Sierra Loma Assisted Living

Additional Personal Rights of Residents in Privately Operated Facilities: To protection of their property from theft or loss according to Health and Safety Code sections 1569.152, 1569.153, and 1569.154. This requirement was not met as evidenced by staff and other interviews, the facility did not make reasonable efforts to ensure the former resident's personal property was secured as items were stored in an unsecured room with resident, staff and visitor access which poses a potential health, safety or personal rights risk to residents in care.

1569.269 (a)(16) Enumerated rights; severability: Residents of residential care facilities for the elderly shall have all of the following rights: reasonable accommodation of individual needs and preferences in all aspects of life in the facility...This requirement was not met as evidence by: Based on file review and interviews, the Licensee did not ensure R1 was provided a third party witness during the review of Admission Agreement and facility documents, causing R1 to not be fully informed of the admission agreement and facility documents. This posed a potential health and safety risk to R1.

87464(e) Basic Services: If the resident is an SSI/SSP recipient, then the basic services shall be provided and/or made available at the basic rate at no additional charge to the resident. This requirement was not met as evidence by: Based on file review and interviews, the Licensee did not ensure R1 was not charged above their basic SSI rate. This posed a potential health and safety risk to R1.

Care and supervision as defined by statute and rules

87464(f)(1) Basic Services: Basic services shall at a minimum include: 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 evidence by: based on interviews and file review, the Licensee did not ensure staff were responding to R1's call button in timely and providing care in a timely manner. This posed a potential health and safety risk to R1.

Obtain required California clearance or exemption

All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 87355(c) this requirement was not met as evidenced by LPA review of staff records and observed two staff member without a criminal record clearance which poses an immediate health, safety or personal rights risk to residents in care.

Request a transfer of criminal record clearance

Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 87355(c) this requirement was not met as evidenced by a review of current staff roster, and associated staff members, LPA observed 10 staff member who have not had their criminal record clearance associated to the facility which poses an immediate health, safety and personal rights risk to residents in care.

Assist residents with self-administered medication

87465(a)(4) Incidental Medical and Dental Care: A plan for incidental medical and dental care shall be developed by each facility...The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidence by: Based on observation, records review, and interviews, the Licensee did not ensure staff assisted R1 with their medications. This posed a potential health and safety risk to R1.

Regular observation and documentation of resident changes

87466 Observation of the ResidentThe licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning... when such observation reveals unmet needs...the licensee shall ensure that suchchanges are documented and brought to the attention of the resident's physician and the resident's responsible person... This requirement was not met as evidence by. Based on file review /interviews, the Licensee did not ensure R1's change in condition was documented on service plan and communicated to R1's responsible party. This posed a potential health and safety risk to R1.

Licensee responsibility for records confidentiality

Resident Records 87506(c)(1): All information and records obtained from or regarding residents shall be confidential. The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. This requirement was not met as evidence by: Based on observation, the licensee did not ensure R1's and R2's health care record was safeguarded and kept confidential. This posed a potential health and safety risk to R1 and R2.

87555(b)(15) General Food Service Requirements(b) The following food service requirements shall apply:(15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination. This requirement was not met as evidenced by:Based on interviews and observation, the facility did not ensure that residents are provided with food of good quality. This poses an immediate health and safety risk for person in care.

Acceptance obligations tied to pre-admission appraisal needs

87464(d) Basic Services(d) 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 was not met as evidenced by:Based on observation, review records and interviews, the licensee/administrator did not ensure that residents’ needs were being met by facility staff. This posed an immediate health and safety risk to R1

1569.312(a) Basic services requirementsEvery facility required to be licensed under this chapter shall provide at least the following basic services:(a) Care and supervision as defined in Section 1569.2.This requirement is not met as evidence by: Based on records review and interviews with the facility staff, the facility did not comply with the section cited above. R1 left the facility unsupervised and then was located approximately four blocks from the building on the ground. The LIC 602 states R1 was not allowed to leave the facility unassisted. This results in an immediate health and safety risk for the residents in care.

Maintain facility in clean, safe, sanitary condition

87303(a) Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times.This requirement was not met as evidenced by: Based on statements obtained from residents, facility staff and observation the facility staff did not ensure that the facility was in clean and sanitary condition, which poses a potential health, safety and personal rights risk to residents in care.

87307 Personal Accommodations and Services(a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodation and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:(F) Basic laundry service (washing, drying, and ironing of personal clothing). This requirement was not met as evidenced by:Based on statements obtained from residents, facility staff, records review and observation, the facility did not meet residents’ laundry needs by ensuring that resident laundry was being done and ensuring that residents laundry are returned to the residents.

Acceptance obligations tied to pre-admission appraisal needs

87464(d) Basic Services:(d) 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 as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources.This requirement was not met as evidenced by: Based on statements obtained from residents, facility staff and records review indicated the facility did not provide 2-person assistance to meet the resident's needs per their physician report and residents’ assessment plan. which poses a potential health, safety and personal rights risk to residents in care.

1569.312(a) Basic services requirementsEvery facility required to be licensed under this chapter shall provide at least the following basic services:(a) Care and supervision as defined in Section 1569.2.This requirement is not met as evidence by: Based on records review and interviews with the facility staff, the facility did not comply with the section cited above. R1 left the facility unassisted and was found down the street at the corner of Annadale Lane and Auburn. The LIC 602 states R1 was not allowed to leave the facility unassisted. This results in an immediate health and safety risk for the residents in care.

