Mission Lake Villa, Inc.

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: (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by: Based on interviews, and record review, Licensee did not notify R1's representative when R1 was sent to the hospital. This poses a potential health and safety risk to residents in care.

Based on interview and record review, the licensee did not comply with the section cited above in based on S1's file not being avaible during the visit which poses a potential 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 in with R1 not having a centrally stored list which posed a potential health, safety or personal rights risk to persons in care.

Additional Personal Rights of Residents in Privately Operated Facilities: (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: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This did not meet the requirement by: Based on LPA evidence review, the Licensee did not provide medications as ordered by the physician. This is a potential health and safety risk to residents in care.

Reporting Requirements: (a)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 of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not being met as evidenced by: Based on interview withe staff, and record review, LPA determined that there was not a report submitted to the Department in reference to R1 going to the hospital to treat their medical condition. This poses a potential health and safety and personal rights risk to residents in care.

Criminal Record Clearance.:An immediate civil penalty of $100 a day shall be assessed if an individual subject to a criminal record review has not obtained a clearance or exemption. This requirement has not been met by During visit it was revealed that an unclear individual was present on the premise of the facility. This poses a safety risk to residents in care. An immediate Civil Penalty has been issued.

EVALUATION OF SUITABILITY FOR ADMISSION: Prior to accepting a resident for care & in order to evaluate their suitability, the facility shall...: Obtain & evaluate a recent medical assessment. This requirement was not met as evidence by: Based on interviews, the Licensee did not ensure R1's medical assessment was evaluated prior to agreeing to admit. The Administrator indicated, after receiving R1's medical assessment on 03/31/21, & after observing the resident's additional care needs, she decided the resident was not appropriate for admission. This posed a potential risk to the resident's health/safety.