SPYGLASS SENIOR VILLA 4

Official classification

Type B

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: Based on observation, two roach nymphs were found in the kitchen utensil drawer which poses a potential health risk.

Official plan of correction

On or before plan of correction due date, pest control will be called to perform services and a receipt of the services performed will be emailed to CCLD.

Deadline recorded: Apr 3, 2026. A deadline is not proof that correction was completed.

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 by having the laundry room door open with the key in the lock which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2025 Plan of Correction Administrator agreed that the laundry room will remain locked at all times and the key will not be hanging in the lock. DEFICIENCY CLEARED DURING VISIT.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(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 that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having unlocked medication in resident's room which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/03/2025 Plan of Correction Staff locked up the medication during inspection. DEFICIENCY CLEARED DURING VISIT.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having roaches in the facility which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/11/2025 Plan of Correction Administrator agreed to provide the department with a copy of the pest control company that is servicing the facility by the POC date

Official classification

Type A

Official code

87309

Regulation authority

CCR

What the official deficiency says

87309 Storage Space and Access (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: Based on observation , the licensee did not comply with the section cited above by having cleaning supplies and other chemical in all the bathroom cabinets unlocked, and unlocked medication in a kitchen drawer, and inside resident dresser, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator (ADM) agree to removed and locked up chemical and medication and review the regulation and submit a self-certification that ADM understand the regulation and submit photo proof to CCLD by 1/17/25. ADM will conduct an in service to all care staff and submit proof of training to CCLD by 1/22/25.

Deadline recorded: Jan 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident's dementia care needs. 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 4 out of 4 resident files, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/28/2024 Plan of Correction Licensee shall schedule appointments for the 4 residents to have an annual medical assessment wherein the physician will complete an LIC602 for the resident and that LIC602 will be added to their file.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465(h)(2) 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 that is not accessible... This requirement is not met as evidenced by: Based on observation, medication (tablets and insulin) was accessible in the kitchen drawer and refrigerator which poses/posed an immediate Health, Safety risk to persons in care.

Official plan of correction

Deficiency cleared during visit. LPA observed Administrator lock medications in cabinet and garage. Administrator will review regulation and conduct in-service training with staff and submit a copy of training agenda with staff signatures to CCL by 9/22/2023

Deadline recorded: Sep 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

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. This requirement is not met as evidenced by: Based on observation, bathroom cleaner (toilet bowl cleaner, windex, cleaner with bleach) was unlocked in residents bathroom which poses/posed an immediate Health, Safety risk to persons in care

Official plan of correction

Deficiency cleared during visit. Administrator locked cleaning solutions in garage. Administrator will review regulation and conduct in-service training with staff and submit a copy of training agenda with staff signatures to CCL by 9/22/2023

Deadline recorded: Sep 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(23)

Regulation authority

CCR

What the official deficiency says

87555(b)(23) General Food Service Requirements (b) The following food service requirements shall apply(23) All readily perishable foods ..capable of supporting rapid and progressive growth of micro-organisms which can cause food infections...shall be stored in covered containers at appropriate temperatures. This requirement is not met as evidenced by: Based on observation, eggs were left in the kitchen pantry which poses/posed an immediate Health, Safety risk to persons in care.

Official plan of correction

Deficiency cleared during visit. LPA observed Staff throw eggs away in garbage bin Administrator will review regulation and conduct in-service training with staff and submit a copy of training agenda with staff signatures to CCL by 9/22/2023

Deadline recorded: Sep 20, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

87628(a) Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood .. and is able to administer his/her own medication ... This requirement is not met as evidenced by: Based on observation and interview, LPA observed glucose testing machine and was informed that S1 performs glucose testing for R1 which poses/posed an immediate/potential Health, Safety risk to persons in care

Official plan of correction

Administrator will review regulation and submit a plan to address R1 diabetic care needs and submit a copy to CCL by POC date.

Deadline recorded: Sep 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(8)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (8) If a facility has no medical unit on the grounds, a complete first aid kit shall be maintained and be readily available in a specific location in the facility. The kit shall be a general type approved by the American Red Cross, or shall contain at least the following..... This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not maintain a comapleted first aid kit which poses/posed a potential health, safety or personal rights risk to persons in care. LPA observed the kit did not contain a current manual, sterile first aid dressings, bandages, scissors nor tweezers.

Official plan of correction

POC Due Date: 04/14/2023 Plan of Correction Administrator will buy a completed first ait kit that contains all of the reqiuired items and submit photographic proof to CCL by POC date

Official classification

Type B

Official code

87506(e)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. -This requirement is not met as evidenced by: -Based on interviews and record reviews, the licensee did not comply with the section above by not retaining all of R1's records for at least 3 years which posed potential health and personal rights risks to person in care.

Official plan of correction

R1 is no longer at the facility. Administrator to read the regulations and send a self-certification that residents' records will be kept for a minimum of 3 years by the POC due date.

Deadline recorded: Aug 2, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

(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 by having chemicals and detergents left unlocked and accessible to the residents in the laundry room which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/29/2022 Plan of Correction Cleared during visit.

Official classification

Type B

Official code

87309(b)

Regulation authority

CCR

What the official deficiency says

(b) Medicines shall be stored as specified in Section 87465(c) and separately from other items specified in (a) above. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above by having medication left out and accessible to the residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/18/2022 Plan of Correction The facility will fix or replace medication cabinet. Proof of correction will be sent to CCLD by POC date.