Iris Guest Home

(a) The licensee shall complete an individual written admission agreement... (1) The text of the admission agreement... shall be: (A) Printed... on plain white paper. The print shall appear on one side of the paper only.This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above in five of five admission agreements, which poses a potential personal rights risk to persons in care.

Obtain baseline medical assessment before resident admission

(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...This requirement is not met as evidenced by: Based on record review, the Licensee did not comply with the section cited above in three of five resident files, which poses an immediate health, safety, and personal rights risk to persons in care.

Maintain separate complete record for each resident

Resident Records (a) Licensee shall ensure that a separate, complete, and current record is maintained for ea resident in facility or in central administrative location readily available to facility staff and licensing agency staff. Based on record review this requirement was not met as evidenced by facility failed to ensure resident records were complete. R1 is missing signatures on appraisals and missing Admission agreement.R1 is no longer at facility as of 1/6/26.This poses a potential health & safety risk to residents in care.

Based on observation, the licensee did not comply with the section cited above in which facility had several containers of yogurt and bread products with expired dates inside facility fridge, which poses a potential health, safety or personal rights risk to persons in care.

Food quality controls and rejected damaged goods

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain required personnel records for staff

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential 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. LPA observed 2 smoke detectors are not working, closet threshold is in need of repair, back right burner is inoperable and water is backing up in second restroom which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain physician order documentation in resident record

Based on observation, the licensee did not comply with the section cited above. Resident 1 does not have a physician order for bed rails which poses a potential health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on observation, the licensee did not comply with the section cited above. LPA tested water temperature in one restroom at 103.1 degrees F and was unable to test the other restroom due to sink backing up which poses/posed a potential health, safety or personal rights risk to persons in care.

Basic Services-87464(d): (a)The services provided by the facility shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care. ..This requirement was not CONT met as evidenced by: On 1/22/2024, on or about 11:40am LPA Quiroz observed Resident 3 (R3) to be unkept with maladorous scent noted and unkept, long toe nails and finger nails. This was verified with Caregiver 1. Witness indicated "The Administrator never CONTINUED...

Protection from punishment and intimidation

87468.1 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:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...CONTINUED This requirement is not met as evidenced by:During today's visit while conducting inspection tour of the facility, on or about 2:50pm, LPA Quiroz observed recording monitor in Resident's 1 bedroom. On or about 3:07pm, LPA Quiroz observed monitor in bedroom area displaying CONTINUED

Maintain cleanliness and prevent incontinence odors

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.CONT This requirement was not met as evidenced by:On 1/22/24 or about 11:58am, LPA Quiroz observed Resident 5 (R5) to have soiled diaper. Witness indicated alerting staff of soiled diaper and request to change diaper and that request was ignored. CONTINUED...

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician..., to reside in the facility and receive hospice services from a hospice agency in the facility when all of the following conditions are met: (3) Hospice agency services are contracted for by each terminally ill resident.. not by the licensee on behalf of a resident or prospective resident...This requirement was not met as evidence by Licensee signed up resident for hospice. This poses an immediate risk to persons in care

Each terminal resident needs a written hospice care plan

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician..., to reside in the facility and receive hospice services from a hospice agency in the facility when all of the following conditions are met: (4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident.. This requirement was not met as documents were not complete.

Call 9-1-1 for imminent health threats

(g) 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 including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidence facility told R1's family that he was on hospice and would be discontinued. This poses an immediate health and safety risks to person in care.

Dignity in personal relationships

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidence by: 2 out of 6 residents stated that S1 yells. This poses a potential risk to persons safety in care.

Modified diets for medical necessity

(b) The following food service requirements shall apply:(7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This requirement was not met as evidence by 1 out of 2 staff was not aware of Resident 1's prescribed diet. This poses a potential health risks to persons 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 is not met as evidenced by: Based on observation conducted at the facility, on at least (...) two separate occasions staff members were observed to be absent from the premises. This constitutes an immediate 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 was not met as evidence by LPA observed drain in bathroom 1 to have pooling when water was ran. This poses a potential safety risk to persons in care.

Maintain physician order documentation in resident record

87608(a)(3) (a) Postural Supports. Based on the individual's preadmission appraisal, and subsequent changes to that appraisal,...(3) A written order from the physician indicating the need for the postural support shall be maintained in the resident's record. This requirement was not as evidence by R2 did not have physician's orders for half bed rails. This poses an immediate health and safety risk to persons in care.

(a) The services provided by the facility shall be conducted so as to continue and promote, to the extent possible, independence and self-direction for all persons accepted for care... This requirement was not met as evidence by in 4 out of 4 residents needs and services did not provide actionable items to assist residents in any given category. This poses a potential risk to persons in care.

Maintain cleanliness and prevent incontinence odors

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met as evidence by LPA Mendivil experienced a strong body odor and urine smell from R1 & R3's room. This poses a potential health and safety risks to persons in care.

