BETHANY HOME SENIOR LIVING, LLC

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. (a)The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by having R1's toilet in disrepair and clutter in R1's bathroom which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to repair R1's toilet and de-clutter R1's bathroom. Administrator will submit picture proof to CCLD by POC date. Civil penalty of $250 is being assessed for a repeat violation.

Deadline recorded: Oct 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87415(a)(2)

Regulation authority

CCR

What the official deficiency says

Night Supervision. In facilities caring for sixteen (16) to one hundred (100) residents at least one employee shall be on duty on the premises, and awake. Another employee shall be on call, and capable of responding within ten minutes. This requirement is not met as evidence by: Based on interviews, licensee did not comply with the section cited above by not having an awake staff at night shift which poses a potential health and safety risk to the persons in care.

Official plan of correction

Facility has agreed to create a written plan to address night staff schedule to ensure awake staff is present during night shift. Facility will submit plan to CCLD by POC date. Additionally, facility will submit an updated LIC500 to CCLD by POC date.

Deadline recorded: Sep 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

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 observation, licensee did not comply with the section cited above by having the 3rd level flooring in disrepair which poses a potential health and safety risk to the persons in care.

Official plan of correction

Manager stated the 3rd level's floor was installed about 2 weeks ago. LPA observed the flooring on the 3rd level was completely replaced. Deficiency cleared.

Deadline recorded: May 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidence by: Based on record review and observation, licensee did not comply with section cited above by not following physician's order for R1's medication which poses a potential health and safety risk to the persons in care.

Official plan of correction

Manger has agreed to inform R1's physician's of this medication error and verify medication list with R1's physician. Additionally, manager has agreed to conduct medication training with all staff that administer medications and submit documents to CCLD by POC date.

Deadline recorded: Apr 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, ....and social condition. -This requirement is not met as evidenced by: -Based on records review and interview, the licensee did not comply with the section above for not doing reappraisal when R1's condtion changed which posed a potential health, safety and/or personal rights risks.

Official plan of correction

The resident is no longer at the facility. Administrator to read the Regulations and ensure reappraisal is completed accordingly and as needed. Self-certification to be submitted by 10/02/24.

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

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 health screening and TB test for staff which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2024 Plan of Correction Facility has agreed to obtain health screening for S2 and S3 and TB test results for S2. Facility will submit copies of documents to CCLD by POC date. Civil penalty of $250 is being assessed for a repeat violation.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. 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 by not following doctor's order for R2's medication which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/24/2024 Plan of Correction Facility purchased Calcium Carbonate 500mg and Cholecalciferol (Vitamin D3) during inspection. Deficiency cleared. Civil penalty of $250 is being assessed for a repeat violation.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 health screening completed for S2 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction Manager has agreed to obtain health screening for S2 and submit a copy to CCLD by POC date.

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 interview, the licensee did not comply with the section cited above by not conducting a recent disaster drill which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction Manager has agreed to conduct a disaster drill and submit documentation to CCLD by POC date.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. 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 appraisal needs and service plan for R3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction Manager has agreed to obtain an appraisal needs and service plan for R3. Manager will submit a copy to CCLD by POC date.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. 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 by not following doctor's order for R5's medication which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2023 Plan of Correction Manager was able to obtain a new order for R5's medication during inspection. Deficiency cleared.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 current first aid training for S2 and S3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction Manager has agreed to obtain current first aid training for S2 and S3. Manager will submit completed certificates to CCLD by POC date.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious diseases or other medical conditions which would preclude care of the person by the facility. 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 TB test/chest x-ray for R1 and R3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2023 Plan of Correction Manager has agreed to obtain TB test or Chest x-ray results for R1 and R3. Manager will submit a copy to CCLD by POC date.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities. To care, supervision, and services that meet their individual needs...by staff that are sufficient in numbers... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by having residents leave the facility unassisted which poses an immediate health and safety risk to the persons in care.

Official plan of correction

Facility has agreed to create a written plan to address future wandering behaviors and submit the written plan to CCLD by POC date.

Deadline recorded: Feb 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

***This is an amended report from visit on 2/24/2023*** Additional Personal Rights of Residents in Privately Operated Facilities. To care, supervision, and services that meet their individual needs...by staff that are sufficient in numbers... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by having residents leave the facility unassisted which poses an immediate health and safety risk to the persons in care.

Official plan of correction

***This is an amended report from visit on 2/24/2023*** Facility has agreed to create a written plan to address future wandering behaviors and submit the written plan to CCLD by POC date.

Deadline recorded: Feb 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

***This is an amended report from visit on 2/24/2023*** Reporting Requirements. A written report shall be submitted to the licensing agency...within seven days of the occurrence of any of the events specified... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not submitting incident report to CCLD which poses a potential health and safety risk to the persons in care.

Official plan of correction

***This is an amended report from visit on 2/24/2023*** Facility has agreed to re-train staff on reporting requirements and submit staff sign-in sheet & training materials to CCLD by POC date.

Deadline recorded: Mar 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

Not listed

What the official deficiency says

87465 Incidental Medical and Dental Care (h) (1) Medications shall be centrally stored under the following circumstances:(C)Because of potential dangers related to the medication itself, or due to physical arrangements in the facility ....or Department to be a safety hazard to others -This requirement is not met as evidenced by: -Based on observation, the licensee did not comply with the section above. Gas relief medication and Magnesium supplement were observed in the closet in resident's bedroom. which pose immediate health risks to persons in care.

Official plan of correction

The manager locked the items, In addition, an in-service training will be conducted and proof to be submitted by 11/12/2022.

Deadline recorded: Nov 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia:(1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s) -This requirement is not met as evidenced by. -Based on observation, the licensee did not comply with the section above. Razor was observed unlocked in one of the bedrooms on the second floor which poses immediate safety risk to persons in care.

Official plan of correction

The manager locked the item. In addition, an in-service training will be conducted and copy training topic with attendees signatures to be submitted by 11/12/2022.

Deadline recorded: Nov 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 staff complete health screening and TB test which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2022 Plan of Correction Manager has agreed to obtain health screening and TB test for S1 and S2. Manager has agreed to submit a copy of health screening and TB test to CCLD by POC date.