Prohibit false or misleading facility statements

87207False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility...This requirement was not met as evidenced by: Based on record review and interview staff members indicated that medications were administered when they were not which poses an immediate health, safety and/or personnel rights risk.

87208 Plan of Operation(a)The licensee shall have and maintain a current, written definitive plan of operation for the facility...This requirement was not met as evidenced by: Based on record review and interviews the facility mismanaged the residents medication which poses an immediate health, safety and/or personnel rights risk.

Ensure hazardous items are locked and not unattended

87309 Storage Space and Access(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions...This requirement was not met as evidenced by: Based on observation and interviews the facility had bleach in the shower room accessible to residents which poses an immediate health, safety and/or personnel rights risk.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above in 2 out of 2 places. The bottom of the gate to memory care is broken and sharp to the touch. The bed for R13 is broken at the foot of the bed and is sharp which poses an immediate health, safety or personal rights risk to persons in care.

Record findings for communicable tuberculosis conditions

Based on record review, the licensee did not comply with the section cited above in one out of eight residents did not have a TB test which poses an immediate health, safety or personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on observation, the licensee did not comply with the section cited above in the laundry door was not lock in memory care leaving detergent accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Keep bath, laundry and kitchen floors clean

Based on observation, the licensee did not comply with the section cited above in that there was a cockroach in the new shower which poses an immediate health, safety or personal rights risk to persons in care.

87705 Care of Persons with Dementia(5) Facility staff shall ensure the continued safety of residents if they wander away from the facility without violating...This requirement was not met as evidenced by: Based on interviews and record review R1 eloped from the facility which poses an immediate health, safety and/or personnel rights risk.

Maintain cleanliness and prevent incontinence odors

87625 Managed Incontinence(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be...This requirement was not met a evidenced by: Based on observation and interview resident incontinence was not managed or cleaned up which poses an immediate health, safety and/or personnel rights risk.

Dignity in personal relationships

(a)(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.This requirement was not met as evidenced by: Based on interviews personal relationships with staff are not handled with dignity which poses an immediate health, safety and/or personnel rights risk.

Care and supervision as defined by statute and rules

(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).s This requirement was not met as evidenced by: Based on observation and interview residents are not receiving the basic services that they need which poses an immediate health, safety and/or personnel rights risk.

Protection from punishment and intimidation

(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.This is not met as evidenced by: Based on interviews, the Licensee did not ensure that facility staff did not ensure that facility staff did not speak inappropriately to residents in care. It was learned that staff would often speak to residents while providing assistance and make commentary that would be inappropriate to say to the resident and around others. This poses an immediate health, safety, and personal rights risks to persons in care.

Personal assistance and care for required daily activities

(4) Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports.This is not met as evidenced by: Based on observation, record review, and interviews the facility did not provide personal assistance and care with activities of daily living such as incontinence care, bathing and toileting. It was learned that 5 staff members have witnessed facility staff not providing hygiene needs and 7 residents stated that they do not receive consistent hygiene care. Through record review, it was learned that all residents are scheduled and should obtain consistent hygiene care. In addition, LPA observed a strong urine smell in hallways 2 and 3 during a course of 3 unannounced visits. This poses a potential health, safety, and personals rights risks to persons in care.

Dignity in personal relationships

(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.This is not met as evidenced by: Based on interviews and record review, the Licensee did not ensure that the facility staff did not yell at the residents. It was learned that often times, residents would hear staff members yelling at other residents or staff while caring for others. This poses an immediate health, safety, and personal rights risks to persons in care.

Facility personnel sufficiency and competence

(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 is not met as evidenced by: Based on record review and interview, the licensee did not ensure that there are sufficient staff to ensure that call buttons are met within a sufficient period. It was learned that the facilities best practice is to answer call buttons within a 15-30 min period, however based on interviews conducted with staff and residents’ response time can vary past 2 hours or even overnight due to assistance with other residents. LPA reviewed facility call button logs which confirm this response time. This poses an immediate health, safety and personal rights risks to persons in care.

1569.312(d)Basic services requirements: Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement was not met as evidence by: Based on file reviews and interviews, the Licensee did not ensure staff were aware of R1 general whereabouts as R1 was last seen on 09/16/2024 and was not found in their room the next morning. R1 was found outside of the facility on 09/18/2024 by Sacramento Sheriff's department and returned R1 to the facility. This posed an immediate health and safety risk to R1.

Report specified resident events within seven days

(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. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.This is not met as evidenced by: Based on observation and record review, the licensee did not ensure that the facility reported 22 incident reports within seven days of occurrence. LPA reviewed incident reports received by the department on 08/18/2024 and 08/19/2024 and found that the incidents occurred between the dates of 07/26/2024-07/31/2024 or 08/02/2024-08/08/2024 and were reported outside of the seven-day required period. This poses an immediate health, safety and personal rights risks to persons in care.

Maintain fire clearance before retaining specified persons

"(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal." This requirement was not met as evidenced by: Based on interviews and record review, this facility did not adhere to local fire requirements and is currently in violation of its previously issued fire clearance, which poses an immediate health, safety and/or personal rights risk.