Valley View Care Center

Inspectors wroteBased on interview and record review, the facility failed to develop and implement care plan interventions for one of three sampled residents (Resident 1) when Resident 1's gastrostomy tube (G-tube- a tube which delivers liquid, nutrition, and medications, through a flexible tube that goes directly into the stomach) was repeatedly dislodged. This failure resulted in Resident 1 being sent to the acute hospital two times in a 24-hour period and potential for complications including severe pain and infections.

Inspectors wroteBased on interview and record review, the facility failed to develop a complete care plan with interventions for one of three sampled residents (Resident 1) when antibiotics was not administered as ordered. This failure had the potential for staff to be unaware of how to care for Resident 1 when the antibiotic was not administered.

Inspectors wroteBased on interview and record review, the facility failed to follow physician orders when an antibiotic was not administered as ordered for one of three residents (Resident 1). This failure resulted in a missed dose of antibiotics and the potential for Resident 1's wound to worsen.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the annual performance evaluation (A written demonstration of nursing staff's knowledge, skills, and techniques necessary to care for residents' needs safely and effectively) was up to date for one of five sampled staff (Certified Nursing Assistant [CNA]). This failure had the potential to result in CNA providing care that does not meet the residents' needs.

Inspectors wroteBased on interview and record review, the facility failed to implement their policy and procedure on Drug Diversion, for three of four sampled residents (Resident 2, Resident 3, Resident 4) to ensure secure storage, accurate documentation, proper administration, monitoring, and accountability of all narcotic controlled substances (a powerful, prescription-only drug used to treat moderate to severe pain). This failure resulted in narcotic diversion (the illegal transfer, theft, or misuse of prescription drugs from their intended medical path) and had the potential to cause pain induced harm to residents.

Inspectors wroteBased on interview and record review, the facility failed to implement their policy and procedure on Use of Psychotropic Medication(s) (medication that affects brain activity, resulting in changes in mood, behavior, thoughts, and perception) for one of four sampled residents (Resident 1). This failure resulted in Resident 1 to be on psychotropic medication without IDT (Interdisciplinary team- a collaborative group of healthcare professionals, including nurses, doctors, therapists, social workers, and the resident/family, who work together to create and implement personalized care plans) approval, and to be without behavioral monitoring to see if the medication was effective.

Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure on Background Investigations, for one of three licensed vocational nurses (LVN 2). This failure had the potential to expose residents to abuse, neglect, and mistreatment.

Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure (P&P) titled, Care Plans, Comprehensive Person-Centered (CCP) for three of six sampled residents (Resident 6, Resident 21, and Resident 32) when:Resident 21's CCP titled, Resident 21 is on Prophylactic Antibiotic Therapy [medications to prevent disease] r/t [related to] diagnosis of latent [inactive] tuberculosis (TB - a serious, contagious bacterial infection that usually attacks the lungs with two forms: latent and active [disease]) was not followed. Resident 32 did not have CCPs developed for anxiety (feelings of unease) and use of hydrOXYzine (medication to help reduce anxiety). These failures had the potential for Resident 6, Resident 21, and Resident 32 to have a delay in care.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow its policy and procedure (P&P) titled, Food Preparation Guidelines, for eight of eight sampled residents (Resident 4, Resident 16, Resident 23, Resident 29, Resident 34, Resident 37, Resident 39, and Resident 49) when food was not mechanical soft to meet their diet orders. This failure had the potential for undesired outcomes such as weight loss or chocking.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow its policy and procedure (P&P) titled, FOOD PREFERENCES, for 20 of 21 sampled residents (Resident 32, Resident 1, Resident 2, Resident 4, Resident 7, Resident 9, Resident 21, Resident 22, Resident 36, Resident 37, Resident 44, Resident 48, Resident 49, Resident 50, Resident 55, Resident 12, Resident 17, Resident 34, Resident 41, and Resident 6) when residents' meals ticket did not have likes and/or dislikes completed. This failure had the potential for food requests to not be honored.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow its policy and procedure (P&P) titled, Food Safety Requirements, when molded bread was not thrown out. This failure had the potential for residents to acquire foodborne illness.

Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure (P&P) titled Influenza (Flu- contagious respiratory disease) Vaccine when:1. The Infection Preventionist (IP) did not provide and document the education of explanation of risks and benefits for the flu vaccine for four of five sampled Residents (Resident 9, Resident 10, Resident 5, and Resident 2). 2. The IP did not contact Resident 53's representative (RP) for Resident 53 to receive the flu vaccine. These failures resulted in inaccurate documentation, and had the potential to spread infectious diseases.

Inspectors wroteBased on interview and record review the facility failed to follow its policy and procedure (P&P) titled Infection Prevention and Control Program when three of five sampled residents (Resident 9, Resident 10, and Resident 5)'s representatives (RP) were not explained of risks and benefits of the Covid-19 vaccines (Coronavirus disease- a highly contagious respiratory disease). This failure had the potential for inaccurate medical records and spread of infectious diseases to staff and visitors.

Inspectors wroteBased on interview and record review, the facility failed to:1. Follow its policy and procedure (P&P) titled, Nursing Care of the Older Adult with Diabetes Mellitus [a condition where the body cannot properly control blood sugar (glucose) levels], for one of one sampled resident (Resident 56). This failure had the potential for Resident 56 to experience hyperglycemia (blood sugar above target levels) symptoms (such as increase thirst, fatigue, headache, and blurred vision) and complications (such as heart disease, stroke, kidney disease, diabetic eye disease, foot complications, and nerve damage [neuropathy]).2. Follow its policy and procedure (P&P) titled, Lab and Diagnostic Test Results-Clinical Protocol, when a physician failed to review one of two sampled residents (Resident 30)'s test results in a timely manner and provide treatment to Resident 30. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow its policy and procedure (P & P) titled, Safe and Homelike Environment, for one of six sampled residents (Resident 13), when cold air entered the room from the closed sliding door. This failure resulted in Resident 13 feeling cold in her room and had the potential for Resident 13 to become hypothermic (extreme cold temperature).

Inspectors wroteBased on interview and record review the facility failed to follow its policy and procedure (P&P) titled, Resident Participation- Assessment/Care Plans, when one of one sampled resident (Resident 10)'s representative (RP) was not followed up to attend the Interdisciplinary Team Meetings (IDT-a meeting where professionals meet to collaborate, develop, review, and coordinate a care plan) to participate and follow-up after those meetings when the RP was not in attendance for the last six months. This failure had the potential to result in Resident 10's unmet care needs.

Inspectors wroteBased on interview and record review the facility failed to provide activities which reflected two of five sampled residents' (Resident 5 and Resident 53) choices and/or interests. This failure had the potential to negatively impact mental and psychosocial well-being of Resident 5 and Resident 53.

Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure (P&P) titled, Hemodialysis [HD - a life-sustaining treatment that filters blood when failing kidneys cannot], for one of one sampled resident (Resident 56) when blood pressure (BP) was taken on the dialysis access arm. This failure had the potential for Resident 56 to acquire complications such as clotting, damage to the access, and increase risk of infection.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of 27 twenty-seven sampled residents' (Resident 48) medication was ordered. This failure resulted in the delay of administering medication and potential for Resident 48 experiencing adverse health outcomes. During a concurrent observation and interview on 12/16/25 at 7:59 a.m. in the hallway, with Licensed Vocational Nurse (LVN) 1, LVN 1 was passing medication, she searched for Resident 48's Pantoprazole (stomach acid reducing medication) medication. LVN 1 was unable to locate Resident 48's medication in the medication cart. During a concurrent interview and record review on 12/16/25 at 8:06 a.m. with LVN 1, Resident 48's Medication Administration Record (MAR), dated December 2025 was reviewed. The MAR indicated, on 12/15/25 code 9 other see nursing notes. [...]

