Vacaville Memory Care

87468.1(a)(3) Personal Rights of Residents in All Facilities: (a)(3) To be free from punishment,humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’...This requirement was not met as evidenced by: Based on interviews conducted, records reviewed, and observations made, the facility failed to ensure resident’s rights and protection from abuse. This poses a potential health, safety or personal rights risk to persons in care.

Plan of Operation 87208(a) Licensee shall have and maintain a current, written definitive plan of operation for the facilit…Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. This requirement was not met as evidenced by: Licensee failed to submit Admissions Agreement for review to ensure changes were not made that required approval by CCL. This poses a potential health and safety risk to residents in care.

87555(b)(29) - General Food Service Requirements, (b)The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. This requirement was not met as evidenced by: Based on interviews and LPA observation of records, it was determined that resident R1’s water bottle contained unknown black substance, that indicating it was not properly cleaned or sanitized. This poses a potential 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,... shall have all of the following personal rights: (4) to care, supervision, and...This requirement was not met as evidenced by: Based on interviews conducted and observations made, Licensee did not ensure residents' personal rights and incontinence care needs were met. This is an immediate health and safety risk to residents in care.

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times...for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on observations made, Licensee did not comply with the section cited above and did not ensure that bathrooms were in good operating condition. LPAs observed the following to be broken or in disrepair: paper towel dispenser, toilet paper holder, toilet out of order, soap dispenser, and utility sink. This poses a potential health and safety risk to residents in care.

87470 Infection Control Requirements(b) In addition to subsection (a), when one or more residents in the facility are diagnosed with a contagious disease, the following shall apply: This requirement was not met as evidenced by: Based on interviews and observations, Licensee did not comply with the section cited above and did not ensure that facility staff were following infection control protocol. This poses an immediate health and safety risk to residents in care.

87307 Personal Accommodations and Services:(a)...The following provisions shall apply:(3)Equipment and supplies... for personal care and...adequate hygiene practice shall be readily available...:(D) Hygiene items of general use such as soap and toilet paper. This requirement was not met as evidenced by: based on observations amde, Licensee did not comply with the section cited above and did not ensure that facility bathrooms were supplied with general hygiene items such as toilet paper, soap, and paper towels. This poses a potential health and safety risk to residents in care.

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed...(4)The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: based on interviews and record review, Licensee did not comply with the section cited above and did not ensure that Resident 1’s medication was administered per physician’s orders. This poses an immediate health and safety risk to residents in care.

87468.2Additional Personal Rights of Residents in Privately Operated Facilities(a) In addition to the rights listed in Section 87468.1...(1)To have a reasonable level of personal privacy accommodations...personal care & assistance...use of the Internet...this requirement was not met as evidenced by: based on interviews conducted & document review, Licensee did not comply with the section cited above & Residents did not have signed social media consent forms prior to being on social media. This poses an immediate health and safety risk to residents in care.

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal...this requirement was not met as evidenced by: based on observsations made, Licensee did not comply with the section cited above and ensure that all facility exits were unobstructed in the event of emergency. This poses an immediate health and safety risk to residents in care.

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 was not met as evidenced by: based on interviews conducted and document review, Licensee did not comply with the section cited above and ensure that all 5 homes at facility had adequate staffing to meet resident care needs. Licensee has at least 6 residents that require two staff member assistance. This poses an immediate health and safety risk to residents in care.

87208 Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation...plan & related materials shall be on file in the facility & shall be submitted to the licensing agency with the license application. Any significant changes...which would affect the services to residents shall be submitted...for approval. This requirement was not met as evidenced by: Licensee failed to submit Admissions Agreement for review to ensure changes were not made that required approval by CCL. This poses a potential health and safety risk to residents in care.

87211 Reporting Requirements: (a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(1) A written report shall be submitted...within seven days of the occurrence of any of the events specified...below. This requirement was not met as evidenced by: Licensee did not comply with section cited above. Per record review, Licensee did not submit incident reports timely. This poses a potential health and safety risk to residents in care.

87466 Observation of the Resident: Licensee shall ensure...residents are regularly observed for changes...& that appropriate assistance is provided...Licensee shall ensure...changes are documented & brought to the attention of the resident's physician & responsible person, if any. Requirement was not met as evidenced by: based on interviews, records & observations, Licensee did not ensure that facility staff responded appropriately to observations of R1's wound resulting in an unstageable injury. This is an immediate health & safety risk to residents in care.

