Atienza Residential Care

87465(c)Incidental Medical and Dental Care …facility staff designated by the licensee shall be permitted to assist the resident with self-administration… (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Based LPA observations, interviews and record reviews, Licensee unable specify dates medications were administered. There was no Medication Administration Record (MAR) or any documentation of medications administered. Which poses immediate health, safety to persons in care

(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (11)To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon...this requirement is not met as evidenced by: The Licensee did not comply with section cited above by staff not granting Ombudman entry into the facility; which poses a potential health, safety, and personal rights risks to persons in care.

87468.1(a)Residents in all residential care facilities for the elderly shall...personal rights(3)... free from punishment,.. abuse, or other actions of a punitive nature, such as withholding residents’... interfering with daily living... This is evident by Licensee not... Based on LPA interviews, Licensee did not comply with section cited above by not ensuring R1 was free from physical abuse, which poses a potential health, safety, and personal rights risks to residents in care.

87555(b) The following food service requirements shall apply:(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food... shall not be accepted, used or retained. This requirement is not met as evidenced by: Based on observation, the licensee had expired non-perishable items. Licensee did not comply with the section cited above in not providing safe and of quality food to 4 out 4 residents which poses an potential health, safety and personal rights risk to persons in care.

87465(h)The following requirements...(2) Centrally stored medicines shall be kept in a safe and locked...(5)Each resident's medication shall be stored... No medications shall be transferred...This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by making medications accessible to 4 out of 4 residents which poses an immediate health, safety and personal rights risk to persons in care.

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 ...This requirement is not met as evidenced by: Based on observation, LPA observed inside the facility a hole in the hallway wall adjacent to the garage door entrance which poses an potential health, safety and personal rights risk to persons in care.

87775(a) Any duly authorized officer, employee or agent of the licensing agency may, upon proper identification and upon stating the purpose of his/her visit, enter and inspect the entire premise of any place providing services at any time, with or without advance notice..this requirement is not met as evidenced by: The licensee did not comply with the section cited above by not allowing LPA entry into the facility, which poses and immediate health, safety, and personal rights risk to persons in care.

87628 Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes... including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with section cited above by not following the physician's order of (R1) which poses an immediate Health and Safety and personal rights risks to residents in care.

87628 Diabetes (b) (4) In addition to section 87611, General requirements for allowable health conditions, the licesnee shall be responsible for the following: Providing modified diets...physician as specified in Section 87555 (b) (7). This requirement is not met as evidenced by: Based on interviews and records review, the Licensee did not comply with section cited above by not following and providng a proper diet for clients which poses a Potential Health and Safety and personal rights risks to residents in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above by not ensuring the facility has the 72hour Emergency food supply available which poses a potential 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 tracking the medication administered to each client in care which poses an immediate health, safety or personal rights risk to persons in care.

Based onobservation, interview, and record review, the licensee did not comply with the section cited above by not having a First Aid Manual avaliable upon request which poses a potential 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 ensuring the Resident 1 (R1) and resident 2 (R2) had a current physican report which includes the tuberculosis (TB) results which poses an immediate health, safety or personal rights risk to persons in care.

(g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations or.. This requirement was not met as evidence by: Based on interviews with staff #1, LPA's Farlow and Conchas determined that the licensee did not obtain S! criminal backgorund clearnace prior to employment which poses an immeddiate health, safety and personal rights risk to residents in care.Deficiency will be issued

All residents records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Based On LPA's observation and record review licensee did not have updated client files which were missing pertinent documents missing signature on admission agreement, Physician Report, Needs and Service plan and Emergency contact.

Licensee shall ensure the personnel records are maintained on the licensee, administrator and each employee... (c)Licensee shall maintain in the personnel records verification of required staff training and orientation.(g) All personnel records... for review Based On LPA's observation and record review licensee did not have updated staff files which were missing Personnel records, health screening report, Criminal record report, verification of training

87465(h)(2) Centrally stored medication... locked in place that is not accessible to persons other than employees responsible....(i)Prescription or medication which are not taken with resident upon termination of service...to be disposed of and destroyed by facility...not a resident. Based on LPA's records review and observation, the licensee did not ensure all residents medication was centrally stored and kept safe and locked away and inaccessible to residents in care. LPA's also observed expired medications still in facility as well as medications from previous residents not centrally stored and locked and inaccessible to residents in care.

