Reporting Requirements(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.(A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility.This requirement is not met as evidenced by: Based on observation/ interview/ record review the licensee failed to provide the Department with a death report for R1. This poses a potential health, safety, or personal rights risk to residents in care. Resident files are to be retained for a minimum of three years.

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement is not met as evidenced by: Based on observation interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed pendent logs which indicated there are times resident had to wait up to an hour to be assisted.

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. 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. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.This requirement is not met as evidenced by: Based on observation and interview, 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. Administrator at the time informed LPA resident from Generations (Memory Care) was able to get out the facility and into the parking lot without staff being aware.

87506 Resident Records(c) All information and records obtained from or regarding residents shall be confidential.(1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.This requirement is not met as evidenced by: Based on observation and interview, 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 observed door not locked where resident's records are kept making them accessible to anyone.

87465 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:(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.This requirement is not met as evidenced by: Based on observation interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed resident medication logs which were not completed properly. Staff could not explain why medication had not been given to resident.

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 evidenced by: Based on observation interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed dirty widow sills in the dining area, Madera room is dirty (needs be cleaned and maintained due to residents having access room), ice machine has mold, and kitchen needs to be cleaned and maintained.

87555 General Food Service Requirements(b) The following food service requirements shall apply:(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.This requirement is not met as evidenced by: Based on observation interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed kitchen staff while preparring food to not be wearing gloves or hairnets.

87465 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:(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.This requirement is not met as evidenced by: Based on observation interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA reviewed Centrally Stored Medication log which was incomplete and amount of medication in container had more medication then should have been from the filled date.

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:(1) Obtain a California clearance or a criminal record exemption as required by the Department orThis requirement is not met as evidenced by: Based on observation interview, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. LPA observed uncleared staff S1 to be in the facility without proper clearance.

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement is not met as evidenced by:Based on observation, interview, and file review 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 reviewed documents which did not match the number of positive COVID-19 cases with the number of cases reported to CCLD (Outbreak)

(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. This requirement was not met as evidenced by LPAs observation of an incident report dated 07/26/22 was sent late. This poses a potential risk to residents in care.

87707 Training Requirements If Advertising Dementia Special Care, Programming And/Or Environments (a) Licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall ensure that all direct care staff, described in Section 87706(a)(1), who provide care to residents with dementia, meet the following training requirements: (2) Direct care staff shall complete at least eight hours of in-service training on the subject of serving residents with dementia within 12 months of working in the facility and in each succeeding 12-month period...Direct care staff hired as of July 3, 2004 shall complete the eight hours of in-service training within 12 months of that date and in each succeeding 12-month period. This requirement was not met as evidenced by LPAs review of training records. 5 out 5 staff did not have the required training.

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 was not met as evidenced by LPA's observation of a screwdriver, hammer, meat thermometer, pizza slicer and wood skewer sticks accessible to residents in care. This poses an immediate risk to residents in care.

Fire SafetyAll facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidenced by LPA's observations and pictures of furniture intentionally blocking the exit doors in the Gernerations (memory care unit).

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 was not met as evidenced by LPA's observations of facility lobby and hallway to resident's room being in disrepair and under incomplete construction at the base of the walls.

87555 General Food Service Requirements(b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures. This requirement was not met as evidenced by Plastic bins in the pantry containing pancake mix, and flour were observed to be uncovered and exposed to environment.

87555 General Food Service Requirements(b) The following food service requirements shall apply: (28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement was not met as evidenced by LPA's observation of green Jell-O and rice pudding stored in the walk in fridge with no cover, exposed to environment. LPA observed ice cream in freezer to be uncovered

87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports...: (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... (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. This requirement was not met as evidence by:Interview conducted with Executive Director and observation that no verification the incident was reoirted or submitted to CCL.