Atwater Residential Care Facility

Based on record review, the licensee did not comply with the section cited above in Staff 2 does not have required health screening/ TB, 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 two of three facility bathrooms had cleaning supplies accessible to residents,which poses an immediate 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 Staff 1 does not have current CPR/First aid training on file, 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 the facility is using bedrooms for purposes other than listed on facility sketch (using office as bedroom) which poses/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 Resident 3's medications are not logged up to current date on the Centrally Stored Medication record, which poses/posed a potential health, safety or personal rights risk to persons in care.

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.The following requirement has not been met as evidenced by: LPA's observed several goats along with some goat feces in the facility backyard, staff 1 stated the facility residents do not go in the backyard as there is several goats, which poses a potential, health, safety, or personal rights risk to residents in care.

Based on observation, and record review the licensee did not comply with the section cited above in LPA's were not able to review any of the 4 residents records as they were not made available, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, and record review the licensee did not comply with the section cited above in LPA's were not able to verify Staff 1 has required current first aid training, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, and record review, the licensee did not comply with the section cited above in LPA's requested and were not provided facilities 610E Disaster Plan, 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 LPA's observed several expired foot items in facility pantry, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on records review, the licensee did not comply with the section cited above in Resident 1's medications are not currently logged on the Centrally Stored Medication Record, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above in Resident 1 was not given Levothyroxine medication for several days due to being out of the medication, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, and record review, the licensee did not comply with the section cited above in LPA's were not able to review Personnel records as they were not accessible, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in LPA's measured hallway bathroom water temperature to be 129 degrees, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation the licensee did not comply with the section cited above in LPA's observed a lock on the facility front door more than 6 feet high, and not accessible to residents, which poses an immediate health, safety or personal rights risk to persons in care.

87355 Criminal Record Clearance(a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the (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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) orThe following requirement has not been met as evidenced by: Staff 1 is not associated to this facility in LIS or guardian, which poses an immediate health, safety, or personal rights risk to residents in care.

87355 Criminal Record Clearance(a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, residence, or presence in the facility, based upon the results of such review. (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption.The following requirement has not been met as evidenced by: Staff 2 is not background cleared and has been providing care to residents for one month, which 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:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.The following requirement has not been met as evidenced by: Facility staff engaged in a verbal altercation with facility resident which poses a potential, health, safety, or personal rights risk to residents in care.

87224Eviction Procedures(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph. The following requirement has not been met as evidenced by: Resident 1 was not accepted back into the facility after a visit to the hospital on 12/17/23, which poses an immediate, health, safety, or personal rights risk to residents in care.

87507 Admission Agreements(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any.(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any, and the licensee or the licensee’s designated representative no later than seven days following admission. The following requirement has not been met as evidenced by: Resident 1's Conservator was not provided Admission Agreement within 7 days of living at the facility which poses a potential, health, safety, or personal rights risk to residents in care.

87265 Managed Incontinence(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:87265 Managed Incontinence(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence..The following requirement has not been as evidenced by: Based on interviews conducted facility residents are being left in urine soaked clothing for extended periods of time, which poses an immediate, health, safety, or personal rights risk to reisdents 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. 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 not been met as evidenced by: Facility staff frequently called local fire staff to assist with lifitng, and moving facility residents, which poses a potential, health, safety, or personal rights risk to residents in care.

Section 87507(g)(3)(C) Any fee that is charged prior to or after admission, shall be clearly specified. **This requirement was not met as evidenced by review of the admission agreement provided to RP, that did not specify a $1,355.00 holding fee.

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's Centrally Stored Medication Log lists medications with no quantity which poses an immediate, health, safety, or personal rights risk to residents in care.

87265 Managed Incontinence(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(7) Ensuring that the condition of the skin exposed to urine and stool is evaluated regularly to ensure that skin breakdown is not occurring.The following requirement has not been met as evidenced by: Records, and photos document Resident 1's buttocks area was extremely red and irritated over a period of weeks, which poses an immediate, health, safety or personal rights risk to resident in care.

§1569.657 Rate increase due to change in level of resident care; notice(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 represent ative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. The following requirement has not been met as evidenced by: Licensee did not provide Resident 1's responsible party a detailed written breakdown of services provided , and it is not clear when invoice was given, which poses a potential, health, safety, or personal rights risk to residents in care.

87211Reporting Requirementse 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. The following requirement has not been met as evidenced by: LPA reviewed records of incidents on 03/09/2023 that was not reported to State Licensing which poses a potential, health, safety, or personal rights risk to residents in care.

(c) “Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. The following requirement has not been met as evidenced by: Resident 1 attacked several other facility residents which poses an immediate health, safety, or personal rights risk to residents in care.

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.The following requirement has not been met as evidenced by: Based on observation the Licensee does not have resident records in a location readily available to Licensing staff.

87465Incidental Medical and Dental Care(h) The following requirements shall apply to medications which are centrally stored:(4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label.(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Based on LPA observation the facility was dispensing medications not in their orignally marked containers to Resident 1 which poses an immediate, health, safety, or personal rights risk to residents in care.