Inspectors wroteBased on interview and record review the facility failed to provide dignity and respect for one of three sampled resident (Resident 1) when Certified Nursing Assistant (CNA) was observed repeating Resident 1 calling out for help and laughing. This failure has the potential to result in emotional distress for Resident 1.

Inspectors wroteBased on interview and record review, the facility failed to timely develop and implement a care plan to prevent elopement (leaving the facility without authorization or a discharge order) for one of one sampled resident (Resident 1) who was at risk for elopement. This failure had the potential for Resident 1 to elope from the facility and sustain injury.

Inspectors wroteBased on interview and record review, the facility failed to implement their policy and procedure on abuse for one of three sampled residents (Resident 1) when the financial abuse allegation was not reported to the California Department of Public Health (CDPH) and the alleged perpetrator (SSA/Social Services Assistant) was not placed on suspension. These failures had the potential for ongoing financial abuse towards Resident 1.

Inspectors wroteBased on interview and record review, the facility failed to implement their care plan for one of three sampled residents (Resident 1). This failure resulted in Resident 1 physically touching Resident 2 on the jaw with a closed fist.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement their policy and procedure on grievances for one of three sampled residents (Resident 1). This failure had the potential for the grievances to not be addressed and result in negative consequences.

Inspectors wroteBased on observation, interview, and record review, the facility failed to prevent an avoidable fall (move downward, typically rapidly and freely without control from a higher to a lower level) for one of three sampled residents (Resident 1) when Certified Nursing Assistant (CNA 1) and CNA 2 failed to implement the care plan (CP- a document that outlines a resident's needs, treatment, and expected outcomes) to use a Hoyer lift (a mechanical device that helps move people with limited mobility) in transferring Resident 1 from the bed to the wheelchair. This failure resulted in Resident 1 sustaining a fall and experiencing pain to the left foot. [...]

Inspectors wroteBased on observation, interview, and record review, the facility failed to: 1. Ensure staff were provided education on Prevention and Recognition of signs and symptoms of Legionnaires' Disease (waterborne bacteria that cause serious lung disease) and/or other opportunistic waterborne pathogens. 2. Ensure surveillance for infection were properly conducted, data collected, analyzed, track and trended for 52 of 52 residents residing in the facility. 3. Follow infection prevention and control practices in accordance with the Centers for Disease Control and Prevention (CDC, national health organization) guidelines in the facility. 4. Ensure one of one suction machines was maintained in a clean and sanitary manner. These failures had the potential to transmit infectious diseases.

Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure (P&P) titled Resident Rights for three of nine sampled residents (Resident 19, Resident 28, and Resident 43) when the residents were unaware of the Ombudsman (an independent advocate who helps protect the rights of residents in long-term care facilities, including nursing homes) contact information and how to contact the Office of the Ombudsman. This failure had the potential for Resident 19, Resident 28, and Resident 43 not to be able to report concerns/issues regarding their rights.

Inspectors wroteBased on interview and record review, the facility failed to ensure 12 of 32 sampled residents (Resident 1, Resident 3, Resident 7, Resident 8, Resident 13, Resident 21, Resident 22, Resident 24, Resident 31, Resident 199, Resident 201, and Resident 301) had an Advance Directive (AD- a legal document that provides instructions for medical care and only go into effect if the individual is unable to make decisions for themselves) in the medical record. This failure had the potential for responsible parties and/or medical professionals to not honor resident's healthcare wishes and to not provide appropriate treatment in the event of an emergency medical situation.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Binding Arbitration Agreement (BAA - formed when two parties enter into a contract and agree in writing that any disputes arising between them out of that contract will have to be resolved without going to the courts and with the assistance of a neutral person) offered to six of six sampled residents (Resident 2, Resident 21, Resident 25, Resident 34, Resident 40, and Resident 149) were provided in a form and language that the residents and/or resident representatives understood. This failure had the potential for Residents 2, 21, 25, 34, 40, and 149 to not fully understand the terms and conditions stipulated in the arbitration agreement.

