SUNVALLEY RESIDENTIAL CARE HOME

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician on a prescription blank, maintained in the resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. 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 doctor's orders for R1, R2, R3 and R4 Centrum Mulitvitamins Silver Womens 50+, vitamins, iron pills, Bausch & Lomb Ared's pills which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/11/2025 Plan of Correction Administrator will submit copies of doctor's orders to CCLD by POC due date.

Official classification

Type B

Official code

87506(b)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: 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 R4's admission agreement, appraisal needs and services, personal rights signed which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/27/2025 Plan of Correction Administrator will submit copies of admission documents to CCLD by POC due 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 by not having medications inaccessible to residents in a unlocked kitchen drawer which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/15/2024 Plan of Correction Administrator locked top kitchen drawer where medications were located unlocked. Administrator agreed to conduct an In-Service Training and submit staff sign-in sheet to CCLD by POC due date.

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 having a pair of scissors unlocked in top kitchen drawer which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 11/15/2024 Plan of Correction Administrator locked scissors in top kitchen drawer during visit. Administrator agreed to conduct an In-Service Training and submit staff sign-in sheet to CCLD by POC due date. Civil Penalty for $250.00 assessed for repeat violation.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 annual 20hrs of training for Staff (S) S1-S5 in their files which poses a potential 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 submit training certificates for S1-S5 to CCLD by POC due 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... 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 by not having health screening for S1, S2, S5 and TB tests for S2 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to obtain health screening for S1, S2, S5 and TB test results for S2. Administrator will submit a copy of health screening with TB test result to CCLD by POC date.

Deadline recorded: Mar 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (5) Each resident with dementia shall have an annual medical assessment ... 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 by not having an updated annual medical assessment for R1 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to obtain updated Physician's Report for R1 and submit a copy to CCLD by POC due date.

Deadline recorded: Mar 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file... Based on record review, the licensee did not comply with the section cited above in by not having an updated annual medical aseessment for R5 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to obtain an updated Physician's Report and submit to CCLD by POC due date.

Deadline recorded: Mar 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

Liability insurance; coverage requirements...all residential care facilities for the elderly,...shall maintain liability insurance Based on interview and record review, the licensee did not comply with the section cited above in by not having adequate liability insurance which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to get the Evidence of Coverage for Liability Insurance and send a copy to CCLD by POC due date.

Deadline recorded: Feb 26, 2024. A deadline is not proof that correction was completed.

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 record review, the licensee did not comply with the section cited above in ny noy having health screening for S1, S2, S5 and S7 and TB tests for S2 and S7 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction Administrator agreed to obtainh ealth screening for S1, S2, S5 and S7 and TB test results for S2 and S7. Administrator will submit a copy of health screening with TB test result to CCLD by POC date.

Official classification

Type B

Official code

87412(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(b) Personnel records shall be maintained for all volunteers and shall contain the following: (3) For volunteers that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 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 a criminal clearance for S1, S2, S5 and S7 which poses posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction Administrator will submit criminal clearance LIC 508 to CCLD 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 interview, record review, the licensee did not comply with the section cited above in by not having quarterly fire drills with staff which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction Administrator agrees to read the regulation and self-certify that they read the regulation and moving forward abide by the regulation. Administrator will send an updated fire drill with participants and submit copy to CCLD by POC due date.

Official classification

Type B

Official code

87705(c)(6)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (6) Appraisals are conducted on an ongoing basis pursuant to Section 87463, Reappraisals. 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 Appraisal Needs and Services (ANS) for R1 thru R5 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction Administrator agrees to submit updated ANS to CCLD by POC due date.

Official classification

Type B

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 Lactulose Solution, Emergen-C, Fabuloso, Clorox Bleach, ladder which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/14/2023 Plan of Correction Administrator removed the items and locked all items listed. Deficiency cleared.

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 by not having First Aid/CPR for all staff which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/11/2024 Plan of Correction Administrator agreed to get all staff First Aid/CPR certified and submit copy of certification to CCLD by POC date.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

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, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Paint was accessible in the back yard and vitamins in the kitchen were unlocked which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/07/2023 Plan of Correction Administrator secured the paint in the presence of the LPA and LPM; Administrator will submit a copy of the medication destruction record for the vitamins by the POC date.

Official classification

Type B

Official code

87293

Regulation authority

CCR

What the official deficiency says

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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 01/20/2023 Plan of Correction Administrators purchased and obtained a new fire extinguisher while LPA and LPM were at facility. Deficiency cleared.