NEW RIVERSHORE CARE HOME

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 the exit gate from back yard free of obstruction which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction Administrator agreed to remove items, and place garage cans in a area to not block exit.

Official classification

Type B

Official code

87555(b)(21)

Regulation authority

CCR

What the official deficiency says

(21) Freezers of adequate size shall be maintained at a temperature of 0 degree F (-17.7 degree C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degree F. (4 degree C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. 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 the refrigerator and freezer sanitary which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction Administrator agreed to clean out freezer, refrigerator, separate which foods are for residents and Administrator, and submit photos to CCLD by POC date.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in having R4 an updated medical assessment which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction Administrator agreed to assist resident in obtaining a medical assessment and submit proof to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(3)

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: (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, interview, and record review, the licensee did not comply with the section cited above in maintaining a doctor's order for R1 hoyer lift and half-bed rail which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/10/2026 Plan of Correction Administrator agreed to maintain a doctor's order for both hoyer lift and half-bed rail and submit a copy to CCLD by POC date.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that disinfectants and cleaners were in unlocked bathroom cabinet which poses an immediate safety risk to persons in care.

Official plan of correction

POC Due Date: 05/28/2025 Plan of Correction The Administrator agrees to make disinfectants and cleaners inaccessible to residents and submit photo to CCLD by POC date. Administrator locked cabinet containing disinfectants and cleaners. Deficinecy cleared during visit.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 which the required 20 hours of annual training was missing from 2 (two) staff files which poses a potential safety risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2025 Plan of Correction The Administrator agreed to obtain and complete training for S2 and S3, and submit certificates to CCLD by POC date.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in having hospice are plans for R2 and R3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2025 Plan of Correction Administrator agreed to obtain a hospice care plan for R2, R3, and submit a copy to CCLD by POC date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(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 observation and record review, the licensee did not comply with the section cited above in having complete and current records for R1, R2, and R3 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2025 Plan of Correction Administrator agreed to complete records and submit self-certification to CCLD by POC date that the records have been completed.

Official classification

Type B

Official code

87555(b)(21)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (21) Freezers of adequate size shall be maintained at a temperature of 0 degrees F (-17.7 degrees C), and refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C). They shall be kept clean and food stored to enable adequate air circulation to maintain the above temperatures. 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 the refrigerator and freezer sanitary which poses a potential health risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2025 Plan of Correction Administrator agreed to clean out freezer and refrigerator and submit photos to CCLD by POC date.

Official classification

Type B

Official code

87303(d)(6)

Regulation authority

CCR

What the official deficiency says

(c) The following space and safety provisions shall apply to all facilities (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 outdoor passageways free of obstruction which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2025 Plan of Correction Administrator agreed to remove all items in passageways and submit photos to CCLD by POC date.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 window screens in repair on patio and bathroom in master's bedroom which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/03/2025 Plan of Correction Administrator agreed to have patio and bathroom screen in master's bedroom repaired and submit photos to CCLD by POC date.

Official classification

Type A

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5) Based on interview and record review the Licensee did not comply with the section cited above in serving R1 with an appropriate eviction notice, which poses a potential health and safety risk to persons in care.

Official plan of correction

The Licensee will read regulation 87224 and submit self-certification that it has been read and she will abide going forward to CCLD by POC date. A mandatory informal meeting will be held at a later time.

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

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 having all staff with first aid certification which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2024 Plan of Correction Administrator agreed to have all staff first aid certified and at least one (1) staff per shift CPR certified. Administrator will submit a copy of the certification to CCLD by POC date.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(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 a pair of scissors and a lighter accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/23/2023 Plan of Correction Administrator agreed to make scissors and lighter inaccessible for residents and submit photo to CCLD by POC date.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(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 medication accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/23/2023 Plan of Correction Administrator agreed to make all medication inaccessible for residents and submit photo to CCLD by POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c) The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in having all staff with first-aid certification and at least 1 staff on duty with CPR which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Administrator agreed to get all staff first-aid certified and to 1 staff on duty CPR certified and submit certifications to CCLD by POC date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) 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. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above in having current medical assessment for R2 and R4 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/05/2023 Plan of Correction Administrator agreed to get a current medical assessment for R2 and R4, and submit documents to CCLD by POC date.

Official classification

Type B

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, when there is significant change in the resident's condition, or once every 12 months, whichever occurs first, as specified in Section 87467, Resident Participation in Decision Making. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in having a current appraisal needs and services plan for all residents which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Administrator agreed to submit a current appraisal needs and services plan for each resident to CCLD by POC date.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

(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 and free of breaks, open seams, cracks or chips. 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 the refrigerator/freezer and freezer in garage clean which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Administrator agreed to clean refrigerator/freezer and freezer in garage and submit photos to CCLD by POC date.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 the outdoor passageways free of obstruction which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2023 Plan of Correction Administrator agreed to clear passagway and submit photo to CCLD by POC date.

Official classification

Type B

Official code

87208(b)

Regulation authority

CCR

What the official deficiency says

87208 (b) A licensee who advertises... dementia special care... or environments shall include additional information in the plan of operation as specified in Section 87706(a)(2). This requirement was not met as evidence by: Based on LPAs record review the Licensee did not comply with the section cited above in having a plan for dementia care, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to make an amendment to the facility’s plan of operation to include dementia care and submit it to CCLD by POC date.

Deadline recorded: Jun 29, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211 (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (2) Occurrences, such as epidemic outbreaks...which threaten the welfare, safety or health of residents...This requirement was not met as evidence by: Based on LPAs record review and interview, licensee did not comply with the section cited above in reporting to COVID residents to CCLD, which poses a health and safety risk to persons in care.

Official plan of correction

Administrator agreed to submit LIC624 for both residents to CCLD by POC date.

Deadline recorded: Jun 16, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87455(b)(8)

Regulation authority

CCR

What the official deficiency says

87455 (b) The following persons may be accepted or retained in the facility: (8)Persons who have been diagnosed as terminally ill and who have obtained the services of hospice... This requirement was not met as evidence by: Based on LPAs interview and record review, Licensee did not comply with the section cited above in requesting a hospice waiver for R3 and R4, which poses a health and safety risk to persons in care.

Official plan of correction

Administrator agreed to submit a request for a hospice waiver for 2 residents from CCLD by POC date.

Deadline recorded: Jun 16, 2022. A deadline is not proof that correction was completed.

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 having clothing in shower, mattresses, railing, and bags of clothing in back yard which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/22/2022 Plan of Correction Administrator agreed to remove items and send a photo to CCLD by POC date. Administrator removed clothing during inspection. Administrator will removed items from backyard and submit photo 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 observation and record review, the licensee did not comply with the section cited above in having 6 residents files complete which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/22/2022 Plan of Correction Administrator agreed to complete the files for all 6 residents and submit photo of missing and incomplete documents to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (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. (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 record review, the licensee did not comply with the section cited above in having a doctor's order for bed rails for R1 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/22/2022 Plan of Correction Administrator agreed to obtain a doctor's order for R1's bed rails and submit a photo copy to CCLD by POC date.

Official classification

Type A

Official code

87705(f)(1)

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: (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 a knife and tools accessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/16/2022 Plan of Correction Adminsitrator agreed to make knife and tools inaccessible to residents and submit a photo to CCLD by POC date. Administrator locked knife in kitchen drawer and placed tools in locked cabinet in backyard during inspection. Deficiency cleared.,