Jasmin Terrace at Yucca Valley

87465(a)A plan for incidental medical and dental care shall be developed by each facility…(2)The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation…to available medical or dental facility which will meet the resident's need…This requirement is not met at evidenced by: The Licensee did not comply with the section cited above, as staff #1(S1) did not ensure resident #1 (R1) was transported to their medical appointment as scheduled; which poses a potential health, safety, and personal rights risk to persons in care.

87303(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: The Licensee did not comply with the section cited above by not ensuring that resident bedroom carpets in rooms108, 109, and 123 were clean and the sink faucet in resident bedroom #109 was operating properly; which poses an potential health, safety, and personal rights risk to persons in care.

87309(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: The Licensee did not comply with section cited above by a hand saw left unlocked and unattended in the facility's dining room; which poses an immediate, health, safety, and personal rights risk to persons in care.

Title 22, Division 6 Chapter 8 Article 09. Resident Records(c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible...for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. This requirement is not met as evidence by: Based on interviews and file reviews, the licensee did not comply with the section cited above by not ensuring that the licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of their designated representative which poses a potential health, safety or personal rights risk to residents in care.

Based on LPAs records review, the licensee did not comply with the section cited above in by not maintaining admissions agreements that are signed and dated by resident #1, #2, and #3 or resident's representatives which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPAs observations, the licensee did not comply with the section cited above by not maintaining record of annual dementia for staff #2 (S2) on file for LPA review. Last training was conducted in September 2023, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPAs observations, the licensee did not comply with the section cited above by kitchen knives were left unlocked and attended by staff; which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPAs record review, the licensee did not comply with the section cited above staff #1 (S1) first aid/CPR training certification was expired; which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPAs observations, the licensee did not comply with the section cited above by Administrator's personnel file was not at the facility for LPAs to review. File is kept at the corporate office; which poses/posed a potential health, safety or personal rights risk to persons in care.

87303Maintenance 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: Interviews with staff, residents, and document review reveal that the facility does have bed bugs and the Licensee is not utilizing effective measures to mitigate the spread of bed bugs. This poses/posed an immediate health, safety, and personal rights risk to persons in care.

87468.2Additional 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 the following personal rights: (8)To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical...abuse. This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by facility staff financially exploiting R1 while in care; which poses an immediate health, safety and personal rights risk to persons in care.

87506 Resident Records(e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This requirement is not met as evidenced by: The Licensee/Administrator did not comply with the section cited above by not maintaining copies or orginals of R1's facility records for three years after being discharged from the facility for LPA review.

87506 Resident Records(e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by not maintaining copies or orginals of R1's facility records for three years after being discharged from the facility for review.

Additional Personal Rights of Residents in Privately Operated Facilities 87468.2(a) In addition to...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.(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: The Licensee did not comply with the section cited above by not ensuring resident had sufficient supervision to meet their care needs resulting in R1 eloping from the facility; which poses an immediate health, safety, and personal rights risk to persons in care.

H&S:1569.269(a)(6) Enumerated rights; severability: Residents of residential care facilities for the elderly shall have all of the following rights: 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 at evidenced by: The Licensee did not comply with the section cited by facility staff were not competent in meeting R1 needs. Facility staff failed to properly supervise R1. Following R1 leaving facility premises on December 21, 2022, R1 was struck by a vehicle and killed while attempting to cross a highway. This posed an immediate health, safety or personal rights risk to persons in care.

87211 (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...within seven days of the occurrence of...(D)Any incident which threatens the welfare, safety or health of any resident...This requirement is not met as evidenced by: The Licensee did not comply with the section cited above by not reporting incidents that threatened the health and safety of R1, R2, R3, R4, and R5; which poses a potential health, safety or personal rights risk to persons in care.

87303(a) The facility shall be clean, safe, sanitary and in good repair at all times...this requirement is not met as evidenced by: The Licensee did not comply with the section cited above by not maintaining resident's room and facility hallway free of odor; and not maintaining resident's floor clean; which poses a potential health, safety and personal rights risks to persons in care.

