Citrus Hills Assisted Living

Per CCR 87606(a)(5)(B) on Postural Supports: "Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails." This requirement is not met as evidenced by: Based on observation and records reviewed, resident R1 was placed in a bed equipped with half rails functioning as full rails despite not receiving hospice care at the time. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Clean linen quantity and hygiene supplies

Per CCR Personal Accomodations and Services: "(...) the licensee shall assure provision of: Clean linen(..) The quantity shall be sufficient (...) to ensure that clean linen is in use by residents at all times."This requirement is not met as evidenced by: Based on observation and records reviewed, resident R1 was positioned on a bare mattress during the initial investigation visit. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Maintain facility in clean, safe, sanitary condition

(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 is not met as evidence by the kitchen sink does not have hot water. The facility is still able to boil water for cooking, this poses a potential health and safety risk to persons in care.

Provide resident hot water for personal care

(e) Water supplies and plumbing fixtures shall be maintained as follows:(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... ... 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 is not met as evidence by water is not maintained at regulation temp. This poses a potential risk to persons in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include the provisions of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: During a tour of the physical plant, LPAs inspected resident room 105. LPAs observed that the closet doors in resident room 105 were dismantled and not in their appropriate position. This poses a potential health and safety risk to resident in care.

Immediate disposal of contaminated food

Based on observation the licensee did not comply with the section cited above as multiple food items were observed to be expired in the kitchen which poses an immediate health, safety and personal rights risk to persons in care.

Personal assistance and care for required daily activities

Basic services shall at a minimum include: Personal assistance and care as needed by the resident, with those activities of daily living such.. assistance with taking prescribed medications,..This req is not being met as evidenced by: Based on record review, Licensee failed to ensure resident was provided assistance with taking medication. This poses an immediate health and safety risk to residents in care.

Each resident with dementia shall have an annual medical assessmentt, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This req is not being met: Based on record review, Licensee failed to ensure R1 received an updated physician report due to diagnosis of Dementia. This poses a potential health and safety risk to residents in care.

Maintain facility in clean, safe, sanitary condition

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 evidence by: Based on observations and interviews with the resident some screen doors do not open/slide and/or are in disrepair. This poses a potential health, safety or personal rights risk to persons in care

Safe, healthful, comfortable accommodations

87468.1- Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities...(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement is not being met as evidenced by: LPA Observations and interview confirmation from a residents who admitted to smoking right outside their room on the patio area/space available to the resident. The area the resident smokes in is not a designated smoking area. This presents a potential health, safety, and personal rights to resident in care.

12) To wear their own clothes; to keep and use their own personal possessions, including their toilet articles; and to keep and be allowed to spend their own money.This requirement was not met as evidenced by... R!'s clothes were thrown out by the facility without there knowledge and permission. This poses an immediate Health and Safety and/or Personal Rights risk to residents in care.

Allowing diabetic residents based on self-management ability

The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens..., or has it administered by an appropriately skilled professional. This req is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure glucose testing is performed by an appropriately skilled professional. Staff are performing glucose checks on R1. This poses an immediate health and safety risk to residents in care.

Care and supervision as defined by statute and rules

(f) 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 was not met as evidence by Resident 1 (R1) was able to elope a second time. This poses an immediate heath and safety risks to persons in care.

Give PRN medication by physician order

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing...facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidence by: staff admitted not administering R1’s medications when arriving to the facility late if intoxicated; however, no proof could be found that the facility requested written instructions from R1’s physician regarding the resident mixing alcohol and medication.

Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: based on record review and interviews the Licensee did not ensure the medication, Hydrocodone-Acetaminophen, for R1 was given according to physician's orders (PRN) from 4/17/23 to 4/19/23 when requested by R1. This poses an immediate risk to the health & safety of residents in care.

Maintain facilities for fire and panic safety

Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.This requirement is not met as evidence by: LPAs observed evidence of residents smoking cigarettes and marijuana in their rooms and there are residents in the facility that utilize oxygen. This poses an immediate risk to the health and safety of residents in care.*This is an amended report.**$500 Civil Penalty Assesed.

Night supervision when dementia residents require it

87705 Care of Persons with Dementia... In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: Safety measures to address behaviors such as wandering.. This requirement was not met as evidenced by: Based on observation, file review and interviews, facility failed to provide safety measures to address the wandering behavior of R1. R1 was able to leave the facility without assistance. This poses an immediate risk to residents in care.

Fire approval and staff access to unlock systems

Based on [(observation) (interview), the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Keep bath, laundry and kitchen floors clean

87303(a)(1)Maintenance and Operation(a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include...(1)Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. CONTINUED BELOW This requirement was not met as evidenced by: On 11/23/2021 and today's date at 12:45pm, LPA Quiroz along with (MD) Mims toured the facility, LPA Quiroz observed spider webs, dust, trash throughout hallways, hallways lamps,underneath resident's beds and floor area CONTINUED...

Safe, healthful, comfortable accommodations

87468.1 (a)(2)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, furnishings and equipment.CONTINUED BELOW This requirement was not met as evidence by: During today's visit, upon LPA Quiroz's arrival, LPA Quiroz was not properly COVID-19 screened at facility entrance. This poses a potential risk for residents in care.

Maintain facility in clean, safe, sanitary condition

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 evidence by: CONTINUED BELOW On or about On or about 11:33am LPA Quiroz along with Operations Manager (OM) Poemape hole on ceiling cover on left wing of facility on first floor, broken screen door in Room #115 and broken and missing blinds in Room #107. This poses a potential risk for residents in care.