Diamond Care Inc.

87411(a)- Personnel Requirements - General-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.-This requirement is not met by observation and records review R-1 AWOL'd from the facility. The LIC 602 states the resident was not allowed to leave the facility unassisted. This presents an immediate health and safety risk to the resident in care.

(f) Basic services shall at a minimum include:(1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by records reviewed and interviews conducted S-1 did not provide R-2 with assistance in the morning when hospice arrived. This is a potential health risk to resident 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 days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case.(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidenced by: per record review where licensing had not recived a report regarding the client with pneumonia hospitalization.This presents an immediate risk to the health, safety, or personal rights of clients in care.

80063 Accountability(a) The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation.(1) If the licensee is a corporation or an association, the governing body shall be active and functioning in order to ensure such accountability. This requirement was not met as evidenced by: staff interview and record review where the workers comp insurance was not provided due to not being purchased.This presents a potential risk to the health and saftey and personal rights to clients in care.

§1569.605 Liability insurance; coverage requirements On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement was not met as evidenced by: record review where Liability insurance is stated to be 250k per occurance and 750k in total aggrigate.This presents a potential risk to the health and saftey and personal rights of clients in care

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (2)Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: administrator interview and record review where 5 restricted conditions amongst the clients admited into care without either an approved exception plan or needs and services filled out designating responsibilites carried out by the client and facility.This presents an immediate health and saftey risk to clients in care.

87615 Prohibited Health Conditions(a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly:(6) Tracheostomies. This requirement was not met as evidenced by: administrator interview and record review where one client was admited with a tracheostmy tube.This presents an immediate health and saftey risk to clients in care.

87755 - Inspection Authority of the Licensing Agency.(c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the requirements in Sections 87412(f), 87506(d), and 87508(b).This requirement is not met as evidenced by: Based on interview with the adminstrator the file for R1 was not at the facility. Which poses a potential health, safety or personal rights risk to persons in care.

80064(a)(2)        Administrator - Qualifications and Duties (a)        The administrator shall have the following qualifications: (2)        Knowledge of the requirements for providing the type of care and supervision needed by clients, including ability to communicate with such clients This requirement was not me as evidenced by:Based on the record review of discharge paperwork, R1 had been admitted to the facility with both prohibited and restricted health conditions which were not appropriately addressed. The Administrator failed to seek an exception per 87616, ensure a plan was developed, implemented and approved by the Department if necessary. This poses an immediate risk to the health and safety of clients in care.

87464(d) Basic Care, A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. – This requirement was not met as evidenced by:Based on the record review of discharge documentation that states resident requires skilled nursing services which were not implemented. Additionally based on documentation there were worsening signs of infection of prohibited health conditions which should require medical assessment. This poses an immediate risk to the health and safety to clients in care

87303(I) Maintenance and Operation (i) Facilities shall have signal systems which shall meet the following criteria: (A) Operate from each resident's living unit. This requirement was not met as evidenced by: Based on observation and interview, Licensee did not ensure a working call system operating in room #E. This posed an immediate health and safety risk to residents in care.

87468(c) Personal Rights. (c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. This requirement was not met as evidenced by: Based on observation, Licensee did not ensure resident rights and non-discrimination notice posted for resident and visitor viewing. This poses a potential health, safety, and resident rights risk to residents in care.

87507 Admission Agreements(h) The admission agreement shall not contain the following:(1) Any provision that is prohibited from being included in the admission agreement.This requirement was not met as evidenced by: Record review and interview of the administrator detailing specific terms: (87507 (i)The admission agreement shall not require advance notice for its termination upon the death of the resident.)Which posed a potential risk to health saftey or violation of the clients rights of residents in care.

87507 Admission Agreements (g) Admission agreements shall specify the following: (5) Refund conditions. (A)Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. This requirement was not met as evidenced by:Record review and interview of the administror detailing a refund not being issued following procedures outlined in regulation.Which posed a potential risk to health saftey or violation of the clients rights of residents in care.

