Springville

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPA met with Administrator Linda Fan and Sabrina Liu, Assistant Administrator who assisted with visit. LPA explained the reason for the visit. The facility is licensed for residents age range 60 and over. Approved for 29 non-ambulatory residents of which 14 may be bedridden. Facility approved Hospice waiver for 10. There is currently 1 residents on hospice. The facility is a two story building. LPA toured the facility with Assistant Administrator. Inspected random selection of resident bedrooms on both floors, reception area, common area / activity exercise area, Administrator office / Medication area, laundry room, dining area, kitchen, linen supply room, cleaning supplies room, 3 public bathrooms, rest area (TV and computer room). The facility also has a large back patio area. There are no pools or large bodies of water. In the backyard LPA observed old kitchen utensils, bed rails, broken wood frames, window glass. The backyard patio area is well maintained and the common areas are clean and have the required furniture. The resident bathrooms have the required grabs bars and non-skid mat. The water temperature was tested in a random selection of resident bathrooms and was measured within Title 22 Regulation guidelines. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. At the time of inspection, LPA observed 4 residents have a full bed rail on their beds and are not under hospice care ( Rooms 204,209,223,227). Smoke/Carbon monoxide detectors observed throughout the facility and were operational. There are several fire extinguishers located throughout the facility and observed fully charged. Kitchen appliances are clean and were operating at the time of the visit. LPA observed several cans of food had expired on the kitchen shelves. Continue 809C Sharps are locked in the kitchen and are inaccessible to residents. Food supply adequate stored in the kitchen, storage room and consists of the following: 2 days perishable and 7 days non-perishable food supply. Cleaning supplies and toxins were observed in the laundry room and supply room locked and inaccessible to residents. LPA reviewed 4 resident and 4 staff records. All records are updated. LPA confirmed staff working have fingerprint clearances. LPA reviewed 4 residents' medications. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Last fire drill conducted on 6/10/26. Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided to Assistant Administratorthe state’s words, verbatim · CDSS document, Jun 16, 2026

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Nune Margaryan arrived on 04/16/26, for an unannounced inspection to follow up on a substantiated complaint allegation. On October 16, 2023, the Department concluded a complaint investigation regarding the following allegations: Resident sustained a fracture due to staff neglect and staff did not seek medical attention for the resident in a timely manner. The licensee was cited for California Code of Regulations (CCR) § 87411(a) Personal Requirement and 87468.1(a)(2) Personal Rights of Residents in All Facilities. At the time of the complaint visit on October 16, 2023, an immediate civil penalty of $500 was issued and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code §1569.49(f). The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section §15610.67 defines serious bodily injury as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility not providing proper care and supervision to a resident R1 resulting in a fall and fracture. The facility also did not provide care and supervision to R1 in a timely manner after a fall and identified fracture. R1 was diagnosed with a Left Tibia Fracture, Left Fibula Fracture and Left Calcaneus Body Fracture that required medication for extreme physical pain. Continue 809C Today, 04/16/26, the Department will be issuing a civil penalty per Health and Safety Code §1569.49(f) for a violation that the Department determines constitutes as serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on October 12, 2023, the amount of the civil penalty issued today will be $9,500. Exit interview conducted. A copy of the report issued. Appeal rights provided Sabrina Liu, Assistant Administrator and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Apr 16, 2026

