BROOKDALE DANVILLE

Official classification

Type B

Official code

87470(a)(2)(A)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall ensure that infection control...as follows:(2) Environmental cleaning...at a minimum, as follows:(A)Surfaces ... visibly soiled with...potentially infectious material. This requirement was not met as evidence by: Based on LPAs observations the facility did not disinfect the visibly soiled surface in room 11. LPA observed that the surface had dried feces, dried blood on wall next to bed, and floors were unsanitary which posed a potential health and personal rights risk to residents in care.

Official plan of correction

By POC Facility agrees to provide an in service to all staff and notify CCLD

Deadline recorded: Mar 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

(a) Facility personnel shall at all times be sufficient in numbers...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 was not met as evidence by: Based on LPAs observations and record review facility care staff numbers is not suffient to meet the residents needs because on 10/3/2025 5 out of 23 residents require a two person assist and three caregivers and one medtech were on shift which posed a potential personal rights risk to residents in care.

Official plan of correction

By POC facility agrees to submit staff schedules and proof of trainings of other staff available to provide care if neccessary. LPA will asses if staff available is sufficient and follow up with facility.

Deadline recorded: Mar 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

(d) The following...shall apply to all facilities:(2) The premises shall be maintained in a state of good repair... This requirment is not met as evidence by: Based on observation the facility did not maintain the furniture in a state of good repair by activities area sofas ripping at seams and exposing nails that pointed up which posed a potential safety and personal rights risk to residents in care.

Official plan of correction

By POC Facility will make a plan for repairs to furniture or relace and notify CCLD.

Deadline recorded: Mar 26, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87755(c)

Regulation authority

CCR

What the official deficiency says

(c) The licensing agency shall have the authority to inspect, audit, and copy resident or facility records upon demand during normal business hours.... subject to the requirements in Sections 87412(f), 87506(d), and 87508(b) This requirement was not met as evidence by: Based on interview with Operations Specialist, Dimple Kamdar the facility is refusing to provide corrective actions/ writeups issued to staff which poses a potential personal rights violation to residents in care.

Official plan of correction

By POC Facility agrees to submit the requested documents via certified mail to CCLD. Documents requested are all corrective actions/writeups for S1-S3 durring their employment with brookdale and any and all corrective actions/writeups related to care for any and all staff in 2024- current 2025

Deadline recorded: Oct 24, 2025. 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

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 was not met as evidence by: Based on observation, LPA observed vomit left uncleaned on the floor.

Official plan of correction

Facility has since hired a full time housekeeper. POC cleared

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

Official classification

Type B

Official code

87705(c)(4)

Regulation authority

CCR

What the official deficiency says

There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement was not met as evidence by: Based on records review and observation LPA reviewed staff roster and staff schedules and observed that the facility did not have adequate staffing

Official plan of correction

Facility has since hired additional staff and are fully staffed. POC cleared

Deadline recorded: May 28, 2024. 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 written report shall be submitted to the licensing agency and to the person responsible for the resident ... This report shall include...date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. This requirement was not met as evidence by: Based on observation and interviews the staff working were unaware of how and where to report incidents to licensing.

Official plan of correction

The facility agrees to train additional staff on the reporting process. Proof of correction will be sent to CCLD by POC date.

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

Official classification

Type B

Official code

87705(c)(5)(A)

Regulation authority

CCR

What the official deficiency says

When any medical assessment, appraisal, or observation indicates that the resident’s dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. Based on records review and interveiws the facility was not following directions made by reisdents doctor.

Official plan of correction

The facility agrees to review the regulation regarding care plans.Proof of correction will be sent to CCLD by POC date.

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

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 hot water temperature measuring at 121.6 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/12/2024 Plan of Correction By POC date Executive Director agrees to adjust water temprature to be in rangeand notify CCLD

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 record review, the licensee did not comply with the section cited above by not having an updated disaster drill log which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2024 Plan of Correction By POC date Executive Director agrees to complete Drills and update log and submit a copy of log to CCLD.

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) A plan for incidental medical and dental care shall be developed by each facility. The ... assistance in obtaining such care...with the following: The licensee shall assist residents ...as needed. This requirement was not met as evidence by: Based on interviews LPA was informed that previous Health and Wellness Director was not insuring the availability of medications.

Official plan of correction

Executive Director dismissed Health and wellness director and trained Med-techs on the proper medication protocols

Deadline recorded: Apr 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities This requirement is not met as evidenced by: Based on observation and interviews residents rooms are locked and most residents do not have a key and must ask to get let in which poses a potential health and safety risk to the persons in care. .

Official plan of correction

By POC date Executive Director agrees to have all residents’ rooms unlocked and give them a key, and self-certified that Executive Director understand resident personal rights by the and notify CCLD.

Deadline recorded: Apr 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

Safeguards for Resident Cash, Personal Property, and Valuables. Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not safeguarding resident's belongings which poses a potential health and safety risk to the persons in care.

Official plan of correction

By POC date Facility has agreed to develop and implement plan to better safeguard resident's belongings in the future and notify to CCLD

Deadline recorded: Apr 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(4)

Regulation authority

CCR

What the official deficiency says

Licensees who accept and retain residents with dementia shall be responsible for... the following: There is an adequate number of direct care staff to support each resident’s ... needs as identified in his/her current appraisal. This requirement is not met as evidence by: Based on observation and interviews there was not adequate staffing to meet residents needs.

Official plan of correction

Executive Director has hired additional staff to meet care and hygiene needs of residents

Deadline recorded: Apr 19, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

The licensee shall ensure that residents are regularly observed for changes in physical ... such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement is not met as evidence by: Staff was not notifing residents responsible party ofchanges in residents conditions

Official plan of correction

Executive Director dismissed staff not reporting properly and a traing was provided.

Deadline recorded: Apr 19, 2024. A deadline is not proof that correction was completed.

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 record review of five staff, the licensee did not comply with the section cited above in having incomplete employee files for 5 of 5 employees records reviewed which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/04/2023 Plan of Correction By POC date Executive Director agrees to review and update all employee files and provide a checklist of required documents for each file to CCLD.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: 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 R4's file missing the consent form and Appraisal of Needs and Services plan which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/04/2023 Plan of Correction By POC date Executive Director agrees to review resident file and update all required forms and submit a self certification to CCLD.

Official classification

Type B

Official code

87411(c)(1)

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 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review of five staff, the licensee did not comply with the section cited above in not having the required staff first aid certified which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/04/2023 Plan of Correction By POC date Executive Director agrees to have all required staff first aid trained and certified and submit certificates to CCLD.