MAUREEN HOUSE

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). 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 not having scissors locked which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2023 Plan of Correction Scissors were removed during visit. Deficiency cleared.

Official classification

Type A

Official code

87202

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. 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 not having R4 in a Bedridden room which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/13/2023 Plan of Correction Licensee/Administrator says that there's a discrepancy and that the Bedridden room is actually Room# 5 and not #6. Licensee/Administrator says that he will contact the fire department to try to clear the descrepancy with the rooms. Licensee/Administrator will submit to CCLD the facility sketch and LIC200 to request Bedridden for Rm# 5 if it's not corrected by the Fire Marshall by POC due 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, interview and record review, the licensee did not comply with the section cited above in having Quarterly FIre Drills which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Administrator will review the regulation, self-certify that they read and understand the regulation and send a copy of a current fire drill to CCLD by POC due date.

Official classification

Type B

Official code

87705(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (2) The Emergency Disaster Plan, as required in Section 87212, addresses the safety of residents with dementia. 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 not having an Emergency Disaster Drill thats is reviewed and current which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Administrator will review the regulation, self-certify that they read and understand the regulation and send a copy of a current Emergency Disaster Drill (LIC610E) to CCLD by POC due date

Official classification

Type B

Official code

87633

Regulation authority

CCR

What the official deficiency says

Hospice Care of Terminally Ill Residents (b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: 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 hospice care plan available for R1 and R6 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Administrator found the hospice care plan for R1 and R6 later during visit, Deficiency cleared.

Official classification

Type B

Official code

87609

Regulation authority

CCR

What the official deficiency says

Allowable Health Conditions and the Use of Home Health Agencies (c) (c) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: 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 having doctor's orders for private Physical Therapist for R3, R4, R5 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Administrator will read the regulation and self-certify that they read and understand the regulations. Administrator will send doctor's orders for private Physical Therapists. Admnistrator will update care palns for each resident that has the private Physical Therapist or any other private medical/health services and send to CCLD by POC due date.

Official classification

Type B

Official code

87405

Regulation authority

CCR

What the official deficiency says

(a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person.... 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 having an availble Administrator during Annual visit which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Administrator will send to CCLD an updated LIC500 that shows the Administrator days and hours working at the facility to CCLD by POC due date.

Official classification

Type B

Official code

87615

Regulation authority

CCR

What the official deficiency says

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly 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 for retaining R5 without submitting an exception request for prohibited health condition which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Licensee/Administrator will read the regulation and self-certify that they understand moving forward. Licensee/Administartor stated that he is going to submit an exception request with supporting documents to CCLD by POC Due Date. Deficiency will not be cleared until exception request is approved.

Official classification

Type B

Official code

87303

Regulation authority

CCR

What the official deficiency says

(a) 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 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 washing machine, boxes, screen doors, pots/spoons, debris removed from outside yards which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Administrator will remove items, clean yard and send photos to CCLD by POC due date.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

" ...the licensee shall be permitted to accept/retain a resident who requires the use of oxygen...under the following circumstances ... " No Smoking - Oxygen in Use " signes must be posted. " This requirement was not met as evidenced by incomplete signage at the front door.

Official plan of correction

Licensee placed a full " No Smoking - Oxygen in Use " sign in the presence of LPA and LPM. Deficiency Cleared.

Deadline recorded: May 19, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87618(b)(2)

Regulation authority

CCR

What the official deficiency says

" ...Licensee ...permitted to accept or retain a resident who requires oxygen under the following circumstances...if oxygen administration is performed by an appropriately skilled professional. " This requirement was not met as evidenced by staff assisting R1

Official plan of correction

By POC date, Licensee will submit to CCL a detailed plan as to how R1s oxygen administration will be handled by an appropriately skilled professional

Deadline recorded: May 19, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. (2) Bedridden persons 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 S6 in fire clearance room #6 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2022 Plan of Correction Administrator will submit a written plan stating what steps facility will take to correct in which room S6 resides and submit it to CCLD by POC date. Administrator will also submit updated physician's report and Facility roster, if changed to CCLD by 10/17/2022.

Official classification

Type B

Official code

87628(a)

Regulation authority

CCR

What the official deficiency says

87628 Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. 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 acceptance of R5 being able to take own glucose which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/21/2022 Plan of Correction Administrator agreed to submit care plan and sign-in document from skilled professional that will administer R5's glucose if needed, and submit plan and document to CCLD by POC date.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

87305 Alterations to Existing Building or New Facilities (a) Prior to construction or alterations, all facilities shall obtain a building permit. 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 a room built in garage which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/28/2022 Plan of Correction Administrator agreed to submit and updated facility sketch and LIC200 to CCLD by POC date.