Inspectors wroteBased on interview and record review, the facility failed to ensure physicians provide the informed consent (process that a healthcare provider fully informs patient and/or family) for the use of antipsychotic (drugs that treat psychosis [mental distress, mental disorder]) medications for three of three sampled residents (Resident 1, Resident 40, and Resident 149) and verified by two licensed personnel when verbal or telephone consents were obtained. This failure had the potential for the residents to not receive accurate information about the drugs and not fully understand the risks, benefits, and alternative of the medications.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of one sampled resident (Resident 101) was trained in self-administration of suction. This failure had the potential to place Resident 101 at risk for respiratory infection and/or respiratory complications.

Inspectors wroteBased on interview and record review, the facility failed to provide the Office of the State Long-Term Care (OSLTCO) Ombudsman (independent advocate who helps protect the rights of residents in long-term care facilities/nursing homes) a Notice of Transfer for one of one sampled resident (Resident 25) transferred to an acute care facility. This failure had the potential for Resident 25 to not receive the added protection from being transferred or discharged in and out of the facility.

Inspectors wroteBased on interview and record review, the facility failed to ensure one of one sampled resident (Resident 149) had a completed Baseline Care Plan (BCP-an initial person-centered care plan within the first 48 hours of admission that provide instructions for care of the resident) and a summary provided to the resident within 48 hours of admission. This failure had the potential for Resident 149 to not receive the care and the safeguards necessary within the 48-hour of admission.

Inspectors wroteBased on interview and record review, the facility failed to update and develop a comprehensive person-centered care plan for three of 10 sampled residents (Resident 1, Resident 3, and Resident 31). This failure had the potential for unmet care needs.

Inspectors wroteBased on observation, interview, and record review, the facility failed to notify the physician of a psychiatrist (physician whose specialty is mental health) recommendation for one of one sampled resident (Resident 149) state of depression (loss of pleasure or interest in activities for long periods). This failure resulted in Resident 149 's noncompliance and adherence with basic care needs and activities of daily living to meet his physical, mental, and psychosocial needs.

Inspectors wroteBased on observation, interview and record review, the facility failed to: 1. Ensure licensed nurses assessed and notified the physician of foot problems identified for two of two sampled patients (Resident 3 and Resident 149). 2. Ensure the podiatry recommendation dated 6/18/24 to refer one of one sampled resident (Resident 3) to a vascular surgeon was acted upon. 3. Ensure the attending physician documented visit for one of one sampled resident (Resident 149) in the Progress Notes and addressed Resident 149's need for podiatry consult. These failures had the potential to result in adverse consequences when treatments were delayed.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure the physician ordered catheter care for one of one sampled resident (Resident 25) who had an indwelling urinary catheter (soft, plastic or rubber tube that is inserted into the bladder to drain the urine) due to neuromuscular dysfunction of the bladder (when a person lacks bladder control due to brain, spinal cord, or nerve problems). This failure had the potential for Resident 25 to develop urinary tract infection or other bladder infections.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of one sampled resident (Resident 199) had a full portable oxygen tank (cylinder used to store oxygen) for use. This failure had the potential to cause an adverse reaction to Resident 199 including hypoxia (decreased oxygen level).

Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure (P&P) titled Abuse [inappropriate treatment of an individual], Neglect [refusal to provide the needs of the resident], and Exploitation [taking improper advantage of an individual], for twenty-seven of forty two sampled Certified Nursing Assistants ([CNA] 1, CNA 6, CNA 7, CNA 8, CNA 9, CNA 10, CNA 11, CNA 12, CNA 13, CNA 14, CNA 15, CNA 16, CNA 17, CNA 18, CNA 19, CNA 20, CNA 21, CNA 22, CNA 23, CNA 24, CNA 25, CNA 26, CNA 27, CNA 28, CNA 29, CNA 30, and CNA 31), 17 of 22 sampled Licensed Vocational Nurses ([LVN] 1, LVN 6, LVN 7, LVN 9, LVN 10, LVN 11, LVN 12, LVN 13, LVN 14, LVN 15, LVN 16, LVN 17, LVN 18, LVN 19, LVN 20, LVN 21, and LVN 22), and seven of eight sampled Registered Nurses ([RN] 1, RN 2, RN 3, RN 4, RN 5, RN 6, and RN 7), annual training. [...]

