Blessed Homecare 3

Based on review of records, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

87755 Inspection Authority of the Licensing Agency (c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b).This requirement is not met as evidenced by: Based on observation, Licensee did not comply as LPA arrived to conduct a medication audit but the medication administration record was not available at the facility which poses a potential risk.

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 medication audit, Licensee did not comply as LPA observed R1 medication order for Vitamin D3 25mcg daily but S1 has been administering 50mcg, which poses a potential risk.

Based on file review, the licensee did not comply with the section cited above as fire and earthquake drills has not been conducted quarterly which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above as LPA observed gardening tools and recycling boxes located on the exterior pathway 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 osberved two staff files that did not have first aid certification which poses/posed a potential health, safety or personal rights risk to persons in care.

87355 Criminal Record Clearance(c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department:This requirement is not met as evidenced by: Based on observation, file review and interview, the licensee did not comply with the section cited above as S1 was observed to be working but are not associated to the facility roster which poses an immediate health, safety or personal rights risk to persons in care.

87458 Medical Assessment(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Based on file review, Licensee did not comply as R1 did not have a LIC 602 / Medical Assessment present on file which poses a potential risk for residents in care.

87405 Administrator - Qualifications and Duties (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. (3) Ability to maintain or supervise the maintenance of financial and other records. This requirement is not met as evidenced by: Based on file review and interview, Licensee did not comply as R1's skilled nursing facility discharge paperwork was mistaken for LIC 602 which R1 has no current LIC 602 on file, which poses a potential 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: (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This requirement is not met as evidenced by: Based on file review of the incident report and interview, Licensee did not comply as R1 left the facility through the front door without staff seeing which poses an immediate health and saftey risk.

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner.This requirement is not met as evidenced by: Based on LPA and S1's food inspection, Licensee did not comply as there was a jar of instant coffee in the pantry with expiration date of August 31, 2024, which poses a potential risk for residents in care.

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as LPA observed facility fire door to be hooked open and smoke alarm to be removed which poses an immediate health, safety or personal rights risk to persons in care.

87355 Criminal Record Clearance(c) A licensee or applicant for a license may request a transfer of a criminal record clearance from one state licensed facility to another, or from Trust Line to a state licensed facility by providing the following documents to the Department:This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above as one staff was observed to be working and one staff was residing at the facility but are not associated to the facility roster which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above as LPA observed facility fire door to be hooked open which poses an immediate health, safety or personal rights risk to persons in care.Failure to provide POC by due date may result to civil penalty of $100 per day until received.

Based on observation and interview, the licensee did not comply with the section cited above as two staff were observed to be working at the facility since licensure but are not associated to the facility roster which poses an immediate health, safety or personal rights risk to persons in care.