El Rio Memory Care Community

Personnel Requirements: (c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training.. (1) Staff providing care shall receive appropriate training in first aid…This requirement is not met: Based on review of the facility policy, only one staff on premises is required to receive 1st aid training. This poses a potential risk to the health, safety, or personal rights of persons in care.

Basic services shall at a minimum include:Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by: Based on facility staff reporting they were unable to provide proper care and supervision due to being understaffed resulting in multiple falls with injury to R1. This poses an immediate health, safety and personal rights risk to residents in care.

The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement was not met as evidenced by: Based on facility staff not recognizing R1’s severe dehydration resulting in kidney injury. This poses an immediate health, safety and personal rights risk to residents in care.

Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:There is an adequate number of direct care staff to support each resident’s ...health care needs as identified in his/her current appraisal. This requirement was not met as evidenced by facility staff stating they were unable to complete all required tasks which included checking on R1 every 30 minutes due to being understaffed. This poses a potential risk to the health, safety and personal rights of residents in care.

Managed Incontinence...the licensee shall be responsible for the following:Ensuring that incontinent residents are kept clean and dry...This requirement was not met as evidenced by: Based on the Executive Director's confirmation that a resident (R2) was in the common area in soiled clothing. This poses a potential risk to the health, safety and personal rights of residents in care.

Basic ServicesBasic services shall at a minimum include:...Care and supervision as defined in Section 87101(c)(3) and Health and Safety Codesection 1569.2(c). This requirement was not met as evidenced by: Based on LPA Jensen's observation multiple residents were observed to be in need of assistance with grooming. This poses a potential risk to the safety and personal rights of residents in care.

Prior to accepting or retaining a resident with an allowable health condition as specified in Section 87618...facility staff shall have knowledge and the ability to recognize and respond to problems...This requirement was not met as evidenced by: Based on LPA Jensen's interview, the staff member provided care for a resident with a wound and a resident with a hoyer lift but received no specialized training on the wound care or equipment use. This poses an immediate risk to the health, safety and personal rights of residents in care.

Incidental Medical and Dental CareThe licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on LPA Jensen's review of the MAR, R1 did not receive a prescribed medication for a period of 10 days. This poses an immediate risk to the health, safety and personal rights of residents in care.

Reporting RequirementsA written report shall be submitted to the licensing agency... within seven days of the occurrence of ...Any incident which threatens the welfare, safety or health of any resident. This requirement was not met as evidenced by:

ReappraisalsThe pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate....The licensee shall immediately bring any such changes to the attention of the resident's physician and his family or responsible person. This requirement was not based on a comparison of the LIC 602 and Needs and Service Plan. This poses a potential risk to the health, safety and personal rights of residents in care.

Resident RecordsThe licensee shall ensure that a separate, complete, and current record is maintained for each resident. This requirement was not met as evidenced by: Based on LPA Jensen's review of the incomplete Needs and Service Plan and MAR. This poses a potential risk to the health, safety and personal rights of residents of in care.

Basic ServicesBasic services shall at a minimum include:...Personal assistance and care as needed by the resident with those activities of daily living such as dressing, eating, bathing. This requirement was not met as evidenced by: Based on LPA Jensen's record reviews and interviews, the records reviewed were inconsistent with facility policyon showering accordig to staff. This poses a potential risk to the health, safety and personal rights of residents in care.

"The licensee shall assist residents with self-administered medications as needed."This requirement was not met as evidenced by: Based on record review, R1 was not given a second dose of antiparasitic medication as ordered by a physician, which poses an immediate health and safety risk.

Care of Persons with DementiaEach resident with dementia shall have an annual medical assessment as specified in Section 87458...This requirement was not met based on: LPA Jensen's record review of 2 of 4 resident files which did not contain a current LIC 602. This poses a potential risk to the health, safety and personal rights of residents in care.

Based on LPA Jensen's record review of staff files, the licensee did not comply with the section cited above in 2 out of 10 counts which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPA Jensen's observation of 1 resident room with alcohol and 1 resident room with disinfectants, the licensee did not comply with the section cited which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPA Jensen's observation of the facility food supply, the licensee did not comply with the section cited above in maintaining a 7 day supply of non-perishable food which poses/posed a potential health, safety or personal rights risk to persons in care.

87705(b)(1) (b)In addition to ..., Plan of Operation, the plan of operation shall address...with dementia, including: (1) Procedures for notifying the resident’s physician, family members and responsible persons. The Licensee failed to comply with the above regulation as evidenced by: The Licensee failed to follow its own plan of operation. and did not notify responsible parties (RP) about scabies. Based on Interviews and records review in 6/6 instances. This posed an immediate, health, safety and/or personal rights risk to those in care and did not assist in containing the spread of scabies.