Type of visit: Office

Regional Manager Tony Vasallo, Licensing Program Manager David Sicairos, Licensing Program Analyst Mary Flores conducted a Non-Compliance Meeting at the Regional Office with Administrator/Licensee Linda Fan, and Assistant Administrator Sabrina Liu. During the meeting the following was discussed: On 10/12/23 and 9/28/23 Licensing Program Analyst (LPA)s Mary Flores and Christine Wong delivered SUBSTANTIATED findings regarding allegation a resident sustaining a fracture due to staff neglect and staff did not seek medical attention in a timely manner . Facility retained a resident with a prohibited health condition and facility received a resident with pressure injury. Findings were delivered at the facility and informed Administrator Linda Fan that an Additional Civil Penalty was being considered. On 6/17/25 LPA Blanca Gonzalez conducted an annual visit and noted deficiencies under Title 22 Regulations for 87465 Incidental Medical and Dental Care Services. On 6/21/24 LPA Nune Margaryan conducted an annual visit and noted deficiencies under Title 22 Regulations for87465 Incidental Medical and Dental Care Services. On 5/5/23 LPA Kimberly Ramirez conducted a case management visit and noted deficiencies under Title 22 Regulations for 87465 Incidental Medical and Dental Care and 87705 Care of Persons with Dementia. On 6/22/23 LPA Christine Wong conducted an annual visit and noted deficiencies under Title 22 Regulations for 87705 Care of Persons with Dementia. On 6/15/22 LPA Nune Magaryan conducted an unannounced annual visit and noted deficiencies for Title 22 Regulations 87705 Care of Persons with Dementia, 87303 Maintenance and Operation, 87355 Criminal Record Clearance. (CONTINUED ON LIC 809C) Licensee has implemented the following to bring the facility back into compliance: Administrator has began to document all communication with the responsible parties. Administrator has trained staff to communicate all incidents to provide detail information regarding incidents. Administrator has provided training to staff to ensure when a two caregiver transfer is required is provided by two caregivers. Administrator initiated sending residents to the hospital upon changes in condition in a timely manner. Exit interview was conducted with Licensee/Administrator Linda Fan and a copy of this report and LIC9111 was provided.the state’s words, verbatim · CDSS document, Nov 5, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Blanca Gonzalez and Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPAs met with Administrator Linda Fan and Sabrina Liu, Assistant Administrator, who assisted with visit. LPAs explained the reason for the visit. The facility is licensed for residents age range 60 and over. Approved for 29 non-ambulatory residents of which 14 may be bedridden. Facility approved Hospice waiver for 10. There are currently 10 residents on hospice. The facility is a two-story building. LPAs and Administrator toured the facility which included: random selection of resident bedrooms on both floors, Reception area, common area / activity exercise area, Administrator office / Medication area, laundry room, dining area, kitchen, linen supply room, cleaning supplies room, two public bathrooms, rest area (TV and computer room). The facility also has a large back patio area. The passageways, walkways and patios are free from obstructions. The backyard patio area is well maintained and there are no pools or large bodies of water. The common areas are clean and have the required furniture. The resident bathrooms have the required grabs bars and non-skid floor. The water temperature was tested in a random selection of resident bathrooms and was measured within Title 22 Regulation guidelines. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. At the time of inspection, LPAs observed medications in rooms #122 and #125, on a bedside table and in an unlocked cabinet accessible to the residents. Also, medication (Nystatin cream tube) in room #122 observed without a prescription label. Continue 809C LPAs observed proper signage for residents’ rooms who are in hospice and use oxygen. Smoke/Carbon monoxide detectors observed throughout the facility and were operational. There are several fire extinguishers located throughout the facility and observed fully charged. Emergency drill last conducted March 11, 2025. Kitchen appliances are clean and were operating at the time of the visit. Sharps are locked in the kitchen and are inaccessible to residents. Food supply adequate stored in the kitchen, storage room and consists of the following: 2 days perishable and enough food supply for 7 days non-perishable. Cleaning supplies and toxins were observed in the laundry room and supply room locked and inaccessible to residents. LPAs reviewed (4) resident records to confirm emergency contact is updated, physician's reports are on file, and admission agreements are complete. (3) staff records were reviewed to confirm health screenings, training, and fingerprint clearances. LPAs reviewed (4) residents' medications. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D. Civil Penalty was assessed for a violation of the same section within a 12 month period. LIC421FC was issued. Exit interview held. A copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jun 17, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Nune Margaryan conducted an unannounced annual visit using the Care Tool. LPA met with Administrator Linda Fan who assisted with visit. LPA explained the reason for the visit. The facility is licensed for residents age range 60 and over. Approved for 29 non-ambulatory residents of which 14 may be bedridden. Facility approved Hospice waiver for 10. There are currently 8 residents on hospice. The facility is a two story building. LPA and Administrator toured the facility which included: random selection of resident bedrooms on both floors, Reception area, common area / activity exercise area, Administrator office / Medication area, laundry room, dining area, kitchen, linen supply room, cleaning supplies room, two public bathrooms, rest area (TV and computer room), public bathroom but currently used it as storage. The facility also has a large back patio area. The passageways, walkways and patios are free from obstructions. The backyard patio area is well maintained and there are no pools or large bodies of water. The common areas are clean and have the required furniture. The resident bathrooms have the required grabs bars and non-skid mat. The water temperature was tested in a random selection of resident bathrooms and was measured within Title 22 Regulation guidelines. Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen, and the linen is in good condition. At the time of inspection, LPA observed medication in the room #202, on bedside table. LPA observed that facility does not have "No smoking oxygen in use" signs posted on the residents’ rooms who are in hospice and use oxygen. Smoke/Carbon monoxide detectors observed throughout the facility and were operational. There are several fire extinguishers located throughout the facility and observed fully charged. Kitchen appliances are clean and were operating at the time of the visit. Continue 809C Sharps are locked in the kitchen and are inaccessible to residents. Food supply adequate stored in the kitchen, storage room and consists of the following: 2 days perishable but there's not enough food supply for 7 days non-perishable. Cleaning supplies and toxins were observed in the laundry room and supply room locked and inaccessible to residents. LPA reviewed 3 resident records to confirm emergency contact is updated, physician's reports are on file, and admission agreements are complete. Two staff records were reviewed to confirm health screenings, training, and fingerprint clearances. LPA reviewed 3 residents' medications. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Per California Code of Regulations, Title 22, the deficiencies observed are documented on the attached 809D. Exit interview held. A copy of the report and appeal rights were provided to Administratorthe state’s words, verbatim · CDSS document, Jun 21, 2024

Allegation investigated: Unlawful eviction. Resident sustained injury while in care. Resident not being provided adequate services. Facility staff did not provide record request to authorized representative in a timely manner. Staff not providing medication as prescribed.

