Dutchollow Suites I

(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 is not met as evidenced by: Based on observations, the licensee did not ensure that the facility was in a clean manner. It was observed that that facility had clutter across multiple areas, including the kitchen, living spaces, and bedrooms. This poses a potential health, safety, and personal rights risks to persons in care.

Monitoring the activities of the residents while they are under the supervision of the facility to ensure their general health, safety, and well-being. This is not met as evidenced by: Based on interview and record review, this Licensee did not ensure that S1 supervised the residents in care. It was stated through interviews that S1 was witnessed to be sleeping at the time of a family visit which was corroborated through a video recording. This poses an immediate health, safety, and personal rights risks to persons in care.

(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This is not met as evidenced by: Based on interview and record review, the licensee did not ensure that medication was locked and made inaccessible to the residents in care. This poses an immediate health, safety, and personal rights risks to persons in care.

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This is not met as evidenced by: Based on observations, the licensee did not ensure that knives and hazardous materials were locked and made inaccessible to the residents in care. This poses an immediate health, safety, and personal rights risk to persons in care

Based on observation of food in the kitchen, the licensee did not comply with the section cited above, as there were food items that were expired in the refrigerator and pantry, and there were open food items that required refrigeration after opening that were stored in the pantry unrefrigerated, which poses a potential health, safety or personal rights risk to persons in care.

Based on observation of items in kitchen cabinets, the licensee did not comply with the section cited above, as ant and roach killer and leather cleaner were observed stored with food items in the cabinets, which poses/posed a potential health, safety or personal rights risk to persons in care.

Based on LPA Jensen's record review, the licensee did not comply with the section cited above in 1 out of 3 residents files which poses/posed a potential health, safety or personal rights risk to persons in care.

Observation of the ResidentThe licensee shall ensure that residents are regularly observed for changes... and that appropriate assistance is provided when such observation reveals unmet needs. When changes ... are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician ... This requirement was not met as evidenced by Based on an interview with the Administrator and a review of facility records, medical records and photographs, R1 developed a wound while under facility care that was not reported to R1’s physician. This poses an immediate risk to the health, safety and personal rights of residents in care.

Basic ServicesBasic 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). This requirement was not met as evidenced by: Based on interviews conducted, facility records, medical records and photographs taken by the Administrator, R1 did not receive the care and supervision needed to prevent a wound which endangered their physical health. This poses an immediate risk to the health, safety and personal rights of residents in care.

Contents of Residential Care Facility Admission AgreementsThe admission agreement shall include all of the following:(a) A comprehensive description of any items and services provided under a single fee, , such as a monthly fee for room, board... the resident shall receive a monthly statement itemizing all separate charges incurred by the resident. This requirement was not met as evidenced by Licensee's admission that file receipts were inaccurate and no other receipts were generated. This poses a potential risk to the health, safety and personal rights of residnets in care.

Resident Participation in Decision MakingThe licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident’s condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. This requirement was not met as evidenced by LPA Jensen's review of R2's file which contained a Needs and Service Plan conducted in 2018. This poses a potential risk to the health, safety and personal rights of residents in care.

Basic ServicesBasic services shall at a minimum include:...assistance with taking prescribed medications...This requirement was not met as evidenced by: Based on LPA Jensen's review of the MAR, R2 did not receive a prescribed medication from 1/11/24 through 1/15/24. This poses an immediate risk to the health, safety and personal rights of residents in care.

Postural SupportsA written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement was not met as evidenced by: Based on LPA Jensen's observation of R1's bed being blocked by various items effectively restricting R1's mobility without a physician's order. This poses an immediate risk to the health, safety and personal rights of residents in care.

If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives. This requirement was not met as evidenced by: Based on LPA Jensen's review of 3 of 3 resident files that indicate rate increases may be made after 30 days. This poses a potential risk to the health, safety and personal rights of residents in care.

General Food Service Requirements...All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement was not met as evidenced by: Based on LPA Jensen's observation of expired food in the pantry and refrigerator and food items requiring refrigeration being stored in the pantry. This poses a potential risk to the health, safety and personal rights of residents in care.

