AMADOR RESIDENTIAL CARE FACILITY

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above. During resident file review, LPA discovered 2 of 6 resident has become bedridden. Through facility record review from the RO record, fire inspection record dated 7/28/23 does not show facility was granted bedridden residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/27/2024 Plan of Correction Licensee and/or Administrator will submit a statment of understading of the regulation noted above as it relates to fire clearance for bedridden residents. Submit statement by POC due date. Licensee will submit LIC 200 along with updated floor plan and request, bedridden status for residents. LPA will initiate a fire inspection request for bedridden status and Licensee will also contact Fire Department for notification two bedridden residents in facility.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 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: (3) To be free from punishment, humiliation, intimidation, abuse, ...This requirement was not met as evidenced by: Based on records review, the licensee did not ensure R4 was free from abuse while in the care and supervision of the facility, which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee stated staff have increased monitoring, are continuing to communicate with third party/responsible party, and will provide additional in-service training to staff. LPA to receive supportive documentation by POC due date.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (4)Personal assistance and care as needed by the resident...such as.. eating... This requirement was not met as evidenced by: Based on records review and interviews, the facility did not ensure R3 was fed with the assistance of staff, which poses an immediate health and safety risk to resident in care.

Official plan of correction

Licensee added updated care plan to R3's QUICK MAR prior to delivery of findings. Licensee stated the facility will re-evaluating residents needs and ensure needs are met by adding additional specific needs in Quick Mar system. LPA to receive an update on which residents had their care plan changed by POC due date.

Deadline recorded: Oct 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan...shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance...:(1) The licensee shall arrange,.. assist...medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidenced by: Based on records review and interviews, the facility did not ensure R3 dental needs were met, which poses an potential health and safety risk to residents in care

Official plan of correction

Licensee stated an in-service for all staff will be conduct on Relias and have a person come in to provide training on oral hygiene and ADLs. LPA to receive supportive documents on in-service training by POC due date

Deadline recorded: Oct 28, 2022. 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 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 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA's observation, the licensee did not comply with the section cited above in water temperature was checked in two resident rooms - #22 ( 92.2 F)and (94.0 F) #32 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/08/2022 Plan of Correction LIcensee agrees to submit via email to LPA Wallace a month of water temperature logs for section of the building called " long hall " . This is the second citation within one year for annual visits, therefore a civil penalty for a repeat violation is being assessed on today's date.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements(b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair.. This requirement was not met as evidenced by: Based on interviews and observations, the facility did not ensure ktichen cookware items were in good repair, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee stated the kitchen will be cleaned entirely and LPA will be kept updated with progress on obtaining new or updated kitchen applicances by POC due date.

Deadline recorded: May 5, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

87555 General Food Service Requirements (b) The following food service requirements shall apply:(9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. This requirement was not met as evidenced by: Based on interviews and observations, the facility did not ensure proper procedures were in place to ensure food was measured at a hot and warm temperature at all times due to equipment not working, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee stated all kitchen staff will receive in-service training regarding General Food Service Requirements and Food Handling. Licensee to send LPA Valerio in-service training sign in sheet by POC due date.

Deadline recorded: May 5, 2022. A deadline is not proof that correction was completed.