Licensing Program Analysts (LPAs) Elizabeth Irra and Christian Gutierrez conducted a subsequent visit to investigate the above allegations. LPAs were allowed entry by Linda Fan (Facility Administrator). LPAs discussed the purpose of today’s visit. On 12/20/22, Licensing Program Analysts (LPA) Elizabeth Irra conducted the initial 10-day complaint visit. LPA met with Xiao Hong Dong (Staff #1/S-1) and explained the purpose of today's visit. At approximately 9:20 A.M., Linda Fan (Facility Administrator) arrived and assisted with this visit. During this visit, LPA obtained a copy of the Resident Roster and Staff Roster (with staff contact information including language preference). LPA attempted to interview Staff #1 (S-1) and Resident #1 (R-1) and was unsuccessful due to language barrier. LPA obtained relevant documentation for R-1. Additionally, LPA was unable to interview other Staff and/or Residents due to language barriers and due to active cases of COVID-19+ cases at this facility. **Refer to LIC 9099C for the continuation of this report. Unsubstantiated During today’s visit, LPAs interviewed Facility Administrator, Staff #1 (S-1) through Staff #3 (S-3) and interviewed Resident #2 (R-2) through Resident #4 (R-4). R-1 no longer resides at this facility and whereabouts are unknown. LPAs utilized Focus Interpreting for translation services for interviews conducted with staff and residents. Allegation: Unlawful eviction. Interviewed staff indicated that the Facility Administrator handles eviction notices. Per Facility Administrator interview, R-1 was issued an eviction notice due to R-1 not complying with the general policies of the facility and non-payment. Per Facility Administrator, R-1’s Authorized Representative was notified of R-1’s actions. Interviews do not corroborate this allegation. Allegation: Resident sustained injury while in care. (3) out of (4) interviewed staff indicated R-1 reported that R-1 had bumped their head on the door when R-1 was opening the door on 11/03/2022. Per staff interviews, R-1 was examined, monitored and had R-1 take an x-ray to determine if R-1 had an injury and/or fracture (no injury/fracture noted). Per staff interviews, R-1’s authorized representative was notified. A Special Incident Report (SIR) was also submitted to Community Care Licensing pertaining to this incident. Per resident interviews, residents indicated they have not witnessed any residents sustaining any injuries. Staff and resident interviews and reviewed documentation do not corroborate this allegation. Allegation: Resident not being provided adequate services. Staff interviews revealed that residents are provided with adequate services. (3) out of (4) interviewed staff indicated R-1 was provided with showers twice per week (Tuesdays and Fridays). Per staff interviews, staff keep a bathing log for residents. (2) out of (3) interviewed residents indicated they receive showers twice per week. (1) out of (3) interviewed residents indicated staff provide them with daily showers. Staff and resident interviews and reviewed documentation do not corroborate this allegation. Allegation: Facility staff did not provide record request to authorized representative in a timely manner. Interviewed staff indicated that the Facility Administrator handles requests pertaining to resident records. Per Facility Administrator interview, R-1’s Authorized Representative did not request R-1’s records. Interviews do not corroborate this allegation. Refer to LIC 9099C for the continuation of this report. Allegation: Staff not providing medication as prescribed. Interviewed staff indicated they provide residents with medication as prescribed. Per staff interviews, staff provided R-1 with eye drops twice per day and daily saltwater mouth wash cleaning twice per day. Interviewed residents indicated staff provide them with medication on a daily basis. Staff and resident interviews and reviewed documentation do not corroborate this allegation Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, a copy of the Appeal Rights and this report was provided to Linda Fan (Facility Administrator).the state’s words, verbatim · CDSS document, Mar 14, 2024 · control 28-AS-20221216143558

Allegation investigated: Facility refused to allow medical professional to assess resident in care. Facility failed to meet resident's medical needs.

Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Administrator Linda Fan and explained the reason for the visit. The investigation consisted of the following: During inital visit on 2/24/23 LPA Ashley Calderon obtained a copy of the resident roster interviewed Administrator and Office Manager, and the following documents were later gathered via email; Staff Roster, Resident #1 (R1) Physican Report, R1 Special Incidnet Reports (SIR's) , and Supportive Documents. LPA Calderon also toured facility. Due to insufficient information available at this time, and language barrier further investigation was required. During subsequent visit conducted today 2/1/24 LPA Herrera along with LPA Christine Wong (for translation purposes) interviewed 4 residnets and 2 staff. LPA Herrera obtained copies of staff/residnet roster, R1 Police Report and R1 Incident Reports. (Continued on 9099-C) Unsubstantiated The investigation revealed the following: Allegations: "Facility refused to allow medical professional to assess resident in care" and "Facility failed to meet resident's medical needs". It is alleged that on 2/17/23 Staff #2 (S2) refused to allow a home health nurse assess R1 for concerns of bruises, wounds and bed sores. LPA interviewed S2 (with translation assistance from LPA Wong) to ask if they recall this particular incident, S2 stated that they do not recall as this happened a long time ago and also does not remember resident, however, S2 stated that procedures during that time were more strict as the facility was still following Covid19 mandates. S2 further stated that they would only deny a home heath nurse access IF the resident is not on home health or do not have proper clearance to assess resident. S2 stated that during the date that the alleged incident took place, all visitors were required to have scheduled visits and if there was no scheduled visit staff was to schedule one for them. S2 also stated that staff assist residents with bathing needs and at any time redness, bruising, rashes or sores are observed they report it immediately. LPA Herrera reviewed R1's files and there was no documentation within file or on R1's Physician's Report indicating that resident was receiving Home Health Services, R1's family removed resident from facility on 2/20/23. During interview with S1, staff indicated that resident was not on home health or hospice and that staff are instructed to only allow visitors to access residents if authorization has been granted, from either resident, responsible party or medical professional. S1 stated they recall on 2/17/23 family and home health nurse visiting during dinner time to assess resident, due to staff being busy assisting residents with dinner it was asked to return at a later date, authorities were later called and access was granted to visit resident, both family and nurse then assessed resident, and there were no signs of bruising, wounds or bed sores found. S1 also stated that staff is trained to look for these signs while assisting residents with baths and there were no observations made by staff on bruising, wounds or beds sores for R1. LPA reviewed police report and SIR for incident dated 2/17/23 and report stated that "R1 did not appear to be suffering in any manner and appeared to be clean and well groomed". Interview with S3 (conducted by LPA Calderon during initial visit), staff denied the above allegations and stated that appointments are needed, access to residents seeking medical attention is never denied and staff provide residents with their medical needs. Interviews with 4 Residents, 4 out of 4 residents denied the above allegations and stated that they have never had facility staff refuse their medical professional to visit nor does facility staff refuse to allow residents to visit with their doctors outside of the facility and they are provided with all medical needs. (Continued on 9099-C) Based on statements and interviews conducted with staff and residents, and review of R1's file/medical records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report will be emailed to Administrator Linda Fan.the state’s words, verbatim · CDSS document, Feb 1, 2024 · control 28-AS-20230217090050

