Yuba Sutter Care Home Inc.

Observation of the Resident. 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. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the section cited above because the staff did not seek medical attention and waited to be instructed to which poses/posed an immediate health, safety or personal rights risk to persons in care.

Reporting Requirements: Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident and to the person responsible for the resident within seven days of the occurrence This was not met as evidenced by: Based on file review the licensee did not submit a written notice regarding the resident being hospitalized. This poses a possible risk to residents in care.

Diabetes. The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. Based on record review and interview, the licensee did not comply with the section cited above because the resident is not capable and a caregiver who is not an appropriately skilled professional is doing it, which poses/posed an immediate risk to persons in care.

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.Based on record review, the licensee did not comply with the section cited above because the medication lists did not match the medications present in the facility which poses/posed an immediate health, safety or personal rights risk to persons in care.

Reappraisals. The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first... Based on record review, the licensee did not comply with the section cited above because two of three residents have them over 12 months which poses/posed a potential health, safety or personal rights risk to persons in care.

Night Supervision The following persons providing night supervision from l0:00 p.m. to 6:00 a.m. shall be familiar with the facility's planned emergency procedures, shall be trained in first aid as required in Section 87465, Incidental Medical and Dental Care Services and shall be available as indicated below to assist in caring for residents in the event of an emergency. This requirement is not met as evidenced by: Based on record and interviews the licensee did comply with this section because S1 stated they do not change residents nor is there proof of emergency training which poses an immediate risk to residents

Functional Capabilities The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living. Such activities shall include, but not be limited- Based on record review, the licensee did not comply with the section cited because there was no functional capability conducted on any of the residents in care poses/posed a potential health, safety or personal rights risk to persons in care.

Documentation and Support Each facility shall document in writing the findings of the pre-admission appraisal and any reappraisal or assessment which was necessary in accordance with Sections 87457, Pre-admission Appraisal, and 87463, Reappraisals... Based on record review, the licensee did not comply with the section cited because there was no appraisal or reappriasal done on the resident indicating R1 had a wound which poses/posed a potential health, safety or personal rights risk to persons in care.

Resident Records Each resident’s record shall contain at least the following information: Current centrally stored medications as specified in Section 87465, Incidental Medical and Dental Care Services. This requirement was not met as evidenced by: Based on record review, the licensee did not comply with the section cited above because R1 went to the hospital and the list of medications was sent with the resident and not replaced. which poses/posed a potential health, safety or personal rights risk to persons in care.

Resident Records. Each resident’s record shall contain at least the following information: Reports of the medical assessment specified in Section 87458, Medical Assessment, and of any special problems or precautions. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above because R1 went to the hospital and the medical assessment was sent with the resident and not replaced. which poses/posed a potential health, safety or personal rights risk to persons in care.

Managed Incontinence. In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above because S1 stated they do not change residents during the overnight shiff which poses/posed an immediate health, safety or personal rights risk to persons in care.

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 is not met as evidenced by: Based on interviews and record reviews, the Licensee did not compy with the section cited above because the staff did not seek medical attention and waited to be instructed, nor did the provide incontinent care to residents overnight, and cannot communicate with home health agency staff and CCLD staff which poses/posed an immediate health, safety or personal rights risk to persons in care.

Observation of the Resident. 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. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the section cited above because the staff did not seek medical attention and waited to be instructed to which poses/posed an immediate health, safety or personal rights risk to persons in care.

Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section cited above because S1 stated they do not change residents during the overnight shift out of soiled clothes and diapers which poses/posed an immediate health, safety or personal rights risk to persons in care.

General Requirements for Allowable Health Conditions. The licensee shall complete and maintain a current, written record of care for each resident that includes, but is not limited to, the following: Documentation from the physician of the following: Documentation from the physician of the Resident's ability to perform the procedure; Based on record review, the licensee did not comply with the section because there was no incontinent care plan for any of the residents which poses/posed an immediate health, safety or personal rights risk to persons in care.

, Administration and management of residential care facilities; substituted qualifications; employee scheduling. At least one administrator, facility manager, or designated substitute who... has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute may be a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above because current staff did not/does not proof of required training which poses/posed an immediate health, safety or personal rights risk to persons in care.

