PLEASANT HILL VILLA HOME CARE

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

(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 that is designated as storage on the approved facility sketch altered and expanded which is now being used as a caregivers bedroom which poses a potential personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/28/2025 Plan of Correction By POC date, Administrator agreed to submit a new fire clearence, facility sketch, and permits for the unapproved room to CCLD.

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 by not having scissors, knives, matches inaccessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2023 Plan of Correction Administrator removed knives, scissors and matches and locked up in medication cabinet during visit. Deficiency cleared.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (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: (1)Obtain a California clearance or a criminal record exemption as required by the Department... 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 a Fingerprint Clearance/Criminal Record Clearance for a private caregiver for R4 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/22/2023 Plan of Correction Administrator to advise private caregiver to get a Live Scan and submit information for Criminal Record Clearance. Administrator will submit to CCLD a copy of Fingerprint/Criminal Record Clearance and associate private caregiver to the facility.

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 record review, the licensee did not comply with the section cited above in having all Staff Caregivers with valid CPR/First-Aid Training on record which poses a potential health, safety risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2023 Plan of Correction Administrator will schedule CPR/First Aid Training for all Staff Caregivers and submit copies of certifications to CCLD by POC due date.

Official classification

Type B

Official code

87705(c)(3)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (3) In addition to the on-the-job training requirements in Section 87411(d), staff who provide direct care to residents with dementia shall receive the following training as appropriate for the job assigned and as evidenced by safe and effective job performance: (A) Dementia care including, but not limited to, knowledge about hydration, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living; 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 having all Staff Caregivers Training for Dementia care residents on record 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 schedule Dementia training for all Staff Caregivers and send training certifications to CCLD by POC due date.

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 having an current annual Medical Assessment for R3 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 schedule a doctor's appointment and submit updated Medical assessment for R3 to CCLD by POC due date.

Official classification

Type B

Official code

87303(a)

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 by having the back/front yard cleared of ladders, wood, walker, screen door which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/05/2023 Plan of Correction Administrator removed all items noted above. Deficiency cleared during visit.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

Staff training; legislative findings; contents. In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training...This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not completing annual training for staff which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to conduct annual training to all staff and submit completion documents to CCLD by POC date.

Deadline recorded: Jun 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

Storage Space. Disinfectants, cleaning solutions...and other items which could pose a danger...shall be stored where inaccessible to clients. This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by having unlocked cleaning supplies and scissors in the kitchen and garage which poses an immediate health and safety risk to the persons in care.

Official plan of correction

Staff locked up the cleaning supplies and scissors during inspection. Deficiency cleared. Civil penalty of $250 is being assessed for repeat violation.

Deadline recorded: Sep 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87555(b)(25)

Regulation authority

CCR

What the official deficiency says

General Food Service Requirements. The following...shall apply: Soaps, detergents, cleaning compounds...shall be stored in areas separate from food supplies. This requirement is not met as evidence by: Based on observation, licensee did not comply with the section cited above by having furniture polish stored next to food supplies which poses a potential health and safety risk to the persons in care.

Official plan of correction

Staff removed the furniture polish next to the food supplies during inspection. Deficiency cleared.

Deadline recorded: Sep 1, 2022. 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 observation, licensee did not comply with the section cited above by having vent and gate latch in disrepair, vents and shower not clean, and missing toilet seat which poses a potential health and safety risk to the persons in care.

Official plan of correction

Licensee has agreed to repair the vent and gate latch, clean vents and shower, and install toilet seat in room 3. Licensee will send pictures and LIC9098 to CCLD by POC date.

Deadline recorded: Sep 16, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(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. 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 one (1) of the drawers in the kitchen, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/05/2021 Plan of Correction Fix the lock on the kitchen drawer and send proof of it's repair to LPA by End of Business on 10/05/21.

Official classification

Type B

Official code

87555(b)(29)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (29) All equipment, fixed or mobile, and dishes, shall be kept clean and maintained in good repair and free of breaks, open seams, cracks or chips. 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 the refrigerator in the garage that had food on the bottom shelf, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/11/2021 Plan of Correction Clean the spilled food off the floor of the regrigerator by End of Business 10/11/21.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents... shall have all of the following personal rights:(3)To be free from... ...other actions..., such as... or interfering with daily living functions... This requiremnent was not met as evidence by: Based on LPA's observation Licensee did not comply with the section cited above, which poses a potentitial health and safety risk for persons in care.

Official plan of correction

Administrator agreed to remove monitors. Monitors were removed during visit. Deifciency cleared during visit.

Deadline recorded: Sep 24, 2021. A deadline is not proof that correction was completed.