Except as specified in subsection (b)the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches tools, sharp objects... locked storage. Based on LPA's observations sharps, knives and chemicals were seen in pantry, garage and bathroom unlocked, not secured and accessible to clients.

Resident RecordsThe 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 was not met as evidenced by: During time of visit, Administrator confirmed the records for resident #1 were at a different location and not available for review.

Safeguards for Resident Cash, PersonalProperty, and ValuablesExcept as provided in approved continuing care agreements, no licensee or employee of a facility shall:accept any general or special power of attorney for any such person; This was not met was evidenced by: Documentation was obtained that reveals, staff #1 associated to the facility became POA for resident #1.

87207 False ClaimsNo 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 was not met as evidenced by: Documentation was obtained that reveals, staff #1 associated to the facility became POA for resident #1 and altered such document to provide separate services and/or treatments

General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)...This requirement was not met as evidenced by: Based on interview with Staff #2 (S2), LPAs Brown and Allen determined that the Licensee did not ensure that Staff #3 (S3) criminal background clearance was transferred to the facility prior to employment which poses a potential and personal rights risks to residents in care.

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General.this requirement is not met as evidenced by... Based on observation interview and record review the licessee did not comply with the cited section above by not ensuring that staff 4,3,and 5 have the required health screening report maintained in s3,s4 and s5 files which poses an immediate health,saftey ,and personal rights risk to residents in care.

87412 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) Hazardous health conditions documents as specified in Section 87411, Personnel Requirements - General .this requirement is not met as evidenced by Based on observation interview and record review the licessee did not comply with the cited section above by not ensuring that staff 4,3,and 5 have the required Tuberculousis (TB) test and TB test results maintained in s3,s4 and s5 files which poses an immediate health,saftey ,and personal rights risk to residents in care.

(a) Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions. (1) Sufficient information about the facility and its services shall be provided to enable all persons involved in the placement to make an informed decision regarding admission. LPAs Brown and Allen observed that R3 does not have the required Preplacement Appraisal as evidenced of incomplete Preplacement Appraisal (LIC603) in R3 file.

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(20) To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer .... This requirement was not met as evidenced by: Per Licensee/Administrator Armstrong and Resident #5 (R5) responsible party stated written notice of transfer was not given to them only verbal notification which poses a potential health, safety or personal rights risk to persons in care.

c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415,..This requirement was not met as evidenced by: LPAs Brown and Allen observed that the facility does not have a staff scheduled to work the night shift, awake and on duty as required for facility with dementia residentswhich poses an immediate health, safety or personal rights risk to persons in care

HSC 1569.695 Other Provisions (c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios...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 by not conducting the required fire and eathquake drill at least quarterly which poses a potential health, safety or personal rights risk to persons in care

HSC 1569.695 Other Provisions (d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation ....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 by not ensuring that the emergency disaster plan was reviewed annually and signed by the Administrator or Licensee which poses a potential health, safety or personal rights risk to persons in care.

HSC 1569.695 Other Provisions (e) A facility shall have all of the following information readily available to facility staff during an emergency: (2) An appraisal of resident needs and services plan for each resident.This requirement was not met as evidenced by: LPAs Brown and Allen observed that Resident #3 (R3) does not have the required Needs and Services Plan maintained in R3 file.

CCR 87219 Planned Activities (a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participa-tion in planned activities. The activities made available shall include: (1) Socialization...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 by not ensuring that there's planned activities at the facility for the socialization of residents and not just watching television at the living room which poses a potential health, safety or personal rights risk to persons in care.

(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may...This requirement was not met as evidenced by: Based on observation, interview and record review, the licensee did not comply with the section cited above by using the family room area as the sleeping area for Resident #3 (R3) and the staff, which poses an immediate health, safety or personal rights risk to persons in care.