Incidental medical care; residential care facility. A residential care facility for the elderly may permit incidental medical services to be provided through a home health agency, licensed pursuant to Chapter 8 (commencing with Section 1725), when all of the following conditions are met: There is evidence of an agreed-upon protocol between the home health agency and the residential care facility for the elderly... Based on record review, the licensee did not comply with the section cited above because there was no written contract or paperwork between the resident and home health agency, which poses a potential, safety or personal rights risk to persons in care.

Incidental medical care; residential care facility. A residential care facility for the elderly may permit incidental medical services to be provided through a home health agency, licensed pursuant to Chapter 8 (commencing with Section 1725), when all of the following conditions are met: There is ongoing communication between the home health agency and the residential care facility for the elderly about the services provided to the resident by the home health agency and the frequency and duration of care to be provided. Licensee did not comply because there were no records of communication between the facility and the home health care agency.

Administrator - Qualifications and Duties The administrator shall have the responsibility to: Have the personal characteristics, physical energy and competence to provide care and supervision and, where applicable, to work effectively with social agencies. Based on record review, the licensee did not comply with the section cited above because staff don't have the required training, do not check residents who require incontinent assistance, employing staff who are qualified which poses/posed a potential health, safety or personal rights risk to persons in care.

Staff training; legislative findings; contents. In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospicecare, as required by subdivision (a) of Section 1569.696. Based on record review, the licensee did not comply with the section cited above because two current staff did not/does not have the initial training which poses/posed a potential health, safety or personal rights risk to persons in care.

Employees assisting residents with self-administration of medication; training requirements. In facilities licensed to provide care for 15 or fewer persons, the employee shall complete six hours of initial training... Based on record review, the licensee did not comply with the section cited above because there is no proof staff have had medication training which poses/posed an immediate health, safety or personal rights risk to persons in care.

Licensing Fees. In addition to fees set forth in subdivision (a), the department shall charge the following fees: A late fee that represents an additional 50 percent of the established annual fee when any licensee fails to pay the annual licensing fee on or before the due date as indicated by postmark on the payment. Based on record review, the licensee did not comply with the section cited above because the annual fees are overdue which poses/posed a potential health, safety or personal rights risk to persons in care.

Criminal Record Clearance. 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: Obtain a California clearance or a criminal record exemption as required by the Department Based on observation, the licensee allowed someone who does not have criminal record clearance to work by themself which poses an immediate health and safety risk to persons in care.

87705 Care of Persons with Dementia. (l) The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: (2) The licensee shall ensure that the fire clearance includes approval of locked exterior doors or locked perimeter fence gates. Based on observation, the licensee did not comply with the section cited above by placing a lock on the side gate without a fire clearance which poses an immediate health, safety or personal rights risk to persons in care.

87202 Fire Clearance. (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Based on observation, the licensee has a smoke detector with a low battery that continuously beeps which poses an immediate health and safety risk to persons in care.

Based on record review, the licensee did not comply with the section cited above in 1 out of 2 persons which poses/posed a potential health, safety or personal rights risk to persons in care.

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

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

Based on observation and record review, the licensee did not comply with the section cited above by using the storage room as a staff 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 by placing a lock on the side gate which poses an immediate health, safety or personal rights risk to persons in care.

87705 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...This requirement was not met as evidenced by: Based on observations and interviews, Licensee did not ensure medications were unaccessible to residents in care which poses an immediate health and safety and personal rights risk to all residents 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: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night.. This requirement was not met as evidenced by: Based on observation and interviews, Licensee did not ensure that residents can leave the facility at anytime and not be locked in the building which poses an immediate health and safety and personal rights risks to all residents in care.

87705 Care of Persons with Dementia (j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident.This requirement was not met as evidenced by: Based on observations and interviews, Licensee did not ensure auditory devices were on exits and operational which poses an immediate health and safet and personal righs risk to residents in care.

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment...and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement was not met as evidenced by: Based on observations, Licensee did not ensure that 3/4 residents with dementia have an annual medical assessment and reappraisal done at least annually which poses a potential health and safety and personal right risks to residents in care.

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.This requirement was not met as evidenced by: Based on observations and interviews, Licensee did not ensure to obtain a fire clearance for the storage room to be a staff bedroom, which poses a potential health and safety and personal rights risks to residents in care.