Atienza Residential Care

Based on [(observation, interview, record review)], the licensee did not comply with the section cited above by not having an emergency disaster plan available for review 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 having a liability insurance available for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Food quality controls and rejected damaged goods

Based on observation, interview, record review, the licensee did not comply with the section cited above by having a green peas can that expired in 2018 in the cabinet which poses an immediate health, safety or personal rights risk to persons in care.

Infection control plan required in operations plan

Based on observation, interview, record review, the licensee did not comply with the section cited above by not having an infection control plan available for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Document each PRN medication dose taken

Based on [(observation, interview, record review)], the licensee did not comply with the section cited above in by not having a record of each PRN dose that resident #1 (R1) has administered which poses/posed a potential health, safety or personal rights risk to persons in care.

Give PRN medication by physician order

Based on observation, interview, record review, the licensee did not comply with the section cited above because there is no evidence that staff are administering medications according to the physician’s orders, as the dates punched on the medication packaging are not in chronological order. 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 having a first aid kit manual available for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain an approved first aid kit on-site

Based on observation, interview, record review, the licensee did not comply with the section cited above by not having a first aid kid available for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain records of centrally stored medication dosages

Based on observation, interview, record review, the licensee did not comply with the section cited above by not having a record of medication for resident #1 (R1) which are centrally stored which poses/posed a potential health, safety or personal rights risk to persons in care.

Request transfer of criminal record exemption

Based on observation and record review, the licensee did not comply with the section cited above by not having Tenant #1 (T1) associated to the facility, T1 is associated to 331880723 but not 361880724 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, interview, record review, the licensee did not comply with the section cited above by not having the drawer that contains sharps locked leaving it accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Keep window screens clean and in repair

Based on observation, interview, record review, the licensee did not comply with the section cited above by having bedroom #4 window screen in disrepair, as well as the sliding door screen in disrepair which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on [(observation, interview, record review)], the licensee did not comply with the section cited above by having bedroom closet doors in room #2 and #4 in disrepair 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 paying the gas since November 2025, which poses an immediate health, safety or personal rights risk to persons in care.

Maintain facilities for fire and panic safety

Based on [(observation, interview, record review)], the licensee did not comply with the section cited above by not having charged fire extinguishers, the two (2) fire extinguishers at the facility are dated from the year 2020 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 having a needs and service plan (LIC 625) for resident #1 (R1) 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 having a record of quarterly disaster drills available for review which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain records of centrally stored medication dosages

87465 Incidental Medical and Dental Care(a) A plan for incidental medical... shall be developed by each facility...(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. Licensee/Administrator did not comply with the regulation above by not having a Medication Administration Record (MAR) for all residents which poses an immediate risk to the health and safety of residents in care.

Diet quality and preparation in safe healthful manner

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 ... All food shall be selected, stored, prepared and served in a safe and healthful manner. Based on observation, interview, and record review, the licensee did not comply with the section cited above by having expired non perishable foods which poses an immediate health, safety or personal rights risk to persons in care.

87303 Maintenance and Operation(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained ...a temperature of not less than 105 and not more than 120 degree F. Based on observation the licensee did not comply with the section cited above by not ensuring the hot water temperature maintained 105 and not more than 120 degree F which poses/posed a immediate health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

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. Based on observation, the licensee did not comply with the section cited above, by having live crockroaches in the main hallway near the dining room and not ensuring resident shared bathroom is providing clean water which poses an immediate health, safety or personal rights risk to persons in care.

Mark taps at high-temperature threshold

87303 Maintenance and Operation (e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. Based on observation the licensee did not comply with the section cited above by not identifying tap water that delivers water above 125 degree F by warning signs which poses/posed a immediate health, safety or personal rights risk to persons in care.

Living accommodations aligned with facility function

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: Based on observation and interviews, the licensee did not comply with the section cited above by using the living room and a residents' bedroom as a staff bedroom/living area which poses an immediate health, safety or personal rights risk to persons in care.

