Madison Square Senior Living Ii

§1569.185 Fees for license or applications; use of revenues; collected; denial or forfeiture (e) The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement is not met as evidenced by: Based on file review, Licensee did not comply to the section cited above as Licensee has an outstanding fee balance of $742 whihc poses a potential risk for residents in care.

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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. (D) 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 is not met as evidenced by: Based on file review, Licensee did not comply as LPA did not receive an incident report for R3 on an incident occuring on 9-16-2024 and receiving an incident report for R1 which occurred approximately three months prior to reporting to CCLD which poses a potential risk for residents in care.

Assist residents with self-administered medication

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 is not met as evidenced by: Based on file review and interview, Licensee did not comply to the section above as it was observed that R2 was out of three medication refills for approximately a month prior to being sent out to the hospital for new refill orders which poses an immediate risk for residents in care.

§1569.312 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 evidenced by: Based on file review, Licensee did not comply with the section cited above as R1 was reported to AWOL twice within this year which LIC602 stated R1 cannot leave facility unassisted, which poses an immediate risk for residents in care.

Request transfer of criminal record clearance

87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)This requirement is not met as evidenced by: Based on observation, Licensee did not comply with the section as LPAs observed S1 to be working at the facility without a criminal clearance transfer associated to the facility, which poses a potential health and safety risk to residents in care.

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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. (D) 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 is not met as evidenced by: Based on file review and interview, Licensee did not comply to the section cited above as Licensee stated LIC 624 was not submitted for R2 for an incident that occurred on 08/24/2024, which poses a potential risk to residents in care.

§1569.605 Liability insurance; coverage requirements On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Based on interview, Licensee did not comply with the section cited above as Administrator informed LPA via email that facility does not have liability insurance, which poses a potential risk to residents in care.

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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. (D) 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 is not met as evidenced by: Based on interview, Licensee did not comply with the section cited above as Licensee did not submit an incident report for R1 to Licensing as discussed on 12/6/2023, which poses a potential risk to residents in care.

Based on observation and interview, the licensee did not comply with the section cited above as LPA observed 1 of 2 staff working at the facility without a criminial record clearance which poses an immediate health, safety or personal rights risk to persons in care.

RCFE complaint poster posting requirements

Based on observation, the licensee did not comply with the section cited above as LPA observed PUB 475 to be missing from facility which was discussed during pre-licensing inspection, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on file review, the licensee did not comply with the section cited above as LPA observed no first aid training and no CPR training on file, which poses an immediate health, safety or personal rights risk to persons in care.

Facility must clear fire safety for nonambulatory persons

Based on observation and file review, the licensee did not comply with the section cited above in 2 out of 4 non-ambulatory residents are residing in an ambualtory only room which poses an immediate health, safety or personal rights risk to persons in care.

Store disinfectants separately from food supplies

Based on observation, the licensee did not comply with the section cited above as LPA and Administartor observed two kitchen knives to be stored in an unsecured drawer which poses an immediate health, safety or personal rights risk to persons in care.

Include required health screening documents

Based on file review, the licensee did not comply with the section cited above as LPA observed no LIC 503 present for S1 and S2 which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain separate complete record for each resident

Based on file review, the licensee did not comply with the section cited above as LPA observed 4 of 4 resident files to be incomplete, which poses/posed a potential health, safety or personal rights risk to persons in care.