Inspectors wroteBased on interview and record review, the facility failed to ensure two of five sampled residents (Resident 25 and Resident 40) had social services follow-up for medically-related social services. This failure resulted in delay of medically-related social services for Resident's 40's vision and dental services and Resident 25's dental services.

Inspectors wroteBased on observation, interview, and record review, the facility failed to follow its policy and procedure on Medication Storage for one of one sampled resident (Resident 99) when a medication was left unattended at bedside. This failure had the potential for residents to inadvertently use medication without being monitored.

Inspectors wroteBased on observation, interview, and record review, the facility failed to: 1. Ensure one of one sampled resident (Resident 1) received the food as written on the meal ticket to meet the resident's nutritional requirement. 2. Assess Resident 1's ability to cut the meat in bite size and feed herself. These failures had the potential for Resident 1 to not be able to eat and receive the necessary nutritional value.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure an assistive feeding device was available for one of one sampled resident (Resident 13). This failure had the potential to negatively impact Resident 13's nutritional status.

Inspectors wroteBased on interview and record review, the facility failed to maintain an effective antibiotic stewardship program (efforts in hospitals, long-term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate) when: 1. The Infection Preventionist (IP) failed to evaluate and follow up one of one resident (Resident 199) treated with antibiotic for fungal infection. 2. Antibiotic Stewardship Meeting under the leadership of the Pharmacist, the Medical Director, and Director of Nursing has not been conducted. 3. Antibiotic Stewardship education has not been provided to the nursing staff. These failures had the potential for residents to be inappropriately treated with antibiotics, which could be detrimental to the residents' medical care related to antibiotic use.

Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure (P&P) titled Influenza (Flu contagious respiratory disease)Vaccine for five of 32 sampled residents (Resident 2, Resident 7, Resident 8, Resident 10, and Resident 100) when: 1. Resident 10, Resident 8, and Resident 7 were given influenza vaccine without informed consents obtained from the residents or their legal representatives (LR). 2. Resident 100 and Resident 2 did not receive explanation of risks and benefits for their refusal of the flu vaccines. 3. There was no documentation of date, lot number (essential for tracking the exact vaccine used especially in case of adverse reactions or recalls), expiration date, person administering, and site of injection of the flu vaccine vaccine administered to Resident 7. [...]

Inspectors wroteBased on interview and record review the facility failed to complete the Covid-19 (Coronavirus disease (COVID- a highly contagious respiratory disease) consent form for four of 31 sampled residents (Resident 10, Resident 7, Resident 100, and Resident 2) when: 1. Resident 10 and Resident 7 received Covid-19 vaccine without consent from the residents or their legal representatives (LR). 2. Resident 100 and Resident 2 were not explained of risks and benefits for refusing the Covid-19 vaccines. These failures had the potential for inaccurate medical records and spread of infectious diseases.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of one resident (Resident 11)'s oxygen tank with an attached gauge (a medical device designed to display the pressure level in an oxygen tank or cylinder) was secured when stored. This failure had the potential for health hazard and place residents at risk for harm.

Inspectors wroteBased on interview and record review, the facility failed to ensure one of two sampled residents (Resident 1) personal funds were accounted for when they were kept secured in the nurse's medication cart. This failure resulted in Resident 1's personal funds being unaccounted for and the potential for emotional distress for Resident 1.

Inspectors wroteBased on interview and record review, the facility failed to provide physician ordered treatments for four of four sampled residents (Resident 1, Resident 2, Resident 3, and Resident 4). This failure had the potential for worsening of resident condition, increased chance for infection, and increased healing times.

Inspectors wroteBased on interview and record review, the facility failed to treat one of three sampled residents (Resident 1) with dignity and respect. This failure had the potential to affect Resident 1 ' s feeling of self-worth.

