Tarina of Stockton

Prohibit false or misleading facility statements

No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility.This requirement is not met as evidenced by: Based on file reviews, interviews, and medication audit, the licensee did not comply with the section cited above. A med-tech signed off on R1's controlled drug record that medication was administered when it was not administered. The medication (10+ pills are unaccounted for). This action also resulted in controlled medication count being off. This posed an immediate health, safety or personal rights risk to persons in care.

The following food service requirements shall apply:(17) In facilities licensed for fifty (50) or more, and providing three (3) meals per day, a full-time employee qualified by formal training or experience shall be responsible for the operation of the food service. If this person is not a nutritionist, a dietitian, or a home economist, provision shall be made for regular consultation from a person so qualified. The consultation services shall be provided at appropriate times, during at least one meal. A written record of the frequency, nature and duration of the consultant's visits shall be secured from the consultant and kept on file in the facility. (28)All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery.(29)All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. This requirement is not met as evidenced by observation kitchen sink with cracks in the seams, water pooling on the floor by the sink, expired food in the walk-in refigerator and holes in the floor tiles by the ovens. This is a potential health and safety risk.

Assist residents with self-administered medication

A plan for incidental medical and dental care shall be developed by each facility...The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on interviews, file review, and medication audit, the licensee did not comply with the section cited above. facility staff did not follow R1's oxycodone order and was not administered medication as noted on the controlled drug record and MAR. This posed an immediate health, safety or personal rights risk to persons in care.

§1569.695 Emergency Plans(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is notrequired during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by last recorded drill was 4/24/25

Maintain equipment and dishware in good repair

87555 General Food Service Requirements (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. This requirement is not met as evidenced by observation multiple issues in the kitchen including, open seams in the sink, broken thermostat, equipment not operational, drainage issues resulting in puddling on the floor in front of the main oven, mirror not secured on the fireplace mantel and black smoke stains on the walls in the dining area.

Maintain facility in clean, safe, sanitary condition

Based on observation, the licensee did not comply with the section cited above] which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facilities for fire and panic safety

Based on observation and 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.

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.(b) A comfortable temperature for residents shall be maintained at all times. (1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). Based on an interview with the Staff the facility is having issues with the heater. The parts to replace the heater have been received and the facility is actively working on fixing the heater. This poses an immediate risk to the health safety of residents in care.

Ensure hazardous items are locked and not unattended

87309 Storage Space(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. Based on observation the licensee failed to secure toxins. A cabinet in a resident bathroom contained toxins. R1 took the toxin and ingested the cleaning supplies. This poses an immediate health and safety risk to residents in care.

Maintain facility in clean, safe, sanitary condition

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 observation and photos taken. During the walk through LPA observed exposed wires not covered in the main hallways of the construction area which poses an immediate health, safety risk to persons in care.

Maintain facilities for fire and panic safety

87203 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 is not met based on: Observation, The facility failed to maintained in conformity with the regulations adopted by the State Fire Marshal. The "Fixed System" or "Ansul System" in the kitchen, this system is scheduled for a semi-annual maintenance and was last serviced on 7/19/2023

Report specified resident events within seven days

Reporting RequirementsEach licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: 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...any; and disposition of the case.This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not submit a written incident report to Licensing as required. Resident Care Director confirmed with LPA that an incident report was not submitted for any of the identified incidents in the report for today's visit. This poses an immediate health, safety, or personal rights risk to residents in care.

Give PRN medication by physician order

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 observation and records review, the Licensee did not ensure medications ordered for residents were given as prescribed which poses an immediate health and safety risk to residents in care.

Health screening and fitness requirements

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 staff did not have a health screening and TB test results in S1's file.

Certified administrator requirements and substitute coverage

87405(a) All Facilities shall have a qualified and currently certified administrator. This requirement was not met as evidenced by interviews with staff.

Allowing diabetic residents based on self-management ability

DiabetesThe licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement was not met as evidenced by: Based on LPA Jensen's record review of the LIC 602, LIC 624's and needs and service plan as well as LPA Jensen's interviews with 2 staff members and 1 resident, the resident has not had medication administered by a skilled professional. This poses an immediate risk to the health, safety and personal rights of 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...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: Based on the Department's receipt of 6 incident reports that were sent more than 7 days after occurrence. This poses a potential risk to the health, safety and personal rights of residents in care.

Certified administrator requirements and substitute coverage

Administrator Certification RequirementsAll facilities shall have a qualified and currently certified administrator. This requirement was not met based on: The facility's former Administrator having exited the position on or around 3/9/23 and the facility not having any evidence of a new Administrator of record. This poses a potential health, safety and personal rights risk to residents in care.

