The Chateau at River's Edge

Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by department review of facility records, home health care and physical therapy notes and hospital records that that facility did not seek timely medical attention for resident’s degenerating wounds on both legs as the facility continually reached out for wound care to make unscheduled visits to address wounds when staff members documented increased deterioration of resident’s wounds which posed an immediate health, safety and personal rights risk to resident in care.

Reappraisals:The licensee shall ensure corresponding changes are made in the care and supervision provided to the resident. This requirement was not met as evidenced by R1’s medical records, home health and physical therapy care notes and statements obtained by the department. the facility did not ensure corresponding changes to the care and supervision for R1 as R1 was not re-evaluated for changes in condition and no changes to R1’s care plan were made despite developing and worsening wounds on R1’s legs and no intervention in care and supervision were provided to the resident to prevent wounds from developing and worsening including but not limited to timed bathroom breaks and padded toilet seats. As a result, R1 incurred serious bodily injuries which poses an immediate health, safety and personal rights risk to resident in care.

Reappraisals: The licensee shall immediately, or as soon as reasonably possible, communicate with the resident and, if applicable, the resident's representative, about any significant change in condition and the recommendation, if any, of the appropriate licensed medical professional, and if applicable, other specialized care provider. Documentation of such communication shall be added to the resident’s record. This requirement was not met as evidenced by review of resident’s needs and services plan upon return from skilled nursing, staff interviews and documentation in resident’s file. Per the needs and services plan, R1 was identified as only needing a standby assistance for toileting. Statements and documentation obtained indicate that R1 would frequently sit on the toilet for extended periods of time and staff were not always present to ensure resident did not sit on the toilet for extended periods of time and as a result developed the injuries to both legs. Home health documented that R1 is a max 2 personal assist for toileting which was not documented or integrated into R1’s care plan which poses and immediate health, safety or personal rights risk to residents in care.

Based on LPA's observation of 8 items that were still on the pantry shelves after their best by date and 1 item that was supposed to be refrigerated, the licensee did not comply with the section cited above. This poses/posed a potential health, safety or personal rights risk to persons in care.

Maintenance and Operations 87303(a)(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. The facility did not comply with the above regulation as evidenced by:Based upon a record review and interviews, the facility continued to use a broken deli slicer and a malfunctioning refrigerator. This poses/posed a potential health and safety risks to resident in care

General Food Service Requirements: (b) The following food service requirements shall apply: (21)...(-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C)... The facility did not comply with the above regulation as evidenced by:Based on interviews S1, S3 and S7 stated the refrigerator was not working properly and the new Executive Chef replaced it on 9/30/24. This poses/posed a potential health and safety risks to resident in care.

87555 General Food Service Requirements: (b) (1) Where all food is provided by the facility arrangements shall be made so that each resident has available at least three meals per day...Not more than fifteen (15) hours shall elapse between the third and first meal. This requirement is not met as evidenced by:Based on record reviews and interviews, the licensee did not ensure R1 received at least three meals per day from 11/19/23 to 11/21/23 at breakfast.

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 and interview, the licensee did not ensure the facility is clean, safe and sanitary as evidenced of vermin droppings in two apartments. This poses/posed a potential health and safety risk to residents in care.

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 observation and interview, a fire door located near the memory care of the facility was observed to be not functioning and not closing properly when released from its magnet, which poses an immediate health, safety and personal rights risk to the 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 of residents, employees and visitors.This requirement is not met as evidenced by: Based on observation and interview, a fire door located near the memory care area of the facility was observed to be in disrepair which poses a potential health, safety and personal rights risk to the persons in care.

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... compliance with the following: (5) The licensee shall assist residents with. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not ensure R1 was being administered medication as prescribed. Another resident's medications were given to R1 by staff. This posed an immediate health and safety risk to residents in care.

87507(f) Admission Agreement. The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments.This requirement is not met as evidence by: Based on interviews and record review, the licensee did not comply with admission agreement to ensure resident R1 is properly monitored. Resident R1 eloped from the facility without staff noticing as a result of R1's wander guard is not working. The poses an immediate health and safety risk to residents in care.

§1569.657 Rate increase due to change in level of resident care; notice. (a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increases within two business days after initially providing services at the new level of care. This requirement is not met as evidence by: Based on interviews and record review, the licensee did not provide R1 and R1's representative any written notice of rate increases due to change in level of care within two days as required. The poses a potential health and safety risk to residents in care.

87411(a)-Personnel Requirements - General-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.This requirement is not met by: Based on interviews and record review, the facility did not comply with section cited above. R1 AWOL'D from facility. The LIC 602 states the resident was not allowed to leave the facility unassisted. This poses an immediate health and safety risk to the resident in care.

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 was not met as evidenced Based on interview and record review Licensee did not ensure that Resident 1 took the daily prescribed medication. This poses an immediate health and safety risk to residents in 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: (16) To receive or reject medical care or other services. This requirement was not met as evidenced by: Based on interview and record review the Licensee did not ensure that R1's call button was answered in a timely manner. This poses a potential health and safety risk to residents in care.

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on interview, the Licensee did not ensure R1's laundry was done on the day it was scheduled for. This poses a potential health and safety risk to residents in care.

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on interview, the Licensee did not ensure that R1 who was on hospice was receiving pain medication as needed in a timely manner. This poses an immediate health and safety risk to residents in care.

Based on record review, the licensee did not comply with the section cited above in LPA reviewing employee records and in 4 out of 5 files, staff had expired First Aid which poses an immediate health, safety or 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 of residents, employees and visitors. This requirement was not met as evidenced by: Based on interview and record review Licensee did not ensure that the elevator was functioning properly. This poses a potential health and safety risk to residents in care.

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (1)Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. This requirement was not met as evidenced by: based on video footage the licensee did not ensure R1 was able to get out of the recliner after caregiver put the footrest up. This poses an immediate health and safety risk to residents in care.

Basic Services 87464 (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). "Care and supervision" means the facility assumes responsibility for...ongoing assistance with activities of daily living...without which the resident’s physical health, mental health, safety, or welfare would be endangered. This requirement was not met as evidenced by: Based on interviews and video footage review, the licensee did not ensure care and supervision was being provided to R1, as evidenced by R1 being left on the ground overnight.

Basic ServicesThe admission agreement shall specify which of the basic services are desired and/or needed by, and will be provided for, each resident. This requirement has not been met as evidence by: the resident in question did not receive timely assistance in their daily nessecities as stated in their Needs and Appraisal plan and Adminission Agreement.

87303(a) 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 regulation was not met as evidence by:Based on LPA’s interview with Administrator and review of documents Licensee did not ensure the health and safety of residents in care due to elevator in disrepair. This poses as a potential risk to residents in care.