Bello Gardens Assisted Living

Update reappraisal at required intervals

Based on LPA's & Administrator interview and record review, the licensee did not comply with the section cited above in 3 out of 6 residents (R2, R3, & R4) R2 & R4's reappraisals were from 2023 & R 3 did not have a Reappraisal, which poses/posed a potential health, safety or personal rights risk to persons in care.

Admission agreement signing and dating deadline

Based on LPA & Administrator's interview & record review, the licensee did not comply with the section cited above in 1 out of 6 resident files reviewed did not have a signed Admissions Agreement which poses/posed a potential health, safety or personal rights risk to persons in care.

Food handling safeguards during storage and service

Based on observation, the licensee did not comply with the section cited above in at least three instances of observed expired food and several instances of unlabeled opened or unsealed food items throughout facility freezers and refrigerators which poses 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 one instance where a residents bedroom opened up onto a communal bathroom, which poses a potential personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in ensuring that all staff who assist residents with medication administration have proof of all the required initial medication administration training completed 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 in ensuring that all staff have the required initial training which poses 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 ensuring that bathrooms and bedrooms were clean and sanitary. LPAs observed three quarter sized reddish brown feces smear marks on the floor under the toilet in one of the facility's communal bathrooms. Additionally, LPAs smelled urine in resident room where the floor felt sticky upon entry and a bedside commode was observed with urine in it. This poses a potential health, safety or personal rights risk to persons in care.

Maintain required personnel records for staff

Based on observation and record review, the licensee did not comply with the section cited above in ensuring that facility has a complete and accurate record for all staff 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 in ensuring that facility maintains proof of disaster drills completed which poses a potential health, safety or personal rights risk to persons in care.

Maintain cleanliness and prevent incontinence odors

Based on LPA's observations, Administrator did not ensure the regulation above due to Resident bedroom & downstairs facility bathroom having a strong foul odor of urine. This is a potential personal rights and health risk to residents in care.

Fire approval and staff access to unlock systems

Based on LPAs observations, the Licensee did not comply with the section cited above. LPAs observed cleaning supplies , vitamins, razors, and toxins in residents' bathroom and paint on back patio that were unlocked and accessible to residents in care. This poses an immediate health, safety or personal rights risk to persons in care.

Separate storage for cleaning chemicals

Based on LPA's observation and interview with S1 the licensee did not comply with the section cited above as facility had Lysol, comet, & rust remover stored with food supply (see pictures) which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPA's observation the licensee did not comply with the section cited above, when LPA's entered facility, auditory alarm went off altough staff did not respond for the 5 minutes LPA's stood inside front door, which poses/posed a potential health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on observation and interview, the licensee did not comply with the section cited above in that the water temperature tested in 6 out of 9 bathrooms accessible to residents was between 100.4 degrees F & 104.3 degrees F, this poses a potential health, safety or personal rights risk to persons in care.

Based on LPA's observation and interview with staff, the licensee did not comply with the section cited above when finding 3 hand and body towels in joint bathrooms and interview with staff who stated "towel is there in bathroom for all the people to use" which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPA's & Administrator's observation during tour of facility , the licensee did not comply with the section cited above finding side door window shattered & taped together which poses/posed a potential health, safety or personal rights risk to persons in care.

Facility personnel sufficiency and competence

87411(a) 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 has not been met as evidenced by: Based on records reviewed and interviews conducted, facility staff did not respond to residents elopement in an appropriate amount of time and or follow facilities Plan of Operation by contacting Law Enforcement. Records reviewed indicated that resident was a wanderer w/ dementia, not allowed to leave facility unatended. Interviews stated R1 AWOLed for aprox 2 hrs before outside individual contacted 911. Facility protocol is to contact law enforcement within 30 min.This poses an immediate risk to the health and safety of residents in care.

Arrange appropriate medical and dental care

87465(a)(1) Incidental Medical and Dental Care. The Licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of the residents. ***This requirement has not been met as evidenced by: Based on record review, statements, documents, and interviews, at Administrators request staff did not seek emergency medical attention immediately, R1 remained at facility 2 hours with a head wound needing 5 stitches. This posed an immediate risk to the health of R1.

Store centrally held medications in locked secure place

87465(h)(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. Based on LPA's observation of medicaiton and unlocked cabinet located in the kitchen, medications are accessible to residents in care. This is an immediate Health and Safety risk to residents in care.

Provide resident hot water for personal care

Based on observation the licensee failed to maintain hot water temperature between 105 & 120 F in 1 of 6 resident's bathrooms which poses an immediate Health, Safety risk for residents in care. LPA toured the facility w/ administrator. and observed that 1 of the 6 hot water temperatures was 122.7 degrees F.

Submit and maintain current mailing address

Based on observation Administrator didn't comply w/section cited above in 1 out of 5 staff did not have the proper fingerprint clearance and was not associated.

Maintain facilities for fire and panic safety

87203 Fire Safety. All 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 is not met as evidenced by: Based on records obtained and interviews conducted, licensee did not comply by restricting ability of residents to exit, which poses an immediate health, safety or personal rights risk to persons in care. **Immediate Civil Penalty assessed in the amount of $500.

Freedom to leave and not be locked in

87468.1 (a)(6) Personal Rights of Residents in All Facilities (a) Residents in all RCFE shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This requirement was not met as evidenced by: Based on LPA record review & interviews R1 & residents, movements were restricted to the facility. This poses an immediate risk to the health, safety and personal rights of residents in care.

Care of Persons with Dementia The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.This requirement was not met by: LPA observed that the exit door to the front of the facility had the auditory high and low alarms were turned off.This is an immediate Health and Safety Risk to residents in care.