(a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). ...(5) Change of use of the facility.A) The licensee may, upon no less than sixty (60) days written notice... ... evict a resident due to change of use of the facility. This requirement was not met as evidence by Administrator verbally told residents they needed to relocate due to eviction. This poses a potential health and safety risk to persons in care.

Maintain facility in clean, safe, sanitary condition

The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not being met as evidenced by, LPAs observed a dead rodent caught in a trap in the water heater closet. This poses an immediate health and safety risk to residents in care.

Right to accept or decline care or services

To receive or reject medical care or other services. This requirement is not being met as evidenced by, a review of the medication administration record shows R1 did not receive their prescribed medications, Metformin, Simvastatin, Lisinopril and One-Daily Multivitamin on June 30, 2023. This poses an immediate health and safety risk to residents in care.

(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 is not met as evidence by; facility staff was not present when LPA arrived. This poses an immediate health and safety risk to persons in care.

(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 is not met as evidence by; Facility resident answered the door for IB due to staff leaving the facility unattended to go to another facility located in the back of the same property.

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 CCLD for an incident with R2. This poses a potential safety risk to persons in care.

Care and supervision as defined by statute and rules

87464 Basic Services(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, LPA observed a resident had left the faciltiy unassisted, when 602 stated R1 cannot leave the facility unassisted. This causes an immediate health and safety risk to persons in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operations: (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 requriement was not met as evidence by the facility had the present of rodent droppings in mulitple locations. This poses an immediate health and safety risk to persons in care.

Protection from punishment and intimidation

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...This requirement was not met as evidence by: S1 has handled residents belongings in a rough manner. This poses a potential risk safety to persons in care.

(g) Admission agreements shall specify the following:(4) Modification conditions, including the requirement for the provision of at least 60 days prior written notice to the resident of any rate or rate structure change... This requirement was not met as evidence by Administrator did not update Plan of Operations or Admission Agreement with new rate. This poses a potential risk to personal rights for persons in care.

Clean linen quantity and hygiene supplies

(3) Equipment and supplies necessary for personal care ... shall be readily available to each resident... (C) Clean linen... The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair… This requirement was not met as evidence by LPA observed linens in outside patio on 03/14/2023. This poses a potential health risk to persons in care.

Dignity in personal relationships

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidence by: 2 out of 6 residents stated that S1 yells. This poses a potential risk to persons safety in care.

Grounds for eviction listed for residents

(a) Eviction Procedures: (a)The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5). This requirement was not met as evidenced by: Administrator sent R1's responsible party a text message asking R1 to relocate.

To contact the ... ombudsman ... The licensee shall post the telephone numbers and addresses for the local offices ... and ombudsman program, in accordance with Section 9718 of the Welfare and Institutions Code, conspicuously in the facility foyer, lobby, residents’ activity room, or other location easily accessible to residents. This requirement was not met as evidence by LPA Ramirez took photographic evidence of ombudsman poster on a table in the living room. This poses a potential health and safety risk to persons in care,

87307 Personal Accommodations and Services (3) Equipment and supplies necessary for personal care ... shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: B) Bedroom furniture, which shall include, for each resident,.. a lamp, or lights sufficient for reading... This requirement was not met as evidence by 2 out of 3 residents bedrooms have missing light bulbs. This poses a potential risk to persons in care.

87303 (h) Emergency lighting shall be maintained. At a minimum this shall include flashlights, or other battery powered lighting, readily available in appropriate areas accessible to residents and staff. Open-flame lights shall not be used. This requirement is not met as evidence by Administrator stated that the facility utilizes hallway and bathroom lights on at night. Facility does not have emergency lighting set up.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operations: (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 requriement was not met as evidence by the facility had multple rodent traps, but the present of rodent droppings were still visble. This poses an immediate health and safety risk to persons in care.

Maintain cleanliness and prevent incontinence odors

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidence by the facility bedroom of R1 and R2 had a strong urine odor. This poses a potential health and safety risk to persons in care,

Admission Agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, and the licensee no later than seven days following admission. This requirement was not met as evidence by R3 did not sign agreement until 3/4/2023. R3 entered facility on 12/18/2021 This poses a potential health and safety risk to persons in care.

Personal assistance and care for required daily activities

87464 (f)Basic services shall at a minimum include:(4)Personal... assistance with taking prescribed medications...This requirement was not met as evidenced by based on interviews facility was rationing R3's medication.

Store centrally held medications in locked secure place

(h) The following requirements shall apply to medications which are centrally stored: (2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This was not met as evidenced by LPA observed unsecured medication in refrigerator this is a health and safety risk to persons in care.

The California Code of Regulations Section 87705(c)(5) on the Care of Persons with Dementia states that: "(5) Each resident with dementia shall have an annual medical assessment (...) done at least annually(...)."This requirement is not met as evidenced by: Based on a review of resident records kept at the facility, two residents with diagnosed dementia are showing medical assessments that have been conducted more than a year prior to the inspection's date. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Safe, healthful, comfortable accommodations

The California Code of Regulations 87468.1(a)(2) on Personal Rights of Residents in All Facilities states that (a) Residents (...) shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Upon arriving at the facility, LPA observed smoke detectors being triggered across the entire facility by cooking fumes. This constitute a potential risk to the health, safety and personal rights of the individuals in care.

