Nick's Maple Home Iii

Based on observation and record review, the licensee did not comply with the section cited above in by not ensuring all residents file were maintain with a appraisal, pre-admission appraisal report, or ensuring all records are error free and the use of white out does not appear on resident records which 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 in by not ensuring prior to admission and acceptance they have a completed LIC602 report for residents ready for review and in residents file which poses 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 in 1 out of 2 staff by not ensuring the staff had a health screening and TB test results maintain in staff file which posed a potential health, safety or personal rights risk to persons in care.

85075(b) The facility shall develop and implement a plan which ensures that assistance is provided to the clients in meeting their medical and dental needs. Based on interviews, the licensee did not ensure the resident appointment was maintained by not having a valid contact number on file for residents medical provide, which poses an immediate health and safety risk to residents in care.

(a) The licensee shall..and current record is maintained in the facility for each client. (10) Record of current medications, including the name of the prescribing physician, and instructions..medications. Based on record review, interviews conducted with residents, staff and reporting party, the licensee did not ensure the resident MARS, is maintained, and medication is dispensed and prescribed by physician orders, which poses an immediate health and safety risk to residents in care.

87468.2(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. Based on interview and record review, the licensee did not comply with the section cited above evidenced by Licensee did not seek proper assistance from the support team to prevent R1 from burning self. Licensee did not follow smoking cessation plan, which imposes an immediate health and safety risk to residents in care.

Based on observation, and record review, the licensee did not comply with the section cited above by not having an Infection Control Plan ready available to staff, resident in care, or CCL to review. 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 monitoring the MARS and ensuring medication is properly logged and disgarding when no longer needed. This type of error or inconsistency 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 conducting an annual review of the emergency disaster plan, which poses/posed 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 locking the perimeter gate to the front and backyard, which does not allow the residents in care to exit freely in case of an emergency. Additionally, not having a Fire Marshall clearance to do so. This 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 by not ensuring that cleaning supplies are secured and inaccessible to resident in care. These cleaning supplies not being secured poses/posed 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 not having a complete first aid kit, or book, 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 by not ensuring staff files contained updated/current CPR/First Aid Training. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observations of the facility, Administrator did not comply with the section cited above by not ensuring all fire/smoke/carbon monoxide alarms contained working batteries. This poses a potential health, safety or personal rights risk to persons in care.

Based on observations of Resident Rooms #1 and #3 the licensee did not comply with the section cited above by ensuring that each resident window has a properly attached screen. Also, by not making sure the window glass was intact. This poses a potential health, safety or personal rights risk to persons in care.

Based on observation of the backyard the licensee did not comply with the section cited above by making sure all of the yard tools were secure. Also leaving electrical wires hanging wtih duct tape attached. Which poses an immediate health, safety or personal rights risk to persons in care.

Based on observations the licensee did not comply with the section cited aboveby not ensuring that complete and accurate staff files are accessible and maintained at the facility for review. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on observations of the resident records the licensee did not comply with the section cited above by not ensuring that all residents in care maintained client medical asessments which poses a potential health, safety or personal rights risk to persons in care.

Based on observations the licensee did not comply with the section cited above by not ensuring a “No Smoking-Oxygen in Use” sign is posted in the facility. This poses/posed a potential health, safety or personal rights risk to persons in care, in that there are residents in care who smoke.

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 observation, record reviews and interviews the licensee did not ensure facility was in good repair which poses an a potential Health and Safety to risk to persons in care.

800918 Criminal Record Clearence(e) All individuals subject to a criminal record review..."(1) Obtain a California clearance or a criminal record exemption as required by the Department orThe requirement is not met as evidenced by: Based on observation, record reviews and interviews the licensee did not ensure all staff had a criminal records clearence to be employed at the facility which poses an immediate Health and Safety to risk to persons in care.

Resident Records(b) Each resident’s record shall contain at least the following information... (1) through (17)(F)This requirement was not met as evidenced by: Nine resident records were reviewed and all had missing documents such as, LIC 602 Physician's report, admission agreement, Pre-admission appraisal and/or re-appraisal.

(c) A licensee who accepts or retains residents diagnosed by a physician to have dementia shall include additional information in the plan of operation as specified in Section 87705(b). This requirement was not met as evidenced by:One of 9 resident records revealed that one resident is diagnosed with Dementia. This poses an immediate health and safety risk to residents in care.

Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate non ambulatory residents. Residents whose condition becomes non ambulatory shall not remain in rooms restricted to ambulatory residents. This requirement was not met as evidenced by:Resident 1 is non-ambulatory is occupying bedroom #5. Fire clearance only allow the 1st floor bedroom to be occupied by non-ambulatory clients. This poses a potential health and safety risk to residents in care.

A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time. An exception may be made in the case of catastrophic emergency when the licensing agency may make temporary exceptions to the approved capacity. This requirement was not met as evidenced by:Three of 8 records were reviewed and found to be non-ambulatory. This poses an immediate health and safety risk to residents in care.

The nature of the crime including, but not limited to, whether it involved violence or a threat of violence to others. This requirement was not met as evidenced by LPA's observed S1 in the garage of the facility. LPA verified that S1 does not have a criminal record exemption. This poses an immediate health and safety risk to residents in care.