WILLOW GLEN RESIDENCE

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. 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 liability insurance which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction Administrator agreed to obtain liability insurance for the facility and submit a copy to CCLD by POC date.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: 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 personnel records current and complete which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2024 Plan of Correction Administrator agreed to complete staff files and submit self-certification that the files are completed to CCLD by POC date.

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 (a) All facilities shall have a qualified and currently certified administrator...The administrator shall... be on the premises a sufficient number of hours... there shall be coverage by a designated substitute... This requirement was not met as evidence by: Based on observation and record review, the licensee did not comply with the section cited above in having a current administrator certificate which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to hire a qualified Administrator and submit all documents required to change the name of the Administrator for the facility to CCLD by POC date.

Deadline recorded: Oct 26, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87755(a)

Regulation authority

CCR

What the official deficiency says

87755 Inspection Authority of the Licensing Agency (a) Any duly authorized officer, employee... of the licensing agency may... enter and inspect the entire premise... at any time, with or without advance notice. This requirement was not as evidence by: Based on LPA's observation the Licensee did not comply with the section cited above in facility being accessible for Department, which poses a potential health and safety risk for persons in care.

Official plan of correction

Licensee agreed to attach new doorbell, to review and abide by regulation 87755, and to submit photo of new doorbell and copy of self-certification to CCLD by POC date.

Deadline recorded: Aug 20, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. 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 Ajax, Raid, and Windex accessible in unlocked cabinet under kitchen sink which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2022 Plan of Correction Administrator agreed to make disinfectants inaccessible to residents in care and submit photo to CCLD by POC date. Administrator locked disinfectants in hallway closet during visit. Deficiency cleared.

Official classification

Type A

Official code

87632(a)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Care Waiver (a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. To obtain this waiver the licensee shall submit a written request for a waiver to the Department on behalf of any residents who may request retention, and any future residents who may request acceptance, along with the provision of hospice services in the facility. The request shall include, but not be limited to the following: 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 a hospice waiver approved by the department on file and there is a hospice resident residing in facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2022 Plan of Correction Administrator agreed to submit a request for a hospice waiver to CCLD by POC date

Official classification

Type B

Official code

87405(a)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation. 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 a certified Administrator employed at facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/18/2022 Plan of Correction Licensee agreed to submit a plan to hire an Administrator or to recertify as the Administrator for the facility and submit a copy of the plan to CCLD by POC date.

Official classification

Type B

Official code

87405(d)

Regulation authority

CCR

What the official deficiency says

87405 Administrator Qualifications. (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. 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 following the administrator duties for facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/18/2022 Plan of Correction Licensee agreed to review regulation 87405 and submit a self-certification that the regulation has been reviewed and facility will abide by the regulation. Self-certification shall be submitted 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 R1's file is complete and up-to-date which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/18/2022 Plan of Correction Licensee agreed to complete R1's file and submit a self-certification that the file has been completed by POC date.