Windsong of Sonoma

(a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s representative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. This requirement is not met as evidenced by: Based on records reviewed, Licensee did not ensure reappraisal was conducted and notification to responsible party was made within two days. This poses a potential risk to persons in care.

87555 General Food Service Requirements(b) The following food service requirements shall apply:(27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.This requirement is not met as evidenced by: Based on observation and interviews, the licensee did not comply with the section cited above in that rodents, rodent feces and rodent traps were observed in the kitchen and dining areas which poses an immediate health, safety or personal rights risk to persons in care.

87411(a) Personnel Requirements - General 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 evidence by: Based on incident report and interview, facility did not provide supervision to R1 resulting in an elopement. The absence/lack of supervision is an immediate risk to the Health, Safety and Rights of resident in care.

Based on record review and interview with Administrator, the licensee did not comply with the section cited above in 2 out of 5 (S1& S2) files reviewed of direct care providers did not have current 1st Aid certification which poses/posed a potential health, safety or personal rights risk to persons in care.

87411(a) Personnel Requirements - General 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 evidence by: Based on incident report and interview, facility did not provide supervision to R1 resulting in an elopement. The absence/lack of supervision is an immediate risk to the Health, Safety and Rights of resident in care.

1569.652 Termination of admission agreement upon death of resident; removal of resident's property; refund of fees paid; notice of contract termination and refunds (c) A refund of any fees paid in advance covering the time after the resident's personal property has been removed from the facility shall be issued to the individual...responsible for the fees or..resident's estate, within 15 days after the personal property is removed.This requirement has not been met as evidenced by : Based on record review and statements received, licensee did not ensure the Health & Safety Code as required. This is a potential personal rights risk to residents.

87705(b)(2) Care of Persons with Dementia: Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. Not met as evidence by** Based on a review of facility incident reports and resident records it was found that resident (R1) had eloped from the facility without supervision. R1 is diagnosed with dementia and based upon Physicians Report, requires special supervision for confusion and wander risk. This is an immediate health & safety risk to resident in care.

Based on record review & interview with Administrator, the licensee did not comply with the section cited above in 3 out of 3 direct care providers did not obatain required annual trainings, which poses/posed 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 in 5 out of 11 residents bathroom faucets measured between 121.8 & 128.3 degrees F (all memory care residents) which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on record review and interview with Administrator, the licensee did not comply with the section cited above in 1 out of 3 (S1) direct care providers did not have current 1st Aid certification which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPA & Administrators observation while touring memory care, the facility did not comply with the section cited above by finding residents unlocked lidocane strips in unlocked bathroom cabinet (see pics), shampoos & conditioners with creams of multiple residents in unlocked bathroom cabinets (see pics), & finding cleaning supplies in memory care kitchenett's in unlocked cubbords (see pics) although all removed or lockes placed on cabinets by end of visit, which poses/posed a potential health, safety or personal rights risk to persons in care.

87705(b)(2) Care of Persons with Dementia: Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials. Not met as evidence by** Based on record review it was found that resident (R1) had been reported by facility to be missing from facility care. Medical documents indicate diagnosis of dementia.

87465(a)(5) Incidental Medical and Dental Care. 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 was not met as evidenced by: Based on self-reported incident report and interview with RCC, pain med for R1 was to be PRN after 3 days, facility neglected to change for 8 additional days. This is an immediate health, safety and personal rights risk to residents in care.

Based on document review and interview with Administrator showing R1’s incident report to hospital on 8/6/2023 was not reported timely. & Based on observation and interview with Director of Building services that facility has major water damage in dining room of memory care unity that was not reported, this is a potential risk to resident in care.

Based on LPA's observation and record review, 3 out of five staff lacked required first aid certification, the licensee did not comply with the section cited above in three out of five staff which poses/posed 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 in 1 unlocked bathroom cabinet, in memory care, containing wound cleaner was observed by LPA & BOM during inspection, which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation, the licensee did not comply with the section cited above in 6 out of 10 residents bathroom faucets measured between 120.7 & 121.8 degrees F (all memory care residents) which poses an immediate health, safety or personal rights risk to persons in care.

Based on observation by LPA & BOM the facility Insuline medication cart was unlocked and unattended containing suringes and insuline which poses an immediate health, safety or personal rights risk to persons in care.

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature...shall be maintained to automatically regulate the temperature of hot water used by residents...not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). This has not been met as evidence by: LPA measured hot water temperature for 6 random sampled restroom faucets (1 in memory care) used by residents. Hot water measured 120.6, 121.2, & 122.3 degrees F in 3 of the faucets. Facility understands that hot water temperature has to measure 105 degrees F to 120 degrees F.