Citrus Heights Terrace

87705 Care of Persons with Dementia(f) Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements: (6) Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents. This requirement is not met as evidenced by: Based on documentation reviewed and an interview conducted, the Licensee did not ensure that resident (R1) was not able to exit the facility, unassisted, on 4/19/2026 (5:05 pm approximatey), which posed an immediate health and safety risk to residents in care. Resident was returned to the facility, uninjured, 20 minutes later, at approximately 5:25 pm.

Based on observation, the licensee did not comply with the section cited above in a closet conatining hazardous items was left unlocked and unattended which poses/posed a potential health, safety or personal rights risk to persons in care.

87466 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 such as unusual weight gains or losses or deterioration of mental ability or a physical health condition 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 conducted and documentation reviewed, the Licensee did not ensure that staff provided the necessary interventions on August 5, 2025, starting at around 11:00 am, when (R1) was observed to be running throughout the facility, until 4:45 pm, when (R1) fell near the dining room and sustained a nasal bone fracture and laceration on the nose and lips,, requiring stitches in the emergency room, which posed an immediate health and safety risk to residents in care.

87411 Personnel Requirements - General (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 requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that adequate supervision was provided to (R2), prior to April 7, 2025 (12:40 am) when (R2) pushed (R1) in their room), causing (R1) to sustain a right femur neck fracture, which posed an immediate health and safety risk to residents in care.

87411 Personnel Requirements - General (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 requirement is not met as evidenced by: Based on interviews conducted and documenation reviewed, the Licensee did not ensure that adequate supervision was provided to (R2) and (R1), prior to March 30, 2025 (9:30 am) when (R2) entered (R1's) room and attacked (R1) while (R1) was resting, which poses an immediate health and safety risk to residents in care. (R2's) care plan, (dated 7/1/2024), notes that resident requires "maximum assist" with staff monitoring behavioral expressions and resident has had "some expressions that Admin is monitoring closely".

87463 Reappraisals (a)The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. (1) Significant changes in condition, as defined in Section 87101, Definitions, include, but are not limited, to: (C) Behavioral expression, as defined in Section 87101, Definitions, that may result in harm to self or others, such as unsafe wandering, elopement, hallucinations, lacking in hazard awareness, or lacking in impulse control. This requirement is not met as evidenced by: Based on documentation reviewed, the Licensee did not ensure that resident (R2's) care plan was updated following resident showing a change in condition with behaviors/behavioral expressions documented back to October 2024 through March 2025, which posed a potential health and safety risk to residents in care.

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition.This requirement is not met as evidenced by: Based on observations and interviews conducted, the Licensee did not ensure that carpet areas were maintained in a clean, sanitary and odorless condition, on/around September 2024- October 2024, which posed a potential health and safety risk to residents in care.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) 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 not met as evidenced by: Based on interviews conducted and observations made, the Licensee did not ensure that laundry services meet each resident's needs, including sufficient and trained staff to complete the laundry processes, and delivering clean laundry timely to each resident, which poses a potential personal rights violation to residents in care.

87411 Personnel Requirements - General (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 requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that staff frequently monitored resident (R1)'s condition while outside on the patio, on the afternoon of 9/22/24, to prevent (R1) from suffering a heat stroke, when temperatures reached 91*F, which posed an immediate health and safety risk to residents in care. Resident was sent to the emergency room at 1545 approximately and diagnosed with an altered state of consciousness and heat stroke.

87466 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 such as unusual weight gains or losses or deterioration of mental ability or a physical health condition 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 conducted and documentation reviewed, the Licensee did not ensure that resident (R1) received timely medical attention, on 8/28/24, after having an unwitnessed fall that morning, as (R1) was not sent out to the hospital until 19:28 hours, and had displayed a change in baseline behavior with her mobility, which posed an immediate health and safety risk to residents in care. (R1) was diagnosed with a left hip fracture after being sent to the hospital on the evening of 8/28/24.

87464 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 is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that resident (R1) received regular applications of lotion and cream, as ordered, for eczema, and assistance with oral hygiene care, on multiple occasions, which posed an immediate health and safety risk to residents in care.

87625 Managed Incontinence(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that resident (R1) was provided with regular incontinent care to ensure she was kept clean and dry, on multiple occasions, which posed an immediate health and safety risk to residents in care.

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 record review, the Licensee did not ensure that resident (R1) received eye drops as ordered on 5/11/24 (evening /bedtime doses) and on 6/22/24 (evening dose), which posed an immediate health and safety risk to residents in care.

87705 Care of Persons with Dementia.(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.This requirement was not met as evidenced by: Based on interview conducted and documentation reviewed, the Licensee did not ensure that resident (R1) was not able to exit the facility, unassisted, on 4/6/24 (5:10 pm approximatey), which posed an immediate health and safety risk to residents in care. Resident was returned to the facility, uninjured, 20 minutes later, at approximately 5:35 pm.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (3) In addition to the on-the-job training requirements in Section 87411(d), staff who provide direct care to residents with dementia shall receive the following training as appropriate for the job assigned and as evidenced by safe and effective job performance:(A) Dementia care including, but not limited to, knowledge about hydration, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living; This requirement is not met as evidenced by: Based on documentation reviewed, the Licensee did not ensure that staff (S1) had completed the required training related to Dementia care, which posed an immediate health and safety risk to residents in care.

