MT. ZION HOME FOR THE ELDERLY

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as there is junk and trash sprawled through the backyard and in the office area, which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2026 Plan of Correction On or before plan of correction due date, licensee will submit photos to CCLD of the junk and debris cleared from the listed problem areas.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above due to a side gate being broken and unable to be opened, which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2026 Plan of Correction On or before plan of correction due date, licensee will photos to CCLD of the side gate repaired and opening properly.

Official classification

Type A

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night. This does not prohibit a licensee from establishing house rules, such as locking doors at night to protect residents, or barring windows against intruders, with permission from the Department. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above in by having a latch lock on front bottom door which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator removed the latch lock during the visit. Deficiency cleared.

Deadline recorded: May 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 (h)(2) Incidental Medical and Dental Care (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: Based on observation, the licensee did not comply with the section cited above in by not having bottled medications, tablet medications and insulin inaccessible to clients which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator removed the medications. Deficiency cleared during visit.

Deadline recorded: May 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 (h)(2) Incidental Medical and Dental Care (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 in by not having bottled medications inaccessible to clients which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/18/2024 Plan of Correction Administrator will self-certify that they read and understand the regulation moving forward. Medicationes were locked during visit.

Official classification

Type B

Official code

87303(a)

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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in by not having the side/back yards clean with items removed which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/15/2024 Plan of Correction Administrator agree to remove items and clean the back yard. Will submit photo to CCLD by POC due date.

Official classification

Type A

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. 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 not maintaining a clean and safe kitchen area which poses an immediate health, safety or personal rights risk to persons in care. LPA observed mold on the kitchen window, grease on stove, microwave, kitchen walls.

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction Administrator will clean kitchen area and notify LPA once clean up is completed. LPA will come back to conduct a POC visit.

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 in leaving insulin and eyedrops unlocked in the refregerator which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/07/2023 Plan of Correction Administrator locked all medicines in the refrigerator during the visit. Deficiency is cleared.

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 in not conducting required disaster drill quarterly which poses/posed a potential health, safety or personal rights risk to persons in care. Last drill was conducted

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction By POC date, Administrator will submit to CCL proof of current disaster drill.

Official classification

Type B

Official code

87470(a)(2)(A)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in failing to maintain floor surfaces clean which poses/posed a potential health, safety or personal rights risk to persons in care. Floor surfaces were observed dusty, lots of crumbs and dirt.

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction Administrator will clean floors throughout the facility and notify LPA once completed. LPA will conduct POC visit.

Official classification

Type B

Official code

87470(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in failing to maintain walls and windows clean and free from dust, cobwebs which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction Administrator will clean walls and windows and notify LPA once completed. LPA will conduct a POC visit.

Official classification

Type B

Official code

1569.696

Regulation authority

CCR

What the official deficiency says

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 failing to provide training to staff which poses/posed a potential health, safety or personal rights risk to persons in care. Last training was conducted in 2021.

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction Administrator will conduct in-service with staff and submit proof to CCL by POC date.

Official classification

Type B

Official code

87303

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed unused equipments like shower chairs, commode, wheelchairs, empty boxes in the backyard which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction Administrator will clean up back yard and notify LPA once completed. LPA will conduct POC visit.

Official classification

Type B

Official code

87465(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

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. Administrator was providing a resident vitamin (Areds) per instruction from the family but no doctor order and giving resident Senna not according to doctor's order which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction By POC date, Administrator will obtain order from resident's doctor and submit a copy to CCL.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of person 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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having 2 knives sitting on kitchen counter, drawer near kitchen sink unlocked containing knives. poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2022 Plan of Correction Administrator agreed to remove knives from counter and knives in unlocked drawer and make then inaccessible to residents. Administrator locked knives in kitchen cabinet underneath sink during inspection. Deficiency cleared.

Official classification

Type A

Official code

87705(f)(2)

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: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having a can of raid and calcium pills, stool softener sitting on kitchen counter, R4's medication sitting on dining room table, medicine in refrigerator accessible, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2022 Plan of Correction Administrator agreed to remove items to make inaccessible to persons in care and submit a photo to CCLD by POC date. Administrator removed stool softener, raid, and calcium pills and made inaccessible to residents during inspection. Deficiency cleared.

Official classification

Type A

Official code

87608(a)(5)

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. (1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. (A) Physician-prescribed orthopedic devices such as braces or casts, used for support of a weakened body part or correction of body parts, are considered postural supports. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in by having R1 sitting in wheelchair with restraint fastened behind wheelchair which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2022 Plan of Correction Administrator agreed to remove restraint and submit request for an exception to CCLD by POC date. Restraint was removed during inspection.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural support (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. (1) Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc. (A) Physician-prescribed orthopedic devices such as braces or casts, used for support of a weakened body part or correction of body parts, are considered postural supports. (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. 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 in obtaining a doctor's order for R1 to have a restraint which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2022 Plan of Correction Administrator agreed to obtain a doctor's order for R1 to have a restraint and submit a copy to CCLD by POC date.

Official classification

Type B

Official code

87303(a)(1)

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having spider webs around facility, refrigerator clean and sanitary which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2022 Plan of Correction Administrator agreed to remove spider webs around facility, clean refrigerator and submit photos to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

87555 General Food and Service Requirements (b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having gnats, flies, and roaches flying around kitchen, on kitchen counter and kitchen floor which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2022 Plan of Correction Administrator agreed to have a pest control service treat facility inside and submit a copy of the invoice to CCLD with completed visit by POC date.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

87555 General Food and Service Requirements (b) The following food service requirement shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in having expired can goods in the pantry which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2022 Plan of Correction Administrator agreed to clean pantry and remove all expired can goods, and submit a photo of cleaned pantry to CCLD by POC date.

Official classification

Type B

Official code

87307(a)(2)(C)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accomendations and Services a) Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply: (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (C) No bedroom of a resident shall be used as a passageway to another room, bath or toilet. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in using bedroom #1 as a passageway to the bathroom located in bedroom #1 as a personal bathroom for Licensee which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2022 Plan of Correction Administrator agreed to submit documentation stating that bathroom in bedroom #1 is to be used by Licensee only including facility sketch, and submit documentation and sketch to CCLD by POC date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. 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 have resident files for R1 and R2. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2022 Plan of Correction Administrator agreed to put together and complete files for R1 and R2 and submit a copy of all documentation to CCLD by POC.

Official classification

Type B

Official code

1569.269(a)(17)

Regulation authority

CCR

What the official deficiency says

1569.269 Enumerated rights; severability (a) Residents of residential care facilitties for the elderly shall have all of the following rights: (17)To reasonable accommodation of resident preferences concerning room and roommate choices. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in having a male and female not married sleeping in same room which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/05/2022 Plan of Correction Administrator agreed to submit statement of consent from Responsible party's of residents that room it is ok to be shared and submit to CCLD by POC date.