Cyecrest Guest Home

Facility personnel sufficiency and competence

Per CCR 87411(a), “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:Based on interviews and records reviewed, there were only two staff on schedule overall for three residents on hospice at the time of the complaint being filed, with no provisions for time off or unscheduled absences. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.

Enumerated rights; severability (21) “To have prompt access to review all their records and to purchase photocopies. Photocopied records shall be promptly provided, not to exceed two business days, at a cost not to exceed the community standard for photocopies”. This requirement is not met as evidenced by: Based on records reviewed, R1’s authorized representative requested R1’s file on April 18, 2022, and had not received applicable documentation at the time of the present complaint being filed in July 2022. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Per Health and Safety Code, “On and after July 1, 2015, all residential care facilities for the elderly (…) shall maintain liability insurance covering injury to residents and guests (…) caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees”. This requirement is not met as evidenced by:Based on records review, facility insurance coverage lapsed prior to its renewal in February 2022. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.

Per HSC "bedridden persons may be admitted to, and remain in, residential care facilities for the elderly that secure and maintain an appropriate fire clearance”.This requirement is not met as evidenced by:Based on records reviewed and interviews conducted, R1 was bedbound and unable to reposition independently, which made R1 effectively bedridden. No such provision is allowed is the facility’s fire clearance. This constitutes an immediate risk to the health and safety of individuals in care. CIVIL PENALTY ASSESSED.

Reporting Requirements (1) : “A written report shall be submitted to the licensing agency.. within seven days of the occurrence of any of the events.. Any incident which threatens the welfare, safety or health of any resident.. This requirement was not evidenced by: Based on a review of records, the Licensee did not submit an incident report to Community Care Licensing regarding a fall R1 sustained while in care of the facility. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Financial plan and required reporting obligations

Per CCR 87213, “The licensee shall have a financial plan (…) that assures sufficient resources to meet operating costs for care of residents”.This requirement is not met as evidenced by: Based on records reviewed, bank statements provided failed to evidence a minimum of three months’ operating costs on hand. This constitutes an immediate risk to the health, safety and personal rights of individuals in care.

Training documentation requirements

Per CCR “The licensee shall maintain documentation pertaining to staff training in the personnel records”. This requirement is not met as evidenced by: Based on records reviewed during the investigation, no initial or annual training was documented. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Obtain baseline medical assessment before resident admission

Medical Assessment: “(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record”. This requirement is not met as evidenced by: Based on records reviewed during the investigation, the physician report on file for R1 was not signed. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Record findings for communicable tuberculosis conditions

Per CCR 87458(c)(1)(A), “prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment (…) made within the last year, to be kept in the resident's record. (c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis”. This requirement is not met as evidenced by: Based on records reviewed, the medical assessment obtained upon R1’s admission fails to include any information. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Document required significant condition changes

Per CCR 87463(b): “The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition”. This requirement is not met as evidenced by: Based on records reviewed, R1’s change of condition towards active transitioning is not documented. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Include required health screening documents

Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. Based on staff file review, LPA observed that there is not a Health Screening Report on file for Staff #1 (S1) and Staff #2 (S2).

Update reappraisal at required intervals

Based on record review, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care. Based on resident file review, LPA observed that the Reappraisals for Resident #1 (R1), Resident #3 (R3), and Resident #4 (R4).

Grounds for eviction listed for residents

Eviction Procedures- The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required. In addition, the Licensee must notify or mail a copy of the notice to quit to the resident's responsible person. This requirement was not met as evidenced by: Licensee failed to give Resident #1 and/or her responsible party a 30 day written notice of evictionThis poses an immediate Health and Safety and/or Personal Rights risk to residents in care.

Fire Clearance-Prior to accepting or retaining nonambulatory and/or bedridden resident's, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by city or county fire department.This requirement was not met as evidencesd by: Resident #1 was bedridden and the Licensee did not have an approved bedridden fire clearance. This is an immediate Health and Safety risk to 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 was not met as evidenced by: During visit, LPA observed the back door exits to be tied shut and a chair and recliner pushed up against the doors. This is a Health and Safety and Personal Rights risk to residents in care.

Managed Incontinence-The licensee shall be responsible for ensuring that incontinent residents are kept clean and dry and the condition of the skin exposed to urine and stool is evaluated regularly to ensure that skin breakdown is not occurring. This requirement was not met as evidenced by: Staff could not move R1 and failed to ensure that R1 was kept clean and dry. R1 developed skin breakdown. This was evidenced by the Infection and foul odor of the Stage III pressure injury. This is a immediate health and safety risk.

Acceptance obligations tied to pre-admission appraisal needs

Basic Services- A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs either directly or through outside resources.This requirement was not met as evidenced by: R1's ADL's could not be met by staff as staff were limited and R1 was bedridden. The Licensee failed to hire more staff to meet R1's needs and failed to notify R1's doctor and/or outside resources of his wound and bedridden status. R1 was not receiving home health or hospice services. This is an immediate health and safety risk.

Prohibited Health Conditions- Persons who have a Stage 3 and 4 pressure injury shall not be admitted or retained in a residential care facility for the elderly.This requirement was not met as evidenced by: R1 was not removed from bed from 4/8/21 until R1 left the facility on 5/30/21. R1 developed a Stage III pressure injury while in care. R1 was not receiving hospice services. This is an immediate Health and Safety/Personal Rights risk to residents in care.

Facility personnel sufficiency and competence

Personnel Requirements-GeneralFacility 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: R1 was bedridden and Licensee failed to have enough staff to remove him from bed. This is an immediate Health and Safety risk to resident's in care.