A NEW HAVEN CARE HOME - BERLIN

Official classification

Type B

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 observation, the licensee did not comply with the section cited above by having the silicone caulking tubes inside an unlocked container in the backyard which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2025 Plan of Correction Administrator locked up the items during inspection. Deficiency cleared.

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review.......shall prior to working, residing, or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance..... -This requirement is not met as evidenced by: -Based on records review, the licensee did not comply with the section above in S1 working prior to being associated which posed an potential safety and/or personal rights risks to persons in care.

Official plan of correction

The staff was associated to the facility on 5/25/23. In addition, licensee and ADM to read the Regulations and send self-certification by 10/11/24.

Deadline recorded: Oct 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(c)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency..... ... within twenty-four (24) hours as required by Welfare and Institutions Code Section 15630(b)(1). -This requirement is not met as evidenced by:

Official plan of correction

R1 is no longer at the facility. Licensee and administrator to read the Regulations and submit self-certification by 10/11/24

Deadline recorded: Oct 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

0000

Regulation authority

CCR

What the official deficiency says

CONTINUED BELOW: -Based on records review and interviews, the licensee did not comply with the section above in not reporting the incident and not reporting timely the alleged abuse which posed a potential safety and personal rights risks to persons in care.

Deadline recorded: Oct 11, 2024. 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

87309 (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. -This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above for having Lysol and Glade spray, Vicks VapoRub, ointments and creams. razor readilty accessible to residents which pose immediate health and personal rights risks to persons in care, This is a repeat violation,

Official plan of correction

Staff removed and locked the items, Licensee to do in-service training and submit copy of training topic with attendees signatures by 5/26/23, A $250.00 civil penalty is assessed.

Deadline recorded: May 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

9888888

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. -This requirement is not met as evidenced by: -Based on records review and observation, the licensee did not comply with the section above for resident LIC625 without signatures and dated incorrectly which pose potential personal rights risk to persons in care,

Official plan of correction

Administrator to check all the residents' records for completeness and accuracy, and submit a seld-certification by 6/08/23.

Deadline recorded: Jun 8, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. .... -This requirement is not met as evidenced by: -Based on records review and interview, the licensee did not comply with the section above for S1's file not in the facility which poses potential personal rights risk to persons in care.

Official plan of correction

Administrator to the have staff bring back the record. Proof to be submitted by 6/08/23.

Deadline recorded: Jun 8, 2023. 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) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. 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 unlocked scissors in kitchen, key on cabinet with staff vitamins, key on hallway closet with cleaning supplies, and unlocked eletric gardening trimmer in backyard which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 02/11/2023 Plan of Correction Administrator locked up the items and remove keys during inspection. Deficiency cleared.