Balance Assisted Living and Memory Care

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This was not met as evidenced by a resdient being observed by the LPM and Admin with full bedrails and no physicans order, exception or hospice services.

87224(d) Eviction 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 was not met as evidence by: Based on interview, R1 was not served a lawful eviction notice, which poses a potential health, safety, and/or personal rights risk.

(b) Residents may have access to items specified in subsection (a) for personal use unless there is documentation, as specified in Section 87457, Pre-Admission Appraisal or Section 87463, Reappraisals, that indicates the resident's or other residents’ safety would be at risk if allowed access. This was not met as evidenced by several resident rooms in memory care had personal care supplies such as soap, shampoo, body wash, toothpaste. 2 of 6 files reviewed showed the residents were not allowed access based on physician documentation. This poses an immediate threat to the health and safety of resients in care.

(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 was not met as evidenced by: 2of2 resdient rooms water tested at 77 and 76 degrees, kitchen sink water temperature tested at 125 degress. Flooring in the AL med Tech office, carpet in MC and flooring in AL rm 49 were all in need of repair. This poses an immediate threat to the health and safety of resients in care.

(3) Ensuring that the use of oxygen equipment meets the following requirements:...(B) "No Smoking-Oxygen in Use" signs shall be posted in the appropriate areas...(E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. This regulation was not met as evidenced by O2 canisters were not stored poperly in a stand and oxygen signs were not posted on the bedroom doors. This poses an immediate threat to the health and safety of resients in care.

(D) Hygiene items of general use such as soap and toilet paper. This was not met as evidenced by the absense of a hand soap in resdietn rooms. This poses an immediate health and safety risk to clients in care.

(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 was not met as evidenced by bleach and laundry supplies asscessible in both memory care and assisted living; all doors were open and accessible to resdients in care. This poses an immediate threat to the health and safety of resients in care.

(g) The licensee shall ensure corresponding changes are made in the care and supervision provided to the resident. This poses an immediate threat to the health and safety of resients in care. This was not met as evidenced by R1 was discharged with a fracture and prn pain medication. A review of the records revealed there was no update to the care plan. This poses an immediate threat to the health and safety of resients in care.

(4) The licensee shall assist residents with self-administered medications as needed. This was not met as evidenced by R1 sustained a fracture. A review of records showed no Pain mangement medication provied for over 7 days. Interview with the resdietn revealed pain when asked how they were doing today. This poses an immediate threat to the health and safety of resients in care. This poses an immediate threat to the health and safety of resients in care.

(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This was not as evidenced by R1 being forcefully grabbed by R2 resulting in a fracture. This poses an immediate health and safety rsik.

Based on observations, the licensee did not comply with the section cited above when LPAs observed the, the floor in memory care taped over and requiring repair, exposed wiring in memory care room 33, gutters overflowing with debris, and a faulty heating system, all of 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 in residnet room 37 the water temperature was 149 F which poses an immediate health, safety or personal rights risk to persons in care.

This requirement was not met as evidenced by observation by Staff and LPAS also by checking the housekeeping supply room door to see if it was locked. This poses an immediate health and safety risk to residents in care.

80087(a)(1) Buildings and Grounds(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1) The licensee shall take measures to keep the facility free of flies and other insects. This requirement was not met as evicenced by: direct observation of insects in the facility, as well as sources of insectsThis presents and immedate health and safety risk to the clients in care

87628 Diabetes(a) The 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 record review of R1'S file the facility did not ensure to follow the 602 the resident was given an injection on at least one occation.This poses a health and safety risk to residents in care.

(c) If the licensee observes or is made aware of behavioral expression, as defined in Section 87101, that has caused or may cause harm to the resident or others, the licensee shall document all of the following in the resident’s reappraisal:(1) A description of the behavioral expression.(2) If known, identification of events occurring just prior to the behavioral expression including, but not limited to, interactions with other residents or staff, sudden or recent changes in the physical environment, signs of possible new physical illness or injury (such as fever, cough, urinary urgency, or limping), overstimulation (such as from noise or visitors), or physical sensations a resident may not be able to express verbally that may include, but are not limited to, fatigue, heat, cold, pain, hunger, thirst, boredom, fear, wanting to walk, or need for toileting.(3) Interventions to be implemented to minimize the risks to the health and safety of the resident or others associated with the resident's behavioral expression. The licensee shall use the least restrictive intervention to manage the behavioral expression based on the individual needs of the resident.The facility failed to implement this as evidenced by: R7 was sent to the ER due to agitation a change of medication was noted and 2 subsequent falls were reported. A review of the CP documents updates were made, however it is unclear what changes were made. Triggers are not identified and Interventions do not include behavior modifications or monitoring for side effects of new medications which may have attributed to falls. Additionally prn medications were available and not used prior to sending the reisdent to the ER for agitation two times in one day.

