Rosehaven 1

Based on record review, the licensee did not comply with the section cited above in two out of three staff without CPR/ First aid training 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 three out of three faucets with water over 120 degrees F 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 two out of four residents without documentation of an annual assessment 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 four out of six smoke detectors which did not work. This 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. LPA observed exit gate does not latch and the master restroom is missing drawer pulls on cabinets which poses 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 one out of three staff files. Staff 3 does not have a personnel file which poses 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 one out of three residents without an annual assessment which poses 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 two out of two residents with bed rails did not have a written physician order for rails which poses 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 three out of three staff without current training which poses a potential health, safety or personal rights risk to persons in care.

All individuals subject to a criminal record review.. shall prior to working, residing or volunteering in a licensed facility:Obtain a California clearance or a criminal record exemption.. This req is not being met as evidenced by: Based on interview and record review, Licensee failed to ensure two staff obtained criminal record clearance. This poses an immediate health and safety risk to residents in care.

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 req is not being met as evidenced by: Based on observation, Licensee failed to ensure facility is clean, safe and sanitary. LPA observed a broken cupboard, buckling tile, and debris in yard. This poses a potential health and safety risk to residents in care.

Based on the licensee did not comply with the section cited above in six of six resident 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 two of two staff which poses health, risk to persons in care.

Based on records reviewed the licensee did not comply with the section cited above in six of six residents which poses personal rights risk to persons in care.

Based on records reviews the licensee did not comply with the section cited above in two of two staff which poses a potential safety risk to persons in care.

Based on observations the licensee did not comply with the section cited above in 6 of 6 residents which poses safety risk to persons in care.

Basic services shall at a minimum include:Care and supervision as defined in Section 87101(c)(3) and Health and Safety Codesection 1569.2(c). This requirement is not being met as evidenced by: Based on record review, Licensee failed to ensure care and supervision is being provided to R1. R1 has a physician order to turn resident every 2 hours. Facility documentation indicates R1 was not turned 24 times between July 1-12, 2022. This poses an immediate health and safety risk to residents in care. Civil Penalty Assessed.

Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not being met as evidenced by: Based on record review, Licensee failed to ensure verification of staff training is maintained. Two out of four staff do not have documentation of required training. This poses a potential health and safety risk to residents in are.

The licensee shall provide a copy of the signed and dated current admission agreement.., to the resident or the resident's representative, if any, immediately upon signing the admission agreement or modification...This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure an admission agreement was provided to R1/ Responsible Party. This poses a potential health and safety risk to residents in care.

A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department: This requirement is not being met as evidenced by: Based on interview and record review, Licensee failed to ensure S1 is associated to the facility. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

Based on observation, the licensee did not comply with the section cited above. LPA observed items noted in LIC 809 unsecured in the facility. This poses an immediate health and safety risk to persons in care.

Based on observation, the licensee did not comply with the section cited above. LPA observed noted items in need of repair on LIC 809. This poses a potential health and safety risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above. Per staff, resident records are not on-site at facility. This poses a potential health and safety risk to persons in care.

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 is not being met as evidenced by: Based on observation and interviews conducted, Licensee did not have qualifications for operation of facility. Administrator does not have a current certificate and allowed personal rights violations, pests in the facility, and facility to be in disrepair. This poses a potential health, safety, or personal rights violation.

Residents in all residential care facilities for the elderly shall have all of the following personal rights:To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure resident is accorded dignity. During R1's passing, Licensee was involved in a verbal altercation with R1's family member while family member was asking for privacy. This poses an immediate health and safety risk to residents in care.

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 being met as evidenced by: Based on observation, Licensee failed to ensure facility is clean, safe, and sanitary. LPAs observed discarded items in the front of the driveway. This poses a potential health and safety risk to residents in care. CIVIL PENALTY ASSESSED.

In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents.. shall have all of the following personal rights:To have a reasonable level of personal privacy in accommodations... and meetings of resident and family groups. This req not being met.. Based on interviews conducted, Licensee failed to ensure a reasonable level of privacy was provided to residents. Administrator admits to putting a video camera up in the living room without any consent from residents or responsible parties. This poses a potential health and safety risk to residents in care.

The following space and safety provisions shall apply to all facilities:The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.This requirement is not being met as evidenced by: Based on observation, LPA observed live and dead cockroaches in the kitchen and resident bedroom. This poses a potential health and safety risk to residents in care.

Basic services shall at a minimum include:Care and supervision as defined in Section 87101(c)(3) and Health and Safety Codesection 1569.2(c). This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1 was provided care and supervision. Licensee was unable to receive urgent care's calls due to an appointment Administrator was on. R1 was being transferred to the emergency room. This poses an immediate health and safety risk to residents in care.

Residents in all residential care facilities for the elderly shall have all of the following personal rights:To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure incontinence care is being provided as needed. This poses a potential health and safety risk to residents in care.

Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents...Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) ... The poster that is posted shall be 20" x 26" in size and be posted in the main entryway of the facility. This req is not being met as evidenced by: Based on observation, Licensee failed to ensure the "Let Us No" poster is posted in the entrance of the facility in regulation size, 20" X 26." This poses a potential health and safety risk to residents in care.

Based on observation, the licensee did not comply with the section cited above. LPA observed Licensee's administrator certificate expired 09/13/2019. This poses a potential health and safety risk to persons in care.

Each licensee shall furnish to the licensing agency such reports as.., including.., the following: Death of any resident from any cause regardless of where the death occurred... This requirement is not being met as evidenced by: Based on interview conducted, Licensee failed to ensure a death report for R1 was submitted to Licensing. This poses a potential health and safety risk to residents in care.

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 is not being met as evidenced by: Based on observation and record review, Licensee failed to ensure R1's file is maintained at the facility. This poses a potential health and safety risk to residents in care.

Based on (observation, the licensee did not comply with the section cited above. LPA observed discarded items on front driveway, tile coming up in master suite, a broken patio set in backyard, broken cupboard in kitchen, an entry ramp needing repair as well as missing molding on kitchen cupboard. This poses a potential health and safety risk to persons in care.