Ivy Park at Glen Cove

Based on record review, the licensee did not comply with the section cited above in 4 of 15 resident records. Reappraisals were not updated within the last 12 months, which poses/posed a potential health, safety or personal rights risk to persons in care.

Additional Personal Rights of Residents in Privately Operated Facilities 87468.2(a)(2) To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement not met by licensee as evidenced by: Licensee did not dispose of confidential resident records in a secure manner which poses a potential health, safety, or personal rights risk to persons in care.

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 requirement was not met as evidenced by: Facility failed to keep R1s bedroom clean, and odor free. This is a potential risk to resident in care.

87464(d) Basic Services: A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs...This requirement is not met as evidenced by: Based on LPAs observations, interviews conducted and pictures received. Staff did not ensure resident R1 was clean and dry and did not meet their needs. This poses an immediate Health, Safety or Personal rights risk to residents.

87303(a) Maintenance and Operation- (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 requirement was not met. As evidenced by: Residents room had an issue with mice in their closet/room. no mice dropping were observed in the kitchen. This is a potential risk to the health & Safety of 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. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required... This requiement was not met as evidenced by: Based on staff interviews and records reviewed: Facility did not ensure supervision of R2 and R3, who AWOL'd from the facility without their knowledge. R2's & R3's Physician's Report(LIC 602) states diagnoses of Dementia & they may not leave the facility unassisted. This is an immediate risk to the health and afety of residents care.

87211(a)(1)(A)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 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. This report shall include the resident name.............; attending physician's name, findings, and treatment, if any; and disposition of the case. (A) Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility. This requirement was not met as evidenced by: The facility failed to report several incidents and the Death report in November 2023 for resident R1. This is a potential risk to the health & safety of residents in care

87705(f)(2)Care of Persons with Dementia(f) The following shall be stored inaccessible to residents with dementia:(2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidenced by: During the inspection of 2/2/2024 LPA found, cleaning solution, hammer, knife and cup of vitamins accessible to resident R1 and R2. This is an immediate risk to the health and safety of residents in care.

87355(e)(b) Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:(2) Request a transfer of a criminal record clearance as specified in Section 87355(c) This requirement was not met as evidenced by: during the inspection of 2/2/2024, LPA discovered staff S1 who was working, had been fingerprinted, but previous Administrator forgot to properly associate S1 to this facility. This is a potential risk to the health and safety of residents in care.

87463(a) REAPPRAISALS. The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate…*** Based on statements and documents, this requirement has not been met as evidenced by: RI’s condition significantly changed since 5/2/2023 appraisal and now requires substantial bed rest due to pressure injury. No update to R1’s appraisal has been made. This poses a potential risk to R1’s health and safety.

87411(a) Personnel Requirements-Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Based on review of incident report and interview with Administrator, this requirement has not been met as evidenced by: Resident R1 left the facility on two occasions, one being at 9pm at night, without the facility knowing or R1 signing out. This is an immediate risk to the health and safety of residents in care. This requirement is not met

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 self reported incident and interview with Administrator the facility failed to ensure R2's medication was given as prescribed by doctor. Staff found R2 had 2 Fentanyl patches at one time, staff failed to remove one of the patches before applying another one, which poses an immediate health and safety risk to resident in care.

1569.269(a)(6) Enumerated rights; severability(a)Residents of residential care facilities for the elderly shall have all of the following rights:(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 requirement was not met as evidenced by: Facility failed to ensure resident R1 was assisted with their oral, self care needs and plan to ensure injuries are assessed. This is an immediate risk to the health and safety of residents in care.

87211(a)((1)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 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. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: facility failed to report R1's arm injuries to family and Community Care Licensing , within 7 day. This is a potential risk to resident 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:(2)To be accorded safe, healthful and comfortable accommodations...This requirement was not met as evidenced by: Based on LPA’s observations, the Licensee did not comply with the Department of Public Health and Department of Social Services Guidelines and Requirements related to COVID-19. LPA received corroborating ionformation some visitors are not all screened mainly on the weekends or are not hand santizing an being screened for COVID related symptoms. This poses an immediate health and safety risk to residents in care.

874119(d)Personnel Requirements - General(d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: This requirement was not met as evidenced by: Investigation and corroborating statement showed, staff S2 did not have all the required training. This is a potential risk to the health and Safety of residents in care.

87465(a)(4): Incidental Medical and Dental Care Services. (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 in obtaining such care, by compliance with the following: The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on record review, and interview w/Care Coordinator S4 & Administrator. The facility failed to ensure R1's medication was provided as prescribed by doctor when Staff S3 told R1 they were out of medication and could not provide, additional staff located medication an hour and a half later and staff S3 had made a mistake. This poses an immediate health and safety risk to resident 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 when S1 accidentaly gave R1 medication for a resident with the same name (R2) which poses an immediate health and safety risk to resident in care.

87217(b)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. The licensee shall give the residents receipts for all such articles or cash resources. This requirement was not met as evidenced by: Investigation revealed R1's electric shaver was reimbursed to R1 after facility could not locate. This is a potential risk to residents in care