87555(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. This was not met as evidenced by: The facility was unable to provide any records of consult visits from a Registered dietician or dierty consultant service. This poses a potential health and safety risk.

The licensee provides the supporting care and supervision needed to meet the needs of the resident receiving home health care.This was not met as evidenced by R3 - . The CPs although documented as updated did not document the change in condition including new or worsening wounds, facility oversite of care being provided, observation of wounds and pain management for this resident. Additionally the 05/28/25 CP did not document any showering or toileting assistance. R4 was hospitalized on 2 separate occasions in the past 6months. A review of medical records was conducted, CPs have been updated. Interventions are generalized and are not personalized ie there is a third party vendor in place to assist with management of skin care/wounds, however no description of the wound(s) locations, status, treatment or measurable goals are noted on the resident’s CP, nor any direction to staff such as observe for changes. This poses an immediate risk to resdients in care

(E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. This was not met as evidenced by LPM observed one room with 9 oxygen canisters not secured. This poses an immediate threat to residents in care.

(5) Interior and exterior space shall be available on the facility premises to permit residents with dementia to wander freely and safely. This was not met as evidenced by Facility locks dining room of Memory Care area so that resdients cannot access this area during the day. This poses a potential risk to clients in care.

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. This requirement was not met as evidenced by: Based on interview and written evidence, facility staff attempted to stop a desired outing for R1 and R1's family member. This posed a potential health, safety, and resident rights risk to residents in care.

(4) The licensee shall assist residents with self-administered medications as needed. This was not as evidenced by: a review of R7s MARS for the months of June 2025 thru Aug 2025 was conducted and revealed on 6/26/25 am meds were not documented as being provided. Additionally an inhaler was not provided during the month of June, July or August. medications were refused on the following dates, 07/11, 13, 16, 17, 17, 20, 25.No IR received for refusal or missed medications. This poses an immediate risk to clients in care.

(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 was not met as evidenced by: Residents went without AC between May 21, 2025 and June 03, 2025 when portable AC’s arrived. During the period they didn’t have AC, staff checked on residents every two hours and inquired if they felt comfortable. It residents expressed feeling hot, fans were provided. Additionally sliders and windows were pobserved to be inoperable. This poses a potential health and safety risk since the weather was not excessively hot during these days.

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: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidence by: Based on observation and interview, bed in room #3 is not functioning properly, and air mattress in room #55 is not functioning properly. This posed a potential health and safety risk to residents in care.

(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. This was not met as evidenced by A tour revealed a housekeeping closet open and accessible in the Assisted Living Area of the building with chemicals present. Additionally the Memory Care resident rooms had shampoo conditioner periwash toothpaste and deoderant accessible. This poses an immediate threat to resdients in care

(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This was not met as evidenced by The MC area was malodorous this is a potentail risk to clients in care.

1569.2(c) provides:(c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. The facility fails to do this as evidenced by a R:R altercation occuring in which one resident is known to require additional supervision. An IR was received which documented a R:R altercation occuring in which one resident is known to require additional supervision.

(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. The licensee failed to do this asevidenced by Multiple residents had generalized ststements incl R2 had 5 unwitnessed falls, no interventions were documented on the CP to address the fall risk, R6 had 4 falls the generalized intervention remains after the update “staff will provide oversight and complete interventions to help reduce residents fall risk”. Interventions are not documented and the CP is not updated to address the fall risk. Additioanlly the 080325 reappraisal is blank. R11 had 6 unwitnessed falls no specific interventions are noted just that they will be implemented, statement is the same across this resdients CPs. This poses an immediate risk to resdients in care

87307 Personal Accommodations and Services. (a) Living accommodations and grounds shall be related to the facility's function...(3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. This requirement was not met as evidence by: Based on observation, Licensee did not ensure necessary hygiene supplies were available to resident in care. This posed a potential health and safety risk to residents in care.

False ClaimsNo 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 was not met as evidenced by: Service plans that were sent to the department show CNA'S but they are only caregivers and by the admission of the admisnstrator. which poses an immediate health, safety and/or personnel rights risk.