Ivy Park at Laguna Creek

Licensee responsibility for records confidentiality

"(c) All information and records obtained from or regarding residents shall be confidential ... (1) 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 evidenced by: Based on observation, confidential resident records were not stored or safeguarded in a manner which protected their confidentiality, which poses a potential health, safety, and/or personal rights risk.

Comply with all admission agreement terms

"(f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments." This requirement was not met as evidenced by: Based on record review and interview, all terms and conditions of residents' admission agreements and/or modifications were not adhered to, which poses a potential health, safety, and/or personal rights risk.

"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 was not met as evidenced by: Based on interview and record review, facility staff were unaware of R1's general whereabouts for at least 25 minutes, which poses an immediate health, safety, and/or personal rights risk.

Keep prescriptions in original containers

Based on observation, medication was stored outside of its originally received container, which poses an immediate health, safety or personal rights risk to persons in care.

Record annual routine visit documentation

Based on record review and interview, a resident did not receive an annual routine visit with a medical practitioner, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on record review and interview, a resident with a pressure wound was admitted to this facility without home health or other skilled medical supervision or instruction, resulting in the worsening of the wound over the course of several days, 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, multiple cleaning solutions and other hazardous materials were accessible to residents in care, including memory care residents, which poses an immediate health, safety or personal rights risk to persons in care.

"(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 ... 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 was not met as evidenced by: Based on interview and record review, an incident which threatened R1's health, safety, and/or welfare was not reported to CCLD, which poses a potential health, safety and/or personal rights risk.

Provide assistance for residents medical needs

"(4) The licensee shall assist residents with self-administered medications as needed."This requirement was not met as evidenced by: Based on interview and record review, a resident did not receive medications as prescribed, which poses an immediate threat to health, safety, or personal rights.

“(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges.” This requirement was not met as evidenced by: Based on interview and record review, no notification was provided to R1’s RP after rates were raised due to an increase in level of care, which poses a potential health, safety, and/or personal rights risk.

"(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: ... (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision."This requirement was not met as evidenced by: Based on record review and interivews, LPA Moleski did not receive an incident report regarding a resident injury and hospital visit within seven days of the occurrence, which poses a potential health, safety, and/or personal rights risk.

87464 Basic Services (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...This was not met as evidenced by: Based on facility medical record review and witness statements, Licensee did not ensure R1 recieved medication as prescribed. This poses an immediate Health and Safety risk to persons in care.

87506 Resident Records (d) All resident records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours...(H) Records of current medications as specified in Section 87506(b)(12)...This was not met as evidenced by: On 9/15/2023 the Department representative LPA visited the facility to investigate complaint allegations. While at the facility LPA requested resident medical documents and files. The Licensee did not ensure staff could provide documents requested by the Department as required by Title 22 Regulations. This poses an immediate Health and Safety risk to residents in care.

Assist residents with self-administered medication

22 CCR Section 87465(a)(4) - 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 was not met as evidenced by: Based on interviews and review of incident reports and resident records, medications were not administered as required by R1's and R6's doctor's orders, which poses an immediate health and safety risk.

Based on review of R3's resident records, the licensee did not ensure a resident with dementia had their annual medical assessment, which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

87303(a) - Maintenance and Operation: "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 was not met as evidenced by: Based on observation, the licensee did not ensure the facility was clean and sanitary such that cockroaches would not proliferate, and/or did not procure maintenance sufficient to prevent the appearance of cockroaches in room F15.

Authorized physician-prescribed self-administered meds

22 CCR Section 87465(a)(5)(A) – Incidental Medical and Dental Services: “(5) … Assistance with self-administered medications shall be limited to the following:(A) Medications usually prescribed for self-administration which have been authorized by the person's physician.”This requirement was not met as evidenced by: Based on review of R1’s MARs showing an increase of dosage on October 27, 2022, and based on interviews with administrator Morgan Whinery in which she stated that she could not find a doctor’s order to account for the increase, dosages of this prescribed medication were increased without proper authorization from R1’s physician.

Incidental Medical and Dental Care - 87465(4): "The licensee shall assist residents with self-administered medications as needed." This requirement was not met based on LPA review of R1's medication records.This violation poses a potential risk to health and safety of residents in care.

80075(b)(5)(B)Health Related Services (b) Clients shall be assisted as needed with self-administration...(5) If the client's physician has stated in writing that the client is unable to determine...(B) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not ensure residents medication was dispensed as prescribed. This poses a potential health and safety risk to residents in care.

Right to accept or decline care or services

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: (16) To receive or reject medical care or other services. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not ensure residents call button was answered in timely manner. This poses a potential health and safety risk to residents in care.

Reporting Requirements Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: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. Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. The use of an Automated External Defibrillator. 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: A review of submitted SIRs and printed dates.Based on file review and dated faxed documents facility did not submit documents timely. This possess a potential health and safety risk to residents in care.

Keep bath, laundry and kitchen floors clean

Based on observation, the licensee did not comply with the section cited above. LPAs oberserved flooring of each cottage containing dirt and stains with needs of replacement, which poses/posed a potential health, safety or personal rights risk to persons in care.

Limit staff assistance with self-administered drugs

Based on observation,interview and record review the licensee did not comply with the section cited above. LPAs observed night shift caregiver did not log medication administered at 6:30am for dates 7-27-21 and 7-28-21 which poses an immediate health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above. LPAs observed cob webs and bugs located in the corner of each cottage which poses/posed a potential health, safety or personal rights risk to persons in care.

87468(a)(2) Personal Rights. Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement is not met as evidenced by: Based on observation the licensee did not comply with the section cited above in LPA's observed that the bed had stains from urine from R1. Which poses a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

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 observation the licensee did not comply with the section cited above in LPA's observed that the room had damage to the wall and towel rack was damaged. Which poses a potential health, safety or personal rights risk to persons in care.

80087(a) Buildings and Grounds. The facility shall be kept clean, sanitary and in good repair at all times. This requirement is not met as evidenced by: Based on photos and lack of maintenance records the licensee did not maintain the facility grounds. The facility had dirty carpets and debris in R1's room (photos taken). This poses a potential safety risk to residents in care.

Basic Services (c) "Care and supervision" means the facility assumes responsibility for, or provides... assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes ...personal care. This requirement was not met as evidenced by: lack of actions of transferring as mentioned in the assessment dated 10/28/2018. This poses an immediate health and safety risk to resident.