87211(a) Each licensee shall furnish to the licensing... as the Department may require: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident... (2) Occurrences, ...24 hours either by telephone... The Licensee failed to comply with the above regulation when: Based on a review of records, R5 was suspected and treated for scabies on 07/14/23. This was not reported to CCL and pose/posed an immediate risk to residents in care.

Reporting Requirements 87211(a)(2)(a) Each licensee... to the licensing agency such reports as ... the following:(2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes... The Licensee failed to comply with the above regulations as evidenced by Based on records review, interviews and observation, the licensee failed to report an outbreak of scabies within 24 hrs. CCL was not notified of any of the additional cases of scabies and scabies treatment after 08/02/203. This LPA was informed on 10/18/23 that 29 more residents had been treated.

CCR 87465(a)(9)Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed...(9) The licensee shall ensure that infection control practices are maintained in the facility...The Licensee failed to comply with the above regulation: Based on observations, interviews and a records review, the Licensee failed to follow their own infection control plan. Residents suspected of having scabies or showing symptoms of scabies were not separated or isolated. Deep cleanings and vacuuming were not performed. The identification of close contacts was never pursued. This poses/posed an immediate risk to residents in care.

87625 Managed Incontinence(b) In addition to ...Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors ... The Licensee failed to comply with the above regulations as evidenced by: Based on Interviews and observations 6/6 responsible parties stated they had found loved ones in soak adult briefs and/or pants on multiple occasions. 3/5 staff said that incontinent care is not always done as scheduled. This poses/posed an immediate health risk to residents in care during a scabies outbreak.

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:3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was met as evidenced by statements and witness's who observed staff member rughly handling a resident in the shower. Which poses a potential health, safety and personal rights risk to residents in care.

Care, Persons with Dementia 87705(c)(4)(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff...resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement was not met as evidenced by:Sufficient staffing would have provided the opportunity for staff to redirect R1 before either of the 2 situations escalated to violence. Per R1's appraisal, R1 "has a history of physical aggression or violence."

Care, Persons with Dementia 87705(c)(5)(A) (5) Each resident with dementia shall have an annual medical assessment...(A) When any... appraisal, or observation indicates that the resident’s dementia care needs have changed, corresponding changes shall be made in the care... This requirement was not met as evidenced by:Dementia care resident has not had a new LIC 602 since 3/3/2021 and the licensee failed to update the needs and services plan of R1 after R1 was involved in 2 separate resident on resident altercations.

Incidental Medical and Dental Care: The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: On 11/9/2022 Resident (R1) was observed to have a lump on right buttock. On 11/17/2022, R1 was sent to the hospital. The facility did not provide an explanation of why R1 was not provided timely medical assistance. This poses an immediate health, safety and personal rights risk to residents in care.

The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need…. This requirement was not met as evidenced by: Staff failed to notice Resident (R1) changes and failed to seek medical attention resulting in R1 being diagnosed with stage #4 wound and sepsis. This poses an immediate health, safety and personal rights risk to residents in care.

Reporting requirements. (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including :(2) Occurrences, such as epidemic outbreaks...within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement was not met as evidenced by: Based on interview, facility had a total of 15 resident and 2 staff active covid cases between 1/31/22 and 2/13/22 which were not reported to licensing department. This posed an immediate health and safety risk to residents in care.

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.(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not meet as evidenced by interviews and documentation LPA'S reviewed nurse's notes on multiple dates that show falls and there is no records to CCL. This poses an immediate health and safety risk to residents in care.

Care of persons with dimentia 87705K(8)Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents and to escort residents who leave the facility. This requirement has not been met as evidenced by: Facility is aware of residents behaviors but no staff was at entrance. This poses an immediate health and safety risk to residents in care.

Basic Services (f)Basic services shall at a minimum include: (1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c)..."Care and supervision" means the facility assumes responsibility for,... ongoing assistance with activities of daily living ....This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not ensure R1's basic service/ medication needs were being met. Tea Tree oil was not being administered as prescribed. This posed an immediate health and safety risk to resident 1.

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility...(4) When residents require prosthetic devices, vision and hearing aids, the staff shall be familiar with the use... of these devices, and shall assist such persons with their utilization as needed. This requirement is not met as evidenced by:Based on interviews and records review, the licensee did not ensure R1's hearing aids were being inserted in the correct ears. This posed a potential health and safety risk to resident 1.

87465Incidental Medical and Dental Care(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: (7) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not ensure R1's Tea Tree Oil MAR sheets were being maintained. This posed a potential health and safety risk to resident 1.