Vaca Valley Living a Memory Care Community

Type B – 87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary & in good repair at all times…Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees & visitors ***This requirement was not met as evidence by: Based on LPA’s records review and interviews conducted with staff, the facility did not ensure to keep residents’ (R1) room clean, safe, sanitary and in good repair at all times which poses an immediate risk to the health and safety of residents in care.

Type B 87217 Safeguards for Resident…Personal Property (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… ***This requirement was not met as evidenced by: Based on LPAs record review, observation and interview the facility failed to safeguard R1's personal property (dentures) which poses a potential health and safety risk to residents in care.

Type A - 87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication…, facility staff designated by the licensee shall be permitted to assist the resident with self-administration...(2) Once ordered by the physician the medication is given according to the physician's directions. This requirement has not been met as evidence by: Based on LPA’s records review and interviews conducted with Administrator did not ensure that R1 was assisted with their Tranexamic Acid medication as prescribed by their physician which poses an immediate risk to the health & safety of resident in care.

87211(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....(D)Any incident......of any resident., This requirement has not been met as evidenced by: Based on statement of S1staff did not provide a written Incident Report to Responsible Party. This posed a potential risk to the health, safety or personal rights to persons 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 evidence by:**Based on interviews with multiple staff and residents on 07/03/2024, review of records, staff had inappropriately responded to residents. This is an immediate personal rights risk to residents in care.Licensee failed to ensure client personal rights were protected.

87705(b)(2) Care of Persons with Dementia: Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. This requirement is not met as evidence by** ***Based on incident report Resident R1 eloped from facility without staff knowledge on 03/25/23. Current medical assessment for resident states resident has a diagnosis of Dementia and is not able to leave facility unassisted, which poses an immediate health, safety risk to residents in care.

87355 Criminal Record Clearance (e)All individuals... shall prior to working, residing or volunteering in a licensed facility: (1)Obtain a California clearance or a criminal record exemption as required by the Dpt...This requirement is not met as evidenced by: Based on LPA observation, record review & interview with Licensee did not ensure to obtain a criminal record clearance for staff S1 prior to work, reside or provide care to residents in care which poses an immediate health, safety and personal rights risk to residents in care. ***Civil Penalty is being assessed for the amount of $100 per day.

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 LPAs record review and observations the faciltiy failed to provide 2 of 5 residents their medications as perscribed by doctor which poses an immediate health and safety risk to resident in care.

1569.269(a)(6) (a)Residents. .shall have all of the following rights: (6) To care, supervision, and services that meet their individual needs.**Immediate civil penalty of $500.00 was issued today for serious bodily injury. **Based on records reviewed & interviews facility didn't comply w/reg above when R1 & R2 eloped from the facility, and R1 sustained injury. Which posed an immediate risk to the health and safety of residents in care.

87203 Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for theprotection of life and property against fire and panic. This requirement is not met asevidenced by: Based on Observation, Licensee did not comply by obstructing a facility exit, which poses an immediate health, safety or personal rights risk to persons in care.**Immediate Civil Penalty assessed in the amount of $500.]'[