Jade Guest Home

87412(f) All personnel records shall be available to the licensing to inspect, audit, and copy upon demand during business hours.(g) All personnel records shall be maintained at facility & be available to the licensing for review. This requirement is not met as evidence by: Personnel Records are not available at facility for review or copy. This poses a potential risk, personal rights to the health and safety of residents in care.

Maintain separate complete record for each resident

87506 (a) resident records. The licensee shall ensure that a separate, complete, & current record is maintained for each resident in the facility or in a central location available to staff and to licensing staff. This requirement is not being met as evidence by: Records for residents were not complete for R1 and R2. Records were missing required documents for Admission. This poses a potential risk, personal rights to the health and safety of residents in care.

The licensee shall complete an individual written Admission Agreement as defined in section 87101(a), with ea resident or rep, if any: text of the Admin agreement, including any attachments & modifications, shall be printed in black type of not less then 12 point on plain paper. This requirement is not being met as evidence by: Facility had two of four resident agreements modified with handwritten changes. This poses a potential risk, personal rights to the health and safety of residents in care.

**AMENDED REPORT** Safeguards for resident cash, personal property & valuables. Upon discharge of a resident ,all cash resources, personal property & valuables, of that resident...shall be surrendered to resident or responsible person. A signed receiprt shall be retained. Based on investigation this requirement was not met as evidenced by facility failed to transfer personal belongings in a timely manner. R1 has been out of facility since 6/30/25. This poses a potential health & safety risk to residents in care.

Use slip-resistant surfaces in bathing areas

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. LPA observed a shower chair; however LPA did not observe a non-skid floor mat in two of two restrooms.

Notify agency before locking doors or gates

Based on observation, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. During the tour LPAs observed knives and scissors in an unlocked kitchen drawer. Per caregiver she locks the knives in the staff bedroom at night.

Acceptance obligations tied to pre-admission appraisal needs

Based on observation, interview and record review, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care. Per preplacement appraisal dated 10/21/23 under Services Needed it states that Resident 1 (R1) needs help with medication. LPA observed that PM Buspirone 5mg and PRN Hydrocodone-Acetamin were out of pills.

Ensure hazardous items are locked and not unattended

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. LPAs observed a Comex bleach powder cleaner and a liquid bleach cleaner on the first restroom, next to the living room. Chemicals were observed to be unlocked.

Prompt responses to resident communications

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: (9) To have communications to the licensee from their representatives answered promptly and appropriately. Based on interviews conducted, the Licensee did not comply with the section cited above due to the Ombudsman's request for records not being fulfilled and no further communication regarding the request being made.

Resident Records. 87506(b)Each resident’s record shall contain at least the following information: (2) Social Security number.Based on record review, Licensee did not comply with the section cited above due to one resident's file not having a social security number documented.

(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 Residents 1 special diet. This poses a possible 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.

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 hallway.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 is nonoperational and fire door leading to resident bedrooms is proped open, this poses an immediate safety risk to persons in care.CIVIL PENALTY ASSESSED.

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. This poses an immediate health risk to persons in care.

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 missing screen in facility ktichen slider, 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 patiowalkway which poses a potential health 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 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.

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 cleanings solutions left unsecured in the cabinet under the sink.

Requirements for locking exterior exits

Based on observation made during the inspection visit, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Maintain separate complete record for each resident

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

Dignity in personal relationships

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

Store centrally held medications in locked secure place

Based on observation and interviews conducted during the visit, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Address and clearance obligations before facility work

Based on observation, interview and record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Keep bath, laundry and kitchen floors clean

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