Based on LPAs observations, the licensee did not comply with the section cited above by not having a required chair in room#115; which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPAs observations, the licensee did not comply with the section cited above by not maintaining record of (R1s),(R2s),(R3s),(R4s),(R5s) admissions agreements on file;which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPAs record review, the licensee did not comply with the section cited above by resident#6(R6's) physicians report was not signed by the resident and/or legal representative; which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPAs observations, the licensee did not comply with the section cited above by maintaining hot water temperature above 105 degrees F in four (4) resident bathrooms; which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA observations, the licensee did not comply with the section cited above by not maintaining facility free of mosquitos and having roaches in room#140; which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPAs observations, the licensee did not comply with the section cited above by not having an up-to-date activity plan on file; which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPAs record review, the licensee did not comply with the section cited above by not maintaining a current disaster drill conducted with staff on file; which poses/posed a potential health, safety or personal rights risk to persons in care.

87303 Maintenance and Operation(d) There shall be lamps or light appropriate for the use of each room and sufficient to ensure the comfort and safety of all persons in the facility; this requirement is not met as evidenced by: The licensee/Administrator did not comply with the section cited above by not maintaining sufficient lighting in bedroom #103's hallway; which poses a potentional health, safety, and/or personal rights risk to persons in care.

87309 Storage Space(a) Disinfectants, cleaning solutions, poisons...and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients..this requirement is not met by: Based on LPA observations the Licensee/Administrator did not comply with the section cited above by having a Raid insecticide spray next to resident's bed; which poses an immedicate health, safety and/or personal rights risk to persons in care.

Resident Records.The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility…this requirement is not met as evidenced by: resident #1 (R1’s) last medical exam on file was conducted on 6/23/2022, due to R1’s cognitive condition an annual medical assessment is required. Resident #2 (R2) physician’s report was missing physician’s signature. Resident #5 (R5) did not have a complete physician's report or a medical assessment on file, which poses a potential health, safety, or personal rights risk to persons in care.

87464 Basic Services(f) Basic services shall at a minimum include:(4)Personal assistance and care as needed by the resident...with those activities of daily living such as dressing, eating, bathing...this requirement has not been met as evidenced by: interviews with staff #1(S1) and staff #2 (S2) reveal they were told by resident #1 (R1) that they have not received their scheduled bath. review of daily care logs reveal no record of baths for R1 from 12/27/23 through 1/08/2024,which poses a potential health, safety or personal rights risk to persons in care.

REPORTING REQUIREMENTS (a)Each licensee shall furnish to the licensing agency…(1)A written report…within seven days...(D)Any incident which threatens the welfare, safety or health of any resident…This requirement is not met by: The licensee did not provide the licensing agency with written reports regarding R1 injuries which occurred on 6/11/23 and 6/15/23 with 7 days; which poses a potential health, safety or personal rights risk to persons in care.

Incidental Medical and Dental CareFor every prescription and nonprescription PRN medication for which the licensee provided assistance there shall be a signed, dated written order from the Physician, on a blank prescription, maintained in resident's file. This requirement is not met as evidence by the following: Records reveal that medications were prescribed to resident #1 and medication were not located and dispensed according to doctor's orders

Incidental Medical and Dental CareA 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: This requirement is not met as Records revealed resident #1 had an appointment on 09/19/23, missed appt and later attended on 09/22/23

87464Basic Services(f)Basic services shall at a minimum include:(2) Safe and healthful living accommodations and services. This requirement is not met as evidenced by: medications for (2) residents were missing. Staff was unable to locate the medication; which poses an immediate health, safety, and personal rights risks to persons in care.

87464Basic Services(f)Basic services shall at a minimum include:(7)A planned activities program which includes social and recreational activities appropriate...this requirement is not met as evidenced by: Facility staff assigned to activities are on medical leave. Four (4) out of (6) residents interviewed stated that the facility does not have activities for them.

87464 Basic Services (f)Basic services shall at a minimum include:(6) Arrangements to meet health needs. This requirement is not met by: Facility did not refill resident's medication in a timely manner and did not follow-up on the delay of resident's medication.

Based on observation, the licensee did not comply with the section cited above. The outdoor space for Dementia residents is not completely enclosed with open access to the street. 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. LPA observed roaches and insects on several areas of the kitchen; Which poses an immediate health, safety or personal rights risk to persons in care.

