Citrus Gardens

Reporting Requirements 87211(c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours as required by Welfare and Institutions Code Section 15630(b)(1). Welfare and Institutions Code section 15630(b)(1) provides in pertinent part:Any mandated reporter who… has knowledge of an incident that reasonably appears to be…neglect…shall report the known or suspected instance of abuse by telephone … a written report shall be sent, or an Internet report shall be made through the confidential Internet reporting tool established in Section 15658, within two working days.

87705 Care of Persons with Dementia (3) Facility staff shall attempt to redirect a resident at risk for elopement who may be attempting to leave the facility without violating Section 87468.1, Personal Rights of Residents in All Facilities.This requirement was not met as evidenced by: Based on interviews and record reviews, it was determined that the facility staff failed to intervene with resident elopement and is unaware on how they eloped. This poses a potential health safety or personal rights risk to residents in care.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1…elderly shall have …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…to meet their needs. This requirement was not met as evidenced by:Based on interviews and records review, the facility is not staffed sufficiently at night from 10pm to 6am to meet night supervision needs.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in 87468.1…elderly shall have …personal rights:(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers…to meet their needs. This requirement was not met as evidenced by:Based on interviews and records review, the facility is not staffed sufficiently at night from 10pm to 6am to meet night supervision needs.

Night Supervision: 87415 (a) The following persons providing night supervision from l0:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures… to assist in caring for residents in the event of an emergency. This requirement was not met as evidenced by: Based on interviews and record reviews, it was determined that staff failed to assist during an emergency involving a physical altercation between two residents. Staff were unavailable to provide timely intervention, resulting in injuries to both residents.

REPORTING REQUIREMENTS: (c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman... licensing agency, & the local law enforcement agency within 24 hours as required by 15630(b)(1). This requirement was not met, as evidenced by:Based on a record review, 6 out 6 incidents, that met LTCO reporting requirements, were not cross reported by facility staff, per Title 22. This poses a potential health and safety and personal rights risk to residents in care.

Personnel Requirements: 87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met, as evidenced by:

87465 Incidental Medical and DentalIncidental 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 was not met, as evidenced by: Based on observation, interview and record review, Medication was not administered as prescribed by physician, on two of two occasion to residents, which poses a potential health, safety or personal rights risk to residents in care.

87463(1)(E) ReappraisalsSignificant changes in condition, as...Definitions, include,...limited, (E)Illness or injury...ignificant change in the health care or dietary needs of the resident. Based on the evidence the Administrator did not comply with the section cited above by staff not properly reporting, observing and or documenting the changes in R1's condition which resuled in a stage 3 wound, which imposes an immediate health, safety and personal risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above in two out of eight resident records 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 two out of eight staff files which poses a potential health, safety or personal rights risk to persons in care.

87466 The licensee shall ensure residents are regularly observed ..changes in physical, mental, emotional and social... appropriate assistance...bservation reveals unmet needs...changes such as unusual weight gains or losses or deterioration of mental ability..physical health condition are observed..licensee shall ensure that such changes are documented and attention of the resident's physician and the resident's responsible person Based on the evidence the licensee did not comply with the section cited above by staff not properly caring for R1's wound resulting in a stage 3 wound, which imposes an immediate health, safety and personal risk to persons in care.

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. (D) Any incident which threatens the welfare, safety or health of any resident. This requirement is not met as evidenced by: Based on observation, interview, and record review, the facility administration did not comply with the section cited above in one out of one incident between two clients, which posses a potential health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above in one out four buildings that did not have a signal sytem in place. LPA observed call buttons in multiple resident bedrooms used for the facility's signal system to be missing. The LPA observed no signal system device set up for building two. According to staff, it was unknown where the device was moved to. This poses a potential health, safety and personal rights risk to persons in care.

(a) The licensee shall ensure that a...record is maintained for each resident in the facility or in a central administrative location readily available...to licensing agency staff. This requirment was not met as evidenced by: Based on interview, the facility did not have file for R1 readily avaible for licensing review. This poses a potential health, saftey or personal rights risk to residents in care.

87309 Storage Space (a)(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. This requirement was not met, as evidenced by the following.Based on observation, the facility did not ensure to store cleaning solutions inaccessible to clients.

