Lincoln Glen Assisted Living Center

Assist residents with self-administered medication

87465 Incidental Medical and Dental Care(a) (4) The licensee shall assist residents with self-administered medications as needed.This requirement was not met as evidenced by; Based on investigation, the facility administered an additional dose of M1. Medtech did follow facility procedures, and didn't do a physical count of the medication that just arrived. This poses a potential health, safety and personal rights risks to persons in care.

Update reappraisal at required intervals

87463 Reappraisals (a) The pre-admission appraisal,... shall be updated in writing as frequently as necessary... to note significant changes in condition... to keep the appraisal accurate...This requirement was not met as evidenced by; Based on record review, R1's Needs and Services plan was not updated to address R1's falls that occured on 8/7/25 and 9/27/25, and how the facility will address this need. This poses a potential health, safety and personal rights risks to persons in care.

1569.50 Denial, suspension or revocation of license; ...exclusion from licensee without right to petition for reinstatement (a)(3) Conduct that is inimical to the health, morals, welfare, or safety ... from the facility or the people of the State of California. This requirement was not met as evidenced by; Based on interviews conducted, and evidenced reviewed, staff S1 pushed resident R1, causing R1 to fall. This pose/poses an immediate health, safety and personal rights risks to persons in care.

Facility personnel sufficiency and competence

87411 Personnel Requirements - General(a) Facility personnel shall at all times be...competent to provide the services necessary to meet resident needsThis requirement was not met as evidenced by Based on investigation, on 04/05/25, R1 had exited the facility via the delayed egress. ADM stated staff went & deactivated the door, but did not do a head count after the alarm activated.This poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Safe, healthful, comfortable accommodations

87468.1 Personal Rights: (a)(2) Each resident shall be accorded safe, healthful and comfortable accommodations, furnishings and equipment.This requirement was not met as evidenced by: Based on investigation, on 04/05/2025, R1 with a neurocognitive disorder left the memory care unit unassisted and was found 0.9 miles away from the facility, unsupervised. This poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Facility personnel sufficiency and competence

87411 Personnel Requirements - General(a) Facility personnel shall at all times be...competent to provide the services necessary to meet resident needsThis requirement was not met as evidenced by Based on investigation, on 2/22/2025, Staff S1 administered 1 incorrect dose of medication M1 to R1 which poses an immediate health, safety and personal rights risk to persons in care.

Based on record review and interview, the ADM did not comply with the section cited above. ADM stated R1 recently had a change in care, 15 minute checks and being added to elopement risk list. This change in care was not reflected on R1's needs and services plan, dated 10/18/2022. This poses/posed a potential health, safety or personal rights risk to persons in care.

Based on record review and interview, the ADM did not comply with the section cited above. R1's physicians report is dated 07/06/2022. ADM stated his/her next doctors appointment is next month. This poses/posed a potential health, safety or personal rights risk to persons in care.

Maintain facility in clean, safe, sanitary condition

87303 Maintenance and Operation (a) The facility shall be... in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents...This requirement was not met as evidenced by; Based on record review and interview, the ADM did not ensure the delay egress alarm was functioning and in good repair at all times. This poses a potential health and safety risk to persons in care.

(k) The following initial and continuing requirements must be met for the licensee to utilize delayed egress devices ... (4)Without violating Section 87468, Personal Rights, facility staff shall attempt to redirect a resident who attempts to leave the facility.This requirement is not met as evidence by: Based on interview and record review, the ADM did not ensure facility staff attempted to redirect resident (R1) from leaving the facility unassisted which poses an immediate Health and Safety risk to persons in care.