87470 Infection Control Requirements(b) (2)All staff...providing direct care to resident who has a communicable disease shall wear appropriate... PPE ...(B)PPE shall be...discarded in the nearest... receptacle with... immediately upon completing a task.This requirement has not been met as evidence by: Based on photos, observation, interviews and record review Licensee did not follow mandated guidance of infection control plan and failed to discard PPE in a tightly-lidded container as required which poses a potential health, safety, and personal rights risk to clients 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... shall have all of the following personal rights: (4) to care, supervision, and services that meet their individual needs...This requirement was not met as evidenced by: Based on interviews conducted and observations made, Licensee did not ensure residents' personal rights and incontincence care needs were met. This is an immediate health and safety risk to residents in care.

87466 Observation of the Resident: Licensee shall ensure...residents are regularly observed for changes...& that appropriate assistance is provided...Licensee shall ensure...changes are documented & brought to the attention of the resident's physician & responsible person, if any. Requirement was not met as evidenced by: based on interviews, records & observations, Licensee did not ensure that facility staff responded appropriately to observations of R1's wound resulting in an unstageable injury. This is an immediate health & safety risk to residents in care.

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: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: based on interviews conducted, Licensee did not ensure residents' personal rights. This is an immediate health and safety risk to residents in care.

Based on record review and observations made, Licensee did not comply with the section cited above. Licensee did not ensure that 4 of 8 staff members received their annual 20 hours training as required by Health and Safety Code. This poses a potential health, safety or personal rights risk to residents in care.

Based on record review and observations made, Licensee did not comply with the section cited above. Licensee did not ensure that 4 of 10 resident medications were documented and centrally stored as required. This poses a potential health, safety or personal rights risk to residents in care.

Based on observations made, the Licensee did not comply with the section cited above. 4 of 10 facility sinks were found to be out of Title 22 regulations of 105F to 120F measuring at 147.2F, 128.6F, 125.7F, and 138.2F. This poses a potential health, safety or personal rights risk to residents in care.

Based on record review and observations made, Licensee did not comply with the section cited above. Licensee did not ensure that Staff Member 1 (S1) had the proper background clearance and/or associations required to provide care at the facility. This poses an immediate health and safety risk to clients in care.

87705 (f) The following shall be stored inaccessible to residents with dementia: (2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. This requirement is not met as evidenced by:Based on self-reported incident report, the licensee did not comply with the section cited above in that soap in kitchen area was accessible to residents, which poses/posed an imminent health, safety or personal rights risk to persons in care.

Enumerated rights; severability(a(6) - ..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 was not met as evidence by**Based on interviews with Administrator and a review of resident R1 medical and facility records, it was found that facility failed to ensure proper supervision resulting in R1 left unsupervised, causing unwitnessed fall and injury in the facility courtyard. This serves as an immediate health & safety risk to residents in care.

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.. This requirement was not met as evidence by:** Based upon review of facilityand CCLD records, it was found that the facility failed to properly complete and report an Unusual Incident Report LIC624 regarding resident R1 sustaining unwitnessed fall located in facility courtyard. This serves as a potential healthy and safety risk to residents in care.

87411 (a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...This was not met as evidence by: Based on photo evidence and interviews with multiple staff, LPA found that caregiving staff have been witnessed to be asleep during their shifts which serves as a potential health & safety risk to residents in care.

Safeguards for Resident Cash, Personal Property and Valuables: Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables.. This was not met as evidence by: Based on interviews with multiple staff, LPA received consistent information regarding resident clothing being shared amongst each other due to inaccessible clothing (soiled or requiring replacement). This serves as a potential personal rights risk to residents in care.

Enumerated rights; severability-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 was not met as evidence by: Based on observation, records review & interviews, the licensee did not comply with the section cited above involving resident R1's needs not being met resulting in development of pressure sore while under facility care which poses an immediate health & safety risk to persons in care.

Enumerated rights; severability-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 was not met as evidence by:** Based on LPA interviews with Acting Administrator, staff, review of records and observations, it was found that resident R1 sustained an unexplained injury on 12/31/2023 due to several residents not properly supervised. This is an immediate health & safety risk to residents in care.

The licensee shall assist residents with self administered medications as needed. This requirement was not met as evidence by:**Based on review of Omnicare Pharmacy medication audit conducted 12/20/2023 and interview with Omnicare Nurse (N1) it was found that staff (S2) was observed inappropriately administering medications directly into residents' mouths/tongue when staff are to only provide assistance with self-administering. This serves as an immediate health & safety risk to residents in care.

