Oakmont of Novato

87705 Care of Persons with Dementia:(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement is not met as evidenced by: Based on records reviewed and interviews conducted, Licensee did not ensure staff were aware when R1 left the building without assistance, This 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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by Based on observation and document review, the licensee did not comply with the section cited above as R2 slapped R1 in the face which poses a potential 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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Based on observation and document review, the licensee did not comply with the section cited above as R2 slapped R1 in the face 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. 7 out of 8 staff members did not have current first aid certification on file, which poses an immediate health, safety or personal rights risk to persons in care.

87411(a) Personal Requirements - General 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 met as evidence by: Based on incident report and interview, facility failed to provide supervision to R1 resulting in an elopement. The absense of supervision is an immediate risk to the Health, Safety and Rights of resident in care.***A Civil Penalty of $500.00 is being assessed.

W&I 15630(a) Elderly and Dependent adult abuse mandated reporting. Telephone and written report must be completed in compliance with time frames required by law. Based upon interviews and document review, this requirement has not been met as evidenced by: Upon obtaining knowledge of suspected physical abuse of residents by a staff person on and before 4/12, facility staff did not make required reports within 24 hours as required. This posed an immediate risk to the health and safety of residents in care.

87468.2...Personal Rights..(a)...residents in... residential care facilities for the elderly shall have...following personal rights:(8)To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. Based on document review and interviews conducted, the licensee did not comply with the section cited above by S1 physically abusing multiple residents in care.

Based on observation and record review, the licensee did not comply with the section cited above in that LPAs observed a residents bed sheets to be wet and having an incontinence odor throughout the Memory Care unit which poses a potential health, safety or personal rights risk to persons in care.

(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative...written notice of the rate increase within two business days ... This requirement was not met as evidenced by: Based on document review, facility did not ensure a proper rate increase notice was provided within two days to resident and/or their responsible party as required by regulation.

Personal Rights of Residents… Residents… shall have all of the following personal rights: To have their representatives regularly informed by the licensee of activities related to care or services … Based on statements and documents, requirement not met, evidenced by: R1’s Representative not notified of medication issue timely. This posed an immediate violaltion of R1’s personal rights.

87705 Care of Persons with Dementia(j)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 as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above by staff not responding to the auditory device on exit door in Memory Care Unit, allowing a resident to elope.

§1569.69 Employees assisting residents with self-administration of medication; training requirements (a) Each RCFE licensed under this chapter shall ensure...the following training requirements: (1)...the employee shall complete 16 hours of initial training. This training shall consist of eight hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and eight hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement is not met as evidenced by: Based on record review & interview, the licensee did not comply with the section cited above in 2 out of 6 staff which poses/posed a potential health, safety or personal rights risk to persons in care.

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require…(1) A written report shall be submitted to the licensing agency & person responsible for the resident within 7 days of the occurrence of any of the events…(B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement has not been met as evidence by: Based on LPA’s records review and interviews conducted Administrator did not ensure that CCL was notified of incidents involving R1 and R7, which poses a potential health & safety risk to residents in care.

Based on LPA/Administrator observations, the licensee did not comply with the section cited above in bathroom located at room#124 needed assistance, toilet and bathroom floor have feces on it, which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA/Administrator observation, interview and record review, the facility staff did not comply with the section cited above in 1 out of 10 resident's diagnosed with Dementia medical assessments was performed within the last 12 months as indicated per regulation, which poses a potential health, safety or personal rights risk to persons in care.

Based on LPA/Administrator observation, records review and interview with Administrator did not ensure to obtain a criminal record clearance for staff (S9) prior to work, reside or provide care to residents in care which poses an immediate health, safety and personal rights risk to residents in care. ***Civil Penalty is being assesed for the amount of $100 per day.

87208(a) Plan of Operation. Each facility shall have... a current, written .. plan of operation. The plan.. 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…***Based on statements and documents, this requirement not met as evidenced by: Facility did not follow Facility’s Loss policies in response to R1’s missing glasses and hearing aids. This posed a potential risk to personal rights of R1.

87218(a)(1) Theft and Loss. The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative. *** Based upon statements and file research, this requirement has not been met as evidenced by: On or about April 06, 2023, facility staff were unable to produce the inventory for R1’s personal property. This posed a potential risk to the personal rights of R1.

