Merced Senior Living

Maintain facility in clean, safe, sanitary condition

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 observed as evidenced by: Based on observation, second elevator, (west side of the building) is not operational for prolonged time frame which poses potential health and safety risk to persons in care.

Facility personnel sufficiency and competence

87411 Personnel Requirements. (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...... This requirement was not observed as evidenced by: Based on records review facility failed following Title 22 regulation regarding supervision resulting in one out of eighty four residents acquired facial injury and staff was not aware of the incident. This is poses potential health and safety risk to persons in care.

Update reappraisal at required intervals

87463 Reappraisals. (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first.. This requirement was not observed as evidenced by: The facility failed to record reappraisal after multiple fall of one out of 83 residents, which poses potential health and safety risk to persons in care.

Maintain separate complete record for each resident

87506 Resident Records. (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not observed as evidenced by: Based on records reviews, one out of 75 residents have not had updated physician report since 2018. This is poses potential health and safety for clients in care.

Obtain and evaluate recent medical assessment

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.

Right to sufficient care and qualified staff

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities. (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 was not observed as evidenced by: Based on facility records review on multiple occasions facility did not respond to residents calls in timely manner resulting in at least 3 out of 75 residents wait time for assistance in January of 2025 varying from 30 minutes to over an hour

Provide copies of signed agreements and amendments

87507 Admission Agreements. (e) The licensee shall provide a copy of the signed and dated current admission agreement, and all subsequent signed and dated modifications, to the resident or the resident's representative... This requirement was not observed as evidenced by: facility staff failed to provide the resident with updated re-appraisal for resident knowledge and records. This is poses potential health and safety risk to persons in care.

Maintain facility in clean, safe, sanitary condition

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, licensee did not comply with the regulations listed above. LPA observed in pictures there was an infestation of cockroaches in the residents room. This poses an immediate health, safety, or personal rights risk to residents in care.

Dispose of unused medications with required witness

Based on observation and record review, the licensee did not comply with the section cited above for at least 1 out of 70 residents, which posed a potential health, safety or personal rights risk to persons in care.

Ensure outdoor waste containers are cleanable

Based on observation, the licensee did not comply with the section cited above in the bathrooms of ate least 3 out of 70 residents' bathrooms, which posed a potential health, safety or personal rights risk to persons in care.

Right to sufficient care and qualified staff

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:(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.The following requirement has not been met as evidenced by: Resident 1 was not assisted by staff with transfers resulting in several falls, which poses a potential , health, safety, or personal rights risk to residents in care.

87457 Pre-Admission Appraisal - General (a) Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions(3) The prospective resident, or his/her responsible person, if any, shall be involved in the development of the appraisal.The following requirement has not been met as evidenced by: Resident 1's Responsible Party was not provided and did not sign Resident Assesment or Needs and Services plan, which poses a potential, health, safety, or personal rights risk to residents in care.

Facility personnel sufficiency and competence

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. The following requirement has ot been met as evidenced by: Resident 1's wait time for assistance when pushing his pendant was at times more than 60 minutes, which poses an immediate health, safety, or personal rights risk to residents in care.

Acceptance obligations tied to pre-admission appraisal needs

87464 Basic Services (d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. The following requirement has not been met evidenced by: Resident 1 was not correctly assisted with medications or transfers as listed on pre admission, which poses a potential, health, safety or personal rights risk to residents in care.

Develop required incidental medical care plan

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:(4) The licensee shall assist residents with self-administered medications as needed. The following requirement has not been met as evidenced by: Resident 1 was not provided medications listed on medication list, which poses an immediate health, safety, or personal rights risk to residents in care.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above in multiple bedrooms and common areas, which poses/posed a potential health, safety or personal rights risk to persons in care.

Use slip-resistant surfaces in bathing areas

Based on observation, the licensee did not comply with the section cited above in 1 out of 6 resident bathrooms which were toured, which poses/posed a potential health, safety or personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above in 1 out of 6 kitchen cabinets in the memory care unit which posed 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 in 1 out of 1 emergency response binders, which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation(a) The facility shall be...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: LPA observed the signal system devices installed at bedside and in the bathrooms of sampled bedrooms in Memory Care of room #306, 308, 314, and 317 were all inoperable. During interviews, LPA found that staff conduct 30 minute checks on residents and do not use pagers to be able to receive the signal system alert for the memory care residents. This poses a potential health, safety, or personal rights risk to residents in care.

Food quality controls and rejected damaged goods

87555 (b) (8) General Food Service Requirements. The following food service requirements shall apply: All food shall be of good quality.This requirement was not met as evidenced by: Based on observation Licensee did not keep foods of good quality when refrigerator observed to store fruit that was moldy.

