Montclair Royale Senior Living

Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that resident #1, #2 (R1, R2) medications were dispensed properly as per the physicians order, which poses a potential health, safety or personal rights risk to persons in care.

87355 Criminal Record Clearance(a) The Dept shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 (b)Prior... residing in the facility shall have a criminal record clearance or exemption. This requirement was not met as evidenced by: Based on LPA observations, record reviews and interviews, Staff #1 (S1) did not have a criminal record clearance prior to working at the facility. This poses an immediate health, safety or personal rights risk to residents in care

Based on observation, interview, record review, the licensee did not comply with the section cited above by not having the required carbon monoxide detector installed on each floor of the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above by ensuring that staff #3 (S3) does not have the required updated ServSafe certification and staff #4 (S4) has an updated food handler card, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that facility representative signed Resident #2 (R2) resident #3 (R3) and resident #4 (R4) admission agreement which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that resident #2 (R2) has the required pre-placement appraisal which poses a potential health, safety or personal , risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that staff #4 (S4) has the required tuberculosis (TB) test and TB test result, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that floor surface in resident bathroom and the floor bathroom for residents and staff were clean which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that resident #5 (R5) has the required needs and services plan and facility representative sign the completed needs and services plan for resident #2 (R2) and resident #4 (R4), which poses a potential health, safety or personal rights risk to persons in care.

Based on observation, interview,record review, the licensee did not comply with the section cited above by not ensuring that the facility administrator was present at the facility for three (3) consecutive weeks and not at the facility during normal working hours which poses a potential health, safety or personal rights ris k to persons in care.

Based on observation, interview, record review, the licensee did not comply with the section cited above by accepting resident #2 (R2) in memory care and per documents review R2 does not have a diagnosis of dementia but with a primary diagnosis of a mental disorder unrelated to dementia which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation,interview, record review, the licensee did not comply with the section cited above by not ensuring that resident #3 (R3) has the required annual medical assessment as R3s medical asessment date is 08/12/2022 which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, interview,record review, the licensee did not comply with the section cited above by not ensuring that resident #1 (R1) and resident #2 (R2) have half bedrail with written order from their physician indicating the need for half bed rail for mobility, which poses a potential health, safety or personal rights risk to persons in care.

87224. Eviction Procedures (a)The licensee may evict a resident for one or more of the reasons...Thirty (30) days written notice to the resident is required...This requirement was not met as evidenced by: Based on record reviews and interviews the Administrator did not comply with the regulation listed above when the resident was relocated without a proper 30 day eviction notice. This posed an immediate Health, Safety and Personal Rights risk to persons in care.

87224 - Eviction Procedures (C)A statement informing residents of their right to file a complaint with the licensing agency... (a)(4), including the name, address and telephone number of the licensing office with whom the licensee normally conducts business, and the State Long Term Care Ombudsman office.This requirement was not met as evidenced by:Administrator failed to ensure the correct contact information for the Long Term Care Ombudsman was on the eviction notice. This posed a potential health, safety and/or personal rights 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 was not met as evidenced by: Based on observations, the Administrator failed to keep the resident's bathroom clean, safe and sanitary. This poses a potential Health, Safety and Personal Rights risk to persons in care.

87303 Maintenance and Operation(c) All window screens shall be clean and maintained in good repair.This requirement was not met as evidenced by: Based on observations, the Administrator failed to have the resident's window repaired when it became weathered and damaged causing the resident access outside a second story.

87303 Maintenance and Operation"(f)Solid waste shall be stored and disposed...(1)Solid waste shall be stored, located and disposed of in a manner that will not permit the transmission of a communicable disease..."This requirement is not met as evidenced by: Based on observations, the Administrator failed to uphold the requirement listed above by not properly disposing of a resident's solid waste which poses an immediate Health, Safety and Personal Rights risk to persons in care.

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities...Residents in privately operated RCFEs shall have all of the following...rights: To care, supervision, & services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, & competency to meet their needs. This requirement was not met as evidenced by:Based on observations and interviews, Administrator failed to provide the level of care and supervision needed for R1 & R2, which poses an immediate health, safety and personal rights risk to persons in care.

