Acc Maple Tree Village

(b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This was not met as evidenced by cleaning supplies being accessible to residents in care which poses an immediate health and safety risk to clients in care.

(a) The facility shall be clean, safe, sanitary and in good repair at all times. This was not met as evinces by dead bug carcuses being observed, communnal refridgerators not being clean and did not have a freezer thermometer, trashcan lids being open

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 evidence by: Based on observation and interviews, the Licensee did not ensure that the facility was free from pests and sanitary. This posed a potential health and safety risk to all residents in care.

General Food Service Requirements: All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement was not met as evidenced by LPA observations of rodent droppings in the kitchen dry storage area which poses a potential health, safety and personal rights risk to residents in care.

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 observed delays in responses to pressed resident pendant which poses a potential health, safety and personal right srisk to residents in care

General Food Service Requirements: In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist , a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified. The consultation services shall be provided at appropriate times, during at least one meal. A written record of the frequency, nature and duration of the consultant's visits shall be secured from the consultant and kept on file in the facility.

Emergency Disaster Plan: Relocation sites which are equipped to provide safe temporary accommodations for residents. This requirement is not met as evidenced by residents were not relocated to identified sites and department staff provided significant assistance to facility in identifying and arranging relocation of residents and arranging for temporary accommodations which poses an immediate health, safety and personal rights risk to residents in care.

Administrator - Qualifications and Duties: Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by facility's inability to adhere to their emergency disaster plan and complete the relocation to an identified location or viable alternative as part of the emergency disaster plan.

General Food Service Requirements: Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met as evidenced by LPA observations of dirty kitchen floor, undated and unsecured items to prevent contamination, expired foods in storage and walk in freezer with a high temperature of 5 degrees F. which poses a potential health, safety and personal rights risk to residents in care.

Personal Rights of Residents in All Facilities: To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by three declarations provided by three staff members who witnessed staff member act in an unprofessional manner and cursed and handled residents in a manner that did not treat residents with dignity and respect which poses an potential health safety or personal rights risk to residents in care.

Reporting Requirements: 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 met as evidenced by statements obtained from S1 that a staff member had knowledge of inappropriate behavior by another staff member (cursing, rudeness) towards several residents in care that took place in February 2024 and was not reported to management or the department in a manner that meets regulations which poses an immediate health safety and personal rights risk to residents in care.

All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. LPA was unable to review all staff files including Health screening reports as they were stored off site and could not be provided in a timely manner witch poses a potential health, safety and personal rights risk to residents in care.

Additional Personal Rights of Residents in Privately Operated FacilitiesIn 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: To consent to have their relatives and other individuals of their choosing visit during reasonable hours, privately, and without prior notice.This requirement is not met as evidenced by: Based on facility did not ensure resident rights were upheld by dismissing companions from the room. This poses a potential risk to residents in care.

Incidental Medical and Dental CareIn all facilities licensed for sixteen (16) persons or more, one or more employees shall be designated as having primary responsibility for assuring ... assisting residents as needed with self-administration of medications... This requirement is not met as evidenced by: medication that belonged to R1 was administered to R2 and there was no adverse reactionBased on documentation which confirmed the medication error occurredThis violation poses an potential health, and safety risk to residents in care.

Additional Personal Rights of Residents in Privately Operated FacilitiesIn 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: To be free from…financial exploitation… Based on admittance of guilt from S1 to Law enforcement that the theft occurred. This violation poses an immediate health, and safety risk to residents in care.

Additional Personal Rights of Residents in Privately Operated FacilitiesTo care,...and services that meet their individual needs... This requirement is not met as evidenced by: the residents who paid for additional services were billed and the services were not renderedBased on interviews, confirmed the residents services such as bathing and medication management was not rendered but billedThis violation poses an immediate health, and safety risk to residents in care.

Incidental Medical and Dental CareThe following requirements shall apply to medications which are centrally stored:Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: pills were found on the medication cart unlabeled and not prepared for passingBased on interviews, confirmed the pills were found and not labeled facility did not ensure pills were in its original containerThis violation poses an immediate health, and safety risk to residents in care.

Incidental Medical and Dental CareIf the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration provided all of the following requirements are met: Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication. The date and time of each contact with the physician, and the physician's directions, shall be documented and maintained in the resident's facility record. The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement is not met as evidenced by: Facility did not refill medications timely. Based on interviews that confirmed, the Licensee did not refill medication or administer medications as prescribed. This possess an immediate health and safety risk to residents in care.

Incidental Medical and Dental CareA 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: The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: medications were found on residents' room floor, in wheelchair bag, and in pocket of residentBased on interviews, confirmed the pills were found to not have been taken by resident and found later, facility did not ensure medication administration assistanceThis violation poses an immediate 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... (2) The licensee shall provide assistance in meeting necessary medical...needs. This requirement is not met as evidenced by: Based on interviews and records reviewed, the licensee did not follow the care plan for 2 out of 4 residents in care, which resulted in residents sustaining unexplainable bruising and fractures. This poses an immediate health and safety risk to residents in care.

87411(c)Personnel Requirements – General. Responsibility for Providing Care and Supervision: The licensee shall provide care and supervision as necessary to meet the client's needs.This requirement is not met as evidenced by: Based on interviews and records reviewed, the Licensee did not provide adequate supervision to 3 out of 4 residents, which resulted in residents sustaining injuries from falls. This poses an immediate health and safety risk to the residents in care.

Additional Personal Rights of Residents in Privately Operated Facilities 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: 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 requirement is not met as evidenced by: the residents who required a 2-person assist was not assisted due to a staffing shortageBased on interviews, staff confirmed sometimes the residents were not assisted when there was not enough staff, or the MT needed to pass medicationsThis violation poses an immediate health, and safety risk to residents in care.

Personnel Requirements - GeneralFacility 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: Staff were forced to work extra shifts to assist the residents with care and supervision and staffing agency was not used on those days.Based on documentation and interviews the facility failed to ensure staffing was sufficient in numbers for resident care and supervisionThis violation poses an immediate health, and safety risk to residents in care.

Administrator - Qualifications and DutiesAll facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement is not met as evidenced by: Administrator(s) were not reachable during NOC shiftBased on interviews of staff who confirmed the previous administrators did not ensure coverage while not present in the facility during the NOC shiftThis violation poses an immediate health, and safety risk to residents in care.