Cogir of Belmont

Ensure hazardous items are locked and not unattended

Private visitor access without prior notice

Ensure hazardous items are locked and not unattended

Based on observations, LPA observed a housekeeping cart on the second floor and a housekeeping cart on the third floor to be unlocked with chemicals in them which poses/posed a potential health, safety or personal rights risk to persons in care.

Private visitor access without prior notice

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities: (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (11) To have their visitors...permitted to visit privately during reasonable hours and without prior notice, provided that the rights of other residents are not infringed upon. This requirement is not met as evidenced by: According to the interviews conducted, it does not seem like facility has a fixed policy in place for visitation as interviews conducted indicates that the policy is determined by individual receptionists. In addition, based on staff interviews, when R1 came to visit two residents at the facility, S1 indicated he/she notified S2 to let the residents know that the reporting party was at the facility to visit them, however according to S2, he/she indicated that he/she was never told to go check on the residents to see if they wanted the reporting party to visit.

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 is not met as evidenced by based on interview, records review and observation, R1 was evacuated to another facility due to an electrical issue at the facility and upon returned, R1 and R1's responsible party discovered many items were missing that were there before which posed a potential health and safety risk to residents in care.

§1569.657Rate increase due to change in level of resident care; notice(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative,.. written notice of the rate increase.. The notice shall include a detailed explanation.. This requirement is not met as evidenced by based on record review, and interview R1 and R1's responsible party was not provided a written notice of the level of care increase which poses a potential health and safety risk to resident in care.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on R1's medication list, R1 is required to receive his/her one 15mg tablet of Mirtazapine daily at 8:00pm, however the facility did not provide R1 his/her medication as prescribed by the physician which poses an immediate health and safety risk to residents 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...within seven days of the occurrence of any of the events specified in (A) through (D) below...This requirement is not met as evidenced by: Based on records, it was observed that the facility has not submitted any incident reports to CCLD regarding R1’s med-errors that occurred on 8/8/25 and 8/10/25. According to staff interviewed, they believed that an incident report did not have to be submitted because although the med-errors occurred, it was caught by R2 and fixed by the med-tech. 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...This requirement is not met as evidenced by: Based on interviews conducted, R3 indicated he/she was sitting on the side of the bed that was provided by the facility, when the bed's slate underneath the mattress slipped, causing the mattress to collapse on the floor. ccording to staff interviewed, R3's bed was not able to hold his/her weight causing the slate to shift and the mattress to collapse which poses a potentional health and safety risk to residents in care.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on interviews and records reviewed, on 8/8/25 and 8/10/25 at 8pm on both days, R1 was administered only one tablet of Gabapentin instead of three tablets by the med-tech. R2 caught the error and notified the med-tech who fixed the error. Although this incident was caught by R2 and fixed by the med-tech, the med-tech would have administered one tablet of Gabapentin to R1 at 8pm on both days if R2 did not catch this error which poses an immediate health and safety risk to residents in care.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on R1's medication list, R1 is required to take 1 tablet of Lacosomide (100mg) medication daily at 8am, however on 6/22/25, the med-tech administered 150mg. The facility failed to provide R1's medication as prescribed by the physician. In addition, Based on R1's medication list, R1 is required to take 1 tablet of Gabapentin (100mg) at 9am, two tablets of Gabapentin at 1pm and three tablets of Gabapentin at 8pm. Although this incident was caught by R2 and fixed by the med-tech, the med-tech would have administered one tablet of Gabapentin to R1 at 8pm on 6/26/25 if R2 did not catch this.

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 regulation is not met as evidenced by: Based on staff interviews, it was acknowledged that depending on the day and time, it may take staff longer to get to the elevator to assist residents. Based on the residents interviews, there have been several times where it's taken staff more than 10 minutes for staff to open the elevators to go inside and/or outside the facility causing residents to miss their appointments and/or sit in their cars.

Passageways and stairways kept clear

87307 Personal Accommodations and Services: (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.This regulation is not met as evidenced by: Based on observations, LPA observed uneven pavement, uneven bricks, and overgrown greenery on the side of the walk way which poses an immediate health and safety risk to residents in care.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on file reviewed, R1 is required to take 1 tablet of Lacosamide (150mg) medication once every evening at 8pm, however based on the MAR, the med-tech administered the wrong doasge and administered 100mg of Lacosamide to R1 which poses an immediate health and safety risk to residents in care.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on staff interviews, R1's physician's orders and MAR, R1 is required to take 1 tablet of Lacosomide (100mg) medication daily at 8am, however based on the MAR, the med-tech did not administer the medication to R1 which poses an immediate health and safety risk to residents in care.

