Campbell Village

87463 Reappraisals (a) The pre-admission appraisal… shall be updated in writing as frequently as necessary …to note significant changes in condition…and to keep the appraisal accurate…This requirement was not met as evidence by: Based on records reviewed and interviews conducted, the changes facility ADM stated she implemented to address R1’s falls were not reflected on R1’s Needs and Services Plan. ADM acknowledged she did not update the care plan. This poses a potential health, safety or personal rights risk to persons in care.

87457 Pre-Admission Appraisal (c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed ... their individual service needs ... specified in Section 87455, Acceptance and Retention Limitations. This requirement was not met as evidenced by: Based on record review, the residents pre admission appraisal was not filled out and had missing information such as Residents Name & Age, Health, physical disabilities, mental condition, health history & social factors. This poses a potential health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above. While touring resident bedroom 111, LPAs observed a plastic tube obstructing the sliding glass door, preventing the door from opening which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation and interview, the licensee did not comply with the section cited above. While touring Memory Care, LPAs tested delayed egress door #4 (next to resident rooms #124 and #125). LPAs pushed the door completely open, and the delayed egress did not sound the alarm which poses an immediate health, safety or personal rights risk to persons in care.

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: (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 was not met as evidenced by: Licensee did not ensure that resident R1 did not elope from the facility unassisted, which poses an immediate safety risk to residents in care.

87211 Reporting Requirements (a)(1)(D) Any incident which threatens the welfare, safety or health of any resident... or other residents, or unexplained absence of any resident.This requirement was not met as evidenced by; Based on interview & record review, the facility did not send an incident report regarding R1's falls on February 7, 2024, March 2 and 7, 2024, and May 13, 2024. Staff S1 stated he/she didn't send an incident report for these falls. This poses a potential health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above as the water temperature was measured to beneath 105 *F in 3 out of 3 tested bathrooms which poses a potential health, safety or personal rights risk to persons in care.

87303 - Maintenance and Operation - (i) Facilities shall have signal systems which shall meet the following criteria ... (A) Operate from each resident's living unit. This requirement was not met as evidenced by: Based on LPA observation, interviews, and records review, 5 rooms in the facility have had a non operational signal system for more than 2 months. This poses an immediate risk to the personal rights of residents in care.