Allegation investigated: Illegal Eviction

Licensing Program Analyst (LPA) Wong conducted the “Initial 10-Day” visit to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with Staff #1 Anna Dong (Manager) who allowed entry into the facility and was later met by Administrator Linda Fan who assisted with the visit. The investigation consisted of the following: On today's date, LPA interviewed four (4) residents (R3-R6), two staff (S1-S2) and Administrator and obtained resident roster, face sheet and incident reports for R1 and R2. See LIC 9099C for continuation Substantiated The investigation revealed of the following: Allegation "Illegal Eviction". It was alleged that residents (R1 and R2) were discharged from hospital on 09/08/2023 and transported back to the facility via ambulances and R1 and R2 were rejected at the gate upon arrival and facility staff refused to let the ambulances in, and on 09/09/2023, family received the 30 notice from the administrator via email. LPA interviewed four residents and four out of four residents and reported staff take good care of them and they feel safe living in the facility. LPA interviewed administrator and admitted the facility was not able to handle R1 and R2 at that time due to the facility was lack of staffing and there was a COVID outbreak during that period of time. In addition, R1 still had the COVID symptoms and the facility did not have any isolation room for the residents when they come back from the hospital. Administrator also stated it was a mis-communication between hospital and residents' family as the facility is not a medical facility and facility never got any notification from hospital that residents were going to discharge from hospital and back to the facility. Based on LPA interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit Interview Conducted and a copy of the report and appeal right was provided to the Administrator Linda Fan.the state’s words, verbatim · CDSS document, Feb 1, 2024 · control 28-AS-20240129081438

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(a) · Plan of correction due date: Feb 15, 2024

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required The requirement was not met as evidenced by LPA's interviews, the administrator admitted the facility was lack of staffing and they did not have any isolation room during that period of time and R1 was still having COVID symptoms which posed a potential risk to residents in care.the state’s words, verbatim · CDSS document, Feb 1, 2024

Plan of correction: Administrator will ensure to follow the Title 22 regulation about Eviction and Administrator will send the plan to LPA by POC due date and state how the facility would ensure the they follow the regulation in the future.

Allegation investigated: Facility is not following the proper protocol for COVID-19. Facility is not complying with the local health department's guidelines for COVID-19. Facility is violating residents' personal rights. Facility is not allowing visitors.

Licensing Program Analyst (LPA) V. Maldonado made an unannounced subsequent visit to the facility for the purpose of delivering findings in regard to the investigation of the above-mentioned allegations. LPA Maldonado met with Administrator, Linda Fan, and explained the purpose for the visit. On 12/29/22, LPA Maldonado conducted the initial complaint visit. During the visit, LPA Maldonado obtained a copy of the resident roster and staff roster (with staff contact information, including language preference). LPA Maldonado obtained assistance from LPA Christine Wong, telephonically, to assist with translating, as the majority of staff and residents at the facility speak a different language. LPA's Maldonado and Wong conducted interviews with Staff #1-3 (S1-S3) and Residents #1-5 (R1-R5). LPA also obtained copies of the facesheet and physician's report for R1-R5 and conducted a tour of the physical plant with administrator Linda Fan. During today's visit, LPA Maldonado delivered findings to the allegations of this complaint. (Report Continued on LIC9099-C...) Substantiated The investigation revealed the following: Regarding allegation- Facility is not following the proper protocol for COVID-19. It is alleged that the facility is following COVID-19 procedures that are far stricter than any other guidance by requiring residents to isolate for 5 days any time they are out of the community, not allowing visitations in resident rooms, and requiring visitors to take a COVID test upon arrival. On 12/29/22, upon arrival to the facility, LPA Maldonado rang the bell at the gate to request entry and was unable to enter the gated community. LPA was questioned for vaccination status and/or to take a COVID test to be allowed entry by facility staff. LPA explained that the visit was a licensing visit and LPA had inspection authority, regardless. Facility staff then allowed LPA entry through the gate. LPA observed a note posted on the front door of the facility, indicating that only outside visitations were allowed, visitors were to have no physical contact with residents, scheduled visits were required, a negative COVID-19 test was required for entry, face masks were required for both residents and staff at all times, room visits with residents were not allowed, and visitors were not allowed to move about the facility anywhere at any time during said visits. LPA observed a resident in a wheelchair sitting in the lobby area wearing a mask below their chin. Administrator Fan walked up to the resident and without warning, pulled their mask up over their nose and mouth and told the resident to keep it on. At the time of LPA's initial visit, the requirement for requesting a negative COVID-19 test or vaccination status was no longer in place by the Licensing agency. LPA explained this to the Administrator, to which which she stated she still required this to keep residents safe as well as making an appointment prior to visiting. LPA explained that is a violation of resident's personal rights and could not be implemented as a requirement. During interviews with staff, (3) of (3) staff admitted to this allegation stating that they only want to keep residents safe from contracting COVID-19. LPA Maldonado asked Administrator Fan what the quarantine policy was. She admitted that any time a resident went out of the facility, they were required to quarantine/isolate in their room for (5) days to ensure the safety of others, regardless of whether there was possible exposure or they had symptoms. (5) of (5) residents interviewed corroborated the allegations, stating that no room visits are allowed, a 5-day isolation period is required any time they leave, and their visitations are required to be outside. Regarding allegation: Facility is not complying with the local health department's guidelines for COVID-19. It is alleged that the facility is only allowing resident visitors so long as they make an appointment prior to their visit and that the visit is only conducted outdoors, which is different than what the current visitation guidance was, set forth in the Los Angeles County Department of Public Health Guidance for Community Care Facilities, updated 11/10/2022. After review of the LA County Department of Public Health visitation guidance, it was noted that indoor and outdoor visitation is allowed in green and yellow zones regardless of current outbreak status. (3) of (3) staff interviewed admitted to this facility policy/requirement, stating that they are trying to ensure residents health and safety to COVID-19. (5) of (5) residents interviewed corroborated the allegation stating that they can only receive their visitors outdoors, and by appointment only. (Report continued on LIC9099-C) Regarding allegation: Facility is violating residents' personal rights. It is alleged that the facility is not allowing visitors without appointments, is requiring residents to isolate for (5) days any time they leave the facility, are enforcing the isolation by restraining residents from leave by placing a stanchion cord across their room door, which is tied/clipped on both sides of the grab bars located outside their door, and not allowing private visits inside residents rooms, which are all violations of residents' personal rights. (3) of (3) staff interviewed admitted to this allegation, stating they are only trying to maintain residents safe from contracting COVID-19. (5) of (5) residents corroborated the allegation stating that while all this is true, they are okay with the requirements of the facility. LPA attempted to explain to both residents and staff that while residents and their families may be okay with this, the facility is violating residents' personal rights, as they are allowed to have visitations in their rooms, are not required to isolate, and cannot enforce the isolation by restraining them with the stanchion cord. Regarding allegation: Facility is not allowing visitors. It is alleged that that facility requires that visits must take place outside, that visitors without an appointment will be turned away at the gate, that visitors must test, and that bedridden residents will only be allowed visitation in case of emergency. (3) of (3) staff interviewed admitted to the allegation stating that they are only trying to maintain residents safe from contracting COVID-19. (5) of (5) residents corroborated the allegation stating that all of their visits must be outside, given their visitors made an appointment, otherwise the visit is not allowed. Based on LPAs observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated. Per California Code of Regulations, Title 22, deficiencies will be cited on the LIC9099-D. An exit interview was conducted and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Jan 9, 2024 · control 28-AS-20221223090814