(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes:(A) The name of the resident for whom prescribed.(B)The name of the prescribing physician.(C) The drug name, strength and quantity.(D) The date filled.(E) The prescription number and the name of the issuing pharmacy.(F) Instructions, if any, regarding control and custody of the medication.The following requirement has not been met as evidenced by: LPA Hurt observed Resident 1 does not have a centrally stored medication log which poses an immediate, health, safety, or personal rights risk to residents in care.

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any...other medical conditions which would preclude care of the person by the facility. This requirement was not met as evidenced by LPAs interview with Licensee and staff stating resident file is not available at the time of visit. Staff began employment on 08/30/23 at 4:30pm and does not currently have access to residents care plan which poses a potential health, safety, or personal rights risk to residents in care.

§1569.69 Employees assisting residents with self-administration of medication; training requirements(2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement was not met as evidenced by LPAs request for staff and resident files. Licensee was unable to provide files and proof of training at the time of visit. Interviews with staff reveal the required documented training was not conducted. If not corrected, This poses an immediate risk to the health and safety of residents in care.

87411Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. The following requirement has not been met as evidenced by: LPA's observed Staff 1 did not speak english, and was unable to communicate with Licensing staff, and facility residents, which poses an immediate health, safety, or personal rights risk to residents in care.

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. The following requirement has not been met as evidenced by: Based on interviews with Licensee, Resident 1 does not have any records and non were provided at the time of Resident 1's admission, which poses an immediate health, safety, or personal rights risk to residents in care.

Based on observation, the licensee did not comply with the section cited above in LPA's observed backyard Barbecue grill with knobs still on accesible to residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on records reviewed, the licensee did not comply with the section cited above in LPA's observed Resident 2's Centrally Stored Medication Records does not have current information which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation,and records reviewed the licensee did not comply with the section cited above in as LPA's observed Resident 1 to be bedridden, and bedroom does not have fire clearance for bedridden residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in LPA's observed one of three facility gates located on the south side of the backyard gate to have a lock which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in LPA's observed facility alerts on doors leading to outside not functioning which poses an immediate health, safety or personal rights risk to persons in care.

(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. Based on records reviewed, the Licensee did not ensure that a proper pre-admission appraisal was completed prior to admitting R1. During interview, R1 stated that their needs were not met by the facilit staff. This results in a potential health and safety risk for residents in care.

Health and Safety Code section 1569.652 provides in part:(a) A residential care facility for the elderly shall not require advance notice for terminating an admission agreement upon the death of a resident. No fees shall accrue once all personal property belonging to the deceased resident is removed from the living unit. The following requirement has not been met as evidenced by: Resident 1's responsible party has not been refunded after passing on 11/12/2023 which poses a potential health, safety, or personal rights risk to residents in care.

87507((f)The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. The following requirement has not been met as evidenced by: The facility Administrator did not provide written notice of rate increase within two days as stated in signed facility Admissions Agreement, which poses a potential, health, safety or personal rights risk to residents in care.

87507 Admission Agreement (g) Admission agreements shall specify the following:(1) Basic services, as defined in Section 87101(b), (A) Rate for all basic services which the facility is required to provide in order to obtain and maintain a license. Basic services rate(s), including: 1A comprehensive description of any items and services provided under a single fee, such as monthly fee for room, board and other items and services shall be listed. The following requirement has not been met as evidenced by: Administrator did not give detailed itemized description of fees until 14 days after change of condition and rate increase, which poses a potential, health, safety, or personal rights risk to residents in care.

Section 87507(g)(3)(C) Any fee that is charged prior to or after admission, shall be clearly specified. **This requirement was not met as evidenced by review of the admission agreement provided to RP, that did not specify a $1300 holding fee.

87355(e)(1): Obtain a California clearance or a crminal record exemption as required by the Department... This requirement was not met as evidenced by: Based on observation, Licensee did not ensure all staff obtained a California clearance or a criminal record exemption when S1 was present in the facility without a California clearance which poses an immediate health and safety risk to persons in care

(a) A plan for incidental medical and dental care shall be developed by each facility…. (5) Assistance with self-administered medications shall be limited to the following: (D) Assistance with self-administration does not include forcing a resident to take medication, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure that the requirements for the section 87465(a)(5)(D) on 08/28/2022 when ADM administered PRN medications to R1 while R1 was restrained. This poses an immediate health and safety risk to residents in care

(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. Based on interviews, Licensee did not ensure all residents were provided care and supervision when on 08/28/2022, R1 was able to "bypass" facility staff, exit the facility, and enter a neighboring home unsupervised, which poses an immediate health and safety risk to persons in care.

(g) Admission agreements shall specify the following...(5) Refund conditions...(E) Preadmission fees shall be refunded according to the following conditions: 1. A 100 percent refund of a preadmission fee shall be provided to an applicant or the applicant’s representative if: a. The applicant decides not to enter the facility prior to the facility completing a preadmission appraisal...b. The licensee fails to provide full written disclosure of preadmission fee charges and refund conditions. This requirement was not met as evidenced by: Based on interviews and records review, the facility did not ensure 100 percent of the $500 admission fee was refunded to R1, which poses a potential health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above when 2 out of 2 staff did not have documentation to prove staff received initial training prior to working in the faciltiy, which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above as evidenced by R1 missing 8 days of medication and R2 missing 2 PRN medications which poses an immediate health, safety or personal rights risk to persons in care.