80087 Buildings and Grounds (a)The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1)The licensee shall take measures to keep the facility free of flies and other insects.This requirement was not met as evidenced by: Based on observation Licensee did not keep facility free of insects, ants observed in resident rooms 103, 105 and 208 which poses a potential health, safety personal rights risk to clients in care.

HS§1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services:(a) Care and supervision as defined in Section 1569.2.This requirement was not meant by: The incident occurred on 09/04/2022 resulted in Memory Care resident R4 going AWOL from the facility. There was no supervision in the common area, which poses an immediate risk to the health, safety or personal rights of the clients in care. Per R4’s Physician’s Report dated 03/07/2021, R4 has mild cognitive impairment and is unable to leave facility unassisted.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above when LPA observed the assisted living laundry room and memory care housekeeping room unlocked, which poses an immediate health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observations, the licensee did not comply with the section cited above. LPA observed several unused wheelchairs, boxes and various items in the hallway by service entrance. LPA observed a dried tree/branches on top of a metal storage container in the southside of the back-parking lot. LPA and Executive Director entered a memory care resident’s room and it had a strong odor of urine, which poses a potential health, safety or personal rights risk to persons in care.

Resident care and supervision skills

87411Personnel Requirements -General (d) All personnel shall be given on the job training... shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (3) Skill and knowledge required to provide necessary resident care and supervision...This requirement was not met as evidenced by: Based on records reviewed and interviews, the Resident (R1) had an unwitnessed fall. R1 was left on the floor for an extended period of time and staff did not respond in a timely manner, which poses an Immediate health and safety risk to residents in care.

87211 Reporting Requirements (g) The licensee shall notify the Department, in writing, within thirty (30) days of the hiring of a new administrator… This requirement was not met as evidenced by: Based on interviews and records review, the Licensee has not notified the Department, in writing of a new facility administrator, which poses a potential Health, Safety and Personal Rights risks to persons in care.

§1569.312 Basic services requirementsEvery facility required to be licensed under this chapter shall provide at least the following basic services:(a) Care and supervision as defined in Section 1569.2.*This requirement was not met as evidenced by: The incident occurred on 01/12/2021 which resulted in resident R1 going AWOL from the facility. R1 is/was unable to leave the facility unassisted per Physician Report dated 1/21/2020. This presents an immediate risk to the health, safety or personal rights of the clients in care.

Regular representative updates on 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: (8)To have their representatives regularly informed by the licensee of activities related to care or services...This requirement was not met as evidenced by: Based on records review and interviews, the Licensee did not communicate with the R1's Responsible party/Representative listed on the Residence and Care Agreement, which poses a potential Health, Safety and Personal Rights risks to persons in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times…This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure R1’s room is clean, which poses a potential Health, Safety and Personal

87457 Pre-Admission Appraisal - General(a) Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions.This requirement was not met as evidenced by: Based on interview and records, the Licensee did not ensure that on 04/28/2021, Resident (R1) R1 did not participate in the development of the pre-appraisal, which poses a potential health and safety risk to persons in care.

Regular observation and documentation of resident changes

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning…This requirement was not met as evidenced by: Based on interview, the Licensee did not ensure that R1 is regularly observed for changes and was not provided with appropriate assistance, which poses a potential health and safety risk to persons in care.

Give PRN medication by physician order

87465 Incidental Medical...(c)...physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication...(2)Once ordered by the physician the medication is given according to the physician's directions.This requirement is not met as evidenced by: Based on records review, the Licensee did not meet the Incidental Medical Care. R1 missed her prescribed medications on 4/22/2021, which poses an Immediate Health, Safety and Personal Rights risks to persons in care.

Facility personnel sufficiency and competence

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... This requirement was not met as evidenced by delayed response times to call buttons, which poses an Immediate health and safety risk to residents in care.

§1569.312 Basic services requirementsEvery facility required to be licensed under this chapter shall provide at least the following basic services:(a) Care and supervision as defined in Section 1569.2.*This requirement was not met as evidenced by: The incident occurred on 03/21/2021 resulted in resident R1 going AWOL from the facility. R1 is/was unable to leave the facility unassisted per Physician Report dated 5/8/2019. Resident has a dementia diagnosis.This presents an immediate risk to the health, safety or personal rights of the clients in care.

Give PRN medication by physician order

87465 Incidental Medical...(c)...physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication...(2)Once ordered by the physician the medication is given according to the physician's directions.This requirement is not met as evidenced by: Based on records review and interviews, the Licensee did not meet the Incidental Medical Care, which poses an Immediate Health, Safety and Personal Rights risks to persons in care.

Give PRN medication by physician order

87465 Incidental Medical...(c)...physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication...(2)Once ordered by the physician the medication is given according to the physician's directions.This requirement is not met as evidenced by: Based on records review and interviews, the Licensee did not meet the Incidental Medical Care, which poses an Immediate Health, Safety and Personal Rights risks to persons in care.