87355 Criminal Record Clearance(d) All individuals subject to criminal record review shall be fingerprinted...(3)The license shall submit these fingerprints to the California Department of Justice...prior to the individual's employment, residence, or initial presence in the facility. This requirement was not being met as evidenced by: Licensee did not ensure S1 obtained a criminal record clearance prior to beginning working at facility. Based on record review and interview, S1 had been working at the facility since 08/13/21. This poses an immediate health and safety risk to residents in care.

Based on observation, the licensee did not comply with the section cited above due to LPA observing blood in toilet and feces on toilet seat in Villa #1, which poses a potential health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above due to the water damage and leakage in Villa #1's restroom in front of room 102, 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 due to Staff #1 (S1) not having first aid/CPR training, which poses a potential health, safety or personal rights risk to persons in care.

PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES: (a) Residents in all RCFEs shall have all of the following rights: (8) To have their representatives regularly informed...of activities related to care or services...as appropriate to their needs. This requirement wasn't met, as evidenced by: Based on records & interview, the Licensee didn't ensure R1's representative was informed of R1's injury. A Narrative Report revealed R1 was observed w/ a blister & notes don't document notification to R1's representative. R1's representative reported having no knowledge of the blister. This posed a potential threat to R1's personal rights.

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:(8) To be free from neglect...this requirement was not being met as evidenced by: Based on LPA observation, Resident did not have a call button that was working to alert staff of their needs. This poses a potential personal rights risk to residents in care.

General Food Service Requirements: (b) The following food service requirements shall apply:(5) Meals shall consist of an appropriate variety of foods..This requirement was not being met as evidenced by: Staff interview indicated that multiple meal alternatives were not available to be provided to residents in care. This poses a potential personal rights risk to residents in care.

Care of Persons with Dementia: (j) 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 being met as evidenced by: Based on observation, LPA found that there was not a working auditory device which would alarm staff if a resident were to leave the facility. This poses an immediate health and safety risk to residents in care.

Additional Personal Rights of Residents in ...Facilities: (a) In addition to the rights listed...residents...shall have all of the following personal rights: (4)To care, supervision, and services that meet their individual needs... This requirement was not met as evidenced by: Based on record review and interview, the Licensee did not comply with the above regulation with one resident (R1). NOC shift staff observed R1 to have a bump on their head after an unwitnessed fall but did not contact emergency services. This was an immediate health & safety risk to R1.

87506 Resident Recordsd) All resident 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. Removal of records shall be subject to the following requirements... This requirement is not met as evidenced by LPA making the request and having to wait for 40 minutes. This is a potential health, safety or personal rights risk.

Criminal Record Clearance: (e) All individuals...shall prior to working, residing or volunteering in a licensed facility: (b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement was not met as evidenced by: Based on observation the Licensee did not comply with the above regulation with at least one staff (S1). LPA George learned that S1 is not associated to this facility. This is an immediate safety risk to all residents in care.

87355 Criminal Record Clearance(d) All individuals subject to criminal record review shall be fingerprinted...(3)The license shall submit these fingerprints to the California Department of Justice...prior to the individual's employment, residence, or initial presence in the facility. Licensee did not ensure S1 obtained a criminal record clearance prior to beginning working at facility. Based on record review and interview, S1 had been working at the facility since 08/13/21. This poses an immediate health and safety risk to residents in care.

All personnel shall be given on the job training or have related experience in the job assigned to them.(3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not being met as evidenced by: During a review of records, LPA did not observe any Emergency Intervention training for staff when a resident leaves the facility. This poses an potential health and safety risk to residents in care.

Personnel Requirements - Facility personnel shall at all times be sufficient in numbers.... Additional staff shall be employed as necessary to perform.. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services... This requirement was not being met as evidenced by: LPA Gardner the staffing schedule on the dates for the two incidents and found staffing was absent in the area of the incident. This poses an immediate health and safety risk to residents in care.

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 was not being met as evidenced by: LPA Gardner observed two screws securing the door shut. This poses an immediate health and safety risk to residents in care.

1569.652 Termination of admission agreement upon death of resident; removal of resident’s property;... (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been rremoved from the facility... within 15 days after the personal property is removed. This requirement has not been met as evidenced by: Based on interviews and records review conducted, LPA confirmed that R1's responsible party did not receive a refund within 15 days after R1's personal property was removed following R1's death.