Kaego's Richman Gardens

Based on documents, the licensee did not ensure R1, R2, R3, R4, and R5 had appraisals updated within the past year, which poses a potential safety risk to persons in care.

Care of Persons with Dementia- The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. This requirement was not met as evidenced by: Based on interviews conducted, Two of two staff confirmed auditory alarms are turned off and one staff reported alarms are difficult to hear resulting in R1 elopement and subsequent injuries. This poses an immediate health and safety risk to residents in care.

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 req is not being met as evidenced by: Based on observation, Licensee failed to ensure fire safety is being conformed to. Exit gates are secured by either a keypad or key locks prohibiting residents from leaving in an emergency. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED

False Claims- 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 req is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure employees did not make false claims regarding R1’s fall. Two caregivers confirmed providing false statements to R1’s family which was which was confirmed by R1’s family. This poses an immediate health and safety risk to residents in care.

Basic Services- Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This req is not being met as evidenced by: Based on interviews conducted, Licensee failed to ensure R1 received appropriate care and supervision resulting in R1 eloping and sustaining multiple injuries including a fractured jaw. This poses an immediate health and safety risk to residents in care. CIVIL PENALTY ASSESSED.

Outdoor facility space used for resident recreation and leisure shall be completely enclosed by a fence with self-closing latches and gates, or walls, to protect the safety of residents. This requirement was not met as evidence by: Based on interviews conducted, Two of two staff reported observing staff propping open exterior leading gates for ease of access, thus, incapacitating the ability to self close and latch. This poses an immediate risk to safety to residents in care.

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 req is not being met as evidenced by: Based on observation, Licensee failed to ensure facility is in good repair. Exit gate on north side of property has a broken delayed egress push lever. This poses a potential health and safety risk to residents in care.

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 req is not being met as evidenced by: Based on observation, Licensee failed to ensure fire safety in the facility. All exit gates are locked posing an immediate health and safety risk to residents in care.

Based on observation, the hot water tested at 126, 138, 85, and 109 degrees F in the Tea Rose, Jasmine Calla Lilly, and Apple Blossom buildings, respectively, which poses an immediate safety risk to persons in care.

87468.2 Additional Personal Rights… (a) … (19) To have prompt access to review all of their records ... within two (2) business days... This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not ensure R1 had access to their records within two business days of the request dated December 28, 2023, which poses a potential personal rights risk to persons in care.

… all residential care facilities for the elderly … shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not maintain liability insurance covering injury to residents and guests in the amounts specified which posed an immediate Health, Safety, or Personal Rights risk to up to 26 persons in care.

Based on records, the licensee did not ensure 4 out of 5 resident files reviewed contained a current appraisal, which poses a potential health and safety risk to persons in care.

Based on records, the licensee did not ensure 4 out of 5 staff files contained documentation of staff training, which poses a potential health and safety risk to persons in care.