COUNTRY PLACE ASSISTED LIVING

Official classification

Type B

Official code

87463(b)

Regulation authority

CCR

What the official deficiency says

(b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. 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 as yearly updates for the Appraisal Needs and Services Plan are not being done, which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction On or before plan of correction due date, licensee will send LPA updated Appraisal Needs and Services Plans for all residents requiring it via email.

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 observation and record review, the licensee did not comply with the section cited above as quarterly emergency drills are not being conducted, which poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/09/2026 Plan of Correction On or before plan of correction due date, licensee will conduct an emergency drill for all staff and send LPA the signed inservice sheet via email.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

(2) Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety or health of residents, personnel or visitors, shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement was not met as evidenced by facility staff failiing to notifiy CCLD of COVID outbreak and timely submit a written report LIC 624 which posed a potential health & safety risk to residents in care.

Official plan of correction

ED agreed to complete and submit written incident report to CCLD on or before POC due date. ED also agreed to complete and submit in-service staff retraining on implementing current COVID mitigation plan in ocmpliance with COVID infection control procedures.

Deadline recorded: Jun 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87470(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by:(a) A licensee shall ensure that infection control practices are maintained. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above due to the absence of a COVID-19 screening station which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction By POC due date, ADM agrees to submit proof of correction to CCL to be in compliance with Title 22 regulations Section 87470 Infection Control requirements.

Official classification

Type B

Official code

87203

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above due expired fire extinguisher tags which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction By POC due date, ADM agrees to submit to CCL proof of correction (photos of re-inspected fire extinguishers with current tags) in compliance with Title 2 Section 87203 Fire Safety.

Official classification

Type B

Official code

87705(c)(1)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: The facility has a nonambulatory fire clearance for each room that will be used to accommodate a resident with dementia who is unable to or unlikely to respond either physically or mentally to oral instructions relating to fire or other dangers and to independently take appropriate actions during emergencies or drills. Deficient Practice Statement Based on record reviews, the licensee did not comply with the section cited above due to missing emergency/fire drills documentation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/30/2024 Plan of Correction By POC due date, ADM agrees to submit to CCL proof of correction (completed quarterly emergency & fire drills) to be in compliance with Title 22 Section 87705 (c)(1) regulations.

Official classification

Type B

Official code

87458

Regulation authority

CCR

What the official deficiency says

Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. ...LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Based on observation, licensee failed to ensure that resident has a medical assessment maintained in records, which poses a potential risk to the health and safety of resident in care.

Official plan of correction

LPA observed the record file of R1 missing a medical assessment. Administrator agreed to get an updated medical assessment for R1 and provide a copy to the Department by the POC date via email.

Deadline recorded: Oct 29, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87415(a)(5)

Regulation authority

CCR

What the official deficiency says

In facilities required to have a signal system, specified in Section 87303, Maintenance Operation, at least one night staff person shall be located to enable immediate response to the signal system. If the signal system is visual only, that person shall be awake. This requirement was not met as evidenced by absence of supervision on 10/31/23 which posed an immediate health & safety risk to residents in care

Official plan of correction

Immediate civil penalty of $500 is assessed today for absence of supervsion. Administrator corrected deficiency on 11/01/23. S1 was terminated due to work negligence and S2 suspended without pay until retrained on proper care and supervision of residents.

Deadline recorded: Nov 8, 2023. A deadline is not proof that correction was completed.

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 Solid waste shall be stored, located and disposed of in a manner that will not permit the transmission of a communicable disease or of odors, create a nuisance, provide a breeding place or food source for insects or rodents. This requirement was not met as evidenced by presence of ants in open trash bin which posed a potential health & safety risk to residents in care.

Official plan of correction

POC Due Date: 11/30/2023 Plan of Correction By POC due date, Administrator agreed to have an exterminator company eliminate the presence of ants inside the facility and submit a copy of extermination invoice to CCL in compliance with Title 22 Section 87303 (f)(1).

Official classification

Type B

Official code

87303(f)(3)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers; shall be in good repair; shall have external handles; and shall be leakproof and rodent-proof. This requirement was not met as evidenced by open trash bins inside the residents' bedrooms and bathrooms which posed a potential health & safety risk to residents in care.

Official plan of correction

POC Due Date: 11/30/2023 Plan of Correction By POC due date, Administrator agreed to replace and purchase new trash bins with foot operated lids in all residents' bedrooms and bathrooms in compliance with Title 22 Section 87303 (f)(3)