Gracious Care Inc #2

Based on record review, the licensee did not comply with the section cited above by not ensuring a updated centrally stored medication log for Resident #1 (R1) was done, 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 by not having a updated liability insurance, 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 by not ensuring Staff #1 (S1) training was in S1's file/completed, 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 by not ensuring fire and earthquake drills are being done quarterly, which poses a potential health, safety or personal rights risk to persons in care.

Based on observatoin the licensee did not comply with the section cited above by not having room keys available for licensing to check locked bedroom, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above by not ensuring a plan of operation is in place for facility, which poses a potential health, safety or personal rights risk to persons in care.

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.

Based on obsevration, the licensee did not comply with the section cited above by not ensuring facility has hot water. hot water temperature tested at 74 degrees farenheit, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above by having bed located in common room, 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 by not ensuring a pre-placement appraisal or needs or services plan for R1 was located in file, 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 not having updated physician report for Resident #1 (R1) and Resident #2 (R2), 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 by not ensuring Resident #1 (R1) has a reappraisal which poses a potential health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above by having incorrect documentation of PRN medications for Resident #3 (R3). R3's medication is labeled as PRN but being given as a daily medication, which poses an immediate health, safety or personal rights risk to persons in care.

87211 Reporting Requirements (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... (A) Death of any resident from any cause. Based on record review, licensee did not comply with section cited above by not ensuring death report of former Resident #1 (R1) was provided to R1's responsible party, which poses an immediate health, safety, and personal rights risk to those in care.

87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency..(1) A written report shall be submitted to the licensing agency..(A) Death of any resident from any cause regardless of where the death occurred.. Based on record review, licensee failed to meet this requirement by not ensuring Resident #1 (R1) death was reported to licensing within seven days of occurence, which poses a potential health, safety, and personal rights risk to persons in care.

87506 Resident Records: (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. Based on record review, licensee failed to meet this requirement by not ensuring Resident #2 (R2) file was completed and located at the facility upon request, which poses a potential health, saftey, and personal rights risk to persons in care.

Based on observation and record review)], the licensee did not comply with the section cited above by not having all personnel recorsa at the facility which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation interview and record review , the licensee did not comply with the section cited above by not having a staff who had aqequate qualifications to be on premises 24 hours per day which poses an immediate health, safety or personal rights risk to persons in care.

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

Based on record review , the licensee did not comply with the section cited above by not having Plan of Operation maintain at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above by not providing the 10:45am activities for residents which poses/posed a potential health, safety or personal rights risk to persons in care.

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

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

Based on observation , the licensee did not comply with the section cited above by having facility phone off which poses/posed 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 by not having Administrators vaild requirements which poses/posed 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 by R1 not having Pre-Admission Appraisal which poses/posed 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 by R2 and R3 not having a LIC602 which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation the licensee did not comply with the section cited above by not having perishable foods for a minmum of two days which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation , the licensee did not comply with the section cited above by the hot water temperature tested at 78F which poses/posed a potential health, safety or personal rights risk to persons in care.

1569.618(a)Administration and management of residential care facilities; substituted qualifications; employee scheduling.(a)... operation of the facility when the administrator is temporarily absent from the facility. Based on observation and interview the licensee did not comply with the section cited above evidenced by Administractor admitting they not present during working hours which poses an immediate Health, Safety or personal rights risk to persons in care.

87413(a)(1) Personnel - Operations(a) In each facility:(1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks.This requirement is not met as evidenced by: Based on observation, interview and record review the licensee did not comply with the section cited above evidenced by not providing staff coverage when regular staff are on vacation

1569.618(b)Administration and management of residential care facilities; substituted qualifications; employee scheduling.(b).one ..manager..designated substitute qualifications.. responsible designated substitute shall meet..This requirement is not met as evidenced by: Based on observation and interview the licensee did not comply with the section cited above evidenced by Licensee admitting not having a designated substitute which poses an immediate Health, Safety or personal rights risk to persons in care.

87309(a) Storage Space(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. Based on observation and interview the licensee did not comply with the section cited above evidenced by not having cleaning solutions locked which poses an immediate Health, Safety or personal rights risk to persons in care.

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1) A written report shall be submitted to the licensing agency... This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by not submitting Special Incident Report (SIR) to CCL for R2 fall and R1 and R3 Death Report. This pose potential health, safety and personal rights risk to resident in care.

Based on review of records and LPA observation the licensee did not comply with the section cited above as volunteers E1 and E2 are working without supervision which poses an immediate health, safety or personal rights risk to persons in care.

Based on designee interview the licensee did not comply with the section cited above. The facility is not maintaing records for disaster drills which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on review of the record for R4 indicating bedridded status of page 5 of 6 the licensee did not comply with the section cited above as evidenced by lack of bedridden fireclearance approval, which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA observation of the last marked service tag of 01/01/2019 the licensee did not comply with the section cited above in they have not serviced or replaced their fire extinguisher annually which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA observation of volunteers left alone to provide client care the licensee did not comply with the section cited above in (2) out of (2) staff scheduled at this facility. LPA arrived and E1 was alone caring for 5 residents. THey are cleared as volunteer only which poses an immediate health, safety or personal rights risk to persons in care.

Based on the deficiencies regarding fire clearance, volunteers being left alone, fire safety, lack of updated records for residents and staff and missing training records it is evident the administrator is not available to provide the oversight needed. This poses an immediate health, safety or personal rights risk to persons in care.

Based on review of employee training records, LPA observed no traiing records are maintained. The licensee did not comply with the section cited above in (3) out of (3) records reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on lack of training records present for review the licensee did not comply with the section cited above in (3) out of (3) employee records reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on records review R1 and R2 have not had Medical Assessment updates since 2021. The licensee did not comply with the section cited above in (2) of (5) records reviewed which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on review of employee records, the licensee did not comply with the section cited above in three (3) out of (3) records reviewed which poses an immediate health, safety or personal rights risk to persons in care.

...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility The licensee is nable to fulfil their obligation to this requirement as evidenced by their inability to be at the facility due to personal circumstances.

87156 Licensing Fees(a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185. Based on interview, record review, and observation the licensee did not comply with the section cited above evidenced by a past due amount of $495.00 in licensing fees which poses a potential health, safety or personal rights risk to persons in care.

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Based on observation, record review and observation the facility is not meeting this requirement as evidenced by one caregiver working alone for since 0without 8/20/2022 without help and providing care for four residents with dementia which require physical assistance and supervision. This poses a risk to the health and safety of thestaff and residents in care.

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Based on observation, record review and observation the facility is not meeting this requirement as evidenced by one caregiver working alone for the past 24 hours without help and providing care for residents with dementia which requiring moderate physical assistance.