The Gardens at Laguna Springs Memory Care

Observation of the resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes...are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by:Based on interviews and record reviews, R1 developed multiple pressure sores while in care. This poses an immediate heath, safety and personal risks to resident 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: (3) To be free from punishment, humiliation, intimidation, abuse.This requirement is not met as evidenced by: Based on the department's findings, the licensee did not ensure R1 was free from punishment while in the care. Facility staff blocked R1's doorway with a couch to prevent R1 from leaving, which poses an immediate health and safety risk to residents in care.

87405. Administrator Qualifications and Duties(b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee.This requirement is not met as evidence by: Based on interviews and records review, facility representative A1 denied the fact that he was the responsible administrator. This poses an immediate health and safety risk to residents in care.

87208 Plan of Operation - (a) Each facility shall have and maintain a current, written definitive plan of operation (3) Statement of admission policies and procedures regarding acceptance of persons for services.This requirement is not met as evidence by: Based on records review, although the facility has a plan of operation in place the facility failed to follow prohibited conditions outlined in the plan of operation regarding combative, dangerous behavior or the inability to get along in a congregate setting. This poses an immediate health and safety risk to residents in care.

87464 (f)(1) Basic services care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).This requirement is not met as evidence by: Based on the department's findings, the facility did not provide adequate care and supervision which resulted in R1 sustaining multiple injuries from falls. This posed an immediate health and safety risk to R1.

87506(a)(14) Resident Records(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.(14) Current centrally stored medications as specified in Section 87465, Incidental Medical and Dental Care Services.This requirement is not met as evidenced by: Based on LPA's documentation of resident medical records, the licensee did not ensure residents medication logs are accurate. R1's Medication Administration Records (MARs) is not logged accurately. This poses a potential health and safety risk to residents in care.

Basic services requirements: Every facility required to be licensed under this chapter shall provide at least the following basic services:...(d) Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met as evidence by: Based on incident report, the facility did not comply with section cited above in 1569.312(d). R1 AWOL'D from facility. The LIC 602 states the resident was not allowed to leave the facility unassisted. This presents an immediate health and safety risk to the resident in care.

Diabetes. In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following…Providing modified diets as prescribed by a resident's physician as specified in Section 87555(b)(7). This requirement is not met as evidence by: Based on interviews and record reviews, the Licensee did not ensure a diabetic menu is in place. Facility has five diabetics residents. LPA s observed no Diet Menu regarding this matter. This poses a potential health and safety risk to residents in care.

87465(c)(2) Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions.This requirement is not met as evidenced by: Based on LPA’s documentation review. The licensee did not ensure meds were given according to the physician's directions. Facility staff did not ensure insulin is provided timely to resident as prescribed by physician’s order. Resident R1 was given insulin two hours late. This posed an immediate health and safety risk to residents in care

87465(a)(1) A plan for incidental medical and dental care shall be developed by each facility...The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.This requirement is not met as evidenced by: Based on interview and record review, the licensee did not ensure meds were provided to resident. Resident R1 missed his morning insulin dose when leaving the facility. This posed an immediate health and safety risk to residents in care

87464 (d) Basic Services: A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs...This requirement was not met as evidence by: Based on file review the facility did not meet R1's care needs. According to document "Resident Assistance Record" staff did not initial document stating care was provided to R1. It is unknown if care was being provided to R1. This posed a potential health & safety risk to R1.

87705 (c) (4) Care of Persons with Dementia: Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety... This requirement was not met as evidence by: Based on observation the facility did not meet the needs of residents during an activity and lunch. This posed a potential health and safety risk to residents in care.

87463(a)(3) Reappraisals Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or condition specified in Sections 87455(c) or 87615, Prohibited Health Conditions. This requirement is not met as evidence by: Based on file reviews and interviews, reappraisals were not being conducted after R1's significant changes. This posed a potential health and safety risk to R1.

87468.2(a)(4)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...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 met as evidence by. Based on file reviews R1 did not receive care and supervision conducive to his exit/eloping seeking behaviors which lead to breaking nose, suicidal ideations, unusual behaviors. This posed an immediate health and safety risk to R1.

Storage Space 87309(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 evidence by: Based on observation, cleaning carts compartments were left unlocked, which made cleaning toxins accessible to residents in care. This posed an immediate health and safety risk to residents in care.

87468.1(a)(2)Personal Rights of Residents in All Facilities: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidence by: Based on facility record reviews, R1 was being aggressive towards other residents. This posed a immediate health and safety risk to residents in care,

Personal Rights of Residents in All Facilities. To wear their own clothes; to keep and use their own personal possessions.This requirement is not met as evidence by: Based on observation and interviews, the licensee did not ensure that residents' cloths are properly returned to the right resident. This poses a potential health and safety risk to residents in care.

Personal Accommodations & Services. The licensee shall assure provision of basic laundry service…This requirement is not met as evidence by: Based on interviews, the licensee did not ensure that residents receive adequate laundry services. This poses a potential health and safety risk to residents in care.

Maintence and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times.This requirement is not met as evidence by: Based on observation and interviews, the licensee did not maintain the facility in good repair at all times. R1's room had a water leak due to the PTAC unit was not in good repair. This poses a potential health and safety risk to residents in care.

Administrator - Qualifications and Duties (a) All facilities shall have a certified administrator.This requirement was not met by as evidenced by: LPAs reviewed administrators’ documentation and Licensing Information System (LIS), the facility did not have a certified administrator. This poses an immediate health, safety, and personal rights risk to residents in care.

87707(a)(1)Training Requirements If Advertising Dementia Special Care, Programming And/Or Environments: residents with dementia or related disorders shall ensure that all direct care staff, described in Section 87706(a)(1), who provide care to residents with dementia, meet the following training requirements:... Direct care staff shall complete six hours of orientation specific to the care of residents with dementia within the first four weeks of working in the facility. This requirement was not met as evidenced by: based on file review 3 employees did not have supporting dementia training documents. This posed a potential health and safety risk to residents in care.

87224(a) Eviction Proceduresthe licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required...This requirment was not met as evidenced by: Based on record review and interviews, R1 was evicted due to Responsible Party's conduct and requests In addition, eviction letter did not have all the required information. Also, R1 did not violate title 22 eviction reasons. This posed a potential health and safety risk to R1

Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption.This requirement was not met by as evidenced by: Based on Licensing Information System (LIS) reviewed staff S1, S2 and S3 are not currently fingerprint cleared or associated to the facility. This posed an immediate health and safety risk to residents in care.