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(6) · Plan of correction due date: Jan 16, 2024

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 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 interview, the administrator admitted to tying a stanchion red rope accross resident room doors to enforce isolation requirements put forth by the facility, which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 9, 2024

Plan of correction: Administrator to submit a written plan on how they will ensure to not violate resident's personal rights under any circumstances. Written plan to be emailed to LPA by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(11) · Plan of correction due date: Jan 16, 2024

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 (11)To have their visitors... permitted to visit privately... This requirement was not met as evidenced by: Based on observation and interview, the administrator failed to allow residents their private visits at any given time by requiring them to schedule visits and visits to not be in their rooms if preferred, which poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 9, 2024

Plan of correction: Administrator will conduct in-service training for all facility staff regarding all resident personal rights. Training material and Sign-In sheet for participants will be emailed to LPA by POC due date.

Allegation investigated: Staff prohibited resident from having visitors. Staff did not treat resident with dignity or respect. Staff did not keep the facility free from clutter. Staff retaliated against resident due complaints regarding resident care.

*This report will supersede the report dated 07/06/23 to correct specific information on the report* Licensing Program Analyst (LPA) Luis Mora conducted an unannounced initial complaint visit to determine the validity of the above-mentioned allegations. LPA met Linda Fan (Administrator) and explained the reason for the visit. The investigation consisted of the following: LPA Mora obtained copies of the resident and staff rosters, interviewed Administrator, Staff 1 - Staff 2 (S1 - S2), Resident 1 - Resident 7 (R1 - R7), and 4 residents' responsible parties, and toured the facility. The investigation revealed the following: regarding the allegation "staff prohibited resident from having visitors", it is alleged that on 2/20/2023, a family member of a resident made an appointment with the facility and showed up with home health nurse and were denied entry to the facility. Administrator and staff denied the allegation. (Continued to LIC 9099-C) Unsubstantiated They stated that this occurred during dinner time and all staff were in the dining room serving the residents. The staff told the family member via phone to wait a bit until they were done so they can go open the outside gate for them. However, the family member call the police right away because they were not provided entry to the facility right away. Residents interviewed could not corroborate with the allegation. Residents' responsible parties interviewed could not corroborate with the allegation and stated they have never had any visitation issues with this facility. The investigation revealed the following: regarding the allegation "staff did not treat resident with dignity or respect", it is alleged that a resident is being discriminated against based on language dialect and receives unfair treatment. Administrator and staff denied the allegation. Residents interviewed could not corroborate the allegation. Residents' responsible parties interviewed could not corroborate with the allegation and stated that during their visits they have not observed staff mistreating or discriminating against residents. The investigation revealed the following: regarding the allegation "staff did not keep the facility free from clutter", it is alleged that there was clutter obstructing the stairwells. Administrator and staff denied the allegation. Staff 1 (S1) confirmed that pieces of furniture were placed there but it was not obstructing the stairway. They were replacing old furniture with new furniture. The old furniture was removed from that spot by end of the day. A picture was attached to this complaint and based on the picture the clutter is not obstructing the stairwell or hallway. It is in an isolated area near the stairway. It is unknown how long the clutter was there. Residents interviewed could not corroborate the allegation. Residents' responsible parties interviewed could not corroborate with the allegation and stated that during their visits they have not observed any clutter and the facility is clean. During today's visit, the LPA did not observed any clutter in the facility and facility was clean. The investigation revealed the following: regarding the allegation "staff retaliated against resident due complaints regarding resident care", it is alleged that a resident's November 2022 eviction notice and limitations on visitation are believed to be retaliatory actions from the facility. Administrator and staff denied the allegation and stated visitation rules applied equally to all visitors. Administrator stated there is no eviction notice issued in November 2022 and that it was a recommendation to the resident's family that the resident might need a higher level of care due to the resident's violent behavior towards staff and other residents. Review of resident's records the only eviction notice found was issued on 01/09/2023 due to non-payment and resident needing higher level of care. Residents interviewed could not corroborate the allegation. Residents' responsible parties interviewed could not corroborate with the allegation. (Continue to LIC 9099-C) Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview held and a copy of the report was providedthe state’s words, verbatim · CDSS document, Oct 26, 2023 · control 28-AS-20230627145047