This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. Staff#1 did not have required health screening; 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. LPA found two (2) resident files with missing admissions agreements; which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in. LPA observed missing admissions agreements which poses/posed a potential health, safety or personal rights risk to persons in care.

REPORTING REQUIREMENTS (a)Each licensee shall furnish to the licensing agency…(1)A written report…within seven days...(D)Any incident which threatens the welfare, safety or health of any resident…This requirement is not met by: The licensee did not provide the licensing agency with written reports regarding R1 injuries which occurred on 6/11/23 and 6/15/23 with 7 days; which poses a potential health, safety or personal rights risk to persons in care.

Incidental Medical & dental care (a) A plan..shall be by compliance with the following: (1)The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions & needs of residents. This requirement is not met as evidenced by: Based on interviews and record review, R1 had multiple physical injuries between 4/28/23 and 6/11/23 that required follow-up medical care. However, it was not until 6/15/23, when R1 sustained subsequent injuries that R1 was sent to the hospital, which poses and immediate health, safety and personal rights risks to residents in care.

Criminal Record Clearance (e)All individuals subject to a criminal record review...prior to working...in a licensed facility shall...(1)Obtain a California clearance or a criminal record exemption...This requirement is not met as evidenced by: Facility records and staff interviews reveal, Licensee did not ensure a criminal record clearance was obtained for Staff #1 (S1) prior to employment, which poses an immediate health, safety, and personal rights risk to persons in care.

87468.1Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have the following..(3)To be free from...actions of a punitive nature, such as withholding residents’ money. This requirement is not met as evidence by the following: Staff did not provide resident with the entire money requested which poses a potential health, safety and personal rights risk to resident in care.

87412 Personnel Records(f)All personnel...shall be in good health...Good physical health shall be verified by a health screening...performed by a physician not more than six (6) months prior to or seven (7) days after employment. This condition is not met by: The facility did not ensure that staff 1 (S1) and staff 2 (S2) had a verifiable health screening that indicates whether the person is physically qualified to perform the duties to be assigned.Which poses health, safety, and personal rights risk to residents in care.

87211 Reporting Requirements(a)Each licensee shall furnish...reports...including ...(1)A written report shall be submitted to the licensing agency within 7 days.. of the occurrence of...(D)Any incident which threatens the welfare, safety or health...of resident. This requirement was not met by

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... This requirement was not met as evidenced by: Based on observation, interview and record review, the Licensee did not comply with the section cited above by not applying the recommendation of the exterminator for the rodents/roaches at the facility which poses immediate health, safety and personal rights risks 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...(3) To be free from punishment, humiliation, intimidation, abuse...This requirement is not met as evidenced by: Based on interview and records review, the Licensee did not comply with the section cited above due to facility staff neglect to ensure R1 is free from abuse from R2 and resulted to R1’s injury which pose immediate health, safety and personal rights risk to 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...(2) Request a transfer of a criminal record clearance as specified... 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 failure to associate Staff # 4 to the facility which pose immediate health, safety and personal rights risk to resident in care.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall... (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually...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 failure to ensure that R2 have annual medical assessment and reappraisal done annually which pose immediate health, safety and personal rights risk to 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...(1) Obtain a California 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 allowing Staff #5 to work at the facility without criminal background clearance since 06/07/2021 which pose immediate health, safety and personal rights risk to resident in care.

Personal Rights of Residents in All Facilities-Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interviews conducted with residents and facility staff. The facilities air conditioning unit is not working in the main common areas and the kitchen. This poses a potential Health and Safety risk to the clients in care.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia ... (7) An activity program shall address the needs and limitations of residents with ... This requirement is not met as evidenced by: Based on observations, interviews and record review, the licensee did not provide activities for residents at the facility, which poses 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 by having expired dry food in the kitchen panty. LPA found expired peanut butter, expired soup base chicken, and expired sauerkraut in the kitchen pantry which poses a potential health, safety or personal rights risk to persons in care.

Based on interview and record review, the licensee did not comply with the section cited above by allowing S1 to work at the facility for four (4) months without a criminal background clearance which poses an immediate health, safety or personal rights risk to persons in care.

