Health inspection·April 4, 2023

F835 §483.70 Administration. A facility must be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.

F838 §483.70(e) Facility assessment. The facility must conduct and document a facility-wide assessment to determine what resources are necessary to care for its residents competently during both day-to-day operations and emergencies. The facility must review and update that assessment, as necessary, and at least annually. The facility must also review and update this assessment whenever there is, or the facility plans for, any change that would require a substantial modification to any part of this assessment. The facility assessment must address or include: §483.70(e)(1) The facility's resident population, including, but not limited to, (i) Both the number of residents and the facility's resident capacity; (ii) The care required by the resident population considering the types of diseases, conditions, physical and cognitive disabilities, overall acuity, and other pertinent facts that are present within that population; (iv) The physical environment, equipment, services, and other physical plant considerations that are necessary to care for this population; and §483.70(e)(2) The facility's resources, including but not limited to, (i) All buildings and/or other physical structures and vehicles; (ii) Equipment (medical and non- medical); (iii) Services provided, such as physical therapy, pharmacy, and specific rehabilitation therapies; (iv) All personnel, including managers, staff (both employees and those who provide services under contract), and volunteers, as well as their education and/or training and any competencies related to resident care;

F921 §483.90(i) Other Environmental Conditions The facility must provide a safe, functional, sanitary, and comfortable environment for residents, staff and the public. 22 CCR §72435 Social Work Service Unit - Policies and Procedures. (b) The social work service unit shall be organized, directed and supervised by a social worker, who is responsible for supervision of other social work staff, including social work assistants and social work aides. 22 CCR §72523. Patient Care Policies and Procedures. (a)Written patient care policies and procedures shall be established and implemented to ensure that patient-related goals and facility objectives are achieved. On 3/13/2023, the California Department of Public Health made an unannounced visit to the facility to investigate an incident related to abuse and quality of care. The facility failed to have a licensed Administrator employed at the facility to be responsible for the day-to-day functions of the facility. The facility failed to: 1.Ensure the resident bathroom was provided with hot water from the faucet for Resident 12. 2. Conduct a facility assessment to reflect the current resident population and staffing required to meet the needs and care of the residents. 3. Employ a qualified social worker on a full-time basis, as the facility did not have a Social Services Director since 9/14/2021. 4. Maintain a safe and homelike environment for Resident 37 by failing to fix a leaking ceiling. As a result, there were insufficient resources available to meet the resident needs, which resulted in the resident's increased level of discomfort and had the potential to negatively impact the resident's quality of life. a.A review of Notice of Termination of Employment, dated 2/15/2023, indicated the facility Administrator resigned on 2/15/2023. During an observation and tour of the facility on 3/16/2023 at 11:40 AM, the Administrator's license was displayed in the facility lobby. During an interview on 3/16/2023 at 11:43 AM, the Director of Nursing (DON) stated it was a requirement to have a licensed qualified Administrator in the facility. She stated the Administrator was responsible for the entire facility and ensured the facility and staff follow policy and procedure. She stated the facility had not had a licensed Administrator for over a month. The DON stated if there was a licensed qualified Administrator, the facility would be able to assist and ensure the facility had qualified staff such as Social Services Director and resident rooms had hot water. During an interview on 3/16/2023 at 12:22 PM, the Chief Operating Officer (COO) stated the facility currently did not have a licensed Administrator and the facility was required to have a licensed Administrator. The COO stated the Administrator would also be responsible to ensure the facility had sufficient staff to care for the residents, including having a Social Services Director. She stated the facility currently did not have an Administrator to be responsible for the day-to-day functions of the facility. A review of the facility's policy titled, "Administrator," reviewed 1/2023, indicated a licensed Administrator was responsible for the day-to-day functions of the facility. The Administrator was responsible for managing the day-to-day functions of the facility and ensuring that an adequate number of personnel were employed to meet resident needs. b. A review of Resident 12's Admission Record indicated the facility admitted the resident on 7/14/2009 with diagnoses including diabetes mellitus Type II (a chronic condition that affects the way the body processes blood sugar [glucose]), hypotension (abnormally low blood pressure), and quadriplegia (paralysis of all four limbs). A review of Resident 12's Minimum Data Set (MDS- a standardized assessment and care screening tool) dated 2/27/2023 indicated the resident was cognitively intact (decisions consistent/reasonable) and the resident required extensive assistance with one person assist for bed mobility, toilet use, and limited assistance with one person assist for personal hygiene. During an interview on 3/13/2023 at 9:30 AM, with Resident 12, in Resident 12's room, he stated the water from the bathroom sink was not hot sometimes and sometimes it takes a very long time to get hot. Resident 12 stated he disliked having to wait for hot water or wash his hands with cold water. During an interview on 3/15/2023 at 8:10 AM, the Maintenance Supervisor (MS) stated he checked the water temperatures in resident rooms with a thermometer, once a week on Wednesdays. He stated water temperatures should be between 105 Fahrenheit to 120 Fahrenheit (F - a scale of temperature measurement in which water freezes at 32 degrees and boils at 212 degrees). The MS stated the hot water temperature for Resident 12's sink sometimes did not reach 105 F when he checked. During a concurrent observation, the MS