Allegation investigated: Resident received a pressure injury while in care

Licensing Program Analyst (LPA) Christine Wong met with Staff Kevin Qin who allowed the entry for the facility and explained the reason of the visit. A subsequent visit was conducted to issue an additional citation related to allegation “resident received a pressure injury while in care”. Department review of medical records was completed which revealed systemic failures at the facility in preventing pressure injuries. Immediate $500 civil penalty was issued during today’s visit. At this time an Enhanced Civil Penalty (ECP) determination is pending in reference to Health and Safety Code 1569.49(e) & (f) and may be assessed at a later date. All findings remain the same as indicated on report dated 09/28/23. Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit is documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided. Substantiatedthe state’s words, verbatim · CDSS document, Oct 19, 2023 · control 28-AS-20210405152422

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(d)(1) · Plan of correction due date: Nov 19, 2023

87405 Administrator - Qualifications and Duties (d)The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. The requirement was not met as evidenced by Department review of medical records was completed which revealed systemic failures at the facility in preventing pressure injuries which posed a potential risk to residents in riskthe state’s words, verbatim · CDSS document, Oct 19, 2023

Plan of correction: Administrator is to reassess all residents in placement and ensure a reappraisal is developed based on residents personal needs and maintained in the residents file for review by the licensing agency. Administrator to submit

Allegation investigated: Resident sustained a fracture due to staff neglect Staff did not seek medical attention for resident in a timely manner

*This is a corrected version of report created on 10/12/23 to correct information provided in the LIC 9099C* On 10/12/23 Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Kevin Qin and explained the reason for the visit. Administrator Linda Fan arrived 10 minutes later. The investigation consisted of the following: On 5/4/23 LPA Ramirez conducted a 24 hour health and safety check. LPA requested the following documents for Resident #1 (R1): Emergency and Information sheet, Physician’s Report dated: 4/19/21, Preplacement Appraisal, Admission Agreement, Discharge documents dated 4/3/23. On 5/4/23, Investigation Bureau Investigator, Christine Ferris was assigned the investigation. Investigator Ferris requested medical records, and conducted interviews with staff, resident. On 7/7/23, A nurse consult was submitted to the Department’s nurse consultant. On 10/12/23 LPA Flores conducted interviews with 3 staff, 3 residents, 2 family representatives and delivered findings. (CONTINUED ON LIC 9099C) Substantiated The investigation revealed the following: Regarding allegations resident sustained a fracture due to staff neglect and staff did not seek medical attention for resident. It is alleged R1 sustained a fracture to the left tibia on 4/29/23 and facility did not call 911. Interviews conducted with administrator and staff revealed the following: On 4/29/23 Staff #1 (S1) assisted R1 with a shower and strapped R1 to the chair to prevent slipping. S1 wheeled R1 in the chair to R1’s bed. S1 stepped outside the room to ask Staff #2 (S2) for assistance transferring R1 to the bed but, S2 was busy at the time. S1 said they returned to the room, “became inpatient” and lifted R1 from the chair, who was still strapped to the chair. R1 was pulled back and fell down along with the chair and S1. Administrator was made aware of the fall. Family representative was contacted by administrator and informed of the fall. Per administrator they monitor R1 between 4/29/23 to 5/1/23 and did not observe bruising, swelling, or indication of pain. On 5/2/23, administrator observed swelling on R1’s left leg. An in-house x-ray was conducted, and results were texted to administrator at around 11:00pm which noted a fracture was found. X-ray Result dated 5/2/23 at 10:47pm notes: Acute fractures of the proximal tibia and fibula. On 5/3/23, R1 was sent to the hospital at around 6:00am. On 6/19/23, administrator stated S1 was aware that a two-person assist was required to transfer R1. As a result, the administrator verbally reprimanded S1. On 5/24/23, investigator attempted to interview R1 and was not able due to cognitive skills. On 5/24/23, interview conducted with S1 revealed, S1 was aware that R1 needed a two-person assist but became inpatient and decided to lift R1 alone. Physician’s report dated 4/29/21 notes R1 is motor impaired and requires continuous bed care. R1 has limited ability to communicate needs and needs assistance with most ADLs (assistance of daily living). Based on LPAs observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. ***An immediate Civil Penalty of $500.00 is being issued today, due to resident sustained an acute fracture while in care. Refer to LIC 421IM*** The issuance of a civil penalty is being considered based on Health & Safety Code 1569.49(f); if the department determines the severe body injury of the resident is due to neglect. Exit interview was conducted with Linda Fan and a copy of this report, LIC 9099D, and appeal rights were provided.the state’s words, verbatim · CDSS document, Oct 16, 2023 · control 28-AS-20230503164443

Allegation investigated: Resident sustained a fracture due to staff neglect Staff did not seek medical attention for resident in a timely manner

