The Californian

1569.269(a)(6)Enumerated rights:severability(a)Residents of residential care facilities...following rights:(6)To care, supervision....and competency to meet their needs...This requirement is not met as evidenced by: Based on the Dept./Coroners investigation the...Licensee failed to ensure R1 care, supervision and services that meet their ind. needs and are delivered by staff.....which resulted in R1 death which poses an immediate health and safety risk to residents in care.

Right to accept or decline care or services

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:(16)To receive or reject medical care or other services. This requirement was not met as evidenced by: Based on financial statement for R1, the Licensee did not comply with R1’s requested medical services and R1 incurring uncovered medical expenses which poses a potential risk to the health, safety or personal rights risk to residents.

Facility personnel sufficiency and competence

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 failed to provide supervision to R1 resulting in an elopement. The absence of supervision is an immediate risk to the Health, Safety and Rights of resident in care.

Limit staff assistance with self-administered drugs

Incidental Medical and Dental Care Services.(a) The licensee shall assist residents with self-administered medications when needed.This requirement is not met as evdenced by: Based on interviews and record review, staff attempted to administer the wrong medication to the wrong resident, which is an immediate risk to the health and safety of residents in care.

Maintain facility in clean, safe, sanitary condition

87303(a)87303 Maintenance and Operation (a) The facility shall be clean, safe... in good repair at all times. Maintenance shall include provision of maintenance services... well-being of residents, employees and visitor. This was not met as evidenced by: Based on maintenance records and interviews the facility did not ensure that facility was within regulation due to air conditioner toilet and pull cord needing repairs. This is a potential risk to the health and safety of residents in care.

Facility personnel sufficiency and competence

87411(a) Facility personnel shall at all times be sufficient in numbers & competent to provide the services necessary to meet resident needs…This requirement has not been met as evidence by:** Based on records review of alarm response system and interviewsAdministrator did not ensure that staff on duty responded in a timely manner to call system to assist residents in care. Some call bell response times for R1 were 20- 40 minutes, which poses an immediate risk to the health and safety of residents in care.

Diet quality and preparation in safe healthful manner

87555 General Food Service Requirements (a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner. Based upon LPA's observations Licensee did not provide adequate assistance in serving food in a safe and healthful manner. This requirement is not evidenced by : Based on LPA observation of resident unable to receive assistance.This is an immediate risk to the Health, Safety and Rights of residents in care.

Facility personnel sufficiency and competence

87411(a) Personnel Requirements – General- (a) 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 evidenced by: Based on LPA observation, interview and record review residents were not able to receive care in a timely manner. This is an immediate risk to the Health, Safety and Rights of residents in care.

Give PRN medication by physician order

Incidental Medical and Dental Care (c) (2)- Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by LPA's review of records and interviews. The LPA reviewed records, and conducted interviews with staff. The investigation revealed that R1 had a medicated patch ordered to be applied in AM and removed in PM. MAR shows patch applied but documentation for removal was missing several entries. This is a potential health and safety risk to resident in care.

Safe, healthful, comfortable accommodations

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:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:Based on interviews that were conducted, LPA was made aware that the alleged staff member was rude to a resident in care. Furthermore, LPA learned of an incident that occurred on June 28, 2023 in which the alleged staff member was asked to leave the facility after a meeting with Human Resources (HR). LPA obtained an outside agency report which was reported that the alleged staff member would leave and then return back to yell and curse at employees in the presence of residents which presents an immediate health, safety and PERSONAL RIGHTS risk to the residents in care.

Facility personnel sufficiency and competence

87411 Personnel Requirements - General(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met as evidenced by:Based on interviews and observations, LPA observed Call Bell logs from June 15, 2023 through July 3, 2023 in which residents would push the call buttons and the response times were exceeding over 30+ minutes. Furthermore, LPA interviewed 4 of 4 residents and learned that the residents corroborated the wait times for assistance which is a potential health, safety and personal rights risk to the residents in care.

87707(a)(2) Training Requirements If Advertising Dementia Special Care, Programming And/Or Environments:(a) Licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall ensure that all direct care staff, described in Section 87706(a)(1), who provide care to residents with dementia, meet the following training requirements: (2) Direct care staff shall complete at least eight hours of in-service training on the subject of serving residents with dementia within 12 months of working in the facility and in each succeeding 12-month period. Direct care staff hired as of July 3, 2004 shall complete the eight hours of in-service training within 12 months of that date and in each succeeding 12-month period.This requirement was not met as evidenced by:Based on observation of the training hours for staff members, LPA identified one staff member not having the necessary hours of training as outlined in Title 22 regulation. Staff member has not been trained annually since 2021 which presents a potential health, safety and personal rights risk to the residents in care.

Limit staff assistance with self-administered drugs

87465(a) A plan for incidental medical ..(5) The licensee shall assist residents with self-administered medications as needed..*Based upon interviews and records reviewed this requirement has not been met as evidenced by: S1 did not provide resident with PRN in a timely manner. This posed an immediate risk to the health and safety of residents in care.

1569.269 Enumerated rights; severability(6) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. *Based upon records reviewed, This requirement has not been met as evidenced by: Staff were unable to provide care to residents in care on 88 occasions. This posed a potential health and safety of residents in care.

Maintain cleanliness and prevent incontinence odors

87625 Managed Incontinence (b)(3)(b) In addition ..(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. *Based upon records reviewed and interviews this requirement has not been met as evidenced by: Facility staff did not provided incontinence care to residents. This posed an immediate risk to the health and safety of residents in care.