SIVILAY ELDERLY HOME CARE

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 observation, interview, record review, the licensee did not comply with the section cited above in conducting a quarterly fire drill which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/09/2025 Plan of Correction Licensee agreed to conduct a fire drill and submit documentation to CCLD by POC date

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

Official plan of correction

POC Due Date: 12/03/2025 Plan of Correction Licensee immediately locked cabinet with medications to make inaccessible to residents. Deficiency cleared during visit.

Official classification

Type A

Official code

87303(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs. 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 warning signs for water at 147 degree F. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction Administrator agreed to place warning signs in all bathrooms to show water is above 120 degree F.

Official classification

Type A

Official code

87705(f)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: 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 disinfectants, cleaners, and knives accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/12/2024 Plan of Correction Administrator agreed to lock all items away and submit photo to CCLD by POC date.

Official classification

Type B

Official code

87204(b)

Regulation authority

CCR

What the official deficiency says

(b) Resident rooms approved for 24-hour care of ambulatory residents only shall not accommodate nonambulatory residents. Residents whose condition becomes nonambulatory shall not remain in rooms restricted to ambulatory residents. 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 2 residents in ambulatory room only which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/18/2024 Plan of Correction Administrator agreed to submit a LIC200 and updated facility sketch to CCLD by POC date.

Official classification

Type B

Official code

87465(d)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: 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 accurate MAR records which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/18/2024 Plan of Correction Administrator agreed to update MARs for all residents and submit a self-certification to CCLD that updates have been completed 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 and record review, the licensee did not comply with the section cited above in having an appraisal needs and services plan for each resident which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/18/2024 Plan of Correction Administrator agreed to create an appraisal needs and service plan for each resident, and submit a self-certification to CCLD by POC date.

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 observation and record review, the licensee did not comply with the section cited above in conducting a fire drill which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/18/2024 Plan of Correction Administrator agreed to conduct a fire drill and submit document 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 and record review, the licensee did not comply with the section cited above in a doctor's order for bedrails for R3, R4, R5, and R6 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/18/2024 Plan of Correction Administrator agreed to request a doctor's order for R4, R5, and R6 and submit a copy to CCLD by POC date.

Official classification

Type A

Official code

87355(d)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement... This requirement was not met as evidence by: Based on record review and observation the Licensee did not comply with the section cited above in having S2 fingerprinted before working, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to have S2 fingerprinted and submit copy to CCLD by POC date.

Deadline recorded: Jul 4, 2024. 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 Incidental Medical and Dental Care (h)...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... This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in requesting a hospice waiver before admitting a hospice resident, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator locked all medications away and made inaccessible. Deficiency cleared during visit.

Deadline recorded: Jul 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

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 was not met as evidence by: Based on observation and interview the Licensee did not comply with the section cited above requesting a hospice waiver from CCLD before retaining a resident, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to read and review regulation 87632 and submit a self-certification that the facility will abide by the regulation going forward to CCLD by POC date.

Deadline recorded: Jul 10, 2024. 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 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. Based on observation Licensee did not comply with the section cited above in having medications inaccessible to residents which poses an immediate health and safety risk to persons in care.

Official plan of correction

Administrator immediately locked medications in cabinet. Deficiency cleared during visit.

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

Official classification

Type B

Official code

87705(f)(2)

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: (2)Over-the-counter medication, nutritional supplements or vitamins... gardening supplies, cleaning supplies and disinfectants. This requirement was not met as evidence by: Based on observation Licensee did not comply with the section cited above in having gardening tools, freezer, , pressure washer, and mattress inaccessible and blocking passageway, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to remove items and submit picture to CCLD by POC date.

Deadline recorded: Dec 6, 2023. 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

87412 Personnel Records (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 was not met as evidence by: Based on observation the Licensee did not comply with the section cited above in having all staff files complete, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to complete all staff files and submit a self-certification that files are completed to CCLD by POC date.

Deadline recorded: Dec 6, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (c) ...staff who assist residents with personal activities of daily living shall receive initial and annual training... (1)Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement was not met as evidence by: Based on record review the Licensee did not comply with the section cited above in having staff first aid certified, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to get all staff first aid certified and 1 staff per shift CPR certified and submit a copy of the certifications to CCLD by POC date.

Deadline recorded: Dec 6, 2023. 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 2 sheds locked, garden tools and a gallon of paint inaccessible which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/09/2022 Plan of Correction Administrator agreed to lock sheds, make gallon of paint and garden tools inaccessible, and submit photos 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 observation, interview, and record review)the licensee did not comply with the section cited above in having doctor's orders for R1 and R2 for hospital beds which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/15/2022 Plan of Correction Administrator agreed to obtain doctor's orders for R1 and R2 hospital beds and submit a photo copy to CCLD by POC date.