Graces Home

87308: Resident and Support Services(c) General storage space shall be maintained for equipment and supplies as necessary to ensure that space used to meet other requirements of these regulations is not also used for storage. Based on observations made by LPA the Administrator failed to ensure that sufficient storage space was made available to store items, and allow for a clean and sanitary environment for residents in care which poses an immediate personal rights violation for residents in care.

87219 Planned Activities (h) The licensee shall provide sufficient space to accommodate both indoor and outdoor activities. Activities shall be encouraged by provision of: (2) Outdoor activity areas that are easily accessible to residents, protected from traffic, and have adequate shady areas.Based on observations the Administrator failed to meet this requirement by storing large ammounts of objects unerneath the shaded sitting area.

Passageways and stairways kept clear

87307 Personal Accommodations and Services(d) The following space and safety provisions shall apply to all facilities:(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. Based on observations made by LPA the Administrator failed to meet this requirement by containing large objects along the passage ways of the side exits making the exits inaccessable which poses a potenial saftey risk to residents in care.

Maintain admission agreement and appraisal

Based on interview and record review, Resident #3 did not have a signed admission agreement on file, which poses a potential health, safety or personal rights risk to persons in care.

Based on interview and record review, the licensee did not have First Aid certification for himself or staff on duty at the time of the visit, which poses a potential health, safety or personal rights risk to persons in care.

Based on record review, Staff #2 does not have 20 hours of training at the time of the visit, which poses a potential health, safety or personal rights risk to persons in care. Staff #2 has 12 hours of training.

Based on record review, the licensee did not conduct quarterly emergency drills with staff and residents, which poses a potential health, safety or personal rights risk to persons in care.

Based on observation and recored review, the licensee did not comply with the section cited above by not having valid libility insurance which poses an potential health, safety or personal rights risk to persons in care.***THIS IS AN EMDED REPORT***

Mark taps at high-temperature threshold

Based on observation, the licensee did not comply with the section cited above by hot water measuing 126.6 degree F which poses an immediate health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above by having uncleared backyard nor space for residents activity which poses an potential health, safety or personal rights risk to persons in care.***THIS IS AN AMENDED REPORT***

Based on observation, the licensee did not comply with the section cited above by which poses an potential health, safety or personal rights risk to persons in care.***THIS IS AN AMENDED REPORT***

Address and clearance obligations before facility work

(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:This requirement is not met as evidenced by: Based on LPA's observation, new staff does not have background clearance to be at the facility. This poses an immediate health and safety risk to residents in care.

Certified administrator requirements and substitute coverage

Administrator - Qualifications and Duties ... facilities shall have a qualified and currently certified administrator. 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. This requirement is not met as evidenced by:Based on LPA's observation, facility lacks enough staffing and back up administrator while away, which poses an immediate health and safety risk to residents in care.

Report specified resident events within seven days

Reporting Requirements ... (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to ...This requirement is not met as evidenced by: Based on LPA's observation, licensee can not recall if the incident on 02/01/2023 was reported to CCLD. LPA searched past SIRs during the time of incident and there is no LIC624 reporting the incident from the facility.

Care and supervision as defined by statute and rules

Basic Services ... Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not being met as evidenced Based on interview and review of documents licensee failed to supervise R1 in which they left the facility unassisted and ended up at emergency at hospital.

"Care of Persons with Dementia" ... Each resident with dementia shall have an annual medical assessment ... done at least annually ... of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidence by: Based on LPA's review of resident records, LPA discovered outdated Physician Report sign and dated by Physician 02/17/2023.

Licensee must supervise facility operations

(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 evidence by faciltiy received a notice to pay electricity bill or face a disruption in service. This poses an immediate health and safety risks to persons in care.

87211(a)(1)(D) Reporting Requirements. Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following…A written report…Any incident which threatens the welfare, safety or CONTINUED... health of any resident…This requirement is not met as evidence by: Licensee failed to submit a written report to the Licensing agency regarding R1’s unwitnessed fall in October of 2022 or hospitalization on 8/26/22. This poses a potential risk to residents in care.

Required administrator qualifications listed in this subsection

87405(d) Administrator- Qualification and Duties. The administrator shall have the qualifications specified…Knowledge of the requirements for providing care and supervision … and ability to conform to the applicable laws, rules and regulations. This CONTINUED... CONTINUE...requirement was not met as evidence by: Administrator failed to ensure the facility was properly staffed; failed to submit necessary written reports to licensing and failed to seek appropriate medical attention for R1. This poses an immediate risk to residents in care.

Facility personnel sufficiency and competence

87411(a) Personnel Requirements- General. 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 evidence by: The facility failed CONTINUED... CONTINUE...to seek immediate medical attention for R1 in part due to the caregiver needing to care for two other residents. The facility lacked sufficient staffing to be able to meet the resident’s need for immediate medical attention. This poses an immediate risk to residents in care.

Document behavioral expression and related causes

87463(c) Reappraisals. The licensee shall arrange a meeting … when there is significant change in the resident’s condition, or once every 12 months, whichever occurs first. This requirement was not met as evidence by: Following R1’s fall the facility failed to CONTINUED... CONTINUE...complete a reappraisal despite R1 being unable to walk. R1 was able to walk with assistance prior to fall. This poses a potential risk to residents in care.

