Silverado Senior Living - Belmont Hills

Develop required incidental medical care plan

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.This requirement is not met as evidenced by: Licensee failed to seek timely medical attention after R1 had a fall and complained of pain. Based on interviews and records reviewed, R1 had a fall at 11am and R1 was not sent out to the hospital till about 5:30pm. Based on interview conducted with S2, S2 admitted that 911 should have been called immediately after R1 had a fall and complained of pain, however indicated because resident was not in severe pain, S2 did not call 911. Nevertheless, R1 complained to 3 staff members of pain and observed by staff of having pain and the facility did not seek medical attention for R1 which poses an immediate health risks to residents in care and resulted into a left hip fracture.

Call 9-1-1 for imminent health threats

87465 Incidental Medical and Dental Care: (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2)... This regulation is not met as evidenced by: Licensee failed to seek timely medical attention after R1 fell and immediately complained of pain. Staff interviewed admitted that R1 needed to go to the hospital but chose to wait stating R1 was not in enough pain. R1 had a severe injury and could not move their leg. Staff left R1 to endure pain for hours from approximately 11am to 5:30pm without seeking emergency medical services which poses an immediate health and safety risk to residents in care.

Safe, healthful, comfortable accommodations

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.Violation of this regulation is not met as evidenced by: Based on interviews conducted and documents reviewed, the facility failed to provide orientation/training to the private on-on-one agency staff member assigned to R1 which resulted to R1 being left unattended. Nevertheless, due to R1 being left unattended, R1 was observed in the room with R2 touching his/her breasts.

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…(b) “Any suspected physical abuse that results 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 two (2) hours as required by Welfare and Institutions Code Section 15630(b)(1)”.Violation of this regulation is evidenced by: The facility failed to provide the LIC624 and SOC341 to the Department within regulatory timeframes for the incident of alleged abuse that occurred on February 13, 2022.

Safe, healthful, comfortable accommodations

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 equipmentViolation of this regulation is not met as evidenced by: Based on the interviews conducted and the file reviewed, R1 has a history of aggressive and inappropirate behaviors towards other residents in care. Furthermore, due to R1's inappropriate behaviors, the facility environment is not comfortable for other residents in care.

Care and supervision as defined by statute and rules

87464(f)(1) Basic Services(f)- Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Codesection 1569.2(c).Violation of this regulation is not met as evidenced by: Based on the file reviewed and interviews conducted, R1 has a diagnosis of dementia. In addition, staff were aware of R1's prior history of unusual behavior that occurred on 5/26/22 but failed to ensure another unusual incident involving R1 will occur.

Care and supervision as defined by statute and rules

87464(f)(1) Basic Services(f)- Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Codesection 1569.2(c).Violation of this regulation is not met as evidenced by: Based on interviews conducted and file reviewed, although R1 is a newly admitted resident, R1 has a history of elopement from his/her previous facility by climbing a wall. In addition, file reviewed indicated R1 has a diagnosis of Alzheimer's dementia and is unable to leave the facility unassisted.

Care and supervision as defined by statute and rules

87464(f)(1) Basic Services(f)- Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Codesection 1569.2(c).Violation of this regulation is not met as evidenced by: Based on the file reviewed and interview conducted, the facility did not ensure basic services were being met, due to lack of supervision, R1 possibly eating cat food. In addition, there were no witenesses during the time of the incident so facility is unaware if R1 ate cat food which poses a potential health, safety and personal rights risk to residents.

Facility personnel sufficiency and competence

87411 Personnel Requirements: (a) acility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...Violation of this regulation is not met as evidence by: Based on staff interviews and file reviewed, it was indicated that Resident (R1) has dementia and is unable to leave the facility unassisted. In addition, it was indicated that there was no staff member who observed R1 leave the facility until R1 was observed walking toward the main office. Nevertheless, there wa no staff member present to supervise the resident. This poses a potentional 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 ... services and procedures for the safety and well-being of residents, employees and visitors.This requirement is not met as evidenced by: Based on the documentation collected and interviews conducted, the facility failed to isolate COVID positive residents in the designated isolation unit at the facility. In addition interviewed staff indicated that because residents have dementia, it was difficult to isolate residents in their rooms but staff did try to ensure the positive residents were not in close proximity to the negative residents. This poses a potential health, safety or personal rights risk to persons in care.

Report specified resident events within seven days

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…Violation of this regulation is not met as evidenced by: Facility failed to report an incident that occurred on February 13, 2022 as required to Licensing. In addition, facility failed to submit a written report within 7 days of the occurrence date of the incident.

Obtain required California clearance or exemption

Criminal Record Clearance (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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)Violation of this regulation is not met as evidence by: Based on record review and information collected, it was indicated that although the private caregiver was fingerprint cleared, the facility failed to associate the caregiver to the facility. In addition, the facility was unaware they had to associate staff who were hired privately.

87211 Reporting Requirements: (b) Any suspected physical abuse that results 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 two (2) hours as required by Welfare and Institutions Code Section 15630(b)(1).Violation of this regulation is not met as evidence by: Facility failed to report an incident of alledged abuse that occurred on February 13, 2022 as required to Licensing. This poses a potential health and safety risk for residents in care.

Facility personnel sufficiency and competence

Personnel Requirements: Facility personnel shall at all times be sufficient in numbers... to provide the services necessary to meet resident needs...Sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608.... The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. Violation of this regulation is evidence by staff interviews indicating that R1 and R2, both with dementia, were alone in the library without a staff member present to supervise the residents. Staff were aware of R1’s aggressive behaviors due to 2 prior altercations involving R1; November 10, 2021 and January 18, 2022 but failed to provide additional supervision. Although it was acknowledged by the facility that R1 demonstrates violent and aggressive behaviors, and the goal will be to ensure R1 does not cause injury to self or others, the facility failed to provide an appropriate intervention to identify R1’s needs in order to avoid similar behavioral and physical situations moving forward.

Protection from punishment and intimidation

87468.1(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or eliminationThis requirement is not met evidenced by: Based on reviews and interviews, Licensee failed to protect residents personal rights which posed an immediate Health, Safety and Personal rights risk to residents in care.Staff was observed by another staff being abusive to residents.