Angels Ii

Based on observation and record review, the licensee did not comply with the section cited above as R1 was observed with a full bed rail, but is not currently on hospice, which poses an immediate health, safety or personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above as S1 has a criminal record clearance, but was not associated to the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Incidental Medical and Dental Care(g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis…This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. Facility staff did not seek timely medical care when R1 fell and sustained facial and head injuries, yet was put to bed, which posed an immediate health and safety risk to resident in care

Additional Personal Rights of Residents in Privately Operated Facilities.Residents shall have all of the following....: To care, supervision, and services that meet their individual needs........ This requirement was not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as R1 was not properly supervised which led to an elopement, which poses an immediate personal rights risk to residents in care.

§1569.312(a) Basic services requirements. Basic services shall at a minimum include:(a)Care and supervision as defined in Section 1569.2.This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. Facility staff did not supervise R1 which resulted in R1’s fall, sustaining traumatic subdural hematoma, resulting in death, which posed an immediate health and safety risk to residents in care.

(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 (5) Regular observation of the resident's physical and mental condition..... This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above.Facility staff failed to assess R1 completely for fall prevention and develop a service plan as R1 had a history of falls with visible injuries noted, which posed an immediate health and safety risk to residents.

(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 within seven days of the occurrence.. This requirement was not met as evidenced by: Based on records review, R1 eloped from the facility on 01/17/2023, however this incident was not reported to CCL timely, which poses a potential health and safety risk to residents in care.

Based on record review, the licensee did not comply with the section cited above. One out of five resident files reviewed identified that Resident #3 is receiving home health service; no written agreement between facility and home health agency was observed on file. This 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. Bottle of tylenol observed on kitchen table accessible to others. This poses an immediate 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 four (4) out of five (5) resident medications reviewed it was observed that staff are not logging in all prescribed/nonprescribed medications on the Centrally Stored Record log for the four residents. This 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 three (3) out of three (3) staff records reviewed no staff had record of this training. This 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. Two out of five clients observed in their room with full urine bottles; one full sitting on the night stand/on the other several urine bottles on and near resident's bed. This 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 three (3) out of three (3) staff files reviewed lacked required annual training. This 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 three (3) out of three (3) staff files reviewed all three staff lacked proof of required annual medication training. This poses/posed a potential health, safety and personal rights risk to persons in care.

Based on record review, the licensee did not comply with the section cited above. Resident #3's needs and services plan was observed over a year old. This 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. Licensee/Administrator did not review the Emergency Disaster Plan annual since developed. This poses/posed a potential health, safety or personal rights risk to persons in care.

Personal Rights of Residents in All facilities(9) To have communications to the licensee from their representatives answered promptly and appropriately.This requirement is not met as evidence by: Based on interview with Licensee/ administrator, licensee did not comply with the above regulation. Licensee did not communicate or provide records to former resident's family representative despite the several attempts made by requestor/family representative.

Based on observation, the licensee did not comply with the section cited above. LPA observed living area and resident room walls window coverings with dust and stains. This poses a potential health, safety or personal rights risk to persons in care. Resident #1's room was observed with dirty napkins on the floor; urine stains on the bedding.

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...... This requirement is not met as evidence by: Based on interviews and records reviewed Administrator did not comply with section cited above. R1's family was not issued the correct refund for unused rent following removal of belongings on 3/13/2023. This posed a potiential personal rights risk to

87303 (a) Maintenance and OperationThe facility shall be clean, safe, sanitary and in good repair at all times...This requirement was not met as evidenced by: Based on Observation, the licensee did not comply with the section cited above, as the facility did not maintain clean carpets, refrigerator and freezer which poses a potential health and safety risk to residents in care.

Based on observation, the licensee did not comply with the section cited above. LPA observed knives stored in an unlocked drawer in the kitchen which poses an immediate health, safety or personal rights risk to persons in care.