Prn Care Home Llc

Maintain separate complete record for each resident

Based on 6/6 resident records reviewed, the files were not complete which poses/posed a potential health, safety or personal rights risk to persons in care.

Complete admission suitability appraisal

Based on 6/6 resident records reviewed, 3/6 resident files did not have a pre-admission appraisal in their files which poses/posed a potential health, safety or personal rights risk to persons in care.

Update reappraisal at required intervals

Based on 6/6 resident record, 5/6 resident records did not have a service plan and/or had an outdated service plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Annual routine visit with medical professional

Based on 4/6 resident records reviewed, LPA did not observe any documentation to show that 4/6 of the residents have received an annual routine visit with a licensed professiona oncel every year which poses an immediate health, safety or personal rights risk to persons in care.

Store centrally held medications in locked secure place

Based on observations, LPA observed R1's prescribed insulin unlocked and accessible in the refrigerator which poses an immediate health, safety or personal rights risk to persons in care.

Based on observations, LPA observed R1's bed to have a full bed rail. Based on interviews and records reviewed, R1 is not on hospice which poses an immediate health, safety or personal rights risk to persons in care.

Based on records reviewed and interviews, 3/4 staff were observed to not have the required training which poses an immediate health, safety or personal rights risk to persons in care.

Based on records reviewed and interview, Administrator was unable to provide LPA documenation to show that emergency drills are being conducted at least quarterly which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observations, LPA observed mice droppings in the garage where facility stores their non-perishables which poses an immediate health, safety or personal rights risk to persons in care.

Provide resident hot water for personal care

Based on observations, the water temperature throughout the facility measured between 127-131 degrees F which poses/posed a potential health, safety or personal rights risk to persons in care.

First aid training requirements

Based on 4/4 staff records reviewed, 4/4 staff did not have their first aid/CPR training which poses an immediate health, safety or personal rights risk to persons in care.

Maintain required personnel records for staff

Based on staff record review, Administrator was unable to provide a complete file for Staff 1 (S1) which poses/posed a potential health, safety or personal rights risk to persons in care.

Agree in writing on agency and facility responsibilities

87609 Allowable Health Conditions and the Use of Home Health Agencies (b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4)The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s). This was not met as evidenced by Licensee was not able to provide a written agreement with a Home Health agency to address R1’s condition.

Document required significant condition changes

87463 Reappraisals (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. This was not met as evidenced by Licensee does not have an updated Needs and Appraisal form to document a significant change in condition of R1 having Stage 2 Pressure ulcer.

Facility personnel sufficiency and competence

87411 Personnel Requirements - General:(a) 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 interviews and file reviews, on 12/11/24, there were six residents at the facility, all which have dementia. According to the administrator, he went to get groceries for the facility when R1 eloped and S1 was the only one present providing care to all six residents. Nevertheless, due to the lack of staffing, R1 was able to elope from the facility twice on 12/11/24 which poses an immediate health and safety risk to residents in care.

Care and supervision as defined by statute and rules

87464 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 Code section 1569.2(c).This requirement is not met as evidenced by Based on file reviews and interviews, R1 has a diagnosis of dementia and is unable to leave the facility unassisted, however R1 left the facility two times on 12/11/24, at 11am and at 4pm. Although the facility doors have working alarms, R1 was still able to leave the facility with two staff members being present which poses an immediate health and safety risk to residents in care.

Submit and maintain current mailing address

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: (1)Obtain a California clearance or a criminal record exemption as required by the Department or....Violation of this regulation is not met as evidenced by: Based on observations, LPAs observed S1 to providing care and supervision to clients in care however, based on record review, S1 was obseved to not have any fingerprint clearance. According to the administrator, S1 has been working at the facility for more than a year.

Based on record review and interviews, no emergency drill log was provided and/or available to LPAs during the visit. Based on interviews, staff indicated she/he has not heard of any drills being conducted at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

Based on observations, Bedroom #4 bathroom was observed to have water on the floor, faucet was observed to be in disrepair, power strip locatedi n bedroom #4 was observed partially burnt. In addition, LPAs observed Bedroom #3 with mold on the ceiling which poses an immediate health, safety or personal rights risk to persons in care.