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.This requirement is not met as evidenced by: Based on R1's medication reviewed and the MAR reviewed, R1 was supposed to be given Carbidopa at 6am and 10am, however was not given the medications until 8:24am and 11:15am which poses an immediate health and safety risk for 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. This requirement is not met as evidenced by: The facility failed to provide residents notification or communicate with residents regarding a fire inspection that occurred on 11/7/24, resulting in residents to feel unsafe, scared, and nervous. According to the Maintenance Director, he was aware that outside vendor, Cintas was going to come to the facility a few days prior and was aware that Cintas was going to test the fire alarms, however admitted that he allowed them to continue and test the alarms without any notification to residents

Assist residents with self-administered medication

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...(4) The licensee shall assist residents with self-administered medications as needed. This was not met as evidenced by, based on records review, the medication that needs to be given on a specific time was not administered on time between Ferbruary and March 2024, which poses an immediate health, safety, or personal rights risk to clients in care.

Facility personnel sufficiency and competence

87411(a): Personnel Requirements-General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Based on interviews with residents, the Licensee did not comply with this requirement in 1 out of 1 instances, in which the facility did not have enough staff to meet residents' needs, which poses/posed a potential health, safety or personal rights risk to persons in care.

Right to sufficient care and qualified staff

87468.2(a)(4): Additional Personal Rights of Residents in Privately Operated Facilities a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs. The licensee did not comply with the section cited above in 1 out of 1 instances in which residents did not have access to hot water prior to an emergency evacuation, which poses an immediate health, safety or personal rights risk to persons in care.

Dispose of unused medications with required witness

87465 Incidental Medical and Dental Care: (i) Prescription medications which are not taken with the resident upon termination of services, not returned to the issuing pharmacy, nor retained in the facility as ordered by the resident’s physician and documented in the resident’s record nor disposed of… shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following...Violation of this regulation is not met as evidenced by: Based on observations, LPA observed expired medication and medications for residents who no longer reside at the facility in a locked cabinet in the medication room. In addition, based on interviews conducted, facility staff were aware of the medications that should've been disposed since the facility reopened in January 2024.

Maintain separate complete record for each resident

87506 Resident Records: 87506 Resident Records: (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.Violation of this regulation is not met as evidenced by: Based on record review and staff interviews, facility misplaced R1's file and are unable to provide R1's records (admission agreement, pre-appraisal, care plan) to licensing staff when R1 was residing at Vista Terrace of Belmont, prior to the emergency evacuation

Admission agreement signing and dating deadline

87507 Admission Agreement: (c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident’s representative, if any, and the licensee or the licensee’s designated representative no later than seven days following admission...Violation of this regulation is not met as evidenced by: Based on record review, facility failed to maintain a copy of a signed and dated admission agreement for R1 prior to admission at Vista Terrace of Belmont.

Obtain baseline medical assessment before resident admission

87458 Medical Assessment :(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment.Violation of this regulation is not met as evidenced by: Based on record review, R1's physicians report is dated 12/20/2021 and R1 had a change in condition that was discussed during a care conference on 4/19/2023. Nevertheless, the facility failed to ensure R1's physician's report was current.

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...procedures for the safety and well-being of residents...Violation of this regulation is not met as evidenced by: Based on interviews conducted and observations made,although the facility ensured the residents were safe and comfortable during the time the facility had a power outage, the facility failed to ensure that a main electrical system was in good repair after the incident that occurred on January of 2023. an invoice dated 2/6/23 and 2/16/23, indicating that service conducted on 1/11/23 and 1/12/23 by Direct Supply electricians diagnosed the main breaker system as an issue.Furthermore, facility failed to have the Maintenance Director and/or electricians check on the electrical systems routinely after having issues with the power and being aware that the breaker system was an issue.

Dispose of unused medications with required witness

87465 Incidental Medical and Dental Care: (i) Prescription medications which are not taken with the resident upon termination of services...shall be destroyed in the facility by the facility administrator and one other adult who is not a resident. Both shall sign a record, to be retained for at least three years, which lists the following...Violation of this regulation is evidenced by: Based on documents reviewed and information collected, the faciliy med-tech had a hospice nurse sign for medication destruction without the hospice nurse being present for the destruction. In addition, med-tech acknowledged that he/she did not get authorization to detroy medications.

Give PRN medication by physician order

87465 Incidental Medical and Dental Care: (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration...(2) Once ordered by the physician the medication is given according to the physician's directions.Violation of this regulation is evidenced by: Based on record reviewed and staff interviews, the facility Med-Tech missed a dosage of R1's AM medication as ordered by their physician.

Give PRN medication by physician order

87465 Incidental Medical and Dental Care: (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration...(2) Once ordered by the physician the medication is given according to the physician's directions.Violation of this regulation is evidenced by: Based on record reviewed and staff interviews, the facility Med-Tech missed a dosage of R1 and R2's prescribed medication as ordered by their physician.

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 interviewed conducted, the facility did not ensure basic services were being met, due to lack of supervision R1 AWOL. In addition, R1 is unable to leave the facility unassisted, which poses an immediate health, safety and personal rights risk to residents.