BROOKDALE DIABLO LODGE

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 evidence by: Based on interviews and record review facility staff did not adhere to the requirement above of conducting a reappraisal after R1 sustained multiple falls on 6/10/2022, 1/9/2023, or 3/25/2024 to address change in condition which poses a potential safety risk to clients in care.

Official plan of correction

By POC date Facility agrees to review regulation above. Review current resident roster and identify residents with unidentified care needs that are not addressed in existing appraisal. Notify CCLD of residents identified and dates reappraisals will be conducted.

Deadline recorded: Nov 19, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:(4)To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirment was not met as evidence by Based on interviews and record review the staff acknowledged that R1 was a fall risk as identified in (list the documents that support this) and facility staff failed to provide adequate supervision to meet R1 needs resulting in a serious injury which poses an immediate safety risk to residents in care.

Official plan of correction

Facility has hired and trained additional staff. $500 civil penalty assessed

Deadline recorded: Nov 5, 2025. A deadline is not proof that correction was completed.

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 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 and record review, the licensee did not comply with the section cited above by R4 having Miralax in apartment and R5 having TUMS in apartment. Physician's report for R4 and R5 indicates that both residents are not able to store PRN medications which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/20/2023 Plan of Correction By POC date Administrator agrees to remove all PNR medications from R4 & R5 apartment and submit self-certification letter to CCLD. In addition Administrator will review regulation and audit all clients records and apartments to be in compliance with the section cited above and submit self certification to CCLD by 11/02/2023.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) STORAGE SPACE 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, Licensee did not comply with the regulations cited above. LPAs observed unlocked cleaning supplies and gardening tools in R2's apartment; and cleaning supplies in R1's apartment which poses an immediate health and safety risk to persons in care.

Official plan of correction

By POC date, Administrator agrees to conduct room checks and submit a self-certification letter that cleaning supplies have been removed and locked away to CCLD

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

Official classification

Type B

Official code

87618(b)(3)(E)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (E) Oxygen tanks that are not portable shall be secured in a stand or to the wall. 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 not having stands for R1's portable tanks which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2022 Plan of Correction Administrator agrees to obtain additional stands for R1's oxygen tanks and provide photographic proof to CCLD by POC date

Official classification

Type B

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance. Request a transfer of a criminal record clearance as specified in Section 87355(c) or... This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not associated S4 to the facility which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director has agreed to submit LIC9182 and a copy of photo ID for S4 to CCLD by POC date.

Deadline recorded: Nov 24, 2021. 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

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times... This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by having R1's room uncleaned which poses a potential health and safety risk to the persons in care.

Official plan of correction

LPA observed a new resident occupying R1's room and observed the room to be cleaned without odor. No POC needed. Deficiency cleared during inspection.

Deadline recorded: Nov 19, 2021. A deadline is not proof that correction was completed.