Provide adequate lighting for room safety and comfort

Based on observations, LPAs toured bedroom #3 and observed a table light that does not provide sufficienct lighting for resident which poses/posed a potential health, safety or personal rights risk to persons in care.

Requirement for building permit before construction

Based on observations, the licensee constructed an office room in the garage which poses an immediate health, safety or personal rights risk to persons in care.

Prohibition on using other rooms as bedrooms

Based on observations, LPAs observed a closet room right across from the garage, located next the dining room table to have a bed and personal belongings which poses an immediate health, safety or personal rights risk to persons in care.

Passageways and stairways kept clear

Based on observations, the garage passageway was observed to be blocked with clutter. In addition, LPAs observed the exit route area from Bedroom #4 to the patio in the backyard to have suitcases, covered furniture, wheelchair and a desk chair blocking the exit route passeway which poses an immediate health, safety or personal rights risk to persons in care.

Ensure hazardous items are locked and not unattended

Based on observations, LPAs observed chemicals, and sharps unlocked and accessible to residents in the kitchen and in the bathroom which poses an immediate health, safety or personal rights risk to persons in care.

Maintain personnel records at facility location

Based on record review, no personnel records were present at the facility for review which poses an immediate health, safety or personal rights risk to persons in care.

Store centrally held medications in locked secure place

Based on observations, LPAs observed medication cabinet to be unlocked and accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Maintain separate complete record for each resident

Based on 5 resident records reviewed, 1/5 resident does not have a file at all and 1/5 resident record does not have physician's report, needs and service plan, ermegency contact sheet which poses/posed a potential health, safety or personal rights risk to persons in care.

Food quality controls and rejected damaged goods

Based on observations, LPAs observed a gallon of expired milk in the refrigerator. In addition, LPAs observed frozen milk in the garage freezer to also be expired which poses an immediate health, safety or personal rights risk to persons in care.

Based on observations, Bedroom #4 has a resident with dementia. Bedroom #4 has an exit door leading from the room to the patio area in the backyard. The door alarm was observed to not be in working condition which poses an immediate health, safety or personal rights risk to persons in care.

INCIDENTAL MEDICAL CAREPrescription medications which are... otherwise to be disposed of shall be destroyed in the facility by the facility administrator & one other adult who is not a resident. Both shall sign a record, to be retained for at least 3 years, which lists...:Name of the resident, Rx number, name of pharmacy, drug name, strength, quantity destroyed, date of destruction.This requirement is not met, as medications included on 3 clients' Medication Administration Records were stopped or discarded, per staff, but there is no documentation maintained of the MD orders or destruction. Licensee failed to ensure that records are maintained for med destruction, which poses a potential risk.

Onsite food stock levels for nonperishables and perishables

FOOD SERVICESupplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises.This requirement is not met, as facility does not maintain at least a 2 day supply of fresh vegetables. Licensee failed to ensure that at least 2-day supply of fresh food is maintained, which poses a potential health, safety or personal rights risk to clients in care.

Record centrally stored prescriptions and refill data

INCIDENTAL MEDICAL CAREA record of centrally stored prescription medications for each resident shall be maintained & include names of the resident for whom prescribed, prescribing physician and pharmacist, drug name, strength, & quantity, dates filled, started & expiration, prescription number and instructions.This requirement is not met, as evidenced by review of client records and absence of Centrally Stored Medications Records. Licensee failed to ensure that CSMR is maintained to track clients' medications, which poses a potential health, safety or personal rights risk to clients in care.

Maintain required personnel records for staff

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. According to Licensing records, Albert Liu is not associated with the facility or has received background clearance.

Safe, healthful, comfortable accommodations

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care. Facility failed to ask screening questions upon arrival to the facility, keep an appropriate amount PPE, have COVID signage posted throughout the facility, and have bathrooms equipped with paper-towels.