MARYMOUNT VILLA RETIREMENT CENTER

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (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: Based on observation, the licensee did not comply with the section cited above in that disinfectants and cleaners like Lysol sprays, Petroleum Jelly, Razor, and A+D Ointment, were in an unlocked cabinet in the common area where residents have access which poses an immediate safety risk to persons in care.

Official plan of correction

By POC date, the administrator agrees to remove the disinfectants and cleaners like Lysol sprays, Petroleum Jelly, Razor, and A+D Ointment and send photo proof to CCLD.

Deadline recorded: Jan 29, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87309

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in that the cabinet in the common area on level 3 is missing a handle, dresser and floor in room 315 is in disrepair, which poses a potential safety risk to persons in care.

Official plan of correction

By POC date, the administrator agrees to repair the missing handle cabinet and the dresser and floor and send photo proof to CCLD.

Deadline recorded: Feb 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

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... 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 evidence by: Based on observation, the licensee did not comply with the section cited above in that the water temperature was measured at 95.7 degrees Fahrenheit in a random sample of residents shared bathrooms which poses a potential health and safety risk to persons in care.

Official plan of correction

By POC date, the administrator agrees to adjust the water temperature and send photo proof to CCLD.

Deadline recorded: Feb 4, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87219(i)

Regulation authority

CCR

What the official deficiency says

87219 Planned Activities (i) The licensee shall implement reasonable interventions in order to ensure the safety of all residents utilizing indoor and outdoor areas and take precautions to prevent residents from unsafe wandering and elopement, as defined in Section 87101, Definitions. Such precautions may not conflict with residents' personal rights as specified in Section 87468.1, Personal Rights of Residents in All Facilities and Section 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities. This requirement is not met as evidenced by: Based on record review and interviews, the facility did not meet the requirement above by staff neglecting to ensure that R1 who is a memory care resident was being supervised during group activities with assisted living residents in the common area which led to R1's elopement. There was also not a process in place to assure residents safety during activities which posed an immediate safety risk to residents in care.

Official plan of correction

By POC date, the Licensee agrees to coordinate all staff to complete training regarding care and supervision of dementia residents through a CCLD approved vendor and submit proof to CCLD. The facility also agrees to develop and implement a plan to ensure residents safety during activities and notify CCLD.

Deadline recorded: Jan 7, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements-General 87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement is not met as evidenced by: Based on interviews, the licensee did not comply with the section above by not having sufficient and competent number of staff to meet R1's care needs. Executive Director states that staff were not aware of R1's elopement and they did not complete head counts until after the activity which resulted in R1 having eloped for approximately 40 minutes before the facility was aware which is a potential safety and personal rights risks to residents in care.

Official plan of correction

By POC date, the Licensee agrees to update LIC500 to ensure adequate staffing for all shifts and all staff will receive an in service training and notify CCLD.

Deadline recorded: Jan 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.655(a)

Regulation authority

HSC

What the official deficiency says

1569.655 Increase in fee rates for elderly residents; 90 days’ written notice...(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives... This requirement is not met as evidience by: Based on record review, licensee did not comply with the section cited above by not providing 90 days written notice for increase rate which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director (ED) has agreed to send an email to rescind the rate increase and submit a copy of the email to CCLD by POC date.

Deadline recorded: Jan 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(a)(4)

Regulation authority

CCR

What the official deficiency says

Eviction Procedures. (a) The licensee may evict a resident for one or more of the reasons listed... (4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident. This requirement is not met as evidence by: Based on record review, the licensee did not comply with the section cited above by not providing an explanation in the eviction notice which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director (ED) has agreed to revise the eviction notice for R1 and submit the revised letter to CCLD by POC date.

Deadline recorded: Jan 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87612(a)(11)

Regulation authority

CCR

What the official deficiency says

87612 Restricted Health Conditions (a) The licensee may provide care for residents who have any of the following restricted health conditions, or who require any of the following health services:(11) Wound care as specified in Section 87631. Based on files review and interview the Licensee did not comply with the section cited above by R1 having an unstageable wound residing in the facility, which poses an immediate health and safety risk to persons in care.

Official plan of correction

By POC date, Administrator will inform licensing, and submit all require documents regarding wound care and updates reports any wound residents developing, or return back to facility upon wound care. Review the cited regulation with a self-certification understanding regulation, fax all documents to CCLD.

Deadline recorded: Oct 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(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 in that 0 out of 5 staff members did not have first aid certification on file which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2025 Plan of Correction By POC date, the Administrator agrees to schedule all five (5) staff members to recieve first aid training and submit documentation of scheduled training and the completion of the training to CCLD.

Official classification

Type B

Official code

87211(a)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: This requirement is not met as evidenced by: -Based on interview with ED/ADM there were no incident reports submitted to CCLD for the emergency exit blockages on the 3rd, 4th and 5th floors of the facility which poses a potential safety and risks to person in care.

Official plan of correction

By POC due date, ED/ADM agrees to complete and submit to CCLD in-serive staff retraining on reporting requirements and compliance with section 87211.

Deadline recorded: Aug 11, 2025. A deadline is not proof that correction was completed.

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 pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) -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 having S1 associated which poses a potential safety risk to the persons in care.

Official plan of correction

Excutive Director stated she'll work on the association of staff. Proof to be submitted by 12/20/24.

Deadline recorded: Dec 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General: (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. -This requirement is not met as evidenced by: -Based on observation and interviews, the licensee did not comply with the section above when staff did not attend to R1 nor call the facility nurse when R1 sustained injury which posed an immediate health, safety and/or personal rights risks to person in care.

Official plan of correction

Executive Director to in-service the staff and submit copy of training topic with attendees signatures by 9/28/24.

Deadline recorded: Sep 28, 2024. A deadline is not proof that correction was completed.

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 that appropriate assistance is provided... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not observing R1's open wound which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director has agreed to train all staff on procedures regarding observation of residents and submit staff sign-in sheet & training materials to CCLD by POC date.

Deadline recorded: Dec 17, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (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 ....and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s...... -This requirement is not met as evidenced by: -Based on records review and interview, the licensee did not comply with the section above. R1 who has dementia does not have reappraisals for 2020 and 2021which posed potential health and safe risks to person in care.

Official plan of correction

Wellness Coordinator agreed to have reappraisals completed and provide copies by 10//28/2021.

Deadline recorded: Oct 28, 2021. A deadline is not proof that correction was completed.