Care and Care Residence I

Maintain facility in clean, safe, sanitary condition

87468.1: Personal Rights of Residents in All Facilities - To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This was not met as evidence by: Based upon LPA observation and photos taken, the facility was observed to have bed bug carcasses in resident (R1) bedroom as well as multiple bedrooms throughout the facility. In addition, upon interviews with staff (S1 & S2) and outside parties (I1), bed bugs were observed as early as 10/10/2024 without acquiring extermination services until 10/22/2024. Lastly, interviews with I1 indicate that I1 observed both live and dead bed bugs in R1's bedroom and on R1's person on mulitple occasions from 10/10/2024 to 10/23/2024. This serves as an immediate health & safety risk to residents in care.

Facility maintenance and healthful environment

87307: Personal Accommodations and Services - The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This was not met as evidence by: Based upon interviews with staff (S1) it was found that bed bug chemical spray was applied around resident R1's bed. In addition, interview with outside party (I1) indicated that I1 witnessed staff spray the chemicals directly on R1's bed and bedding. This serves as an immediate health & safety risk to residents in care.

Obtain baseline medical assessment before resident admission

Based on record review, the licensee did not comply with the section cited above in 1 out of 12 resident records, which did not have a completed LIC 602: Physician's order, 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, the licensee did not comply with the section cited above in 1 out of 1 bedroom ceilings which was observed to have been been damaged, 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 in 5 out of 12 resident records, which did not have completed Annual Needs and Services Plans, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on interview with the Administrator , the licensee/Administrator did not comply with the section cited above in 1 out of 1 instances in which they do not have record of an emergency drill being conducted since 2022, which poses an immediate health, safety or personal rights risk to persons in care.

Health screening and fitness requirements

87411-Personnel Requirements-General: Based on record review, the licensee did not comply with the section cited above in 3 out of 6 staff files that had incomplete LIC 503: Health Screening Reports that did not show whether a TB test had been performed nor the results, which poses an immediate health, safety or personal rights risk to persons in care.

Store centrally held medications in locked secure place

Incidental Medical and Dental CareThe following requirements shall apply to medications which are centrally stored:Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on: LPA observed medications belonging to staff accessible and on top of refrigerator not locked.This violation poses an immediate health, and safety risk to residents in care.

Maintain separate complete record for each resident

Resident RecordsThe 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: Based on: LPA observed records of residents incomplete, without signatures and dates. This violation poses a potential health, and safety risk to residents in care.

Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Based on: LPA did not observe current first aid/CPR certificates for staff during this visit. This violation poses an immediate health, and safety risk to residents in care.

Keep window screens clean and in repair

Maintenance and OperationAll window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Based on: LPA observed screen at front of facility window to be not in good repair. This violation poses a potential health, and safety risk to residents in care.

Certified administrator requirements and substitute coverage

Administrator - Qualifications and DutiesAll facilities shall have a qualified and currently certified administrator...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... This requirement is not met as evidenced by: Based on: LPA did not observed an LIC308 Designation of Responsibility as designee on file was sleeping during this visit. This violation poses an immediate health, and safety risk to residents in care.

Administrator Certification RequirementsCertificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements. This requirement is not met as evidenced by: Based on: LPA did not observe an Administrator certificate for Jose Nevarez nor supporting documents with proof of payment for renewal. This violation poses an immediate health, and safety risk to residents in care.

Health screening and fitness requirements

Personnel Requirements - GeneralAll personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Based on:LPA did not observe TB results for staff during this visit. This violation poses an immediate health, and safety risk to residents in care.

Incidental Medical and Dental CareIf a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following:A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. Sterile first aid dressings. Bandages or roller bandages. Scissors. Tweezers. Thermometers. This requirement is not met as evidenced by: Based on: LPA did not observe a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, tweezers, and antiseptic solution. This violation poses an immediate health, and safety risk to residents in care.

Infection control plan required in operations plan

Infection Control RequirementsAn Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. This requirement is not met as evidenced by: Based on: LPA inquired with both staff regarding the Infection Control Plan. LPA did not receive an answer from either.This violation poses an immediate health, and safety risk to residents in care.

Keep window screens clean and in repair

Maintenance and OperationAll window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Based on: LPA observed screen at front of facility window to be not in good repair. This violation poses a potential health, and safety risk to residents in care.

Health screening and fitness requirements

Personnel Requirements - GeneralAll personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Based on:LPA did not observe TB results for staff during this visit. This violation poses an immediate health, and safety risk to residents in care.

Incidental Medical and Dental CareIf a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following:A current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency. Sterile first aid dressings. Bandages or roller bandages. Scissors. Tweezers. Thermometers. This requirement is not met as evidenced by: Based on: LPA did not observe a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency, tweezers, and antiseptic solution. This violation poses an immediate health, and safety risk to residents in care.

Store centrally held medications in locked secure place

Incidental Medical and Dental CareThe following requirements shall apply to medications which are centrally stored:Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Based on: LPA observed medications belonging to staff accessible and on top of refrigerator not locked.This violation poses an immediate health, and safety risk to residents in care.

Infection control plan required in operations plan

Infection Control RequirementsAn Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. This requirement is not met as evidenced by: Based on: LPA inquired with both staff regarding the Infection Control Plan. LPA did not receive an answer from either.This violation poses an immediate health, and safety risk to residents in care.

Maintain separate complete record for each resident

Resident RecordsThe 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: Based on: LPA observed records of residents incomplete, without signatures and dates. This violation poses a potential health, and safety risk to residents in care.

(3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Based on: LPA did not observe current first aid/CPR certificates for staff during this visit. This violation poses an immediate health, and safety risk to residents in care.

Administrator Certification RequirementsCertificates issued under this section shall be renewed every two (2) years provided the certificate holder has complied with all renewal requirements. This requirement is not met as evidenced by: Based on: LPA did not observe an Administrator certificate for Jose Nevarez nor supporting documents with proof of payment for renewal. This violation poses an immediate health, and safety risk to residents in care.

Certified administrator requirements and substitute coverage

Administrator - Qualifications and DutiesAll facilities shall have a qualified and currently certified administrator...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... This requirement is not met as evidenced by: Based on: LPA did not observed an LIC308 Designation of Responsibility as designee on file was sleeping during this visit. This violation poses an immediate health, and safety risk to residents in care.

Safe, healthful, comfortable accommodations

Based on interview and record review, the licensee did not comply with the section cited above as the staff and resident daily COVID-19 monitoring log was last completed in December 2020, the visitor symptom review questionnaire was last completed on 3/24/21, and the staff members were never tested for COVID-19 except for the Administrator, Marlon Sicat. which poses/posed a potential health, safety or personal rights risk to persons in care.