Walnut House

Additional Personal Rights of Residents in Privately Operated Facilities -(a) (1) To have a reasonable level of personal privacy in accommodations,...This requirement was not met based on interviews that found R1 was photographed without knowledge or consent and the inforation was shared with others. This posed an immediate risk to resident rights.

Assist residents with self-administered medication

Incidental Medical and Dental Care (a)(4) The licensee shall assist residents with self-administered medications as needed.This requirement was not met based on records and statements with found the facility's plan was not followed for correct medication administration. This posed a potential risk.

Right to sufficient care and qualified staff

Additional Personal Rights of Residents in Privately Operated Facilities(a)Residents shall .. rights: (4) To care, supervision, and services …by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met based on records and statements that found staff did not recognize and respond to R1’s change of condition and increased need for assistance. This posed an immediate risk to R1.

Regular observation and documentation of resident changes

Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes ...and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as …, deterioration of mental ability or a physical health condition are observed, the licensee shall ensure... changes are... brought to the attention of the resident's physician and... This requirement was not met based on records and statements which found R1’s changes to physical and social function were not responded to. This posed an immediate risk to R1.Civil Penalty Applied.

Maintain facility in clean, safe, sanitary condition

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 of residents, employees and visitors. This requirement is not met as evidenced by: Based on LPA's observations, the facility did not ensure that the premises was clean and in good repair when R5's apartment had linoleum coming apart and R6 and R7's apartment had feces on the toilet, which poses a potential health, safety, and personal rights violation to the residents in care.

Store centrally held medications in locked secure place

87465(h)(2) Incidental Medical and Dental Care:(h) The following requirements shall apply to medications which are centrally stored:(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 an interview with the Administrator, Administrator acknowledged that after seeing a bad Yelp review, medications were found in the former residents room which presents a potential health, safety and personal rights risk to the residents in care.

Ensure hazardous items are locked and not unattended

87309 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.This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the section above as LPA observed two cleaning supplies in R1's vacant room. LPA was informed family members may have dropped it off to resident as facility does not use the folowing cleaning supply, which poses a potential risk for residents in care.

Keep bath, laundry and kitchen floors clean

Based on observation, the licensee did not comply with the section cited above as LPA observed the shower room to have pink mildew around the floors which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

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 of residents, employees and visitors. This requirement is not met as evidenced by: Based on LPA's observation, Licensee did not comply to the section cited above as LPA observed R1's room to have an approximate two-feet brown stain next to R1's bed, used urinal bottle on top of night stand and red stains on linens which poses a potential risk to residents in care.

Assist residents with self-administered medication

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:(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on file review of R1 and R2's medication administration records and medication audit, licensee did not comply with the section cited above as LPA and Regional Nurse observed four different medication counts to be inconsistent with MAR, which poses an immediately risk to residents in care.

Facility personnel sufficiency and competence

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. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds... This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above as R1 and R2 both stated there is staff shortage at the facility resulting to delays on level of care, which poses a potential health and safety risk for residents in care.

Store centrally held medications in locked secure place

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (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 is not met as evidenced by: Based on LPAs' observation and interview with R1, Licensee did not comply with the section above as LPA Yang and LPA Ratajczak observed R1 to have Ondansetron in her room, which poses an immediate health and safety risk for residents in care.

Maintain facility in clean, safe, sanitary condition

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 of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the regulation above as LPA Yang and LPA Ratajczak observed R1's room to have a strong odor of urine, unsecured headboard and multiple discoloration on bathroom floor, which poses an immediate health and safety risk to residents in care.

Assist residents with self-administered medication

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: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced: Based on observation of medication audit, Licensee comply to the section cited above as LPAs observed R1's medication to have one tablet missing from the original bottle which was also not signed off on the MAR, which poses an immediate health and safety risk for residents in care.

Dignity in personal relationships

87468.1 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: Based on interviews conducted, Licensee did not ensure residents in care to be accorded dignity, as residents informed LPA and LPM the PM shift staffs are rude and disrespectful, which poses a potential risk to residents in care.

Assist residents with self-administered medication

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... provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on observation during medication audit, Licensee did not ensure medications were administered, as LPA and LPM observed MARs was not sign if medications were administered to residents, Rooms #1-47. Days of missing signatures ranged from 3-6 days from the date of inspection, which poses an immediate 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, 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: (6) To make choices concerning their daily lives in the facility. This requirement is not met as evidenced by: Based on interviews and file review, Licensee did not ensure that residents have the rights to make choices concerning their daily lives in the facility as smoking residents are to wait 10 minutes after mealtime in able to go outside to smoke, which poses a potential health safety and personal rights risk to residents in care as it is not listed in the House Rules.

Facility personnel sufficiency and competence

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. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. 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 is not met as evidenced by: Based on record review and interviews conducted, the Licensee did not ensure that staff responded timely to resident's (R1) request for assistance when the call button was used on 7/5/22, 7/14/22 and on 7/20/22, which posed a potential health and safety risk and/or personal rights violation to residents in care.

Store centrally held medications in locked secure place

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (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 is not met as evidenced by: Based on observation, LPA observed multiple unlocked medications in residents' rooms on 10/19/22 from 10::00 am- 3:40 pm, which poses an immediate health and safety risk to residents in care. RCC or Administrator promptly removed the unlocked medications.

Right to confidential records and approved disclosure

Additional Personal Rights of Residents in Privately Operated Facilities. (a)(2)To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement was not met as evidenced by interviews and observation that found personal information was posted in the dining area and was able to be seen by others. This posed a potential violation of resident rights.

Additional Personal Rights of Residents in Privately Operated Facilities. (a)(6) To make choices concerning their daily lives in the facility.This requirement was not met as R1 was told that she must transfer from her wheel chair at meal. This posed a potential violation of R1's personal rights.