Call 9-1-1 for imminent health threats

87465(g) Incidental Medical and Dental Care. The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health…This regulation was not met as evidence by: Resident was found on ground CONTINUED... CONTINUED...following an unwitnessed fall sometime in October of 2022. Despite reporting hip pain and being unable to walk, no medical attention was sought. R1 was transferred to the hospital approximately a month later and diagnosed with a hip fracture.

Include medical assessment and special precautions

(b) Each resident’s record shall contain at least the following information:(10)Reports of the medical assessment specified in Section 87458, Medical Assessment, and of any special problems or precautions.This requirement was not met as evidenced by:During today's record review CONT... LPA Quiroz did not observe physician reports for R1 and R2. This was verified wtih L/AD Mai who indicated not having physician reports for R1 and R2 indicating they were admitted without a physician report. This poses an immediate risk for residents in care.

87705(f)(1)(2):Care of Persons With Dementia(f) the following shall be stored inaccessible to residents with dementia:(1) Knives, matches, firearms, tools, and other items that could constitute a danger to the resident(s). (2) OTC medication, supplements or vitamins, alcohol, cigarettes & CONTINUE... CONT...toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by while LPA Quiroz conducted tour along with L/AD Mai between 9:53am-12:50pm, LPA Quiroz observed pair of scissors in kitchen area, diabetic CONT...

Prohibit false or misleading facility statements

False Claims 87207: No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was met as evidenced by: Upon arrival to facility, L/AD Mai CONTINUED... CONT...indicated Caregiver had just left to go get bread to eat. During interview conducted with caregiver, Caregiver indicated she had not been present at facility since 2/2/23. This was verified with L/AD Mai. This poses an immediate risk to residents in care.

Report serious outbreaks and major accidents

Reporting Requirements-87211(a)(2)(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(2) Occurrences, such as epidemic outbreaks...which threaten the welfare, safety or health CONT... of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement was not met as evidenced by: During today's record review for R1, LPA Quiroz observed resident's discharge

Keep bath, laundry and kitchen floors clean

Maintenance and Operation (87303)(a)(1):(a) The facility shall be clean, safe, sanitary and in good repair at all times... for the safety and well-being of residents, employees and visitors.(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. CONTINUED... This requirement is not being met as evidenced by, between 9:53am-12:50pm while LPA Quiroz toured facility along with L/AD Mai, LPA Quiroz observed food particles and grease stains on the kitchen stove, kitchen counters, sink area and food crumbs on the kitchen floor area CONT...

Passageways and stairways kept clear

87307(d)(6)Personal Accommodations and Services(d)The following space and safety provisions shall apply to all facilities:(6)All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: While LPA Quiroz toured facility along CONT with L/AD Mai, LPA Quiroz observed excessive amount of storage items in garage area and back yard east side location of facility premises but not limited to: window panels, gardening tool items varying in sizes from small to large, unused items,gallons of paint CONTINUED...

Passageways and stairways kept clear

87307(d)(6)Personal Accommodations and Services(d)The following space and safety provisions shall apply to all facilities:(6)All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: While LPA Quiroz toured facility along CONT with L/AD Mai, LPA Quiroz observed excessive amount of storage items in garage area and back yard east side location of facility premises but not limited to: Toilets, sinks, window panels, tool items, unused items, CONTINUED...

87705(f)(1)(2):Care of Persons With Dementia(f) the following shall be stored inaccessible to residents with dementia:(1) Knives, matches, firearms, tools, and other items that could constitute a danger to the resident(s). (2) OTC medication, supplements or vitamins, alcohol, cigarettes & CONTINUE... CONT...toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by while LPA Quiroz conducted tour along with L/AD Mai between 10:13am-10:42am, LPA Quiroz observed knives, scissors, OTCmedications and R4's medication in bedroom area CONT...

Keep bath, laundry and kitchen floors clean

Maintenance and Operation (87303)(a)(1):(a) The facility shall be clean, safe, sanitary and in good repair at all times... for the safety and well-being of residents, employees and visitors.(1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. CONTINUED... This requirement is not being met as evidenced by, between 10:13am-10:42am while LPA Quiroz toured facility along with L/AD Mai, LPA Quiroz observed food particles and grease stains on the kitchen stove, kitchen counters, sink area and food crumbs on the kitchen floor area CONTINUED...

Facility personnel sufficiency and competence

Personel Requirements-General-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.This requirement is not met as evidenced by; Records reviewed and interviews conducted disclosed that residents present during the visit were non-ambulatory, had limited mobility and needed assistance with all ADL's due to their cognitive ability. LPAs observed only 1 staff present during the visit.This poses an immediate health and safety risk to residents in care.

Personal Accomations and Services- Resident bedrooms shall meet the following requirements; No bedroom of a resident shall be used as a passageway to another room, bath or toilet.This requirement was not met as evidenced by Residents are being showered in the master bedroom that is being occupied by Resident #3.

Criminal Record Clearance-All individuals subject to a criminal record review shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption (2) Request a transfer of a criminal record clearance. This requirement was not met as evidence by; Staff #1 has been working at the facility for approximately 1 month and does not have a criminal record clearance through the Department.This poses an immeidate health and saftey risk to residents in care.

87705-Care of Persons With Dementia(f) the following shall be stored inaccessible to residents with dementia:(1) Knives, matches, firearms, tools, and other items that could constittute a danger to the resident(s). (2) OTC medication, supplements or vitamins, alcohol, cigarettes & toxic substances such as plants, gardening supplies,and disinfectants.