A1 Del Monte Stockton

87305 Alterations to Existing Building or New Facilities(a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirements is not met as evidenced by The facility has moved the memory care door back approximately 10 feet to expose additional rooms to be used for none memory care residents.This is an immediate saftey risk to residents in care.

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 is not met as evidenced by: Based on record reviews and interviews, Licensee is addressing the situation with a routine bed bug treatment service after an initial bed bug occurrence.

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: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement was not met as evidenced by based on touring the facility and interviews with the staff. R1's room was an access point for the shower and the bathroom.

(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 R1 sustaining an injury.

87468.1 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:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons.(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by the actions of S1 opening the door to the kitchen without regard causing an injury to R1. This is an immediate safety risk for residents in care.

Administrator - Qualifications and Duties. (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)… (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: Based on record review, Administrator did not exercise the practice of initiating a necessary change in plan of operation and submit to the Department. This resulted in a potential health, safety, and resident rights risk to residents in care.

Plan of Operation. (a) Each facility shall have and maintain a current, written definitive plan of operation… Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval…(9) A statement whether or not the applicant will handle residents' money and/or valuables. If money or valuables will be handled, the method for safeguarding…This requirement is not met as evidenced by: Based on record reviews and interviews, licensee did not ensure the practice and method of maintaining and using resident debit card for purposes of obtaining monthly rent be explained in the facility’s plan of operation which resulted in a potential health, safety, and resident rights risk to residents in care.

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 interviews and record reviews, the facility maintained a presence of bed bugs between 8-24-23 and 8-30-23 with treatment for bed bugs initiated on 8-30-23. This posed a potential health, safety, and resident rights risk to residents in care.

Alterations to existing buildings and new facilities. (a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement was not met as evidenced by: Based on interview and record review, licensee did not secure a buidling permit for an alteration regarding memory door relocation. This poses an immediate health and safety risk to residents in care.

Fire Clearance. (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...This requirement was not met as evidenced by: Based on interview and record review, Licensee initiated a relocation of memory care door without securing an updated fire clearance. This poses an immediate health and safety risk to residents in care.

Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidenced by: Based on observation and interview, Memory care door alarm was not functioning in that bar door was unable to move forward, which poses an immediate health, safety, and resident rights risk to residents in care.

Administrator Qualifications-Duties. (h) The administrator shall have the responsibility to:(5) Provide or ensure the provision of services to the residents with appropriate regard for the residents' physical and mental well-being and needs...This requirement was not met as evidenced by: Based on interview and record review, Licensee did not ensure a provision of safety for residents in that a plan to ensure resident rights and safety was not submitted in regards to a building alteration. This posed an immediate health and safety risk to residents in care.

Based on record review, the licensee did not comply with the section cited above in 5 out of 11 staffing files reviews. Health screening forms were completed more than 7 days after employee hire and facility licensure which poses/posed a potential health, safety or personal rights risk to persons in care.

Eviction Procedures. (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement was not met as evidenced by: Based on record review and interview, licensee did not ensure an eviction notice issued to R1 on 4-17-23 was sent to licensing department within regulatory time frame as noted above.

Maintenance and Operation. (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement was not met as evidenced by: Based on observation, licensee did not comply with this regulation in that LPA observed a used adult diaper on the floor of room 107 near the foot of R1's bed. This posed a potential health and safety risk to residents in care.

Additionial Personal rights...(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities...(2) To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement was not met as evidenced by: Based on record review and interview, Licensee did not ensure confidential medical information for R2 in that a photograph of medication information was sent to the wrong receipient. This posed a potential health, safety and resident rights risk to residents in care.

87625(b)(3). Managed Incontinence. (b) ...the licensee shall be responsible for the following: (3) Ensuring that...facility remains free of odors from incontinence. This requirement was not as evidenced by: Based on observation, licensee did not comply with this regulation in that LPA observed a strong urine odor in and around room 107 on 3-24-23. This poses a potential health and safety risk to residents in care.

Basic Service Requirements. Every facility required to be licensed under this chapter shall provide at least the following basic services: (d) Being aware of the resident's general whereabouts… This requirement was not met as evidenced by: Based on interview and record review, Licensee did not ensure facility’s knowledge of R1’s whereabouts on 2-28-23 leading to an absence of supervision. This posed an immediate health, safety, and resident rights risk to resident in care.

Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not as evidenced by: Licensee did not ensure a proper medication order was followed for R3 in that R3 was given 80mg of Lasix instead of the physician ordered 40mg of Lasix on 12-27-22. This posed a potential health and safety risk to resident in care.

