Pendar's Residential Care

Ensure hazardous items are locked and not unattended

Based on observation, interview, the licensee did not comply with the section cited above by having the knives drawer and toxics under sink unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Obtain baseline medical assessment before resident admission

Based on observation and record review, resident R3's file did not contain LIC 602 Physician's Report last Physicians Report was on 05/25/23 which poses/posed a potential health, safety or personal rights risk to persons in care.

Passageways and stairways kept clear

Based on observation and interview the licensee did not comply with the section cited above by having a pad lock on the gate exiting from backyard and front yard which poses an immediate health, safety or personal rights risk to persons in care.

(a) ... : (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. … (D) Any incident which threatens the welfare, safety or health of any resident, ... or unexplained absence of any resident. Based on interview, record review and observation the licensee did not ensure to report R1's elopement incidnet on 04/25/2025 to the Department which poses a potential health, safety and personal rights risk to persons in care.

Coverage for absent regular staff members

(a) In each facility: (1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not ensure that a staff member was present with 4 residents, when 2 out of 2 staff members left to pick up R1 after R1 eloped from the facility which poses an immediate health, safety, and personal rights risk to persons in care.

Document required significant condition changes

(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 requirement is not met as evidenced by: Based on interview, record review and observation the licensee did not ensure to update R1’s reappraisal to document R1’s new behavior of elopement which poses a potential health, safety, and personal rights risk to persons in care.

Right to sufficient care and qualified staff

(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 and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on observation, interview, and record review the licensee did not ensure resident (R1) was provided supervision to meet R1’s exit seeking behavior resulting in R1 leaving the facility unassisted which poses an immediate health, safety and personal rights risk to persons in care.

Passageways and stairways kept clear

(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 requirement is not met as evidenced by: Based on interview, record review, and observation the licensee did not ensure the front door was not free of obstruction as the front door contained a pad lock at the bottom left side of the front door which poses an immediate health, safety and personal rights risk to persons in care.

Dignity in personal relationships

Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This facility was found to be deficient as evidenced by lack of dignity and respect shown towards R1 when attempting update forms and documents without resident consent which posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.

Protection from punishment and intimidation

Residents in all residential care facilities for the elderly shall have all of the following personal rights: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 elimination.This facility was found to be deficient as evidenced by lack of professionalism, dignity and respect shown towards R1 after R1's refusal to comply with staff's demands to update R1's forms and documents which posed an immediate threat to the Health, Safety, and Personal Rights of all residents in care.

Maintain facility in clean, safe, sanitary condition

Based on observation the licensee did not maintain the planks that was rotting and needs repair on the ramps of BR2 and BR5, the sliding door screen of BR2 was frayed and the bathroom shower chair has a broken leg and tied together by a rope, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and record review the licensee did not correctly administer the medication for 3 out of 3 residents in care, which poses an immediate health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not maintain an updated record for 3 out of 3 resident's file that was reviewed during the time of inspection which poses/posed a potential health, safety or personal rights risk to persons in care.

Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by: Licensee did not ensure that resident R1 had a medical assessment that was updated annualy, which poses a potential safety risk to residents in care.

87506 Resident Records (b) Each resident’s record shall contain at least the following information: (17) Documents and information required by the following: (B) Section 87459, Functional Capabilities. This requirement was not met as evidenced by: Licensee did not ensure that resident R2's resident record included a Functional Capabilities form, which poses a potential safety risk to residents in care.

Based on observation and interview, the facility's exterior handrails was observed to be in disrepair with broken/sharp pieces of wood which poses a potential health, safety or personal rights risk to persons in care.