Pacific Grove Senior Living

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in records for R2 missed updated and required records for reside t home health care plan 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 one out of five records reviews missing records pertaining to required hospice care 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 reside t administrered oxygen, missing warning signgs outside door which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 3 out of 5 staff members which poses/posed a potential health, safety or personal rdid not have in possession required staff files wich poses potentail health and safety risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in didster plan missed records of facility coducted emergancy disaster and fire drill accordomg to regulation ( with in each quarter which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in assisted living facility section observed launndry room door unlocked with detergent on the countertop, unlocked and not hidden from dementia residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not maintain re appraisald for R2 and R5 to comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in R1's medications showed a start date of 11/21/25 with 25 out of 30 pills missing indicating R1 was not administered 1 pill, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and records review, the licensee did not comply with the section cited above in three out of 5 reside t records reviewd missed record required in this regulation which poses a potential health, safety or personal rights risk to persons in care.

87412 Personnel Records. (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement was not observed as evidenced by: During file review, staff (S1) records missing staff training regarding fire response / disaster response, which poses potential health and safety risk to persons in care

Emergency Plans. (c) A facility shall conduct a drill at least quarterly for each shift...... Documentation of the drills shall include the date, the type of emergency covered by the drill. This requirement was not observed as evidenced by: Based on interviews and records review the facility have not conducted recent emergency disaster drill and or maintained the records of last emergency disaster drill conducted recently, which poses potential health and safety risk to persons in care.

87468.2 (a)(3) Personal rights(3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. This requirement was not met as evidenced by: Based on interviews and record review, the Licensee did not comply with section 887468.2 (a)(3) when facility failed to provide residents free from discrimination their personal rights by refusing residents to their personal mail boxes for distributing memos, which is a potential health and safety risk to person’s in care.

87224(f) Eviction Procedures - A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement was not met as evidence by:Based on records reviewed and interviews conducted, the facility failed to notify the Department of the eviction, which poses a potential health, safety, and personal rights to the residents in care.

87208(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials 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.This requirement is not met as evidenced by:Based on observations, interviews and record review, the licensee did not comply with the section cited above in by changing the plan of operation without CCLD approval which poses a potential health, safety or personal rights risk to persons in care.

87468.2 (a)(3) Personal rights(3) To be encouraged and assisted in exercising their rights as citizens and as residents of the facility. Residents shall be free from interference, coercion, discrimination, and retaliation in exercising their rights. This requirement was not met as evidenced by: Based on interviews and record review, the Licensee did not comply with section 887468.2 (a)(3) when facility failed to provide residents free from discrimination their personal rights, which is a potential health and safety risk to person’s in care.

§1569.695 Emergency Plans (c) A facility shall conduct a drill at least quarterly for each shift… this requirement was not met as evidenced by:Based on record review and interviews, the Licensee did not comply with section 1569.695(c) when that the facility’s last documented fire drill was conducted on 02/24/2025 and prior to this, the last year fire drill was conducted on 04/30/2024, which is a potential health and safety risk to residents 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… This requirement was not met as evidenced by:

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: (2) To be accorded safe, healthful and comfortable accommodations; this requirement was not met as evidenced by: Based on interviews conducted, the licensee did not comply with section 87468.1(a)(2) when constructions crew began working prior to 7:00AM and played loud music, which is an immediate health and safety risk to residents in care.

87303 Maintenance and Operation. (b) A comfortable temperature for residents shall be maintained at all times. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). This requirement was not observed as evidenced by: Based on observations facility measured temperature during the visit recorded at 65.9 degrees, staff failed to maintain comfortable temperature for residents at the facility, which poses potential health and safety risk to persons in care.

(a) 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 evidenced by; when on 2/16/24, at approximately 4:45PM resident trapped in the elevator when it malfunctioned. Residents calls for assistance went unanswered for approximately 30 min, this poses potential health and safety risk ti persons in care.

87303 Maintenance and Operation. (i) Facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall: This requirement was not observed as evidenced by; the facility call light system does not work as required. Four out of nine residents unable to utilize call system services, which poses potential health and safety 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. This requirement was met as evidenced by: on 02/16/2025 at approximately 4:45PM a resident was trapped in the elevator when it malfunctioned for approximately 30 minutes. Based on records review elevator was not serviced since 2021, which poses potential health and safety 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. This requirement was not observed as evodenced by: Based on the interviews conducted and records reviewed, the elevator wasn't working properly on 11/20/24. Staff had to manually use the elevator by key for residents.

87212 (b) The plan shall be subject to review by the Department and shall include: (2) Plan for evacuation including... This requirement was not observed as evidenced by: the Emergency Disaster Plan was missing information regarding transportation of residents in an emergency and staff and resident's emergency drills.

87303 Maintenance and Operation. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). This requirement was not observed as evidenced by: Based on observation, space heaters were used to heat the dining room.

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.

87208 Plan of Operation(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials 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.This requirement is not met as evidenced by: Based on observations, interviews and record review, the licensee did not comply with the section cited above in by changing the plan of operation without CCLD approval which poses a potential health, safety or personal rights risk to persons in care.

87303 Maintenance and Operation (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This requirement was not observed as evidenced by: The facility failed to maintained water temperature within regulatory requirement of Titlte 22 regulation (105 degree F (41 degree C) and not more than 120 degrees F) .At a minimum, there were three days, from 10/14, to 10/17 hot water was not accesible to residents. This is poses immediate health and safety risk to persons in care.

87224 (a)(1) Eviction 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 (5). (1) Nonpayment of the rate for basic services within ten days of the due date. This requirement was not observed as evidenced by: Based on review of record , interviews and documentation obtained during the investigation, the facility administrator did not provide the resident with the required 30 day written notice of eviction. The facility failed to follow title 22 regulation in regards to Eviction procedures which poses potential health and safety risk to persons in care.

H&S §1788 (a)(31) The Care and Residence Agreement and the Continuing Care Contract Statutes both provide for termination of an agreement upon ninety (90) day’s written notice to resident with good and sufficient cause as required by Health and Safety Code section 1788(a)(31). This requirement was observed as evidenced by: Based on review of records, interviews and documents obtained during the investigation, the provider issued the resident a three-Day Notice to Pay or Quit to the resident on August 16, 2024, which poses potential health and safety 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: The facilities hot water, and heat has been in disrepair and not working intermittently since 05/25/24, which poses a potential, health, safety, or personal rights risk to residnets in care.

87303 Maintenance and Operation(a)(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). The following requirement has not been met as evidenced by: LPA Hurt observed the facility water temperature inside residents south wing bedrooms to measure at 92 degrees, which poses a potential, health, safety, or personal rights risk to residents 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. This requirement was not met as evidenced by: Based on obervation and interview, the licensee failed to ensure that the facility was in good repair and free from hazard around the time of 5/25/2023-5/31/2023, which presented a potential risk to the health and safety of residents in care.