87411 Personnel Requirements – General (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidence by.. Based on observations and record review the licensee didn't comply with the section above by not ensuring that staff 1, 3, 4.and 5 did not have appropriate training in first aid from persons qualified by such agencies as the American Red Cross.

(g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations or..This requirement was not met as evidenced by: Based on interview with Staff #2 (S2) and Staff #4 (S4), LPAs Brown and Allen determined that the Licensee did not obtain S4 criminal background clearance prior to employment which poses an immediate health, safety and personal rights risk to residents in care. Deficiency will be issued

87465 Incidental Medical and Dental Care (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility...This requirement was not met as evidenced by: LPAs Brown and Allen observed that R3 does not have the required record of dosages of medications that are centrally stored which poses a potential health, safety or personal rights risk to persons in care.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (3) In addition to the on-the-job trainingrequirements in Section 87411(d), staff who provide direct care to residents with dementia .... This requirement was not met as evidenced by:PAs Brown and Allen observed that Staff #2 (S2), Staff #3 (S3), Staff #4 (S4) and Staff #5 (S5) do not have the required dementia care training in hydration, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living. which poses an immediate health, safety or personal rights risk to persons in care.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (3) In addition to the on-the-job trainingrequirements in Section 87411(d), staff....This requirement was not met as evidenced by: LPAs Brown and Allen observed that Staff #2 (S2), Staff #3 (S3), Staff #4 (S4) and Staff #5 (S5) do nothave the required dementia care training in Recognizing the effects of medications commonly used to treat the symptoms of dementia.which poses an immediate health, safety or personal rights risk to persons in care

(a) The Department may prohibit an individual from serving as a board of directors, executive director, or officer; being employed or allowed in a licensed facility as specified in Health and Safety Code Sections 1569.58 and 1569.59. Health and Safety Code Section 1569.58 reads in part:.. (g) A licensee's failure to comply with the department's exclusion order after being notified of the order shall be grounds for disciplining the licensee pursuant to Section 1569.50.This requirement was not met as evidenced by: Based on LPAs and interviews with Caroline Armstrong and resident S1 has been allowed at the facility on 11/3/2024 after receiving an exclusion letter.

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following...:This requirement was not met as evidenced by: LPAs Brown and Allen observed that staffs at the facility are not assisting R1, Resident #2 (R2) and R3 with their self-administered medications per their physician’s order as there’s no record at the facility that indicated they are assisting R1. R2 and R3 which poses an immediate health, safety or personal rights risk to persons in care.

c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any, and the licensee or the licensee’s designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. LPAs Brown and Allen observed Resident #1 (R1) and Resident #3 (R3) Admission Agreement do not have the required signature and signature date of R1 and R3 or their Representative.

(a) The Department may prohibit an individual from serving as a board of directors, executive director, or officer; being employed or allowed in a licensed facility as specified in Health and Safety Code Sections 1569.58 and 1569.59. Health and Safety Code Section 1569.58 reads in part:... (g) A licensee's failure to comply with the department's exclusion order after being notified of the order shall be grounds for disciplining the licensee pursuant to Section 1569.50.This requirement was not met as evidenced by: Based on LPAs and interviews S1 has been allowed at the facility after receiving an exclusion letter.

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (h) All personnel records shall be retained for at least three (3) years following termination of employment....This requirement is not met as evidenced by: During the visit LPA Allen requested personnel files that could not be provided.

All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant ...... This requirement is not met as evidenced by: Based on LPA observation,and interviews, the licensee did not comply with the section cited above LPA observed R1 in bedroom #3 which was is not cleared by the fire department for non-ambulatory residents.

(a)-(b)Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days ...... This requirement is not met as evidenced by:LPA requested the special incident report (SIR) for R1 that could not be provided during visit.

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 is not met as evidenced by: Based on LPA observation,and interviews, the licensee did not comply with the section cited above LPA request facility files for R1,R2,R3 and R4 that could not be provided or was incomplete for review.

