Montebello Assisted Living 4 LLC

Cited requirement:R9-10-806.A.8.a-b. Personnel A. A manager shall ensure that: 8. A manager, a caregiver, and an assistant caregiver, or an employee or a volunteer who has or is expected to have more than eight hours per week of direct interaction with residents, provides evidence of freedom from infectious tuberculosis: a. On or before the date the individual begins providing services at or on behalf of the assisted living facility, and b. As specified in R9-10-113;

Provider-listed correction date: Mar 21, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-807.A.1-2. Residency and Residency Agreements A. Except as provided in R9-10-808(B)(2), a manager shall ensure that a resident provides evidence of freedom from infectious tuberculosis: 1. Before or within seven calendar days after the resident's date of occupancy, and 2. As specified in R9-10-113.

Provider-listed correction date: Mar 24, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-808.A.3.c. Service Plans A. Except as required in subsection (B), a manager shall ensure that a resident has a written service plan that: 3. Includes the following: c. The amount, type, and frequency of assisted living services being provided to the resident, including medication administration or assistance in the self-administration of medication;

Provider-listed correction date: Mar 21, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-815.F.2.a-c. Directed Care Services F. A manager of an assisted living facility authorized to provide directed care services shall ensure that: 2. There is a means of exiting the facility for a resident who does not have a key, special knowledge for egress, or the ability to expend increased physical effort that meets one of the following: a. Provides access to an outside area that: i. Allows the resident to be at least 30 feet away from the facility, and ii. Controls or alerts employees of the egress of a resident from the facility; b. Provides access to an outside area: i. From which a resident may exit to a location at least 30 feet away from the facility, and ii. Controls or alerts employees of the egress of a resident from the facility; or c. Uses a mechanism that meets the Special Egress-Control Devices provisions in the International Building Code incorporated by reference in R9-10-104.01; and

Provider-listed correction date: Mar 20, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-819.A.1.b. Environmental Standards A. A manager shall ensure that: 1. The premises and equipment used at the assisted living facility are: b. Free from a condition or situation that may cause a resident or other individual to suffer physical injury;

Provider-listed correction date: Mar 25, 2025. A provider’s plan does not establish agency-confirmed correction.

Cited requirement:R9-10-820.F.1.a-f. Physical Plant Standards F. If there is a swimming pool on the premises of the assisted living facility, a manager shall ensure that: 1. Unless the assisted living facility has documentation of having received an exception from the Department before October 1, 2013, the swimming pool is enclosed by a wall or fence that: a. Is at least five feet in height as measured on the exte- rior of the wall or fence; b. Has no vertical openings greater that four inches across; c. Has no horizontal openings, except as described in subsection (F)(1)(e); d. Is not chain-link; e. Does not have a space between the ground and the bottom fence rail that exceeds four inches in height; and f. Has a self-closing, self-latching gate that: i. Opens away from the swimming pool, ii. Has a latch located at least 54 inches from the ground, and iii. Is locked when the swimming pool is not in use;

Provider-listed correction date: Mar 21, 2025. A provider’s plan does not establish agency-confirmed correction.