stated the water temperature for the hot water in Resident 12's sink was currently 76.8 F. The MS stated he must wait more than four or five minutes sometimes for the water temperature to reach 105 F. A review of the facility's policy titled, "Water Temperature, Safety of," reviewed 1/2023, indicated tap water in the facility shall be kept within a temperature range. Water heaters that service resident rooms, bathrooms, common areas, and tub/shower areas shall be set to 105 F. c. A review of the "Facility Assessment" (FA), dated 5/2/2022, indicated the facility had an Administrator, Therapy Director, and reflected the resident census as 63 residents. A review of Notice of Termination of Employment and employee timecard, dated 9/28/2022, indicated the Therapy Director (TD) status changed from full time to per diem on 9/28/202. The employee timecard indicated the TD last clocked in for work at the facility on 9/28/2022. A review of the Notice of Termination of Employment, dated 2/15/2023, indicated the facility Administrator resigned on 2/15/2023. During an interview on 3/14/2023 at 2:45 PM, the Social Services Assistant (SSA) stated she did not have a bachelor's degree but had a certificate for social work. She stated she was not qualified to be a Social Services Director and the facility did not have a Social Services Director for over a year. During an interview on 3/16/2023 at 11:40 AM, the DON stated and confirmed the Facility Assessment dated 5/2/2022, indicated total residents noted on the assessment were 63 residents, the facility had a licensed Administrator, and a Therapy Director. The DON stated the current census was actually 66 residents, and the facility did not have an Administrator or a Therapy Director. She stated the Administrator listed on the Facility Assessment resigned on 2/15/2023, and the Therapy Director resigned in 9/2022. The DON stated the Facility Assessment should have reflected the changes of staff and the increase of census. The DON stated the facility failed to conduct a facility reassessment to reflect the new resident population and staff. During an interview on 3/16/2023 at 12:22 PM, the Chief Operating Officer (COO) stated the facility was required to have a qualified SSD as the facility had 124 beds. She confirmed the termination letter indicated the SSD last worked on 9/14/2021 and the facility had not had a qualified Social Services Director since the previous SSD resigned. The COO stated a Social Services Director would have helped social services assistant with social services duties such as verifying Power of Attorney (the authority to act for another person in specified or all legal or financial matters) and provide residents with services. d. A review of Resident 37's admission record indicated the facility admitted the resident on 2/3/2023 with diagnoses including hemiplegia, osteoporosis and high blood pressure. A review of the MDS dated 2/9/2023, indicated Resident 37's cognition (ability to process knowledge and understanding) was intact and required extensive assistance with on-person physical assist with bed mobility, transferring, toileting and personal hygiene. A review of Resident 37's risk for fall care plan indicated the resident was at risk for fall due to hemiplegia. One of the care plan's goals was to minimize the risk of repeat fall for three months. The care plan interventions included to implement fall precautions and to provide a safe environment; free of clutter and floors kept not-slippery. During an observation on 3/13/2023 at 8:16 AM in Resident 37's room, there was water observed leaking from the ceiling between the A and C beds going into a trashcan, which had about two inches of water inside. During a concurrent interview, Resident 37 stated the ceiling had been leaking for several days and yesterday her son placed a trashcan under the leak to catch the water. During an observation on 3/15/2023 at 8:11 AM, the previous leak in Resident 37’s room, between the A and C beds was no longer present. Resident 37 stated the leak was fixed on Monday and that they had to remove some clogged leaves. During an interview on 3/15/2023 at 8:31 AM, the Maintenance Supervisor (MS) stated that the ceiling was leaking due to some leaves and the facility staff moved Resident 37 to the C bed because of the leak. The MS stated, "I cleaned the drain of leaves and now it is not leaking." A review of the facility's policy and procedure titled, "Maintenance Service," revised 1/2023, indicated the maintenance department was responsible to maintain the buildings, grounds and equipment in a safe and operable manner at all times. A review of the facility's policy and procedure titled, "Quality of Life - Homelike Environment," undated, indicated residents were provided with a safe, clean, comfortable and homelike environment. A review of the facility's document titled, "Social Services," reviewed 1/2023, indicated the Director of Social Service was a qualified social worker. A review of the facility's document titled, "Social Services Director Job Description," undated, indicated possession of a master's degree was preferred, equivalent certification in an appropriate discipline from an accredit program was the minimum requirement. It further indicated a minimum of two years related experience in a supervisory capacity. The document indicated in facilities with 120 beds and over, Bachelor's degree from accredited college in social work or related field is required. The document further indicated the SSD meets regularly with clinical social worker to consult, discuss concerns, resources available and regulatory requirements. The facility failed to have a licensed Administrator employed at the facility to be responsible for the day-to-day functions of the facility. The facility failed to: 1.Ensure residents were provided with hot water in the restroom sink for Resident 12. 2. Conduct a facility assessment to reflect the current resident population and staffing required to meet the needs and care of the residents. 3. Employ a qualified social worker on a full-time basis, as the facility did not have a Social Services Director since 9/14/2021. 4. Maintain a safe and homelike environment for Resident 37 by failing to fix a leaking ceiling. As a result, there were insufficient resources available to meet the resident needs, which resulted in the resident's increased level of discomfort and had the potential to negatively impact the resident's quality of life. The above violation had a direct or immediate relationship to the health, safety, and security of the residents.