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) 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 interviews conducted and documentation reviewed, the Licensee did not ensure resident (R1) was administered PRN Loperamide 2 mg (Imodium), as prescribed, on 12/9/23 (2:00 am) and following diarrhea, which posed a potential health and safety risk to residents in care. (R1) was sent to the emergency room for further evaluation.

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 documentation reviewed and interviews conducted, the Licensee did not ensure that resident (R1) did not miss a dosage of Olanzapine on/around August 24-25, 2023, which posed an immediate health and safety risk to residents 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: (14) To have reasonable access to telephones, to both make and receive confidential calls. The licensee may require reimbursement for long distance calls.This requirement isn not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that (R1) was allowed to accept a phone call from a family member on 1/20/24 at approximately 8:48 pm, which posed a potential personal rights violation to residents in care. Resident was very agitated and staff didn't feel she was emotionally able to take the call at that time.

87413 Personnel - Operations. (a) In each facility: (1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement is not met as evidenced by: Based on interviews conducted and text messages reviewed, the Licensee did not ensure that there was a Med-Tech staff or other staff on duty on 12/24/23, from approximately 10:54 pm to 11:50 pm, that was able to administer PRN medication for pain to (R1), which posed an immediate health and safety risk to residents in care.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(4) 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 not met as evidenced by: Based on interviews and documentation reviewed, the Licensee did not ensure that (R2) and (R1) were provided with sufficient supervision, on 4/15/23, during the NOC shift, to prevent him from entering (R1's) room and laying naked on (R1) while she was in bed, which posed an immediate 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. This requirement is not met as evidenced by: Based on interviews conducted, the License did not ensure that (R1's) responsible person was provided with copies of incident reports when requested on/around May 2023, which poses a potential health and safety risk to residents in care.

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:(1) 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 record review and interviews, the Licensee did not ensure that (R1) received prompt medical attention, following the incident with (R2) on 4/15/23, which posed an immediate health and safety risk to residents in care.

Incidental Medical and Dental Care.(c )(3)A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement was not met as evidenced by records and interviews That found PRN use by residents are not consistently recorded as required. This posed a potential risk to residents.

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. (5) Good character and a continuing reputation of personal integrity. This requirement is not met as evidenced by: Based on interviews conducted and documentation reviewed, the Licensee did not ensure that the prior Administrator included accurate information only on the LIC624 submitted to the Department on/around 4/27/23 for the incident ocurring on 4/26/23 regarding (R1) going to the hospital, which posed a potential health and safety risk to residents in care.

87507 Admission Agreements(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidenced by: Basd on documentation review, the Licensee did not ensure that item #25- Medication Safety, (listed in the Resident Handbook) which reads: "Medications will be Centrally Stored and monitored by Community Staff ", was followed, which posed an immediate health and safety risk to residents in care.

87303 Maintenance and Operation a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on interviews conducted, the LIcensee did not ensure that all pull cord devices were in working order, including in (R1's) bathroom, from approximately Feb- May 2023, which posed 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. This requirement is not met as evicenced by: Based on interviews conducted, the LIcensee did not ensure that (R1's) family was provided with all LIC624's since moving to the community after they were requested.

Reg 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 accommodations 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: (D) Hygiene items of general use such as soap and toilet paper. This requirement is not met as evidenced by: Based on observation on 5/12/23 and 9/26/23, the Licensee did not ensure that there were paper towels or cloth towels available for use in (R1's) bathroom, which posed a potential heatlh and safety risk to residents in care.

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 interviews conducted, the Licensee did not ensure that the medication Galantamine, for (R1), was administered as ordered on/around April 2023 and that no medication went missing, which posed an immediate health and safety risk to residents in care. (R1) missed several days of this medication.

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:(8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement is not met as evidenced by: Based on interviews conducted, the Licensee did not ensure that family members were notified that (R1) was sent to the hospital, and for what reasons, on 4/26/23, which posed a personal rights violation to residents in care.

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 documentation reviewed and interviews conducted, the Licensee did not ensure that medications changes for resident (R1)faxed to the facility on 7/28/23 were updated timely in the system to be reflected on the MAR, which poses an immediate health and safety risk to residents in care.

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 documentation reviewed (LIC624 and medication documentation), the LIcensee did not ensure that resident (R1) was administered Hydrocodone (Norco) 325-5 mg table from 7/18/23-7/20/23), due to a bottle of the medication missing, which posed an immediate health and safety risk to residents in care.

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 count and record review on 6/28/23, the Licensee did not ensure that medications were administered as ordered for residents (R1 and R3), which posed an immediate health and safety risk to residents in care.

87705 Care of Persons with Dementia(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.This requirement is not met as evidenced by: Based on interviews conducted and observation, the LIcensee did not ensure that the auditory device on the patio exit door was working effectively, on 6/29/2023 (7:30 pm approximately) , to alert staff that resident (R1) had exited the the building, which posed an immediate health and safety risk to residents in care.