JULIETTE'S GARDENS (ROSE)

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not comply with the section cited above. The facility's last drill was on August 18, 2025. S1 stated that was the only drill conducted in 2025. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/24/2025 Plan of Correction ADM stated he will conduct a drill, and provide LPA documentation a drill has taken place. ADM stated the documentation shall include the date, the type of emergency covered by the drill, the duration of the drill and the names of staff participating in the drill. ADM stated he will also send a letter of understanding regarding the regulation. ADM stated he will send the plan of correction to LPA by POC date, September 24, 2025.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

87307 (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not ensure that sliding exit doors tracks were free of obstruction. LPA observed a pole obstructing the sliding exit door tracks which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2024 Plan of Correction During visit, Lead Staff removed the objects (a pole) from the sliding exit doors track. Administrator was not present at the time of the visit. Administrator to submit a written plan to ensure all indoor and outdoor passageways and stairways are free from obstruction via email by POC due date.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) (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 of any of the events... This requiement is not met as evidenced by: Based on interview and record review, ADM did not ensure to report was submitted to the licensing agency when resident being hospitalized after a fall and when two out of three residents had scabies at the facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator was not present during today's visit. Administrator stated to submit a written plan of action understanding regulation and ensure Incident Reports are submitted to licensng agency by POC due date.

Deadline recorded: Oct 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87457(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factors. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 3 residents did not have Appraisal/Needs and Services Plan on file and 1 out of 3 residents did not have Functional Capabilities Assessment on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/28/2023 Plan of Correction Administrator will complete Appriasal / Needs and Services Plan and Functional Capabilities Assessment with residents' POA and send to LPA by POC date. Licensee will provide a written plan for admission procdures for all new residents and will submit to LPA. Administrator agreed and understood.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 3 residents did not have Admission Agreements signed by Responsible Party and Facility Representative which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/28/2023 Plan of Correction Administrator will complete Admission Agreement with residents' POA and send to LPA by POC date. Licensee will provide a written plan for admission procdures for all new residents and will submit to LPA. Administrator agreed and understood.

Official classification

Type B

Official code

87698

Regulation authority

CCR

What the official deficiency says

87698 Postural Support (a) (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above in 1 out 3 residents had half-side bed rails attached to the bed without a written order from their physician which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/28/2023 Plan of Correction Administrator will obtain a written order from a physician send to LPA by POC date. Licensee will provide a written plan to maintain resident's file and will submit to LPA. Administrator agreed and understood.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 3 out of 3 residents with demenita diagnosis did not have an updated Phyician's Report, LIC 602A and updated appraisal/needs and services plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/28/2023 Plan of Correction Administrator will submit a written plan on understanding regulations and procedures on annually updated documents for residents with Dementia and submit to LPA by POC date. Administrator agreed and understood.

Official classification

Type B

Official code

87507(b)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (b) The licensee shall complete and maintain in the resident's file a Telecommunications Device Notification form (LIC 9158, 11/04) for each resident whose pre-admission appraisal or medical assessment indicates he/she is deaf, hearing-impaired, or otherwise disabled in accordance with Public Utilities Code sections 2881(a) and (c). This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview, the licensee did not comply with the section cited above in 1 out of 3 residents did not have a signed LIC 9158 document on file and medical assessment stated the R3 is hearing-imparied and wears a hearing aid which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/28/2023 Plan of Correction Administrator will obtain a signed LIC 9158 form and send to LPA by POC date. Administrator will provide a written plan to maintain resident's file and will submit to LPA. Administrator agreed and understood.

Official classification

Type B

Official code

00000

Regulation authority

CCR

What the official deficiency says

87468 Personal Rights (b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities or and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. (A)The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review,, the licensee did not comply with the section cited above in 1 out of 3 residents did not have a signed copy of Personal Rights of Residents on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/28/2023 Plan of Correction Administrator will obtain a signed Personal Rights of Residents and send to LPA by POC date. Administrator will provide a written plan to maintain resident's file and will submit to LPA. Administrator agreed and understood.

Official classification

Type A

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and record review, the licensee did not comply with the section cited above in 3 out of 3 resident rooms had cameras facing the resident's bed and resident file did not have consent forms, updated Plan of Operations, or facility waiver for video surveillance in the private areas which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2023 Plan of Correction Administrator instructed the staff to remove the cameras in the residents room during today's visit. Administrator does not want to continue with video surveillance in the private areas. Administrator will inform the residents' responsible party. LPA Rai observed the staff removing the cameras from the resident rooms.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

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. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, interview and observation R1's 4 out of 10 medications not administered to R1 as prescribed by the physician which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2023 Plan of Correction Administrator will submit a written plan on understanding regulations and schedule in-services and training to staff by POC date. Administrator agreed and understood.

Official classification

Type A

Official code

87207

Regulation authority

CCR

What the official deficiency says

87207 False Claims No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, interview and observation, R1's medications were counted during today's visit, the tablets/capsules in the prescription bottle did not match the doses given R1 based on the Medication Administration Record (MAR). This concludes the facility staff noted doses were given to R1 when medication was not adminstered, which poses an immediate Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2023 Plan of Correction Administrator will submit a written plan on understanding regulations and schedule in-services and training to staff by POC date. Administrator agreed and understood.