87303 Maintenence and Operation (e)(2)Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Based on interviews and record reviews the Administrator did not insure the facility provided hot water to residents for personal care which poses a potential Health, Safety and Personal Rights risk to persons in care.

87309 - Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.This requirement was not met as evidenced by: Based on observations and interviews, the Licensee failed to keep the storage of chemicals and toxins inaccessible to residents in care. Which poses an immediate Health, Safety and or personal rights risk to resident in care.

87555.General Food Service Requirements. (b)The following food service requirements shall apply: (17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist, a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified. The consultation services shall be provided at appropriate times, during at least one meal. A written record of the frequency, nature and duration of the consultant's visits shall be secured from the consultant and kept on file in the facility. Based on observation, interview and document review, the licensee did not comply with the section cited above evidenced by not employing a qualified kitchen staff to ensure the residents were provided with proper food service which poses a potential health, safety, or personal rights risk to persons in care.

80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.This requirement is not met as evidenced by: Based on observations and interviews, Administrator did not ensure the residents' room was kept in good repair at all times. Which poses poses a potential Health, Safety or Personal Rights risk to persons incare.

Eviction Procedures (b) The licensee may, upon obtaining prior written approval from the licensing agency, evict the resident upon three (3) days written notice to quit. The licensing agency may grant approval for the eviction upon a finding of good cause. This requirement was not met as evidenced by: Based on interviews, collected documentations and onservations the licensee did not acquire the approval of a 3 day eviction from Community Care Licensing. The 30 day Eviction Notice pursued after the denial was invalid as it was not complete which which poses a potential Health, Safety, or Personal Rights risk to persons in care.

§1569.683 Eviction notices; reasons for eviction contents; service(a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction...the notice to quit shall include all of the following:(2) Resources available to assist in identifying alternative housing and care options, including public and private referral services and case management organizations. This requirement was not met as evidenced by:Based on record reviews and interviews, the Administrator illegally issued an eviction notice to the resident when the wrong contact information was given as a resource. This poses a potential health, safety and personal rights risk to persons in care,

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance...This requirement was not met as evidenced by: Based on observations of the resident room and resident interviews the resident was not accorded personal privacy while care was being provided and the window shades were missing. This poses a potential Health, Safety and Personal Rights risk to persons in care,

80087 - Buildings and Grounds- (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.This requirement was not met as evidenced by: Observations of the residents room windows missing a number of blinds. Observations of no record of the window blinds being reported. This poses a potential Health, Safety or Personal Rights risk to persons incare.

Policies and procedures regarding medications, including knowledge in Section 87411(d)(4). Any on-the-job training provided for the requirements in Section 87411(d)(4) may also count towards the requirement in this subsection. This requirement was not met as evidenced by:Staff interview revealed that S2 has not completed their initial medication training and the facility is unable to provide proof that S2 had received such training. This poses an immediate health and safety risk to residents in care.

The following food service requirements shall apply: All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement was not met as evidenced by:Witness interviews confirm that expired food items and milk were stored and sometimes served to residents in care. This poses an immediate health, safety, and personal rights risk to residents in care.

The following space & safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair & shall provide a safe & healthful environment.This requirement was not met as evidenced by: LPA observed a broken front door and LPA received a recorded video of the facility common room ceiling leaking heavily. This poses an immediate health, safety, and personal rights risk to residents in care.

(e) All individuals subject to a criminal record review pursuant to HSC Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a CA clearance or a criminal record exemption as required by the Department... This requirement was not met as evidenced by:Records review and staff interview confirm that S1 was working prior to receiving their background clearance. This poses an immediate safety and personal rights risk to residents in care.

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1) A written report shall be submitted to the licensing agency... This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by not submitting Special Incident Report (SIR) of R1's hospitalization CCLD ASC. This poses a potential Health and Safety risk to the resident in care.

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing...(2) Request a transfer of a criminal record clearance... This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by not transferring Staff 6 (S6) Criminal Background Clearance to the facility. This poses a potential Health and Safety risk to the resident in care.

