SHANNEN GUEST HOME

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, 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, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in 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 not having current appraisal needs and service plans completed for three residents which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/27/2025 Plan of Correction Administrator has agreed to obtain current signed appraisal needs and service plan for (R2, R3, R5) and submit copies to CCLD by POC date.

Official classification

Type A

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 degree C) and not more than 120 degree F (49 degree 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 having hot water measured at 133.7 degrees F which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/04/2025 Plan of Correction Administrator has agreed to lower hot water and submit picture proof to CCLD by POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 staff which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2024 Plan of Correction Administrator has agreed to obtain current First Aid training for S1, S2, S3, S4 and submit copies of completion to CCLD by POC date. Civil penalty of $250 is being assessed for a repeat violation.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. 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 medical assessment for two residents which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2024 Plan of Correction Administrator has agreed to obtain current medical assessment for R3 and R5 and submit copies to CCLD by POC date. Civil penalty of $250 is being assessed for a repeat violation.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. 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 medications in the refrigerator which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2024 Plan of Correction Administrator purchased a lockbox and provided a receipt to LPA during inspection. Deficiency cleared.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, 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. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 having full bed rails for residents who are not on hospice care which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2024 Plan of Correction Staff removed the full bed rails on R2 and R4's beds during inspection. Deficiency cleared.

Official classification

Type B

Official code

87468(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents in residential care facilities for the elderly shall have personal rights which include, but are not limited to, those listed in Sections 87468.1, Personal Rights of Residents in All Facilities, and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities, as applicable to the facility. 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 facility beds stored in R5's room which poses a potential personal rights violation to persons in care.

Official plan of correction

POC Due Date: 10/24/2024 Plan of Correction Staff removed the two facility beds out of R5's room during inspection. Deficiency cleared.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. 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 a doctor's order for R4's Senna which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2024 Plan of Correction Administrator has agreed to obtain doctor's order for R4's medication (Senna) and submit the document to CCLD by POC date.

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 cleaning supplies and gardening tools which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/26/2023 Plan of Correction Licensee locked up the cleaning supplies and gardening tools during inspection. Deficiency cleared. 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 not having the correct order for R1's Tylenol and having Senna and Docusate Sodium available to R1 which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/26/2023 Plan of Correction Licensee obtained a new order for R1's Tylenol 500mg and purchased Senna and Docusate during inspection. Deficiency cleared.

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 chest x-ray results for S1 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2023 Plan of Correction Licensee has agreed to obtain a copy of S1's chest x-ray and submit a copy to CCLD by POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 at least one staff on duty that has current CPR training which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2023 Plan of Correction Licensee has scheduled the CPR training for staff on 11/1/2023. Licensee will submit certification of completion to CCLD by POC date.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 annual training which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2023 Plan of Correction Licensee has agreed to obtain annual training for S2 and S3. Licensee will submit training documents 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 record review, the licensee did not comply with the section cited above by not conducting disaster drill every 3 months which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2023 Plan of Correction Licensee has agreed to conduct a disaster drill and submit disaster drill document to CCLD by POC date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. 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 needs and service plan for R2 and R3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2023 Plan of Correction Licensee has agreed to obtain current needs and service plans for R2 and R3. Licensee will submit copies of the needs and service plans to CCLD by POC date.

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 cleaning supplies which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/28/2022 Plan of Correction Licensee locked up the cleaning supplies during inspection. Deficiency cleared.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities. To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not following CCLD screening guidelines for visitors which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to conduct training to all staff regarding current guidelines for screening visitors and submit staff sign-in sheet & training materials to CCLD by POC date.

Deadline recorded: Mar 25, 2022. A deadline is not proof that correction was completed.