Obtain baseline medical assessment before resident admission

The California Code of Regulations Section 87458(a) on Medical Assessment states that "Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year." This requirement is not met as evidenced by Record for one resident admitted to the facility on January 14, 2023 had a physician report showing a date of examination of November 15, 2021. This constitutes a potential risk to the health, safety and personal rights of the individuals in care.

Certified administrator requirements and substitute coverage

All facilities shall have a qualified and currently certified administrator. . When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible... This requirement is not being met as evidenced by: Based on observation and interviews conducted, Licensee failed to ensure there was a designation of responsibility issued to LPA during absence of administrator. This poses a potential health and safety risk to residents in care.

Maintain separate complete record for each resident

(a) 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 was not met as evidenced by: Administrator had files at a separate location and was unable to produce them at the facility, which poses an immediate health and safety risk.

Store centrally held medications in locked secure place

(h) The following requirements shall apply to medications which are centrally stored: (2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidence by facility had unsecured medication in the refridgerator which poses an immediate health and safety risk to persons in care.

Arrange appropriate medical and dental care

87465(a)(1)Incidental Medical and Dental Care-The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.This requirement was not met as evidenced by: On 1/4/23, R1 was sent to Dialysis in an Uber. No staff accompanied him and the Uber did not have wheelchair access. This poses an immediate health and safety risk as well as a personal rights risk to residents in care.

Facility maintenance and healthful environment

Personal Accommodations and Services-The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.This requirement was not met as evidenced by: On 1/27/2023, LPA observed rodent droppings and small cockroaches in the food pantry of the facility. This pose an immediate health and safety risk to residents in care.

Heat occupied rooms to minimum temperature

87303 Maintenance and Operation(b) A comfortable temperature for residents shall be maintained at all times.(1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). This requirement was not met as evidence by the facility thermostat read at 66 degrees.This poses a potential heatlh and safety risk to persons in care.

Record centrally stored prescriptions and refill data

(h) The following requirements shall apply to medications which are centrally stored:(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: Based on medication reviewed for Resident 1 and Resident 2 medications records failed to consistently document date medication started and medications missed. It remains unclear if medications are being given as prescribed. This poses an immediate health and safety risk to persons in care.

Maintain facilities for fire and panic safety

87203 Fire SafetyAll 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 regulation was not met as evidence by: Based on observation smoke alarm in kitchen and two bedrooms was observed non-operationalis nonoperational and fire alarm pull was observed nonoperational and taped up., this poses an immediate safety risk to persons in care.CIVIL PENALTY ASSESSED.

Maintain comfortable room temperature at all times

87303 Maintenance and Operation(b) All window screens shall be clean and maintained in good repair. This is evidence by broken and/or missing screens in multiple resident bedrooms and kitchen window, which poses a potential health and safety risk to persons in care.

Passageways and stairways kept clear

87307 Personal Accommodations and Servicesd) 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 was not met as evidence by: LPA observed discarded bike and paintings obsturcting walkway along side of house. LPA and LPM observed screws coming out of ground along other side patio/walkwa which poses a potential health and safety 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 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: LPA and LPM observed rodents and pest present in facility along with rodent droppings. LPA and LPM observed sticky brown substance on kitchen wall and broken cabinet drawers. This poses an immediate health risk to persons in care.

Store centrally held medications in locked secure place

87465 Incidental Medical and Dental Care(h) The following requirements shall apply to medications which are centrally stored:(2) Centrally stored medicines shall be kept in a safe and locked....This regulation was not met as evidence by: Based on observation LPA observed an unlocked medication cabinet in facility entryway.This poses an immediate health and safety risk to persons in care.

Requirements for locking exterior exits

The California Code of Regulations Section 87705(f) relative to the Care of Persons with Dementia indicates that: "The following shall be stored inaccessible to residents with dementia: (...) nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances" This requirement is not met as evidenced by: LPA observed sharp instruments, cleanings solutions, insecticide and/or rodenticide and nutritional supplements left unsecured throughout the physical plant.

Maintain facility in clean, safe, sanitary condition

California Code of Regulations Section 87303(a) Maintenance and Operation states that "The facility shall be clean, safe, sanitary and in good repair at all times. Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition". This requirement is not met as evidenced by: Licensing staff observed deodorizer spray making the floor wet and slippery during the inspection visit. Based on observation, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Store centrally held medications in locked secure place

The California Code of Regulations Section 87465(h)(2) relative to Incidental Medical and Dental Care indicates that: "Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication." This requirement is not met as evidenced by: LPA observed that staff present had left the door to the medication closet unlocked while conducting the inspection visit. Caregiver states that they only lock the medication "when they sleep".