Facility personnel sufficiency and competence

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 was not met based on records and statements showing insufficient staffing to meet the needs of residents. On 7/13/21 this posed an immediate risk to Resident health.

Require fire clearance before non-temporary bedridden admission

Care of Bedridden Residents -(c) To accept or retain a bedridden person, other than for a temporary illness or recovery from surgery, a facility shall obtain and maintain an appropriate fire clearance as specified in Section 87202(a). This requirement has not been met as evidenced by:Based on document review, the facility does not have an approved fire clearance for bedridden residents and the resident was not identified as Hospice which poses a potential health and safety risk to residents in care.

Acceptance obligations tied to pre-admission appraisal needs

87464(d) Basic Services (d) … the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal ...This requirement is not met as evidenced by: Based on interviews and documentation reviewed, the Licensee did not ensure that resident’s (R1) care needs were met including hygiene, repositioning every 2 hours and changing briefs, resulting in pressure sore to worsen which posed an immediately health and safety risk to residents in care.

Licensee reports required by licensing agency

Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports ...(2) Occurrences, such as ..., catastrophes ... which threaten the welfare, safety or health of residents...within 24 hours ... This requirement was not met based on records and statemets that the January 27/2021 power outage was not reported as required. This posed a potential risk to residents.

Maintain cleanliness and prevent incontinence odors

Managed Incontinence- b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence.This requirement was not met Based on interviews conducted and documentation reviewed, the Licensee did not ensure that incontinent residents (R2 and R3) were toileted regularly, including throughout the night shift, which posed a potential health and safety risk to residents in care. Additionally, department LPA’s observed incontinent odors to be found on Hall 1, (room 57), on 10/21/2021 and on 11/10/2021.

Maintenance and Operation (i) facilities shall have signal systems which shall meet the following criteria: (1) All facilities licensed for 16 or more ... shall have a signal system which shall: (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement was not met based on records and interviews which found that on 11/18/21, R1 left the building unassisted and staff did not hear the front door alarm when R1 exited the building.This posed an immediate health and safety risk to R1.

87705 Care of Persons with Dementia(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Based on documentation reviewed, the Licensee did not ensure that resident (R2) had an annual medical assessment on file that was completed within the last 12 months, which posed a potential health and safety risk to resident in care. Physician's report indicates medical exam was completed for resident (R2) on 10/5/2018.

Night supervision when dementia residents require it

87705 Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that resident (R2) was not able to leave the building unassisted on 7/16/2021 between 5:20 am- 6:20 am, which posed an immediate health and safety risk to resident in care.

There is not a second citation issued on this page.

§1569.157 Resident-oriented facility council (g) A facility shall not willfully interfere with the formation, maintenance, or promotion of a resident council, or its participation in the regulatory inspection process. For the purposes of this subdivision, willful interference shall include, but not be limited to, discrimination or retaliation in any way against an individual as a result of his or her participation in a resident council, refusal to publicize resident council meetings or provide appropriate space for either meetings or a bulletin board, or failure to respond to written requests by the resident council in a timely manner. This requirement is not met as evidenced by: Based on interviews conducted, the Licensee did not ensure that the facility did not willfully interfere as multiple facility staff attended a resident council meeting, held on 7/9/2021, and took control and adjourned the meeting and didn't allow the residents to lead their meeting, which posed a potential personal rights violation to residents in care.

Regular representative updates on care

87468.1 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:(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 is not met as evidenced by: Based on interview and record review, the Licensee did not ensure that resident's representative was contacted on 2/7/2021 following resident's (R1) fall and being sent out for further medical evaluation around 4;50 pm, which posed a potential personal rights violation to resident in care.

87218 Theft and Loss (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (2) A licensee who fails to make reasonable efforts to safeguard resident property, shall reimburse a resident for or replace stolen or lost resident property at its current value. The licensee shall be presumed to have made reasonable efforts to safeguard resident property if there is clear and convincing evidence of efforts to meet each requirement specified in Section 1569.153.(A) A civil penalty shall be levied if the licensee or facility staff have not implemented the theft and loss program, or if the licensee has not shown clear and convincing evidence of its efforts to meet all of the requirements set forth in Section 1569.153. This requirement is not met as evidenced by: Based on record review and interviews conducted, the Licensee did not ensure that reasonable efforts were made to ensure that each requirement inSection 1569.153, specifically, that a theft and loss record for the last 12 months was made available for review, was met, in order to safeguard resident's property, which posed a potential personal rights violation to residents in care.

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (B) Any medication is determined by the physician to be hazardous if kept in the personal possession of the person for whom it was prescribed. This requirement is not met as evidenced by: Based on interviews conducted, the Licensee did not ensure that all packages dropped off on 5/9/2020 were screened prior to giving to resident (R1) to ensure there were no hazardous items inside, including Tylenol medication. Receptionist stated that the contents of only 1 of 3 bags, which was the bag without tissue paper, was viewed prior to giving to resident, which posed an immediate health and safety risk to resident in care.

§1569.312 Basic services requirements (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that staff was regularly “monitoring resident’s (R1) emotion, frustration or anxiety” resulting from resident’s diagnosis of depression and keeping a daily log to document resident’s needs and care, as noted on resident’s plan of care dated 10/31/2019, which posed an immediate health and safety risk to resident.

Provide assistance for residents medical needs

87465 Incidental Medical and Dental Carea) 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: (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. In providing transportation the licensee shall do so directly or make arrangements for this service. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that essential medical information, including resident's (R1) history of attempted suicide with medications, was conveyed to emergency medical services personnel, on 5/10/2020, which posed an immediate health and safety risk to resident in care.