Based on LPA's observations,interview, record review, the licensee did not comply with the section cited above the licensee did not ensure that the residents files were not complete with information, invalid information and could not be located. This poses a potential health and saftey concern for the residents in care.

Based on interviews,and record review the licensee did not comply with the section cited above the licensee has been informed of past due facility fee's which poses/posed 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 the licensee has not complied with the fire clearance request made by the City of Beaumont fire Marshal dated May 10,2022 listing five (5) non-compliant orders issued which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA observation,interview, and record review the licensee did not comply with the section cited above LPA observed R1 in bedroom #3 which was is cleared by the fire department for non-ambulatory residents which poses an immediate health, safety or personal rights risk to persons in care.

Based on interview and record review the licensee did not comply with the section cited above the licensee has not paid the past due annual fee's. which poses a potential health, safety or personal rights risk to persons in care.

87777- Exclusions(1) Health and Safety Code Section 1569.58 reads in part:(g) A licensee's failure to comply with the department's exclusion order after being notified of the order shall be grounds for disciplining the licensee pursuant to Section 1569.50.This requirement is not met as evidenced by: Based on observation, interview and document review, the licensee failed to comply with the immediate exclusion order issued on 6/3/2024 which poses an immediate health, safety, or personal rights risk to persons in care.

87468.1 (a)(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:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by: Video footage of the S1 retrieving R1 for a location outside the facility making statements to him that did not accord dignity in their personal relationships with staff and resident.

87468.1 (a)(3) 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..This requirement is not met as evidenced by: Video footage of the S1 retrieving R1 for a location outside the facility forcefully pulling R1 by the arms to retrieve and relocate R1 back to the facility.

(a) Residents of residential care...shall have all of the following rights: (5) To be accorded safe, healthful, and comfortable accommodations, furnishings...this requirement is not met as evidence by: Licensee/Administrator did not comply with regulation cited above by staff#1's inappropriate conduct in the presence of residents and Licensing Agency representative when poses an immediate health, safety or personal rights risk to persons in care.

(a) Living accommodations and grounds...The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement is not met as evidenced by: Licensee did not comply with section cited above by staff #1 sleeps in the bed located next to dining table; which poses a potential health, safety, and personal rights risks to residents in care.

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (1)The following...shall be documented:(A)For staff who assist with personal activities of daily living, there shall be documentation of at least ten hours of initial training within the first four weeks of employment, and at least four hours of training annually thereafter...this requirement is not met as evidenced by: Licensee/Administrator did not comply with regulation cited above by hours of training for both S1 and S2 were not maintained in facility files; which poses a potential health, safety or personal rights risk to residents in care.

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. This requirement is not as evidenced by: Licensee did not comply with section cited by S1 and S2 did not have personal telephone numbers, education and/or employment history on file for review; which is a potential health, safety, or personal rights rights to residents in care.

87211- Reporting RequirementsEach licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: 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 This requirement is not met as evidenced by:Caroline Armstrong or staff did not report that resident 1 left the facility without staff members knowledge.

Care of Persons with DementiaPlan of Operation, the plan of operation shall address the needs of residents with dementia, including:Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials.This requirement is not met as evidenced by: Resident 1 was missing from the facility and was reported to be found at San Gorgonio Hospital. R1 left the facility without staff's knowledge on 8/22/2023.

80020 Fire Clearance(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by: The licensee did not comply with the City Of Beaumont Fire Marshal non-compliance order.

87203 Fire Safety 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 requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by having a door that separates rooms 1 and 2 from the remainder of the living space without approval from the City of Beaumont Fire Marshall as it did not meet the egress or secured perimeter requirements per Fire Safety Inspection last 07/24/2019 which pose immediate health, safety, and personal rights risks to clients 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) of R1's falls to CCLD ASC. This poses a potential Health and Safety risk to the resident in care.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia ... (3) In addition to the on-the-job training requirements in Section 87411(d), staff who provide direct care to residents with dementia shall receive the following training ... (A) Dementia care including, but not limited to... 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 providing the appropriate Dementia training to S2 as required which pose immediate Health and Safety risk to the resident in care.