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegations. LPA met with Kevin Qin and explained the reason for the visit. Administrator Linda Fan arrived 10 minutes later. The investigation consisted of the following: On 5/4/23 LPA Ramirez conducted a 24 hour health and safety check. LPA requested the following documents for Resident #1 (R1): Emergency and Information sheet, Physician’s Report dated: 4/19/21, Preplacement Appraisal, Admission Agreement, Discharge documents dated 4/3/23. On 5/4/23, Investigation Bureau Investigator, Christine Ferris was assigned the investigation. Investigator Ferris requested medical records, and conducted interviews with staff, resident. On 7/7/23, A nurse consult was submitted to the Department’s nurse consultant. On 10/12/23 LPA Flores conducted interviews with 3 staff, 3 residents, 2 family representatives and delivered findings. (CONTINUED ON LIC 9099C) Substantiated The investigation revealed the following: Regarding allegations resident sustained a fracture due to staff neglect and staff did not seek medical attention for resident. It is alleged R1 sustained a fracture to the left tibia on 4/29/23 and facility did not call 911. Interviews conducted with administrator and staff revealed the following: On 4/29/23 Staff #1 (S1) assisted R1 with a shower and strapped R1 to the chair to prevent slipping. S1 wheeled R1 in the chair to R1’s bed. S1 stepped outside the room to ask Staff #2 (S2) for assistance transferring R1 to the bed but, S2 was busy at the time. S1 said they returned to the room, “became inpatient” and lifted R1 from the chair, who was still strapped to the chair. R1 was pulled back and fell down along with the chair and S1. Administrator was made aware of the fall. Family representative was contacted by administrator and informed of the fall. Per administrator they monitor R1 between 4/29/23 to 5/1/23 and did not observe bruising, swelling, or indication of pain. On 5/2/23, administrator observed swelling on R1’s left leg. An in-house x-ray was conducted, and results were texted to administrator at around 11:00pm which noted a fracture was found. X-ray Result dated 5/2/23 at 10:47pm notes: Acute fractures of the proximal tibia and fibula. On 5/3/23, R1 was sent to the hospital at around 6:00am. On 6/19/23, administrator stated S1 was aware that a two-person assist was required to transfer R1. As a result, the administrator verbally reprimanded S1. On 5/24/23, investigator attempted to interview R1 and was not able due to cognitive skills. On 5/24/23, interview conducted with S2 revealed, S2 was aware that R1 needed a two-person assist but became inpatient and decided to lift R1 alone. Physician’s report dated 4/29/21 notes R1 is motor impaired and requires continuous bed care. R1 has limited ability to communicate needs and needs assistance with most ADLs (assistance of daily living). Based on LPAs observations, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. ***An immediate Civil Penalty of $500.00 is being issued today, due to resident sustained a subdural hematoma while in care. Refer to LIC 421IM*** The issuance of a civil penalty is being considered based on Health & Safety Code 1569.49(f); if the department determines the death of the client is due to neglect. Exit interview was conducted with Linda Fan and a copy of this report, LIC 9099D, and appeal rights were provided. The investigation revealed the following: Regarding allegation: Staff left resident in a soiled diaper for an extended period of time. It is alleged R1 would smell like urine because R1 wasn’t being changed. Interviews conducted on 10/12/23 revealed the following: Interviews conducted with 3 out of 3 residents revealed residents are check often, at least every two hours. Residents do not smell due to the lack of incontinence care. Interviews conducted with 3 out of 3 staff revealed residents that required assistance with incontinence are check every two hours and change as needed. One resident is changed regardless the resident is soil or not every two hours, per family request. Interviews conducted with 2 family representatives revealed facility assist with incontinence care and residents are always clean and free of odors when visiting. Facility keeps a monthly incontinence care log for the residents, staff notes initials and reason for changing upon assisting the residents. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted with Linda Fan and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 12, 2023 · control 28-AS-20230503164443

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Oct 13, 2023

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...assistance and care as... This requirement is not met as evidence by: Based on document review and interviews conducted licensee did not ensure staff provided a two person assist for R1 which poses an immedicate risk to the health, safety, or personal rights to the persons in care.the state’s words, verbatim · CDSS document, Oct 12, 2023

Plan of correction: Administrator will schedule and conduct an in-service training with all staff regarding proper transfer, and incident reporting and will submit schedule of training by POC due date 10/13/23 and copies of training log sign-in with duration of training and topic by 10/19/23. *An immediate Civil Penalty of $500.00 is being assess during this visit*

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Oct 13, 2023

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities shall...:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidence by: Based on document review, and interviews licensee did not ensure to seek medical care in a timely manner for R1 which poses an immediate risk to the health, safety, or personal rights to the persons in care.the state’s words, verbatim · CDSS document, Oct 12, 2023

Plan of correction: Administrator will schedule and conduct an in-service training with all staff regarding section 87468.1. and will submit schedule of training by POC due date 10/13/23 and copies of training log sign-in with duration of training and topic by 10/19/23.

