CHATEAU PLEASANT HILL

Official classification

Type B

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4) Incidental Medical and Dental Care (4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: The licensee did not comply with the section cited above when R1, R2, and R3 did not receive their morning insulin which posed a potential health and safety risk to persons in care.

Official plan of correction

By POC date, Executive Assistant agrees to have an in-service to ensure that there’s communication between facility staff when there’s coverage needed.

Deadline recorded: Jun 5, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(1)(C)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (C) Because of potential dangers related to the medication itself, or due to physical arrangements in the facility and the condition or the habits of other persons in the facility, the medications are determined by either a physician, the administrator, or Department to be a safety hazard to others. 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 by having R1 medication left unlocked in bathroom sink counter which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/09/2025 Plan of Correction Administrator (ADM) agree to check all residents room to make sure there no other medication left unlocked.ADM agree to condoct an inserve training to staff on medication storage and send POC of training record to CCLD by POC date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above by not having S1 and S2 health screening and TB clearance on files which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2025 Plan of Correction Administrator agree to have S1 and S2 complete their health screening and TB test clearance and send via email documents of S1 and S2 complete their health screening and TB test clearnace by POC date.

Official classification

Type B

Official code

87224(d)(1)

Regulation authority

CCR

What the official deficiency says

Eviction Procedures.(d)The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. (1)The notice to quit shall include the following information: This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not ensuring eviction notice is in compliance with regulation which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director (ED) has review " Eviction Procedures " regulation and submitted email notice to CCLD on 11/26/2024. Original eviction notice was rescinded and new eviction notice was provided on 12/12/2024. Deficiency cleared.

Deadline recorded: Aug 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

87203 Fire Safety All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. -This requirement is not met as evidenced by: -Based on interviews and record review, the licensee did not comply with the section above in trash and recycle bins in the stairwells which posed an immediate safety risks to the persons in care.

Official plan of correction

Corrected. The bins had been removed.

Deadline recorded: Jun 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(e)

Regulation authority

CCR

What the official deficiency says

87463 Reappraisals (e) The licensee shall immediately...bring any significant change in condition...to the attention of the appropriate licensed medical professional...other specialized care provider. Documentation of such communication shall be added to the resident's record and shall include:... This requirement is not met as evidence by: Based on interview and record review the licensee did not comply with the section cited above in by performing reappraisals in significant changes of condition which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct an In-Service training with all staff responsible for reappraisals and submit signature sign-in sheet to CCLD by POC due date.

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

Official classification

Type B

Official code

87211(a)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: This requirement is not met as evidence by: Based on interview and record review the licensee did not comply with the section cited above in by notifying CCLD of R1's hospitalization (LIC624) which poses a potential health, safety and personal rights risk to persons in care.

Official plan of correction

Administrator agreed to read the regulation and conduct an In-Service training with staff on reporting requirements. Submit training sign-in sheet to CCLD by POC due date.

Deadline recorded: Feb 18, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.683

Regulation authority

HSC

What the official deficiency says

§1569.683 Eviction notices; reasons for eviction contents; service (a) In addition to complying with other applicable regulations, a licensee of a residential care facility for the elderly who sends a notice of eviction to a resident shall set forth in the notice to quit the reasons relied upon for the eviction, with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. In addition, the notice to quit shall include all of the following: (1) The effective date of the eviction. (2) Resources available to assist in identifying alternative housing and care options, including public and private referral services and case management organizations. (3) Information about the resident's right to file a complaint with the department regarding the eviction, with the name, address, and telephone number of the nearest office of community care licensing and the State Ombudsman. (4) The following statement: " In order to evict a resident who remains in the facility after the effective date of the eviction, the residential care facility for the elderly must file an unlawful detainer action in superior court and receive a written judgment signed by a judge. If the facility pursues the unlawful detainer action, you must be served with a summons and complaint. You have the right to contest the eviction in writing and through a hearing. " (b) The licensee, in addition to either serving a 30-day notice, or seeking approval from the department and serving three days notice, on the resident, shall notify, or mail a copy of the notice to quit to, the resident's responsible person. This requirement is not met as evidenced by: Based on interview and record review the licensee did not comply with the section cited above in serving R1 with an appropriate eviction notice that did not contain all items required under regulation, which poses a potential health and safety and personal rights risk to persons in care.

Official plan of correction

The Administrator will read the regulation and submit self-certification that it has been read, understood and they will comply going forward to CCLD by POC due date. In addition, the licensee shall rescind the eviction, notify resident, responsible party, and issue legal notice if that is still licensee’s plan.

Deadline recorded: Nov 27, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (25) Soaps, detergents, cleaning compounds or similar substances shall be stored in areas separate from food supplies. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as Comet cleaner was found unlocked in kitchen were food was being prepared, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/02/2024 Plan of Correction LPAs observed kitcehn staff removed cleaner and stored in locked pantry. Defeciency cleared during visit.