Petani Haven

Obtain baseline medical assessment before resident admission

MEDICAL ASSESSMENTPrior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record. This requirement is not met, as there are no MD reports for clients #3 and #4. Licensee failed to ensrue that MD reports are maintained prior to admission and maintained, which poses a potential health, safety or personal rights risk to clients in care.

Record centrally stored prescriptions and refill data

INCIDENTAL MEDICAL CARE 87465A record of centrally stored prescription medications for each resident shall be maintained and include names of the resident for whom prescribed, prescribing physician and pharmacist, drug name, strength and quantity, dates filled, started & expiration, prescription number and instructions. This requirement is not met, as medications for 3 residents are not recorded on Centrally Stored Medications Records. Licensee failed to ensure that medications for clients are logged on CSMR, which poses a potential health or safety risk.

POSTURAL SUPPORTSBed 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 requirement is not met, as hospice client #2 has full bed rails, but this is not included in hospice care plan. Licensee failed to ensure that full bed rails are included in hospice care plan, which poses a potential health, safety or personal rights risk to clients in care.

Maintain personnel records at facility location

PERSONNEL RECORDSAll personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement is not met, as there are no staff records available for review. Licensee failed to ensure that staff records are maintained at facility, which poses an immediate health, safety, or personal rights risk to clients in care.

Requirement for building permit before construction

ALTERATIONS TO BUILDINGS/GROUNDSPrior to construction or alterations, all facilities shall obtain a building permit.This requirement is not met, as rear family room has been extended almost 8 feet, but there is no approved building permit. Licensee failed to maintain approved building permit, which poses a potential health, safety or personal rights risk to clients in care.

Complete admission suitability appraisal

PREADMISSION APPRAISALPrior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of their individual service needs. This requirement is not met, as there are no appraisals on file for all residents. Licensee failed to ensure that appraisals are maintained for all clients, with poses a potential health, safety or personal rights risk to clients in care.No preadmission appraisals for clients #3 and #4 and no appraisals for clients #1 and #2

INFECTION CONTROL PLANSee page 2 for regulation text.This requirement is not met, as there is no Infection Control Plan maintained.This poses a potential health, safety or personal rights risk to clients in care.

HEALTH AND SAFETY CODEA 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 not required 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.- tThere is no record of disaster drills

Submit and maintain current mailing address

CRIMINAL RECORD CLEARANCEAll individuals subject to a criminal record review pursuant to HSC Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:obtain a CA clearance or a criminal record exemption as required by the Department This requirement is not met as staff #1 is present at facility, but has not yet obtained criminal record clearance. Licensee failed to ensure that all staff have criminal record clearance prior to working with clients. This poses an immediate health, safety or personal rights risk to clients in care.

First aid training requirements

PERSONNEL REQUIREMENTS-GENLStaff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross.This requirement is not met, as there is no documentation maintained that all staff have current first aid training. Licensee failed to maintain evidence that caregivers have required first aid training, which poses a potential health, safety or personal rigjts risk to clients in care.This was cited in 2024 and subsequently corrected.

Complete admission suitability appraisal

PRE-ADMISSION APPRAISALPrior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455. This requirement is not met, as there are no appraisals maintained for both hospice clients. Client #1 admitted 7/2023 & client #2 admitted 9/2024. This was cited in 2024. Licensee failed to ensure appraisals are completed for clients, which poses a potential health, safety or personal rights risk

Based on staff record review, the licensee did not comply with the section cited above, as there is no documentation maintained that staff have received required 4 hours of training on postural supports, hospice care and restricted health conditions.This poses a potential health, safety or personal rights risk to persons in care.

Based on staff record review, the licensee did not comply with the section cited above, as there is no evidence that staff have required dementia training.This poses a potential health, safety or personal rights risk to persons in care.

Maintain fire clearance before retaining specified persons

Based on observation and record review, the licensee did not comply with the section cited above, as Client #2 is bedridden, as per MD report 1/24 and facility does not maintain bedridden fire clearance.This poses an immediate health, safety or personal rights risk to persons in care.

First aid training requirements

Based on staff record review, the licensee did not comply with the section cited above, as there is no evidence that staff #1, #2, #3, #5 have current first aid training.This poses a potential health, safety or personal rights risk to persons in care.

Health screening and fitness requirements

Based on staff record review, the licensee did not comply with the section cited above, as 4 out of 5 staff do not have evidence of health screening and TB test results on file, which poses a potential health, safety or personal rights risk to persons in care. Staff #2, #3, #4, #5 do not have HS and TB results on file.

Based on observation and staff record review, the licensee did not comply with the section cited above, as Staff #6 is observed having contact with client #2, and does not have criminal record clearance and association with facility.This poses an immediate health, safety or personal rights risk to persons in care.

Complete admission suitability appraisal

Based on client record review, the licensee did not comply with the section cited above, as pre appraisals and/or reappraisals for both clients are not maintained. Client #1 was admitted 7/2020 and client #2 admitted 7/2023.This poses a potential health, safety or personal rights risk to persons in care.

Based on client record review, the licensee did not comply with the section cited above, as client #1--who is diagnosed with dementia--has MD report dated more than 1 year ago, which poses a potential health, safety or personal rights risk to persons in care.