Inspectors wroteBased on interview and record review, the facility failed to treat one of three sampled residents (Resident 1) with dignity and respect. This failure had the potential for negative self-esteem, lack of self-worth and other negative consequences.

Inspectors wroteBased on interview and record review, the facility failed to follow its policy and procedure on reporting allegations of abuse for one of three sampled residents (Resident 1). This failure resulted in placing Resident 1 at risk for further abuse and had the potential to place other residents at risk for abuse.

Inspectors wroteBased on interview and record review, the facility failed to accurately assess one of three sampled residents (Resident 1) for fall risk. This failure had the potential for Resident 1 to not have the appropriate interventions in place to prevent fall incidents.

Inspectors wroteBased on interview and record review, the facility failed to treat one of three sampled residents (Resident 1) with dignity and respect. This failure had the potential for Resident 1 to have low self-esteem and other negative psychosocial outcomes.

Inspectors wroteBased on interview and record review the facility failed to implement its policy and procedure titled Discharge Planning Process for one of three sampled residents (Resident 1). This failure had the potential for unsafe discharge.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents completed an Advance Directive (AD- legal document which specifies a person's health care related choices and what actions should be taken when the person is no longer able to make decisions for themselves because of illness or incapacity) Acknowledgement (ADA- asks if resident had or did not have an advanced directive) or were given the option to formulate an AD, for four of 40 sampled residents (Resident 36, Resident 31, Resident 7, and Resident 201). This failure had the potential for health care decisions to not be honored.

Inspectors wroteBased on observation, interview, and record review the facility failed to provide a safe, clean, comfortable, and homelike environment for three of 40 sampled residents (Resident 39, Resident 201 and Resident 40). These failures had the potential for negatively impacting residents well-being.

Inspectors wroteBased on observation, interview and record review, the facility failed to provide in-room activities for three of 40 sampled residents (Resident 17, Resident 20, and Resident 303). This failure had the potential to affect the overall well-being and quality of life for Resident 17, Resident 20 and Resident 303.

Inspectors wroteBased on interview and record review, the facility failed to ensure the Level II PASRR (Preadmission Screening and Resident Review-a form to determine if a resident has, or is suspected of having a mental illness) was completed after part I was positive for one of 40 sampled residents (Resident 8). This failure had the potential to not meet the needs and mental health services for Resident 8.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop and implement a comprehensive person-centered care plan to reflect the resident's needs for three of 40 sampled residents (Resident 44, Resident 303, and Resident 4). These failures had the potential of not providing appropriate, consistent, and individualized care to these residents.

Inspectors wroteBased on interview and record review, the facility failed to meet standards of practice for two of 40 sampled residents (Resident 8 and Resident 303) when speciality consults were ordered and never arranged. This failure resulted in the delay of care and treatment needed by the specialist.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure one of 40 sampled residents (Resident 16) received podiatry (foot and nail) care. This failure resulted in Resident 16's nailcare not being met.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure routine dental services were provided to two of 40 sampled residents (Resident 34 and Resident 44). This failure had the potential for these residents dental care not being met.

Inspectors wroteBased on interview and record review, the facility failed to ensure a qualified dietary staff member supervised the dietary staff and food service department. This failure had the potential for foodborne illness to spread to residents.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure: 1. Refrigerator logs were being recorded per policy. 2. Staff was cooling cooked foods per policy. 3. Dishware stored in sanitary conditions. 4. Repair water damage areas of tile and wall. These failures had the potential to spread foodborne illnesses to residents, and the potential to lead to pest infestation.

Inspectors wroteBased on observation, interview, and record review, the facility failed to ensure infection precautions were followed when a Medical Records (MR) staff member passing meal trays had long artificial fingernails. This failure had the potential to spread infection to residents.

Inspectors wroteBased on interview and record review, the facility failed to provide adequate space (80 square feet for each resident) in 15 of 19 rooms. This failure had the potential to affect resident's comfort, health and safety.