87303 Maintenance and Operation (a) The facility shall be clean, safe and sanitary and in good repair at all times. Maintenance shall include ... This requirement is not met as evidenced by: Based on observations and interviews, the Licensee did not comply with the section cited above by having a pull button/cord in room 116 near the resident bed in disrepair which poses an immediate health, safety and personal rights risks 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 ... Based on observations, interviews and record review, the Licensee did not comply with section cited above by not reporting incidents of unwitnessed fall of Resident 1 (R1) at the facility to Community Care Licensing Division (CCLD) which poses potential health, safety and personal rights risk to resident in care.

87705 Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of operation shall address the needs of residents with dementia, including: (1) Procedures for notifying the resident's physician, family members ... Based on observation, interview and record review, the Licensee did not comply with the section cited above by not notifying Resident 1 (R1) responsible party of the incident last 01/09/2022 which poses a potential Health, Safety or Personal Rights risk to resident in care.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to ... This requirement is not met as evidenced by: Based on observations, interviews and record review, the Licensee do not have adequate number of direct care staff working at the facility to meet residents needs which poses an immediate risk to resident in care.

87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include ... This requirement is not met as evidenced by: Based on observations, interviews and record review, the facility do not have working call button (rroom #116) near the residents bed to alert staff if residents need care which poses an immediate risk to resident in care.

87705 Care of Persons with Dementia(b) In addition to the requirements as specified in Section 87208, Plan of Operation, the plan of ...(1) Procedures for notifying the resident’s ... This requirement is not met as evidenced by: Based on observations, interviews and record review, the Licensee did not comply by not reporting incidents of unwitnessed fall of Resident 1 (R1) at the facility to Community Care Licensing Department (CCLD) which poses a potential risk to resident in care.

87705 Care of Persons with Dimentia (c) Licensees who accept and retain residents with dementia ... (7) An activity program shall address the needs and limitations of residents with dementia and include ... This requirement is not met as evidenced by: Based on observations, interviews and record review, the licensee did not provide activities for residents at the facility, which poses a potential Health, Safety, or Personal rights risk to persons in care.

87705 - Care of Persons with Dementia - Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents and to escort residents who leave the facility. This requirement was not met as... evidenced by: Interviews, record reviews, and observation, the licensee did not ensuire that staff were able to provide adequate care and supervision for R1. R1 was found wandering outside the facility on 1/9/2022 without care and supervision. Interviews revealed that only two staff members were working that shift. This poses an immediate health & safety risk to the 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: (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 observation, interview and record review the licensee did not administrator medication as prescribed on 1 out of 1 times. This poses an immediate health, safety or personal rights risk to persons in care.

1569.618 Administration and management of residential care facilities; substituted qualifications; employee scheduling (a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. This requirement is not met as evidenced by: based on observation, interview and record review the administrator was not available during normal working hours on 1 out of 1 times. This poses a potential health, safety or personal rights risk to persons in care.

1569.269 Enumerated rights; severability(a) Residents of residential care facilities for the elderly shall have all of the following rights: (5)To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. This requirement is not met as evidenced by: Based on observation, interview and record review the licensee did not ensure safe and healthful accommodations on 2 out of 2 times.

1569.269(a)(5) ENUMERATED RIGHTS: SEVERABILITYResidents of residential care facilities for the elderly shall have all of the following rights: To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. This regulation was not met as evidenced by: The facility has a pest infestation. This is an immediate Health and Safety risk to residents in care.Based on observation, interviews and record review the licensee did not ensure that the residents were accorded safe, healthful and comfortable accommodations for multiple residents in care.

1569.269 ENUMERATED RIGHTS: SEVERABILITYResidents of residential care facilities for the elderly shall have all of the following rights: To be accorded safe, healthful, and comfortable accommodations, furnishings, and equipment. This regulation was not met as evidenced by: The facility has a pest infestation. This is an immediate Health and Safety risk to residents in care. This requirement is not met as evidenced by:Based on observation, interviews and record review the licensee did not ensure that the residents were accorded safe, healthful and comfortable accommodations for multiple residents in care.

80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by:Based on observation, interview and record review the licensee did not ensure that there was adequate staffing on at leasing one occasion.