Reporting Requirements...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...Any incident which threatens the welfare, safety or health of any resident...This requirement was not as evidenced by: Based on LPA Jensen's verification through interviews and review of submitted incident reports that the power outage was not reported to the Department as required. This poses a potential health, safety and personal rights risk to residents in care.

Emergency Plans...a residential care facility for the elderly shall have an emergency and disaster plan that shall include, but not be limited to, all of the following:...Residents and their responsible parties shall be informed of the process for communicating during an emergency.This requirement was not met as evidenced by: Based on interviews conducted and a review of the LIC 610E the facility has a plan to notify families of emergency or disaster occurrences and this did not occur for every resident during the power outage from 12/31/23-1/2/23. This poses a potential risk to the health, safety and personal rights of residents in care.

(i) Facilities shall have signal systems which shall meet the following criteria:(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which 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....This requirement was not met as evidenced by: Based on LPA Jensen's test of 2 resident suite signal systems for which there was no response by staff in over ten minutes each. This poses an immediate health, safety and personal rights risk to residents in care.

Heat occupied rooms to minimum temperature

87303 Maintenance and Operation...(b) A comfortable temperature for residents shall be maintained at all times.(1) The facility shall heat rooms that residents occupy to a minimum of 68 degree F, (20 degrees C). This requirement was not met as evidenced by: Based on an interview with the Executive Director there are currently 9 occupied units using portable heaters which does not allow for accurately setting a temperature in resident suites within the required range and creates a tripping and fire hazrd. This poses a potential risk to the health saftey and personal rights of residents in care.

Facility must safeguard entrusted cash and valuables

87217 Safeguards for Resident Cash, Personal Property, and Valuables(b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirement was not met as evidenced by: Based on the facility's self reporting, a staff member used a resident's check to deposit funds in to their own account. This poses a potential health, safety and personal rights risk to residents in care.

Cool occupied rooms to regulated temperature range

The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. This requirement was not as evidenced by: Based on LPAs temperature readings of the upstairs hallway and 3 resident rooms that were above 85 degrees. This poses an immediate safety, health and personal rights risk to residents in care.

Based on record review of personnel file for S2 which contained a first aid/CPR certificate that had expired on 12/12/21, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Store disinfectants separately from food supplies

Based on LPAs observation of multiple toxins in an unlocked storage room next to the elevator on the second floor, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

This requirement is not met as evidenced by:Based on LPAs observation of an unlocked sliding door on the second level with access to a portion of the roof that was unstable with a high fall risk and tripping hazards, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons 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 R1s facility's signal system did not function. This poses an immediate health, safety, and resident rights risk to residents in care.

Maintain facility in clean, safe, sanitary condition

873039a) Maintenance and OperationThe 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 based on observation of LPA observing the building and grounds to be unsanitary and not in good repair. This poses a potential health and safety risk to residents in care.

Acceptance obligations tied to pre-admission appraisal needs

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 observationa and record review of R3, R4 and R5 hourly check log did not reflect that residents were being checked hourly therefore residents did not receive the required care. This poses a potential health and safety risk to residents R3, R4 and R5

87303 i(1)(A) Maintenance and OperationFacilities shall have signal systems which shall meet the following criteria:(1) All facilities licensed for 16 or more and all residential facilities having separate floors or buildings shall have a signal system which shall:(A) Operate from each resident's living unit. This requirement was not met as evidenced by based on observation call button page alert displaying misinformation. This posed a potential threat to the Health, Safety, and Personal Rights of all residents in care.

Health and Safety Code 1569.50(a)(3)Conduct Inimical: Conduct which is inimical to health, morals, welfare or safety of either an individual in, or receiving services from the facility or the people of the State of California.This requirement was not met as evidenced by based on observation the facility did not follow proper usage of face covering and did not implement COVID-19 pre-screening measures at entrance of facility. This poses an immediate health and safety risk to residents in care.

Plan of Operation87208(a)(7)(B) 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..Sketches, showing dimensions, of the following: The grounds showing buildings, driveways, fences, storage areas, pools, gardens, recreation area and other space used by the residents.This requirement was not met as evidenced by based on observation resident room 119 is being utilized as an office for staff. This poses a potential health and safety risk for residents in care.

Maintain facility in clean, safe, sanitary condition

87303(a): Maintence and Operation :(a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement was not met as evidence by: Based on observation, Facility did not comply with the section cited above in 87303(a). LPAs observed debris and cob webs throughout the facility, which is a potential health and safety risk to residents in care.

Ensure hazardous items are locked and not unattended

87309(a): Storage Space: (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.This requirement was not met as evidence by: Based on observartion, facility did not comply with the section cited above. LPAs observed unlocked tools and chemicals accessible to residents which is an immediate health and safety risk to residents in care.