Pink Lady Carehome, Llc.

87405 Administrator-Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator... The Administrator shall have sufficient freedom... to permit adequate...management...of the facility. This requirement is not met as evidence by:Based on observation, interview and record review, the licensee did not have an administrator in place which poses an immedate health, safety and personal rights risks to persons in care.

Hospice Care Waiver. In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. This requirement has not been met as evidence by: Based on LPAs/Licensee observation, interview and record review, the licensee did not comply with the section cited above by having three residents (R1, R2 & R3) receiving hospice services without obtaining an exception or hospice waiver increase approval from the Department, which is a potential risk to the health & safety of the residents in care.

(a) All facilities shall maintain a fire clearance approved by...fire department. Prior to accepting or retaining any of the following types of persons the licensee shall notify the licensing agency & obtain an appropriate fire clearance approved: This requirement is not met as evidenced by: Based on LPAs/Licensee observation, interview and record review, the licensee did not comply with the section cited above in all by having R1 occupying a non-cleared room which poses an immediate health, safety or personal rights risk to persons in care.

Administrator - Qualifications and Dutie (b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee.(c) Failure to comply with all licensing requirements pertaining to certified administrators may constitute cause for revocation of the license of the facility.(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. This requirement was not met as evidenced by:Based on FInancial Audit conducted by the department, Licensee failed to properly operate the facility financially. This poses a potential risk to the Health & Safety of residents in care.

Accountability of Licensee Governing Body (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met as evidenced by : Based on FInancial Audit conducted by the department, Licensee failed to operate the facilities financial matters. This poses a potential risk to the Health & Safety of residents in care.

Finances-87213 The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records; and shall submit such financial reports as may be required upon the written request of the licensing agency. Such request shall explain the need for disclosure. The licensing agency reserves the right to reject any financial report and to request additional information or examination including interim financial statements. This requirement was not met as evidenced by:Based on FInancial Audit conducted by the department, Licensee failed to have an adequate financial plan. This poses a potential risk to the Health & Safety of residents in care.

Liability On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees This requirement was not met as evidenced by: Based review of facilities current liability insurance today and on 5/8/2024. Facility had proof of liability insurance but it did not meet the liability required amount per regulation requirement. This poses a potential risk to the Health & Safety of residents in care.

87211(d) Reporting Requirements(d) The licensee shall notify the Department, the State Long-Term Care Ombudsman, all residents, and, if applicable, their representatives, in writing within two business days of any of the following specified events, or knowledge thereof:(5) A utility company has sent a notice of intent to terminate electricity, gas, or water service on the property within not more than 15 days of the notice. This requirement was not met as evidenced by: during inspection LPA discovered the facilities water had been turned off for non payment. This is an immediate risk to the health and safety of residents in care.

87355(e)(2) Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall request a transfer of a criminal record clearance from another facility or Trustline This requirement was not met as evidenced by: during ee roster record review and confirmation with regional office, staff S1 was fingerprint cleared but not associated to this facility- This is a potential risk to the health and safety of all residents in care.

Administrator - Qualifications and Duties 87405(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement was not met as evidenced by LPAs observations, and interview with licensee, and other related parties. The Licensee Jean Felix has not ensured the facility has a qualified certified Administrator on-site as required by regulation; there has not been an Administrator since Oct 31, 2023. This is a potential risk to the health and safety of all residents in care.

Based on record review, the licensee did not comply with the section cited above in 4 out of 4 Needs and Services Plans were not current which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, 1 out of 4 resident medication bottles not refilled. LPA learned that the Administrator is in the process of reaching out to the Primary Care Physician to notify of the medication refill. This regulation 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 due to laundry room unlocked and toxins were left accessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.Civil Penalty Assessed due to repeat violations.

Based on observation and interview the licensee did not comply with this section above due to the facility not having an Active Administrator. Furthermore, Licensee's Administrators Certificate expired in October 26, 2022. This regulation poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and Guardian Review, the licensee did not comply with the section cited above in 1 out of 3 staff members were not background cleared which poses an immediate health, safety or personal rights risk to persons in care. Civil Penalty Assessed.

Based on observation, the licensee did not comply with the section cited above in 1 of 1 kitchen sink had a cover on it and was clogged which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on tour and observation, the licensee did not comply with the section cited above in that the laundry room was left open where chemicals were not locked 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 2 out of 2 auditory devices were not operable during the inspection 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 due to missing a smoke detector in Room #2 where a resident resides which poses an immediate health and safety risk to residents in care.