GOLD QUARTZ INN RETIREMENT HOME

Official classification

Type B

Official code

87470

Regulation authority

CCR

What the official deficiency says

CCR 87470 Infection Control The above regulation was not met as evidenced by: Based on a review of medical records and interviews with the ED and the responsible party for R1, the facility was aware of a potentially infectious condition and did not implement infection control protocols. This posed a potential threat to the health, safety and personal rights of residents in care.

Official plan of correction

The ED will be bringing in an outside service to conduct an training on infectious diseases/conditions with all staff. ED will send the agenda with the facilitor's contact information and a signature sheet for all participants.

Deadline recorded: Sep 16, 2026. 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

(a) Each licensee shall furnish to the licensing...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days...specified in (A) through (D) below... The above regulation was not met as evidenced by: Based on interviews with the ED and the responsible party for R1, the facility did not send an LIC 624 to CCL, it did not notify the PCP and it did not contact the resposble party for R1. This posed a potential threat to the health, safety and personal rights of residents in care.

Official plan of correction

ED will have a training on reporting requirements with all staff. ED will send the agenda with the facilitor's contact information and a signature sheet for all participants.

Deadline recorded: Aug 31, 2026. 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)...shall be developed by each ...(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. The above regulation was not met as evideced by: Based on interviews with the ED, the responsible party for R1, and a a review of medical records, the facility waiting 9 days after hone health notified them that R1 might have scabies. This posed a potential threat to the health, safety and personal rights of resdients in care.

Deadline recorded: Aug 31, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 (a)(4) Incidental Medical and Dental Care (a)A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4)The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on interviews and record reviews, the licensee did not comply with the regulation cited. Facility did not ensure medications were administered to R1 as prescribed. This poses immediate health, safety, and personal rights risks to persons in care.

Official plan of correction

AA Butler/facility agrees to conduct staff training regarding medication administration and medication record-keeping by the POC due date 06/11/2026 end of day 5:00 PM. Administrator agrees to email LPA Lee a copy of the training materials used for the training and staff sign-in sheet for attending the training.

Deadline recorded: Jun 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements: 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 was not met as evidenced by LPA observations of dented canned goods retained in canned goods supply and emergency food supply which poses a potential health, safety and personal rights risk to residents in care.

Official plan of correction

Administrator agrees to review regulation with dietary and maintenance staff to ensure canned goods are returned to vendor and not retained or used.

Deadline recorded: Feb 20, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents...(a)In additionto...Section 87468.1... residents... shall have all of the following personal rights: (4)To care, supervision, and services that meet their individual needs...This requirement was not met as evidenced by: Based on records review and interviews, the licensee neglected to ensure R1's needs were met by staff, which resulted in R1 falling to the floor while in a moving vehicle. This poses a potential health and personal rights risk to residents in care.

Official plan of correction

Licensee to submit copies of in-service training for Transportation Procedures conducted for 2023 and 2024 for all staff by POC due date.

Deadline recorded: Apr 23, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents (a)In addition to.. Section 87468.1,.. residents...shall have all of the following: (4)To care, supervision, and services that meet their individual needs ...delivered by staff that are sufficient in numbers, qualifications, and competency... This requirement was not met as evidenced by: Based on records review and interviews, the licensee neglected to ensure R1's needs were met by staff, which resulted in R1 sustaining injuries. This poses a potential health and personal rights risk to residents in care.

Official plan of correction

Licensee stated they conducted and completed training on Transportation Procedures during May and June of 2023. Licensee stated facility staff will continue refresher training every 6 month/as needed. By the POC due date, Licensee will submit a statement of their training plan/procedures.

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

Official classification

Type B

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7)... (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: Based on records review and interviews, R1's POA/RP records request has not been completed, therefore, the licensee and administrator did not conform to applicable laws, rules, and regulations. This poses a potential health, safety, and personal rights risk to residents in care.

Official plan of correction

The Licensee shall provide LPA Valerio a written statement acknowledging review of Health and Safety Code and Title 22 regulations and the facilities plan to ensure the POA/RP receives all documents requested by POC due date.

