CORDIAL CARE HOME

Official classification

Type B

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or 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 in by ensuring that S5 was associated to the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2026 Plan of Correction Administrator will complete transfer association via Guardian by submitting LIC9182 along with copy of US Issued Photo ID to CCLD by POC due date.

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. 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 6 out of 6 Admission Agreements, which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/30/2025 Plan of Correction On or before the due date, the Licensee shall: (A) read and understand Section 87507 of Title 22, Admission Agreement, and (B) replace the LIC 604 " ADMISSION AGREEMENT GUIDE FOR RESIDENTIAL FACILITIES " with the LIC 604A " ADMISSION AGREEMENTS FOR RESIDENTIAL CARE FACILITIES FOR THE ELDERLY " for 6 of the 6 residents.

Official classification

Type A

Official code

87618(b)(3)(A)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (A) A report shall be made in writing to the local fire jurisdiction that oxygen is in use at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review, the licensee did not comply with the section cited above in by not reporting to the local fire dept that oxygen is in use for R1 in Bedroom #1 which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/15/2024 Plan of Correction Administrator agree to submit a copy of letter to CCLD by POC date.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 in by not having First Aid and CPR for S1 and S2 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administrator agree to submit coppies of First Aid/CPR and/or health professional license/certification to CCLD by POC date.

Official classification

Type B

Official code

87533(e)(2)

Regulation authority

CCR

What the official deficiency says

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 not having S6, S7 and S8 associated to facilicity in Guardian which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/21/2024 Plan of Correction Administrator agree to submit LIC9182 with valid U.S. issued picture ID to CCLD by POC date

Official classification

Type B

Official code

87468(c)(2)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (2) Information on the appropriate reporting agency in case of a complaint or emergency, including procedures for filing confidential complaints, shall be posted as follows: (A) Licensees may use the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) or may develop their own poster as provided in this section. A poster developed by the licensee shall contain the same content as the PUB 475. The poster that is posted shall be 20” x 26” in size and be posted in the main entryway of the facility. PUB 475 may be accessed, downloaded, and printed from the www.ccld.ca.gov website. 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 by not having 20x26 poster sized PUB 475 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administrator agree to submit a photo to CCLD by POC date.

Official classification

Type B

Official code

87458(b)(5)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (5) The determination whether the person is ambulatory or nonambulatory as defined in Section 87101(a) or (n), or bedridden as defined in Section 87455(d). The assessment shall indicate whether nonambulatory status is based upon the resident's physical condition, mental condition or both. 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 by not having an updated Physician's report for R1 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administrator agree to submit an updated Physician's Report (LIC602A) for R1 by POC date.

Official classification

Type B

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical, mental, and social condition. Significant changes shall include but not be limited to: (3) Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or condition specified in Sections 87455(c) or 87615, Prohibited Health Conditions. 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 by not having an updated Appraisal Needs and Services (ANS) Plan for R1 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administrator agree to submit an updated ANS for R1 to CCLD by POC date.

Official classification

Type B

Official code

1569.695(d)

Regulation authority

HSC

What the official deficiency says

(d) A facility shall review the plan annually and make updates as necessary, including changes in floor plans and the population served. The licensee or administrator shall sign and date documentation to indicate that the plan has been reviewed and updated as necessary. 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 by not having updated review of Emergency Disaster Plan LIC610E (P.9) signed and dated which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administrator agree to submit copy of updated reviewed LIC610E to CCLD by POC date. While at the facility S2 updated and signed LIC610E. Deficiency cleared.

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 not having doctor's orders on file for R2-R4,R6 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administrator agree to submit copies of doctor's orders for 1/2 rail beds for R2-R4,R6 to CCLD by POC date.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. 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 not having an doctor's order for R1 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administrator agree to submit an copy of doctor's order for hospital bed for R1 to CCLD by POC date.

Official classification

Type B

Official code

87616(b)(2)

Regulation authority

CCR

What the official deficiency says

(b) Written requests shall include, but are not limited to, the following: (2) The licensee's plan for ensuring that the resident's health related needs can be met by the facility. 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 not having an exception request for R1's foley catheter which poses a potential healt and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administrator agree to submit an exception request for foley catheter with all supporting documents to CCLD by POC date. Deficiency will not be cleared until all documents are received and approved.

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 by not having an updated Physician's Report for R2 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2024 Plan of Correction Administrator agree to submit updated Physician's Report for R2 to CCLD by POC date.

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... 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 by notifying Licensing of hospitalizations, and death which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2023 Plan of Correction Licensee/Administrator agreed to read section 87211 and submit self- certification that the regulation has been reviewed and he will abide by the regulation going forward. Self-certification will be submitted to CCLD by POC Due Date.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements – General (f) All personnel, including the licensee and administrator, shall be in good health...health screening...chest x-ray 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 by not having health screening and TB tests for S4, S5 and S6 which poses a potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 08/31/2023 Plan of Correction Licensee/Administrator will complete a health screening and TB test for S4, S5 and S6 and will submit copies of completed results to CCLD by POC Due Date.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Care Waiver (d) If the Department grants a hospice care waiver it shall stipulate terms...(2)The licensee shall notify the Department in writing within five working days of the initiation of hospice care services... 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 by not notifying Licensing of residents that have started hospice services which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2023 Plan of Correction Licensee/Administrator shall review section 87632 and self-certify that they have read the regulation. Self-certification will be submitted to CCLD by POC Due Date.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning, and that appropriate assistance is provided when such observation reveals unmet needs. ..... the licensee shall ensure that 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 evidenced by: Based on interview and records review, the licensee did not comply with the section above for not properly observing and documenting resident's changes in condition.

Official plan of correction

R1 is no longer at the facility. Administrator will come up wth a plan on how to properly observe and document changes in residents and communicate the changes to all the parties involved in residents' care needs.

Deadline recorded: Nov 30, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.269(a)(6)

Regulation authority

HSC

What the official deficiency says

§1569.269 Enumerated rights; severability: (a) Residents of residential care facilities for the elderly shall have all of the following rights:(6) To care, supervision, and services that meet their individual needs and are delivered -This requirement is not met as evidenced by: .. -Based on records review and interviews, the licensee did not comply with the section above for R1 who developed unstageable pressure injury. R1 also sustained severe sepsis and acure organ dysfunction while in care which posed immediate health risk to person in care. Civil penalty is assessed.

Official plan of correction

R1 is no longer at the facility. Administratror to in-service the staff. Copy of in-service training with attendees signatures to be submiited by 11/17/2022. A$500.00 civil penalty is assessed on this day.

Deadline recorded: Nov 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). -This requirement is not met as evidenced by: .. --Based on records review and interviews, the licensee did not comply with the section above for not meeting R1's needs, R1 was found to have dried feces when sent out to the hospital.

Official plan of correction

R1 is no longer at the facility. Administratror to in-service the staff and ensure residents' care needs are met. Copy of in-service training with attendees signatures to be submiited by 11/30/2022.

Deadline recorded: Nov 30, 2022. A deadline is not proof that correction was completed.