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 according to the hospice’s established procedures or which are otherwise to be 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: This was not met as evidence by:** Based on Omnicare Pharmacy audit it was found that the facility staff have not properly processed or disposed of several expired medication. This serves as potential health & safety risk.

87303(a)-The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This was not met as evidence by:** Based on tour of the facility, LPA observation and photo evidence it was found that the facility was not in safe or sanitary condition. Urine was observed uncleaned on resident bedroom floors, bathrooms as well as photo evidence indicating feces in common areas. This serves as a potential health & safety risk to residents in care.

87464(f) - Basic services shall at a minimum include care and supervision as described in Health and Safety Code section 1569.2(c). These requirements were not met as evidenced by:**Based on interview with home health agency (H1) it was found that H1 had observed resident R2 left in soiled continence care on multiple occasions. In addition, based on photo evidence, resident R1 was observed to be left in soiled clothing on multiple occasions. This serves as an immediate health & safety and personal rights risk to residents in care.

87465(a)(5): Incidental Medical and Dental Care Services. The licensee shall assist residents with self-administered medications when needed.This requirement is not met as evidenced by: Based on record review and interview with Administrator the facility failed to ensure R1's medication was given as prescribed by doctor which poses an immediate health and safety risk to resident in care.

87211 Reporting Requirements:(a)Each licensee shall furnish to the licensing agency such reports as the Department may require, including...the following:(1)A written report shall be submitted to the licensing agency...within seven days of the occurrence of...(D)Any incident which threatens the welfare, safety or health of any resident... This requirement is not met as evidenced by:Based on Record Review, the Licensee did notcomply with the section cited above, and did not submit reports to CCL as required. This poses a potential health and safety risk to residents in care.

Peronnel Requierments-General: Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This was not met by:** Based on a observations, staff interviews and record review LPA found that staff (S3) had provided supervision for residents alone without approrpriate caregiver traning and against S3's required duties. Potential risk to residents in care.

87506(b)(10) Resident Records:(b) Each resident’s record shall contain at least the following information:(10): Reports of the medical assessment specified in Section 87458, Medical Assessment, and of any special problems or precautions.This requirement was not met as evidenced by:Based off of observation of facility records and interviews with staff members. LPA learned and identified that R1 did have a change of condition, and was not documented on a LIC 602/Physicians Report nor retained in resident records. This is a potential health, safety and personal rights risk to the residents in care.

Direct care staff shall complete at least eight hours of in-service training on the subject of serving residents with dementia...and in each succeeding 12-month period. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not have at least 8 hours of documented in-service training for staff. This poses a potential Health, Safety or personal rights risk to residents.

1569.312(d) Being aware of the resident's general whereabouts, although the resident may travel independently in the community. This requirement is not met as evidenced by:Based on interviews conducted, the Licensee did not comply with the section cited above and did not ensure that staff knew the general whereabouts of R1. It was reported that R1 left the facility unassisted and without staff knowledge. A search was conducted and R1 was found unharmed. This poses an immediate risk to the health and safety of residents in care.

87211(a)(1)(d) Reporting Requirements. The licensee shall send a written report, within seven days, to the licensing agency and the person responsible for the resident when any incident occurs which threatens the welfare, safety or health of any resident. **This requirement is not met as evidence by: Based on record review and staff interview facility failed to report incident that threatened the safety or health of resident. This poses a potential health or safety risk to residents in care.

87468.1(a)(2) Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights:To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.**This requirement is not met as evidenced by: Based on record review and interviews facility failed to ensure resident was accorded a safe environment being hit by R1 back to back.

1569.312(d) Being aware of the resident's general whereabouts, although the resident may travel independently in the community. Based on review of incident report and interview with Administrator, this requirement has not been met as evidence by: It was reported R1 went into another residents room, climbed over the air conditioning unit that was against the window, cut the screen with a key that was in his possession and climbed over the widow and got out. R1's physician report states R1 may not leave facility unassisted . This is a potential risk to the health and safety of residents in care.

87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidence by:*** Based on interviews with staff, outside parties and photo evidence LPA found that R1's clothing had been be soiled in urine. In addition, feces were also observed on the floor of R1's bedroom.

87468.1 Personal Rights of Residents in all Facilities. To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidence by:*** Based on interviews with staff, Administrator and outside parties LPA found that staff S1 & S2 failed to wear face coverings while providing care and supervision to residents in care*, in violation of official government orders requiring the wearing of face coverings while working under specified conditions.