FREMONT VILLAGE

Official classification

Type B

Official code

87608(a)

Regulation authority

CCR

What the official deficiency says

87608(a) ...the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. This requirement is not met as evidenced by: Based on observations and interview, the licensee did not comply with the section cited above by having a seatbelt as postural support for residents in wheelchairs without an exception request which poses a potential safety risk to persons in care.

Official plan of correction

By POC date, the Administrator will send an exception request for the all the residents with seatbelt to CCLD for review.

Deadline recorded: Apr 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

87303(c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having window blinds in disrepair in multiple residents’ room which poses a potential safety risk to persons in care.

Official plan of correction

By POC date, the Administrator agrees to repair the window blinds. In addition, the Administrator will come up with a plan if they will continue to use window blinds or find an alternative for the window covering.

Deadline recorded: Apr 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on observations, the licensee did not comply with the section cited above by having items including but not limited to disinfectant spray, acetone nail polish remover, Arm & Hammer Odor Blaster, laundry detergent, Lysol spray, etc., in multiple areas at the facility unlocked and accessible to residents' in care which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2025 Plan of Correction The Administrator agrees to self-cetify the regulation and locked the items. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87309(c)

Regulation authority

CCR

What the official deficiency says

(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having items including but not limited to hydrocortisone cream, Ketoconazole 2% shampoo, prescribed cerave face wash, saline wound cleanser, One Day Vitamin, insulin, etc., in residents' room unlocked and accessible to residents' in care which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 09/23/2025 Plan of Correction The Administrator agrees to self-certify the regulation and locked the items. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having items in disrepair such as dresser handle, ac in the memory care unit, air conditioning in the dining hall, dirty showers, resident’s toilet covered in feces, dirty showers. LPAs also observed items such as foul odor, washing machine, portable heaters, broken toilet, old mattress left out which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/06/2025 Plan of Correction The Administrator agrees to ensure the facility is in good repair and sanitary. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by not having the hot water temperature measured within range which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2025 Plan of Correction The Administrator agrees to have the water temperature measured within range and send proof of correction to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by multiple boxes of sugar dated 05/01/2019 and expired in 2021, canned goods and opened pasta not properly labeled. LPAs also observed mineral oil in a Purell Surface Disinfectant Spray bottle which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/30/2025 Plan of Correction The Administrator agrees to throw out the expired food and self certify the regulation with kitchen staff. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87463(i)

Regulation authority

CCR

What the official deficiency says

(i) When there is significant change in condition, as defined in Section 87101, Definitions, or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff, as specified in Section 87467, Resident Participation in Decision Making. 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 by not having an updated Appraisal Needs and Services Plan (LIC625) for R1, R2, R4, and R7 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/06/2025 Plan of Correction The Administrator agrees to submit an updated LIC625 for the residents and ensure all residents have an updated LIC625. Proof of correction will be sent to CCLD by POC date.

Official classification

Type B

Official code

87307(a)

Regulation authority

CCR

What the official deficiency says

(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. The following provisions shall apply: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having a resident's family member reside in the resident's room which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/30/2025 Plan of Correction The Administrator agrees to come up with a plan for the residents' visitors staying overnight and send proof to CCLD by POC date.

Official classification

Type B

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

(5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above by medications prepoured to be administered the following day which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/06/2025 Plan of Correction The Administrator agrees to conduct an in-service on stopping the prepouring for medications and submit to CCLD by POC date.

Official classification

Type B

Official code

87705(d)

Regulation authority

CCR

What the official deficiency says

87705(d) Care of Persons with Dementia (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates... This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above by not having the auditory signal on at the time R1 AWOL from the facility which posed a potential safety risk to residents in care.

Official plan of correction

The Administrator agrees to conduct a mandatory in-service training on elopement and wandering behaviors. Proof of correction will be sent to CCLD by POC date.

Deadline recorded: Jun 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having auditory signal device displaced, R1's windowsill broken, and rust on the closet panel.

Official plan of correction

The Administrator will repair the auditory signal device, the windowsill, and have the rust on the closet panel cleaned. Proof of correction will be sent to CCLD by POC date.

Deadline recorded: Jun 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(21)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (21) Freezers of adequate size shall be maintained at a temperature of 0 degree F (-17.7 degree C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degree F. (4 degree C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having a malfunction thermostat in the freezer which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/05/2024 Plan of Correction Administrator agrees to place a new thermostat for the freezer and send proof to CCLD by the POC date.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. 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 by not having an updated Appraisals Needs and Services Plan for R1 to R6 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/12/2024 Plan of Correction Administrator agrees to complete an updated appraisal needs and services plan for R1 to R6 and agrees to update the rest of the community service plan on annual basis. Proof of correction will be sent to CCLD by POC date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 having S6 not associated to the facility which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/31/2024 Plan of Correction Administrator agrees to associate S6 to Guardian and send proof of correction to CCLD by POC date.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

87465(g) Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement is not met as evidenced by: Based on interviews and record reviews conducted, 1) S2 failed to perform CPR for R1 immediately 2) the facility failed to call 911 immediately for R1. R1 was found unresponsive at 5am, 911 call was placed at 5:21 am.

Official plan of correction

The Administrator will conduct inservice for all staff on the facility's emergency procedures and submit proof of training to CCL by POC date.

Deadline recorded: Apr 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by having inoperable heater which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to repair R5's heater to be in operating condition by POC date. Administrator will send photo of the repair by POC date.

Deadline recorded: Mar 14, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (a) The total daily diet shall be of the quality... necessary to meet the needs of the residents... All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. LPA observed two cartons of Lactaid in the refrigerator that expired August 10, 2021 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/08/2021 Plan of Correction Administrator agrees to dispose all expired food and label expiration dates on packaged food items and send self-certification to CCL by POC date.