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

Official classification

Type A

Official code

87707(a)(2)

Regulation authority

CCR

What the official deficiency says

87707 Training Requirements...(a) Licensees.. shall...meet the following training requirements: (2) Direct care staff shall complete at least eight hours of in-service training...within 12 months of working in the facility and in each succeeding 12-month period... This requirement was not met as evidenced by: Based on observations, records review, and interviews, the licensee did not ensure staff received updated training on how to properly secured residents with a wheelchair in the facility van. This resulted in a resident getting injured during transport, which poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee stated all facility staff will receive in-service training. Licensee to send LPA a copy of in-service training with staff signatures acknowledging understanding of " Procedures to Transport a Wheelchair Resident in Gold Quartz Van "

Deadline recorded: May 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (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 Based on records review and interviews, the licensee did not ensure 3 out of 3 staff files reviews received required annual training. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee stated the administrator will go through all staff files to determine which files are out of date.

Deadline recorded: Jun 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 room 113. This room was being utilized by construction and tool items along with floor staff showering residents in the walk-in bathroom, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/27/2023 Plan of Correction Licensee had facility staff removed the hazardous and unused items to another vacant room that is not being used by residents or staff. LPA observed the room to be clear from storage items at the end of the visit.

Official classification

Type B

Official code

87219(a)

Regulation authority

CCR

What the official deficiency says

(a) Residents shall be encouraged to maintain and develop their fullest potential for independent living through participation in planned activities. The activities made available shall include: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interviews, the licensee did not ensure activities were made available to residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/23/2023 Plan of Correction Licensee to send a plan to ensure activities are being offered every day. Licensee to send proof that there is a designated person assigned to conduct planned activities every day of the week.

Official classification

Type A

Official code

87208(a)(8)

Regulation authority

CCR

What the official deficiency says

Plan of Operation Transportation arrangements for persons served who do not have independent arrangements. This requirement is not met as evidenced by: Observation Staff is unable to utilize the ramp to assist residents onto and off the van while using a wheelchair Based on interviews, the licensee did not ensure van is properly equipped for the safety of staff and residents This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee shall submit a plan on how to accommodate ambulatory and non ambulatory residents who need transportation for appointments as stated in Plan of Operation. Please fax to (916) 263-4744 by POC due date.

Deadline recorded: Nov 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87625(b)(1-3)

Regulation authority

CCR

What the official deficiency says

Managed Incontinence In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: Ensuring that residents who can benefit from scheduled toileting are assisted or reminded to go to the bathroom at regular intervals rather than being diapered. Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement is not met as evidenced by: Interviews that staff is not assisting residents with incontinence timely Based on interviews, the licensee did not ensure staff is assisting residents with incontinence This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee shall submit a plan on conducting an in-service for staff regarding caregiveing procedures and scheduled incontinence care for all residents. Please fax to (916) 263-4744 by POC due date.

Deadline recorded: Nov 18, 2022. 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

Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Interviews staff is insufficient in numbers to provide care and supervision Based on interviews, the licensee did not ensure sufficient staffing who are used to asssist independent apartments next door This posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee shall submit a plan on how to accommodate their licensed RCFE and the independent apartments next door. Please fax to (916) 263-4744 by POC due date.

Deadline recorded: Nov 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication.. This requirement was not met as evidenced by: Based on records review and interview, 1 resident medication records were missing from the facility,which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee stated a new system will be implemented by POC due date. The licensee will save back up files on a USB drives at the start of each month. Licensee to send proof of medication back up sheets to LPA via fax.

Deadline recorded: Nov 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 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...This requirement was not met as evidenced by: Based on record review and interviews, the facility did not ensure medication for resident 1 and resident 2 were kept safe and locked away, which caused the medications to come up missing. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee stated they have implemented a triple check system. Licensee to send copies of count sheet for October and November to LPA by POC due date.

Deadline recorded: Nov 21, 2022. A deadline is not proof that correction was completed.