1569.652 (c). A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issuedto the individual, individuals, or entity contractually responsible for the fees or, if the deceased, resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. ***Based on statements/documents this requirement not met as evidenced by:R1’srefund was due 15 days after 2/25/2023 but was not made until on or about 4/20/2 **This posed an immediate violation of R1’s personal rights.

***Amended…87465 (a)(5) Incidental Medical and Dental Care Services. The licensee shall assist residents with self-administered medications when needed. This requirement is not met as evidenced by: ***Amended…Based on incident report of 3/4/23 and interviews conducted with facility staff. Facility failed to administer medication per physician’s orders which poses an immediate health and safety risk to clients in care.

87464(f)(1) Basic Services. Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). ***This requirement has not been met as evidenced by: Based on statements and observations, R1 has been observed in need of hygiene services, in a broken wheelchair and, on one occasion, with feces under the fingernails. This posed an immediate risk to the health and safety of R1.

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:(3)To be free from... interfering with daily living functions such as eating, sleeping, or elimination. ***This requirement was not met as evidenced by: Based on record review, interviews conducted and observations, licensee did not ensure the regulation above due to R2 and R3's occasional loud television volume which violated R1's ability to sleep. This is a potential personal rights risk to clients in care.

80075(b) Health Related Services. Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement is not met as evidenced by: Based on incident report of11/26/22 and interview withmedical staff at facility, S1 failed to ensure that resident received the right dosage of medication as prescribed by physician which poses an immediate health and safety risk to clients in care.

Storage Space. Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. ***Based on LPA observation this requirement has not been meet as evidenced by: finger nail polish remover was observed in bathroom of memory care apartment bathroom which was accessible to residents in care. This poses an immediate risk to the health of the residents.

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: …To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. ***Based on statements and documents, this requirement has not been met as evidenced by: Facility sponsored flu shot clinic where R1 obtained vaccine without personal representative’s knowledge or consent. This posed an immediate risk to R1’s health and personal rights.

87411 Personnel Requirements (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall.... This requirement is not met as evidenced by: Based on document review 1 staff have not been fingerprinted and 3 staff have not been associated which poses an immediate risk to the health, safety, personal rights for residents in care.

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 records reviewed, interview, staff transferred R1 by themself, rather than by 2-person assist as required in careplan, which poses an immediate risk to their health, safety, personal rights for residents in care.

87458(a) Medical Assessment. Prior to accepting a person as a resident the licensee must obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. ** This requirement was not met. Based on LPAs record review he facility failed to ensure Residents (R1-4) had submitted a completed medical assessment, within the last year. R1 -R4 did not sign Physician's Report which poses a potential health and safety risk to residents in care.

87468.1(2) Persoanl Rights This requirement isn't met as evidenced by: Based on interviews & records facility didn't comply w/section above R1 had a fall on an apartment of another resident on 7/22/22 sensor alsarm record went off 3 different times during PM shift for R1; R1 was found in another resident's room and sent out to ER. Facility was aware resident wakes up and needs to be redirected during the night.(see LIC 9099 and docs)

87465(c)(2) Incidental Medical and Dental Care. This requirement is not met as evidenced by: Based on interviews, record reviews,facility didn't comply w/section above in 1 out 1 resident which poses a potential risk to resident in care. Resident R1 care plan 6/13/22 requires breathing treatments according with doctor's orders. However, MARs show that between Junde 3 & June 21/2022 resident R1 14 x din't receive treatment due to missing parts of a machine(see9099,docs

87411(a)Personnel Requirements This requirement isn't met as evidenced by: Based on interviews & records facility didn't comply w/section above resident R1 careplan needs which poses a risk to health, safety, personal rights of resident in care. Department learned that R1 has a care plan dated 12/15/21 & 6/13/22 states breathing treatment needs & fall management plan that were not followed (see LIC 9099)

87211 Reporting Requirements. This requirement is not met as evidenced by: Based on records reviewed, interview, facility didn't comply w/section cited above within 2 of2 residents incident reporting which poses a potential risk to their health, safety, personal rights for residents in care. Resident R1 and R2 had incidents that occurred on 7/22/22 & 8/3/22 which were not submitted to the department. (see docs, LIC 809)

87705(b)(2)Care of Persons with Dementia - Safety measures to address behaviors such as wandering.This requirement isn't met as evidenced by:Based on interviews,SIR & physician's report R1 eleoped w/out staff knowledge on 7/30/22 the facility didn't comply w/section above to address behaviors such as wandering for resident R1 which poses an immediate Health, Safety risk to residents in care. (see copies)