The Seville of San Clemente

Basic services shall at a minimum include:Care and supervision as defined in Section 87101(c)(3) and Health and Safety Codesection 1569.2(c). This requirement is not met as evidenced by: Based on interviews conducted, Licensee failed to ensure care and supervision was provided to resident. R1 was locked outside on a patio in the early morning hours which poses an immediate health and safety risk to residents in care.

Each licensee shall furnish to the licensing agency such reports...(1)A written report shall be submitted to the licensing agency..Any incident which threatens the welfare, safety or health of any resident..This requirement is not met as evidenced by: Based on observation, Licensee failed to ensure floor construction was reported to the department which poses a potential health and safety risk to residents in care.

For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative.., written notice of the rate increase within two business days after initially providing services at the new level of care. This req is not met as evidenced by: Based on interviews conducted and record review, Licensee did not provide written notice to responsible party of increase in fees. This poses a potential health and safety risk to residents in care.

Each licensee shall furnish to the licensing agency such reports as the Department may require...Any incident which threatens the welfare, safety or health of any resident... or unexplained absence of any resident. This req is not met as evidenced by: Based on record review, Licensee failed to ensure incident involving R2 being locked outside was provided to the department. This poses a potential health and safety risk to residents in care.

87465 Incidental Medical and Dental Care (c)(2) Once ordered by the physician the medication is given according to the physician's directions.This requirement was not met as evidenced by: Based on record review, two out of seven residents' medications, R2 and R3, were not given as prescribed which poses a potential Health and Safety risk to persons in care.

87208 Plan of Operation (a) The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. This requirement was not met as evidenced by: Based on interviews and record review, S1 corroborated that assessments were conducted by self which violates the facility's plan of operation which poses a potential Health, Safety, and/or Personal Rights risk to persons in care.

87465 Incidental and Medical Care (h)(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 evidenced by: Based on observation, 31 prescription medications were observed and removed from R2's apartment.

87411 Personnel Requirements – General (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 evidenced by: Based on documents and interviews, the Licensee did not ensure that R1 was assisted in a timely manner after pressing her call button. There are numerous dates documented which demonstrate that R1 would have to wait extended periods of time to be assisted by facility staff after pressing her call button. This poses an immediate health and safety risk to people in care.

Incidental Medical and Dental Care:(a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.This requirement is not evidenced by: Based on documents and interviews, the Licensee did not ensure R1 received her medication as prescribed. Facility staff mismanaged R1’s medication on May 2, 2025, and May 16, 2025, by providing R1 the incorrect dosage of her routine medications. This poses an immediate health and safety risk to persons in care.

Whenever a certified administrator.. relinquishes responsibility for administering a residential care facility for the elderly.. shall provide written notice, within thirty (30) days, to:The local licensing office responsible for receiving information regarding personnel changes...This req is not met as evidenced by: Based on observation and interviews conducted, Licensee failed to provide notice of change of Administrator to the department which poses a potential health and safety risk to residents in care.

Based on 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.

Based on record review, the licensee did not comply with the section cited above in six out of six staff without 4 hours of training in postural support, restricted health conditions and hospice which poses a potential health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in one out of six staff without a TB screen in the file which poses a potential health, safety or personal rights risk to persons in care. Staff 5 does not have a TB test in file.

(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in... (D) Any incident which threatens the welfare, safety or health of any resident... This requirement was not met as evidence by facility did not report a fall for Resident 1 (R1). This poses a potential risks to persons in care.

2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows:(A) Licensees may use the RCFE Poster (PUB 475) or may develop their own poster A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20" x 26" in size and be posted in the main entryway of the facility. This requirement was not met as evidence by LPA did not observe PUB 475 in entryway.