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have ... (9) To have communications to the... This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above by not having a staff answer facility telephone calls from the hospital involving R1 the night of 07/11/2022. This poses a potential Health and Safety risk to the resident in care.

A written report of any eviction shall be sent to the licensing agency within five (5) days.This requirement was not met as evidenced by: The Department did not receive notices of eviction until investigation of complaint #s 18-AS-20220105101235 and 56-AS-20220318083750.

The licensee may, upon obtaining prior written approval from licensing agency, evict the resident upon 3 days written notice to quit. The licensing agency may grant approval for eviction upon a finding of good cause. Good cause exists if the resident is engaging in behavior which is a threat to the mental and/or physical health or safety of himself or...others in the facility. This requirement was not met as evidenced by:The Department did not receive eviction notices until complaint #56-AS-20220318083750 was filed and investigated.

All facilities shall have a qualified & currently certified administrator. The licensee & administrator may be...the same person. The administrator shall have sufficient freedom from other responsibilities & shall be on the premises a sufficient number of hours to permit adequate attention to the management & administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. This requirement was not met as evidenced by:Based on interviews and observations, facility has not submitted an LIC308, Designation of Facility Responsibility, to the Department since Administrator went on medical leave/full time telework/on-call status on

Fingerprints and criminal records of individuals in contact with clients; exemptions; criminal records clearances - (C) A third-party contractor retained by the facility if the contractor is not left alone with clients in care. This requirement was not met as evidenced by:Based on interviews and record reviews, the licensee has retained the contractor since July 2021 and allowed the contractor to work alone with residents.

87303 (b) (1) Maintenance and Operation(b) A comfortable temperature for residents shall be maintained at all times.(2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature.Based on interviewss and record review, this requirement is not met as evidenced by:AC unit was broker from 7/24/21-9/8/21.This poses a potential health and safety risk to persons in care.

Enumerated rights- (a) Residents of resid- ential care facilities for the elderly shall have all of the following rights: (22)be pr- otected from involuntary...evictions in vio- lation of state laws and regulations..."inv- oluntary” means an...eviction that is initia- ted by the licensee, not by the resident. This requirement was not met as evidenc- ed by: The Licensee did not ensure R1 was provided a 30 day eviction notice as required by law. Based on interviews which were conducted, the facility refused to readmit R1 following thier hospitalization. This poses a potential health, safety and personal rights risk to residents in care.

Personal Rights- (a) Residents in residential care facilities for the elderly shall have personal rights...those listed in Sections 87468.1, Personal Rights... and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. This requirement was not met as evidenced by: The Licensee did not ensure resident's call light alarms were answered in a timely manner. Based on LPA observation and interviews which were conducted, resident call light alarms are not answered in a timely manner. This poses a potential health, safety and personal rights risk to residents in care.

87411 (a) Personnel Requirements: (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 was not being met as evidenced by: Interviews with staff members revealed that staffing gaps occur due to a high turnover rate from employees. Per staff’s statements this creates more workload for staff than they can handle. This posed an immediate health and safety risk to resident in care.

87307 (3)(f) Personal Accommodations and Services: (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: (F) Basic laundry service (washing, drying, and ironing of personal clothing). This requirement was not being met as evidenced by: Facilities washing machines and dryers been in-operable or in need of repair for a prolonged period, as a result residents clean clothing needs were not being met. This posed an immediate health and safety risk to resident in care.

87465(a)(1) Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility. (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 evidence by: Facility failed to seek timely medical attention for residents R1,R2, R3, and R4. After the first case of scabies was identified by a medical professional, this poses a potential risk to the health , safety, and personal rights of residents in care.

87211(2) Reporting Requirements:(2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement was not being met as evidenced by Facilities failing to report scabies outbreak after first case, as a result 3 other cases developed within the memory unit. This posed an immediate health and safety risk to resident in care.

87307 (3)(f) Personal Accommodations and Services: (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: (F) Basic laundry service (washing, drying, and ironing of personal clothing). This requirement was not being met as evidenced by Facilities washers and dryers endure a 6-month period in which one of the main industrial dryers used for drying residents’ linens was broken.