Address and clearance obligations before facility work

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 or volunteering in a licensed facility: Based on observation, record review, and interviews the Licensee did not comply with the section cited above by not having a background clearance for S3

Request transfer of criminal record exemption

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review ...(4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility. Based on observation, record review, and interviews the Licensee did not comply with the section cited above by not having S4 associated to the facility

Maintain personnel records at facility location

87412 Personnel Records(g) All personnel records shall be maintained at the facility. Based on observation, interview, and record review, the licensee did not comply with the section cited above by not having personnel records for Residents 2,3,4,&5 which poses an immediate health, safety or personal rights risk to persons in care.

87633 Hospice Care of Terminally Ill Residents (f) The licensee shall maintain a record of all hospice-related training provided... (1) The record of each training session shall specify the names...This requirement was not met as evidenced by: Based upon record review, LPA did not observe staff training specifically related to hospice care. The facility did not ensure that staff were trained in hospice care which poses an immediate risk to the health and safety of residents in care.

Maintain separate complete record for each resident

87506 (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a centrally...This requirement was not met as evidenced by: Based upon a request to review records, LPA observed a few of the current resident files but not the requested file. The facility did not ensure that all residents files were available for review which posed a potential health and safety risk to residents in care.

Store centrally held medications in locked secure place

Incidental Medical and Dental Care 87465(h)(2) The following requirements shall apply to medications: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible...This requirement was not met as evidenced by: Based upon observation, LPA requested to audit medications and observed the medications cabinet to be unlocked. The staff did not ensure that the centrailly stored medications were locked and inaccessible to residents, which poses an immediate health and safety risk to residents in care.

87211 Reporting Requirements(1)(A)(1) A written report shall be submitted to the licensing agency... (A) Death of any resident from any cause regardless of where the death occurred...This requirement was not met as evidenced by: Based upon record review, LPA did not observe a Death Report. The Administrator did not ensure that the death reporting requirements were followed which posed a potential health and safety risk to residents in care.

80087(a)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 observation the faucets on the facility kitchen sink and resident bathroom sink are both leaking water. The licensee did not ensure that the faucets are in good repair for the safety and well being of clients, employees and visitors.

Incidental Medical and Dental CareThe licensee shall assist residents with self administered medications as needed.This requirement was not met as evidenced by. Interview with R1 and medication review would reveal that medication Clonazepam and Trazodone were not refilled and not dispensed.

Maintain facility in clean, safe, sanitary condition

Maintenance and OperationThe 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: LPA observed facility bedrooms with scuffed walls, dirty carpets, spiders and webs. LPA observed one small roach during inspection. Facility entrance door as dirty baseboards

Facility maintenance and healthful environment

Personal Accommodations and ServicesThe following space and safety provisions shall apply to all facilities: The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met as evidenced by: LPA observes broken dresser drawers, broken picture frames, broken door stops. LPA also observed poorly repaired door slate plate.

Maintain admission agreement and appraisal

Based on observation, interview, and record review, the licensee did not comply with the section cited above by not having admission agreements, pre admission appraisal, physicians reports for residents #2,3,4 which poses an immediate health, safety or personal rights risk to persons in care.

Maintain records of centrally stored medication dosages

Based on observation, interview, and record review, the licensee did not comply with the section cited above by not having a Medication Administration Record which poses an immediate health, safety or personal rights risk to persons in care.

Maintain personnel records at facility location

Based on observation, interview, and record review, the licensee did not comply with the section cited above by not having personnel records for Residents 2,3,&4 which poses an immediate health, safety or personal rights risk to persons in care.

Request a transfer of criminal record clearance

Based on observation, interview, and record review, the licensee did not comply with the section cited above by staff #1 and #2 are not associated to facility on guardian 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 and interview, the licensee did not comply with the section cited above by having bleach unlocked under the sink in the bathroom and knives unlocked in the kitchen which poses an immediate health, safety or personal rights risk to persons in care.

