CAREFIELD PLEASANTON

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 at 130.4 degrees F which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/13/2025 Plan of Correction Staff lowered hot water and LPA re-measured hot water at 111.4 degrees F in the same bathroom. Deficiency cleared.

Official classification

Type B

Official code

87705(e)(7)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia. Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents... This requirement is not met as evidence by: Based on interview and record review, licensee did not comply with the section cited above by having a resident leaving the facility unassisted which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director (ED) has agreed to create a plan to address situations when exit door is propped open. ED will submit a copy of the plan to CCLD by POC date.

Deadline recorded: Feb 7, 2025. A deadline is not proof that correction was completed.

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 for S3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/13/2024 Plan of Correction Executive Director has agreed to obtain current annual training for S3 and submit completion document to CCLD by POC date.

Official classification

Type A

Official code

87411(g)(1)

Regulation authority

CCR

What the official deficiency says

(g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance or a criminal record exemption as required by law or Department regulations 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 by not having staff fingerprint cleared which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Executive Director has agreed to contact Guardian regarding S6's fingerprint clearance and submit correspondence to CCLD by POC date. Civil penalty of $500 is being assessed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance. Obtain a California clearance or a criminal record exemption as required by the Department or... This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by having uncleared staff work at the facility which poses an immediate health and safety risk to the persons in care.

Official plan of correction

S1 was asked to leave the facility. Facility has agreed to obtain fingerprint clearance for S1 prior to S1 returning to the facility. Facility will submit correspondence with CCLD regarding S1's clearance or S1's life scan form to CCLD by POC date. Civil penalty of $500 is being assessed.

Deadline recorded: Jan 15, 2024. 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

Reporting Requirements. A written report shall be submitted to the licensing agency and to the person responsible for the resident 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 reporting all of R1's falls which poses a potential health and safety risk to the persons in care.

Official plan of correction

Facility has agreed to conduct a training regarding reporting requirements. Facility will submit staff sign in sheet and training materials to CCLD by POC date.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87609(b)(4)

Regulation authority

CCR

What the official deficiency says

(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident's medical condition(s). 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 a home health agency written agreement which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/20/2023 Plan of Correction Facility has agreed to obtain the home health agency written agreement and 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 having a bottle of Acetaminophen 325mg when doctor's order was for Acetaminophen 1000mg which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/30/2023 Plan of Correction Facility currently has another bottle of Acetaminophen 500mg. Facility has faxed R4's doctor the medication clarification/request and provided a copy to LPA during inspection. Deficiency cleared.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

Safeguards for Resident Cash, Personal Property, and Valuables. Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not safeguarding resident's belongings which poses a potential health and safety risk to the persons in care.

Official plan of correction

Facility has agreed to develop a plan to better safeguard resident's belongings in the future and submit plan to CCLD by POC date.

Deadline recorded: Oct 20, 2023. A deadline is not proof that correction was completed.

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 or contagious 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 results for R2 and R3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/13/2023 Plan of Correction Facility has agreed to obtain TB test results for R2 and R3. Facility will submit the TB test results to CCLD by POC date.

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 S4 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/13/2023 Plan of Correction Facility has agreed to obtain current first aid training for S4 and submit a copy 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 temperature at 126 degrees F in a resident's bathroom which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2023 Plan of Correction Staff lowered the hot water and LPA re-measured hot water temperature at 107.5 degrees F. Deficiency cleared.