87309(a) Storage Space and Access. (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 was not met as evidenced by: Based on observation, side door leading to storage area for chemicals was unlocked with no supervision within area present, this posed an immediate health and safety risk to residents in care.

87468.1(a)(2) 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: (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by: Based on observation and interview, wheelchair ramp at entry of room #5 is steep and presents a challenge when exiting room for R1. This poses a potential health, safety, and resident rights risk to residents 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. (e)(6)(6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. This was not met as evidenced by:LPA observed spiders and spider webs located throughout facility observed on office and 2 exterior unitsBroken cabinets in kitchen.sink and tolet nonfunctional in exterior unit.This is an immediate risk to health and safety of clients in care

87465 Incidental Medical and Dental Care (h)(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.The licensee failed to do so as observed by observation of preporued medication and interview with staff and General Manager. This is an immediate risk to health and saftey for clients in care.

(e) Water supplies and plumbing fixtures shall be maintained as follows:(1) All residential care facilities for the elderly where water for human consumption is from a private source shall:(A) As a condition of initial licensure, provide evidence of an on-site inspection of the source of the water and a bacteriological analysis by a local or state health department or other qualified public or private laboratory which establishes the safety of the water.(B) Following licensure, provide a bacteriological analysis of the private water supply as frequently as is necessary to assure the safety of the residents, but no less frequently than the time intervals shown in the table below. However, facilities licensed for six or fewer residents shall be required to have a bacteriological analysis subsequent to initial licensure only if evidence supports the need for such an analysis to protect residents. This requirement was not met as evidenced by LPA observed bacterial analysis of private water supply is not being conducted annually. the last analysis was completed on 9/21/2021.

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:(4) The licensee shall assist residents with self administered medications as needed.(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. The following requirements shall apply to medications which are centrally stored:(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by the department discovered that the facility is per pouring medication 24 hours in advance, no PRN letters for any resident in care, observed missing medications for R4 and half pill for R5 with no record of destruction or purpose for splitting the pill and medication not being given according to doctor's orders for R6.

General. Good physical health of personnel shall be verified by a health screening, including a T.B. test, performed and signed by a physician not more than six months prior to or seven days after employment. LPA observed two volunteers/staff did not have a health screening and TB test results in her file. Based on record review the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

(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:(1) Obtain a California clearance or a criminal record exemption as required by the Department or(2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or(3) 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 record review the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

(a) A licensee shall ensure that infection control practices are maintained as follows:(3) In addition to Section 87629, Injections, all staff who are assigned to assist residents with the self-administration of injectable medication shall observe the following procedures:(B) A syringe and needle shall only be used once per injection on one resident and then properly disposed of in accordance with the California Code of Regulations, Title 8, Section 5193. This requirement was not met as evidenced by observation and interview conducted. The facility is cleaning and reusing syringes to administer controlled medication for hospice residents.

87465(c)(2) Incidental Medical and Dental Care. 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 interviews and records review, the Licensee did not ensure medications ordered for resident was given at discharge which poses an immediate health and safety risk to residents in care.

Reporting RequirementsA written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. ...Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement was not met as evidenced by: Based on LPA Jensen's review of an LIC 624A that was faxed on 1/3/23 for a death that occured 12/22/23 which falls outside of teh reporting requirement timeframe. This poses a potential health, safety and personal rights risk to residents in care.

General Food Service RequirementsThe following food service requirements shall apply:...refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. This requirement was not as evidenced by: Based on LPA Jensen's observation of the refrigerator in site 100 being 68 degrees. This poses a potential risk to teh health, safety and personal rights of residents in care.

Licensing FeesThe failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement was not met as evidenced by: Based on LPA Jensen's verification in the Licensing Infromation System annual feels have not been paid since initial licensure. This poses a potential risk to the health, safety and personal rights of residents in care.

Based on obsevation and interview, the licensee did not comply with the section cited above in five of eight rooms observed with out all elements of required furniture which poses/posed a potential health, safety or personal rights risk to persons in care.