Incidental Medical and Dental CareCentrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement was not met as evidenced by: Based on LPA Jensen's observation upon arrival of medication in the kicthen that was accessible to residents in care. This poses an immediate risk to the health, safety and personal rights of residdents in care.

Buildings and GroundsThe facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not met as evidenced by: Based on LPA Jensen's observation of toxins, tools, sharp objects and insects. This poses an immediate risk to the health, safety and personal rights of residents in care.

Plan of OperationEach facility shall have and maintain a current, written definitive plan of operation...The plan and related materials shall contain the following:Sketches...including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used for nonambulatory residents and for bedridden residents. This requirement was not met as evidenced by LPA Jensen's observation that a client room had been converted in to a staff room. This poses a potential threat to the health, safety and personal rights of residents in care.

Personal Accommodations and ServicesAll outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement was not met as evidenced by: Based on LPA Jensen's observation of a bedroom sliding door and bedroom door blocked by equipment or furniture. This poses a potential threat to the health, safety and personal rights of residents in care.

Refund conditions.Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. dmission agreements shall specify the following:(1) Basic services, as defined in Section 87101(b), to be made available. (2) Additional items and services which are available. (3) Payment provisionsA 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, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. Based on records review and interviews with R1 and the ombudsmen (ON) LPA reviewed the admissions agreement , the licensee did not comply with the section cited. After a review of resident records LPA found that the admissions agreement only had N/A under refunds and no other information which poses a potential health, safety or personal rights risk to persons in care.

Refund conditions.Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death, pursuant to Health and Safety Code section 1569.652. dmission agreements shall specify the following:(1) Basic services, as defined in Section 87101(b), to be made available. (2) Additional items and services which are available. (3) Payment provisionsA 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, individuals, or entity contractually responsible for the fees or, if the deceased resident paid the fees, to the resident’s estate, within 15 days after the personal property is removed. Based on records review and interviews with R1 and the ombudsmen (ON) LPA reviewed the admissions agreement , the licensee did not comply with the section cited. After a review of resident records LPA found that the admissions agreement only had N/A under refunds and no other information which poses a potential health, safety or personal rights risk to persons in care.

87309 Storage Space(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.This requirement is not met as evidenced by: The following requirement has not been met as evidenced by: LPA observed toxins, and cleaning supplies unlocked and accesible to residents in several rooms including the garage, kitchen and backyard area of the facility which poses an immediate health, safety or personal rights risk to residents in care.

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored:(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.This requirement is not met as evidenced by: LPA observed the facility has medications in the kitchen, and living room areas unlocked and accessible to residents which poses an immediate health, safety, or personal rights risk to residents in care.

Personal Accommodations(e) Facilities providing services to residents who have physical or mental disabilities shall assure the inaccessibility of fishponds, wading pools, hot tubs, swimming pools, or similar bodies of water, when not in active use by residents, through fencing, covering or other means.The following requirement has not been met as evidenced by: LPA Hurt observed a large empty in ground swimming pool in facility backyard to be unlocked and accessible to facility residents which poses an immediate, health safety or personal rights risk to residents in care.

Based on observation, the licensee did not comply with the section cited above in LPA observed the facility to be cluttered, and not clean 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 as LPA observed several tupperwares inside the refrigerator did not have labels or dates, 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 LPA observed medications on facility kitchen table, and in an unlocked drawer inside a residents room 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 LPA observed cleaning supplies unlocked and accessible on the back porch, which poses an immediate health, safety or personal rights risk to persons in care.

Based on LPA observation, the licensee did not comply with the section cited above. LPA observed disinfectants on the back patio unlocked and accesible to residents. This 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. LPA observed clutter all over the entire home. The entire home was filled with belongings from a storage unit outside. The kitchen area was not usable as it had items scattered all over the counters 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. LPA observed several over the counter medications out on the kitchen table upon the entering the facility which poses an immediate health, safety or personal rights risk to persons in care.