Jazba Glenroy

Based on record review and interview, a resident was admitted with MRSA, a prohibited health condition, which poses an immediate health, safety or personal rights risk to persons in care.

"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 incident which threatens the welfare, safety or health of any resident..." This requirement was not met as evidenced by: Based on record review, CCLD was not notified regarding two unusual incidents, which poses a potential health, safety, and/or personal rights risk.

Assist residents with self-administered medication

"(4) The licensee shall assist residents with self-administered medications as needed." This requirement was not met as evidenced by: Based on record review and interview, a resident (R4) was given the wrong medications on one occasion, which poses an immediate health, safety, and/or personal rights risk.

Keep prescriptions in original containers

"(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers." This requirement was not met as evidenced by: Based on observation, medications were not stored in their originally received container, which poses an immediate health, safety, and/or personal rights risk.

Notify agency before locking doors or gates

“(f) The following shall be stored inaccessible to residents with dementia:(1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s).” This requirement was not met as evidenced by: Based on interviews and record review, a resident was allowed access to knives, which poses an immediate health and safety risk.

Document required staff training and orientation

“(c) Licensees shall maintain in the personnel records verification of required staff training and orientation.” This requirement was not met as evidenced by: Based on interviews and record review, S1 had no staff training records on file, which poses a potential health, safety, and/or personal rights risk.

Obtain required California clearance or exemption

"(e) 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:(1) Obtain a California clearance or a criminal record exemption as required by the Department or(2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or(3) Request and be approved for a transfer of a criminal record exemption..."This requirement was not met as evidenced by: Based on interview and record review, a staff member (S1) worked for 15 days without being associated to this facility, which poses an immediate health and safety risk.

Conformance with applicable laws and regulations

"(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply....(2) Knowledge of and ability to conform to the applicable laws, rules and regulations."This requirement was not met as evidenced by: Based on interviews and record review, the licensee allowed an excluded individual to be present in the facility, and repeatedly allowed staff without appropriate background clearances to work in the facility, which poses an immediate health and safety risk.

"(d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. ... (5) Good character and a continuing reputation of personal integrity."This requirement was not met as evidenced by: Based on interviews, the licensee does not have a reputation for integrity among staff, which poses an immediate health, safety, and/or personal rights risk.

Maintain required personnel records for staff

"(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information:"This requirement was not met as evidenced by: Based on record review, S1 did not have a staff file, and other staff files were not complete, which poses a potential health, safety, and personal rights risk.

Obtain required California clearance or exemption

Based on observation and record review, the licensee did not ensure three staff members were associated to this facility prior to starting work, which poses an immediate health, safety or personal rights risk to persons in care.