Allegation investigated: Facility retained resident with a prohibited health condition Resident received a pressure injury while in care Staff did not notify authorized representative of residents change in condition

Licensing Program Analyst (LPA) Wong conducted a “Subsequent” visit to ascertain additional information regarding the above-mentioned allegations and for the purpose of rendering the findings. LPA met with Staff #1 Kevin Qin who allowed entry into the facility and assisted with the visit. The investigation consisted of the following: On 4/6/2021, LPA Sicairos conducted a virtual tour of the facility with the assistance of the Administrator which included the common areas and a random sample of resident rooms. LPA did not observe any immediate health and/or safety concerns. LPA also interviewed the Administrator. LPA requested copies of resident & staff rosters and copies of Former Resident #1 (R1's) file including but not limited to Physician's Report, Wound Care Assessment, Home Health Information, and Resident Appraisal. On 6/22/2023, LPA Wong interviewed the administrator and Staff#1 (S1). On 03/15/23, LPA Wong referred the complaint to Community Care Licensing (CCL) Program Clinical Consultant (PCC) for a review of medical records that were obtained. (See LIC 9099C for continuation) Substantiated The investigation revealed of the following: Allegation#1 “Facility retained resident with a prohibited health condition.” R1 was admitted to the facility on 12/28/20 but due to R1’s declining health and began to receive home health services on 1/1/2021. R1 began receiving home health services due to R1’s advanced age, decline in mental health, increased weakness and decline in functional status and incontinence. Per review of medical records obtained and the following was determined: On 01/04/21, R1 developed pressure ulcers on both buttocks. On 1/7/21, it was determined that the pressure ulcers on the left and right buttocks were determined to be stage 2. By 02/01/21, R1 had a total of 4 pressure ulcers determined to be stage 3. It was reported the pressure ulcers worsened over time. Although home health contacted the wound doctor to provide evaluation and treatment for R1, the facility continued to retain the resident with a prohibited health condition and failed to submit an exception request to the Licensing Department. Allegation#2 “Resident received a pressure injury while in care” R1 was admitted to the facility on 12/28/20 and R1’s family doctor ordered a home health service for R1 due to R1 was bedridden, weakness, and limited mobility. R1 was also identified as high-risk requiring emergency care services and hospitalization due to advanced age, decline in health and incontinence with a high risk of breakdown. It is alleged that when R1 was admitted to the facility on 12/28/20, R1 had a red mark on their buttocks area. Facility staff was aware of this. On 1/7/21, R1 was reported to have two pressure ulcers which had developed on left and right buttocks which were determined to be stage two. On 1/28/21, its documented that R1 developed three pressure ulcers. By 2/1/21, R1 had a total of 4 pressure ulcers with two stage 2, one deep tissue injury and one stage 3 pressure ulcers. Additionally, the facility also did not update, develop, and implement a plan of care when home health identified R1 was at risk of developing pressure ulcers. Allegation #3 “Staff did not notify authorized representative of residents change in condition” R1 was admitted to the facility on 12/28/20 and family took R1 out from the facility on 3/29/21. It was reported that prior to R1 admitted into the facility, R1 did not wear diapers and was not in wheelchair. It is alleged that, R1's family members were not allowed to be visited R1 in person due to COVID and visitors were only able to communicate with the facility through phone calls. According to R1’s family member, the administrator never provided any updates regarding R1’s change in health condition including that R1 had developed pressure ulcers while residing at the facility. R1’s family members stated that they attempted to go to the facility to visit R1 however due to COVID, she was not allowed to see R1 at the facility. (See LIC 9099C for continuation) R1’s family member also tried calling the administrator many times for follow up on R1’s health condition, but the administrator never communicated any updates regarding R1’s pressure ulcers. R1’s family member indicated that she was unaware of R1’s pressure ulcers until R1's family member took R1 out from the facility on 3/29/21 and a hole was observed on R1’s sacrum. At that time, R1’s pressure ulcers were staged by a doctor to be stage 4. No one in the facility notified R1’s family that R1 had developed these wounds. Based on LPA interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. At this time an Enhanced Civil Penalty (ECP) determination is pending in reference to Health and Safety Code 1569.49(e) & (f) and may be assessed at a later date. Exit interview was conducted and a copy of this report was provided, LIC 9099D, and appeal rights were provided. The investigation revealed the following: Allegation “Staff did not seek timely medical care for the resident” R1 was admitted to the facility on 12/28/20, and R1’s initial Needs and Service Plan indicated that R1 had smelly urine. Facility did consult with R1’s primary care physician who ordered the home health services for R1. Home health ordered physical therapy for evaluation of physician status and rehabilitation. On 2/1/21, R1 developed total of 4 pressure ulcers and reported the pressure ulcers had worsened. Home health ordered the wound doctor for R1 to provide wound evaluation and treatment as needed. Before R1’s family took R1 back home on 3/29/21, R1 was under the care of a wound doctor. Wound doctor follow up on R1’s pressure injuries every 7 days until the last visit on 3/24/21. Based on record review and although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED, Exit interview held and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 28, 2023 · control 28-AS-20210405152422

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87615(a)(1) · Plan of correction due date: Sep 29, 2023

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. The requirement was not met as evidenced by record review, R1 had a total of 4 pressure injuries and determined to be stage 3 and R1 was still retained in the facility which posed an immediate risk to residents in care.the state’s words, verbatim · CDSS document, Sep 28, 2023

Plan of correction: The administrator will ensure person who required health services shall not be admitted or retained in a residential care facility. The administrator will submit a plan of correction to ensure facility is meeting the Title 22 regulation by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Oct 5, 2023

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(a)(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4)(4) 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. The requirement was not met as evidenced by record review, when R1 was admitted to facility and facility staff was aware of R1 had a red mark on buttock area and facility did not update and develop a plan of care which posed a potential risk to residents in care.the state’s words, verbatim · CDSS document, Sep 28, 2023

Plan of correction: Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Licensee to submit a faxed or mailed copy of POC by due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Oct 5, 2023

87466 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. The requirement was not met as evidenced by LPA's interviews and R1's family reported they never got any updated from facility about the resident's change of condition until the day the family took R1 out from facility.the state’s words, verbatim · CDSS document, Sep 28, 2023

Plan of correction: Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Licensee to submit a faxed or mailed copy of POC by due date.