Encourage resident participation in varied planned activities

Based on observation, interview, and record review, the licensee did not comply with the section cited above by not offering activities for residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation and record review, the licensee did not comply with the section cited above by not having an updated resident roster which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observation, interview, and record review, the licensee did not comply with the section cited above by Staff #1 did not have a CPR certificate on file, as well as other caregivers which poses an immediate health, safety or personal rights risk to persons in care.

Food quality controls and rejected damaged goods

Based on observation, interview, and record review, the licensee did not comply with the section cited above by having expired non perishable foods which poses an immediate health, safety or personal rights risk to persons in care.

Applicant and licensee fees are charged by statute

(a) An applicant or licensee shall be charged fees as specified in Health and Safety Code section 1569.185.This is requirement is not being met as evidenced by: LPA noted that annual fees have not been paid.

87355 Criminal Record Clearance(a) The Department shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 and shall have the authority to approve or deny a facility license, or employment, resident... This requirement was not met as evidenced by: LPA observed two staff members who were not associated to the faciity.Rosalinda Antonio Penela andCarmelita Dadivas did not have clearance or associated to the facility.

Maintain required personnel records for staff

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (h) All personnel records shall be retained for at least three (3) years following termination of employment....This requirement is not met as evidenced by: During the visit LPA Allen requested personnel files that could not be provided. This is requirement is not being met as evidenced by: S1 and S2 did not have a file for review. This is a potential health and safety risk for residents in care.

Limit staff assistance with self-administered drugs

(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: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.This requirement was not met as evidenced by: LPA observed Residents medications were transferred between containerswhich poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain separate complete record for each resident

(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff This requirement is not met as evidenced by: LPA request files for resident 1, 2, 3, & 4 that could not be provided or the file was not complete for review. This is a potential health and safety risk for residents in care.

Licensee reports required by licensing agency

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 ..... This is requirement is not being met as evidenced by: LPA requested special insident reports for R1 and R4 and there were no reports available for review.This is a potential health and safety risk for residents in care.

Rapid-growth perishable foods must be covered

Based on LPA observation, the licensee did not comply with the section cited above by having uncovered perishable food items in kitchen refrigerator; which poses an immediate health, safety or personal rights risk to persons in care.

Label and preserve medicine compliance standards

Based on LPA observation, the licensee did not comply with the section cited above by LPA observed in resident #2 (R2) had medication box, medication in a zip-lock bag with no prescription label. LPA observed in resident #3 (R3) medication box, a medication that was missing the name of medication, dosage, and instructions; which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA document review, the licensee did not comply with the section cited above by not having documentation of a drill on file for review; which poses/posed a potential health, safety or personal rights risk to persons in care.

Document required staff training and orientation

Based on LPA observations, the licensee did not comply with the section cited above by not maintaining record of staff on the job training, dementia training, and first aid training; which poses/posed a potential health, safety or personal rights risk to persons in care.

Allow licensing inspection and controlled record removal

Based on LPA observations, the licensee did not comply with the section cited above by not providing LPA upon demand access to staff files; which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain records of centrally stored medication dosages

Based on LPA observations, the Licensee did not comply with the section cited above by LPA observed medications that resident (R1), (R2), (R3), (R4), and (R5) were taking were not all documented and did not have a record of dosages; which poses an immediate health, safety or personal rights risk to persons in care.

Maintain admission agreement and appraisal

Based on LPA observations, the licensee did not comply with the section cited above by not maintaining a pre-admission appraisal on file for resident #1 (R1) on file; which poses/posed a potential health, safety or personal rights risk to persons in care.

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. This requirement was not met as evidenced by: LPA found through interviews, staff disconnected the facility phone between the hours of 6 PM - 8 AM for at least one week, 7/12/20- 7/18/20 this poses an immediate danger to those in care.