Basic Service Requirements. Every facility required to be licensed under this chapter shall provide at least the following basic services: (d) Being aware of the resident's general whereabouts… This requirement was not met as evidenced by: Based on interview and record review, Licensee did not ensure facility’s knowledge of R1’s whereabouts on 8-19-22 leading to an elopement episode and absence of supervision. This posed an immediate health, safety, and resident rights risk to resident in care. An immeidate civil penalty in the amount of $500 is being issued on today's visit due to the violation of absence of supervision Additional civil penalty may be assessed upon further department review.

87468.1 (a)(11)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 have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours. This requirement was not met as evidence by:Based on interviews it was learned resident's visitors were not granted entry during reasonable hours. This posed a potential health and safety risk to residents in care.

Administrator - Qualifications and Duties 87405(d)(5) The administrator shall have the qualifications specified in Sections 87405...Good character and a continuing reputation of personal integrity. This requirement was not met as evidence by: Based on observation facility administrator did not implement personal integrity. this posed a potential health and safety risk to R1.

Personal Rights of Residents in All Facilities 87468.1(a)(1) residents in all residential care facilities for the elderly shall have all of the following personal rights: to be accorded dignity in their personal relationships with staff...This requirement was not met as evidence by: Based on observation: staff 1 and staff 2 did not provide R1 with dignity. This posed a potential health and safety risk to resident 1 (R1).

87303 (a) Maintenance and Operation: 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 evidence by: based on observation and interview review, LPA Martinez observed R1 and R2 bedroom were unsanitary and not in good repair. This posed a potential health and safety risk to residents in care.

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:(2) Occurrences...which threaten the welfare, safety or health of residents...shall be reported within 24 hours...to the licensing agency and to the local health officer... This requirement is not met as evidenced by: Based on record review and interviews: A suspected outbreak of flu occurred on 6-5-22 involving multiple residents, resulting in the threat to welfare, safety, and health of residents in care. This poses a potential health and safety risk to residents in care.

Incidental Medical and Dental Care.A plan for incidental medical and dental care shall be developed by each facility (1)The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on record reviews and interviews, licensee did not ensure physician was efficiently notified for medication order clarification for R1. This poses an immediate health and safety risk to residents in care.

Incidental Medical and Dental Care. (e) For every prescription…medication for which the licensee provides assistance there shall be a signed, dated written order from a physician…This requirement is not met as evidenced by: Based on record reviews and interviews licensee did not ensure physician’s order for blood pressure medication was followed appropriately. Medication for R1 was held by facility staff and not given to R1 without a physician’s approved order to hold or stop medication. This poses an immediate health and safety risk to residents in care.

Administrator-Qualifications and Duties. (h) The administrator shall have the responsibility to: (5) Provide or ensure the provision of services to the residents with appropriate regard for the residents' physical and mental well-being and needs…This requirement is not met as evidenced by: Based on interviews and record reviews, Licensee did not ensure Administrator communicate effectively with designee, other staff, and outside entities to resolve a medication order discrepancy for R1’s blood pressure medication resulting in R1 not receiving medication for a period longer than 3 weeks. This poses an immediate health and safety risk to residents in care.

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. This requirement is not met as evidenced by: Based on interviews and record reviews, Licensee did not ensure R1 receive a prescribed blood pressure medication for a period of more than 3 weeks. This poses an immediate health and safety risk to residents in care.

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 (2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. This requirement is not met as evidenced by: Based on interviews and record reviews, Licensee did not ensure the staff present appropriately coordinate to address R1s wandering behavior resulting in R1 exiting facility unattended on 3-12-22. This poses an immediate health and safety risk to residents in care.

Reporting Requirements. (a) Each licensee shall furnish to the licensing agency such reports...:(1) A written report shall be submitted to the licensing agency…within seven days of the occurrence of any of the events specified…(D) Any incident which threatens the welfare, safety or health of any resident… This requirement is not met as evidenced by: Based on interviews and record reviews, R1 did not receive prescribed blood pressure medications for approximately 3 weeks and incident was not reported to licensing agency. This poses a potential health and safety risk to residents in care.

Maintenance and Operation (i) Facilities shall have signal systems which shall...(1)All facilities licensed for 16 or more...shall:(A)Operate from each resident's living unit.(B)Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. (C) Identify the specific resident living unit. This requirement is not met as evidenced by: Based on observation and interview, it was determined that facility's signal system did not function properly per regulatory requirements in 8 out of 8 resident rooms. This poses an immediate health, safety, and resident rights risk to residents in care.

