SUNOL CREEK MEMORY CARE

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning...This requirement is not met as evidence by: Based on interviews and record reviews, licensee did not comply with the section cited above by R1 wandered off the facility without staff knowledge 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 mitigate elopements and submit the plan to CCLD by POC date.

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

Official classification

Type A

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 interview and record review, licensee did not comply with the section cited above by not administering medication according to physician's order which poses an immediate health and safety risk to the persons in care.

Official plan of correction

Executive Director (ED) has agreed to submit a plan to conduct medication training for S1 including hands on shadowing within two weeks. ED will submit written plan to CCLD by POC date.

Deadline recorded: Nov 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.312(a)

Regulation authority

HSC

What the official deficiency says

Basic services requirements. Every facility required to...provide at least the following basic services...Care and supervision... This requirement is not met as evidence by: Based on interviews and record reviews, licensee did not comply with the section cited above by R1 wandered off the facility without staff knowledge which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director (ED) has already conduct training on elopement and will submit staff sign in sheet to CCLD by POC date. ED has agreed to re-evaluate R1's care plan and submit new care plan to CCLD by POC date.

Deadline recorded: Oct 18, 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...This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not providing a written report to the family which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director (ED) has agreed to review reporting requirements and conduct training for staff regarding reporting requirements. ED will submit staff sign in sheet to CCLD by POC date.

Deadline recorded: Oct 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(19)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities. To have prompt access to review all of their records and ...Photocopied records shall be provided within two (2) business days... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not providing the records within 2 business days which poses a potential personal rights violation to the persons in care.

Official plan of correction

Executive Director send out the documents today and provided receipt to LPA during visit. Deficiency cleared.

Deadline recorded: Jun 28, 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 by not having health screening for S4 on file which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction Facility has agreed to obtain S4's health screening and submit a copy to CCLD by POC date.