At Haven Home

Prohibition on using other rooms as bedrooms

On 08/05/2025, during annual inspection visit LPA observed resident occupying/sleeping on the bed in the office. The licensee did not comply with the section cited above in 87307 (a)(2)(B) which poses/posed a potential health, safety or personal rights risk to persons in care.

Keep administrator certification or recertification records

On 08/05/2025, during annual inspection visit LPA observed missing updated administrator certification. Based on phone call to admin. certification unit, the licensee did not comply with the section cited above and did not complete required educational units in timely manner which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain fire clearance before retaining specified persons

On 08/05/2025, during annual inspection visit LPA observed missing fire clearance. The licensee did not comply with the section cited above 87202 (a ) which poses a potential health, safety or personal rights risk to persons in care.

87705 Care of Persons with Dementia. (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia.This requirement was not observed as evidensed by: Based on interrviewes and record reviews facility staff failed to follow title 22 regulation resulted in dementia resident unassisted falling ans breaking her pelvis.Resident was taking the following day to the hospital were was diagnosed with broken pelvis, which poses health and safety risc to persons in care

Based on observation and interview, the licensee did not comply with the section cited above for 2 out of 5 residents which 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 three out of seven exterior doors, which poses/posed a potential health, safety or personal rights risk to persons in care.

Obtain baseline medical assessment before resident admission

Based on record review, the licensee did not comply with the section cited above in one out of five resident files, which poses a potential health, safety or personal rights risk to persons in care.

Record dose details and resident medication response

Based on record review, the licensee did not comply with the section cited above in one out of five medication adminidtration records, which posed a potential health, safety or personal rights risk to persons in care.

Retain original and modified agreements in resident file

Based on record review, the licensee did not comply with the section cited above in one out of five resident files, which poses a potential health, safety or personal rights risk to persons in care.

Admission agreement signing and dating deadline

87507 Admission Agreements (c) Admission agreements shall be signed and dated, acknowledging the contents of the document... if any, and the licensee or the licensee’s designated representative no later than seven days following admission...This requirement is not met as evidenced by: During the complaint investigation complaint, it was reported Licensee/Administrator did not provide Admission Agreement to Resident’s (R1) Responsible Party upon signing the admission agreement and Admission agreement was not signed by the licensee, which poses a potential personal rights risk to residents in care.

Notice to quit must state specific reasons and details

87224 Eviction Procedures (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons.This requirement was not met as evidenced by: Based on observation, record review and interview, the Licensee did not serve the resident with a proper 30-day eviction notice, which poses a Potential Health, Safety and Personal Rights risk to persons in care.