Increase in fee rates for elderly residents...60 days' written notice..(a)If a licensee of a residential care facility for the elderly increases the rates of fees for residents...the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs. This requirement is not met as evidenced by: Based on record review and interviews Licensee did not ensure proper 60-day notification was given to R1 for a rate increase. This poses a potential resident rights risks to residents in care.

c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours as required by Welfare and Institutions Code Section 15630(b)(1). This requirement is not met as evidenced by: Based on interviews conducted an incident of suspected abuse occurred on 1-4-22 and was not reported timely to local law enforcement and ombudsman. This poses a potential health and safety risk to residents in care.

Ammended from original report dated 12-9-21: 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 as evidenced by: Based on record reviews, interviews, and observation, R1 sustained a fall with injury...Licensee did not ensure R1 received appropriate care and supervision due to inadequate staff coverage. This poses an immediate health, safety, and resident rights risk to residents in care.

Reappraisals. (a) The pre-admission appraisal shall be updated in writing…as frequently as necessary to note significant changes and to keep the appraisal accurate. This requirement is not met as evidenced by: Based on records review and interviews, facility did not update an appraisal form for R1 to address fall precautions and a fall event of R1 which occurred on 10-27-21 at 5:00am. This poses a potential health and safety risk to residents in care.

Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have…the following rights: (9) To have communications to the licensee from their representatives answered promptly and appropriately. This requirement is not met as evidenced by: Based on interviews, Licensee did not ensure responsible person for R1 was answered promptly when requesting documents relating to a fall event for R1. Documents were requested on 11-1-21 and not received until 11-19-21. This poses a potential health, safety, and resident rights risk to residents in care.

Client Medical Assessment. Except for licensees of ARFs, prior to or within 30 calendar days following the acceptance of a client, the licensee shall obtain a written medical assessment of the client…The requirement is not met as evidenced by: Based on record review and interview, physician’s report from R1’s chart was absent and not obtained. This poses a potential health and safety risk to residents in care.

Reporting Requirements (a) Each licensee shall furnish….reports as the Department may require…(1) A written report shall be submitted…to the person responsible for the resident within seven days of the occurrence…(B) Any serious injury….occurring while the resident is under facility supervision. This requirement is not met as evidenced by:Based on interviews and record review, responsible person for R1 was not notified in writing of fall that occurred on 10-27-21 at 5:00am within seven days of occurrence. This poses a potential health, safety, and resident rights risk to residents in care.

Reporting requirements. (b) Upon the occurrence...of any of the events specified in (1)...a report shall be made to the licensing agency within the agency's next working day...a written report containing the information...shall be submitted to the licensing agency within seven days following the occurrence of such event. (1) Events reported shall include...(D)Any injury to any client which requires medical treatment. This requirement is not met as evidenced by: Based on record review licensee did not ensure timley reporting of incident in 6 of 14 incident reports reviewed. This poses a potential health and safety risk for resident in care. Civil penalty assessed due to repoeat violation.

Section 87413 Personnel-Operations (a) In each facility (1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement is not met as evidenced by: Based on interviews and record review, One staff member was attending to memory care unit and left unit unattended. Licensee did not ensure qualified personnel coverage in the memory care unit when staff member left memory care unit unattended which poses an immediate health, safety, and resident rights risk to residents in care.

80078 Responsibility for Providing Care and Supervision (a) The Licensee shall provide care and supervision as necessary to meet the client’s needs. This requirement is not met as evidenced by: Based on interviews and record reviews licensee did not ensure R1 received appropriate repositioning and lifting by staff on duty for purposes of promoting fall prevention. This poses a potential health and safety risk to residents in care.

Reporting requirements. (b) Upon the occurrence...of any of the events specified in (1)...a report shall be made to the licensing agency within the agency's next working day...a written report containing the information...shall be submitted to the licensing agency within seven days following the occurrence of such event. (1) Events reported shall include...(D)Any injury to any client which requires medical treatment. This requirement is not met as evidenced by: Based on record review and interviews, Licensee did not furnish incident reports for R1's hospitalizations on 8/5/21 and 8/7/21 in a timely manner. This posses a potential health and safety risk to residents in care.

87224 Evicition Procedures (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement is not has evidenced by: Based on record review, Licensee did not ensure all requirement components of the eviction letter issued to R1 including proper date of eviction, resources, notitice of right to appeal and required statement as specificed in Health and Safety Code 1569.683(a)(4). This poses a potential health, safety, and resident rights risk to residents in care.