KENSINGTON AT WALNUT CREEK, THE

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidence by: Based on record review and interview the licensee did not comply with section above by not ensuring care and supervision when R1 eloped during the night and later found by local police which poses an immediate Health & Safety risk to residents in care.

Official plan of correction

Administrator agreed to conduct an In-Service training with community care leadership on ensuring that residents' care plans (appraisals) are updated as appropriate with change of conditions and staff training on supervision and elopement prevention, and any additional safeguards implemented to prevent future incidents. Sign-in sheet and lesson plan to be submitted to CCLD by POC due date. Immediate $500 civil penalty assessed.

Deadline recorded: Jul 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing... facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above in by not administering medication for R1 ordered by the physician and given according to the physician's directions. R1 was administered the same dose of narcotic medication in the morning which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct training with med techs to assist the residents with self-administration of narcotics including but not limited to documenting and will send staff sign-in sheet and any training documents to CCLD by POC due date. Civil Penalty assessed for repeat violation $250.00

Deadline recorded: Feb 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

CCR 87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. Based on record review and interviews, the licensee did not comply with section above by not administering medications to residents (i.e., R1, R2, R3, R4, R5) according to the physician's directions which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator shall have all staff that administer medications to complete a 4hrs minimum Medication Training course with an approved CDSS vendor. Repeat Violation Civil Penalty $250.00 Course topics shall cover Medication Administration including but not limited to documentation procedures, narcotics, injections, enemas, suppositories, missed and medication errors. Completed certificates will be submitted to CCLD by POC due date.

Deadline recorded: Jan 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

CCR 87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by: Based on record review and interviews, the licensee did not comply with section above by not activating 9-1-1 if an injury or other circumstance which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator agreed to conduct a In-Service training with all staff on emergency 911 response and will send participant sign-in sheet to CCLD by POC due date.

Deadline recorded: Jan 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87622(a)(2)

Regulation authority

CCR

What the official deficiency says

Fecal Impaction Removal, Enemas, and/or Suppositories (a) The licensee shall be permitted to accept or retain a resident who requires manual fecal impaction removal, enemas, or use of suppositories under the following circumstances: (2) Manual fecal impaction removal, enemas, and/or suppositories shall be permitted if administered according to physician's orders by either the resident or an appropriately skilled professional. This requirement was not met as evidenced by: Based on record review and interviews, the licensee did not comply with section above by not following dr's orders with R1 self-administering their intravaginal cream or appropriately skilled professional will administer the medication which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator will conduct an audit of all residents that require medication assistance including but not limited to suppositories and care plan will be updated and send to CCLD by POC due date.

Deadline recorded: Jan 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing... facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Based on record review and interview, the licensee did not comply with the section cited above in by not administering medication for R1 ordered by the physician and given according to the physician's directions which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agreed to conduct a refresher training with all Med Techs and will send certificates or transcript of completed training to CCLD by POC due date.

Deadline recorded: Sep 26, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in by not reporting R1's elopement within the next day to Licensing which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator stated that R1 has a 1:1 companion that started 06/18/25 and since then there has not been anymore elopements by R1. Deficiency cleared.

Deadline recorded: Sep 3, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

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: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events... This report shall include the resident's name... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above in by not submitting a written report within 7 days of the occurences of any of the events for residents in care. Reports received to CCLD were dated 11/15/24, 11/12/24 and 12/1/24 as an example and were received on 01/02/25 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator will have a In-Service training with care leadership team staff to go over reporting requirements and will submit participant sign-in sheet to CCLD by POC due date.

Deadline recorded: Sep 2, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). 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 hot water temp. in residents bathrooms measuring at 105-120. The hot water temperature measured above 130 degree F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/15/2025 Plan of Correction Administrator send a photo of hot water measuing within 105-120 degrees 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 and record review, the licensee did not comply with the section cited above in by not having prescription medication inaccessible to R1 in their apartment kitchen cabinet and refrigerator. R1's physican's report indicates " Able to administer and store own medications.. " with a " No " which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/15/2025 Plan of Correction Administrator shall remove the medications from R1's room and will inform R1's family that visitors' medications needs to be inaccessible to the resident. Administrator will send a copy of email communication to family by POC due 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 record review, the licensee did not comply with the section cited above in by not having the CPR/First Aid updated for S2 and S6 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/04/2025 Plan of Correction Administrator to submitted CPR and First Aid Certificates for S2 and S6 to CCLD by POC due date.

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 training for S1, S2, S4, S5, S6 and S7 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2025 Plan of Correction Administrator will submit training transcripts for S2, S5, S6 and S7 to CCLD by POC due date. Repeat Violation. Civil Penalty $250.00

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 PUB 475 posted in main entry (mailboxes) as a 20 " x 26 " poster which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/28/2025 Plan of Correction Administrator agreed to submit a photo(s) of PUB 475 in 20 " x 26 " poster form posted in all main entry way including mailbox area and memory care to CCLD by POC due date.

Official classification

Type A

Official code

87355(d)

Regulation authority

CCR

What the official deficiency says

(d) All individuals subject to criminal record review shall be fingerprinted and sign a Criminal Record Statement (LIC 508 [Rev. 1/03]) under penalty of perjury. This requirement was not met as evidence by: Based on LPAs observation and record review the Licensee did not comply with the section cited above in having S2 and S5 fingerprinted and associated to facility, which poses a potential health and safety risk to persons in care.

Official plan of correction

Administrator agreed to have S2 and S5 fingerprinted and submit document to CCLD by POC date.

Deadline recorded: Nov 20, 2024. 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

87303 Maintenance and Operation (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 visitors This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above in by not having egress doors working properly in Memory Care to prevent residents (R1) from eloping the facility which posed an immediate health and safety risk to persons in care. Repeat Violation assessed civil penalty $250.00

Official plan of correction

Administrator agrees to have the egress doors checked by maintenance twice a day and documented. Administrator will train all associates to confirm egress is functional after walking through doors. Administrator will submit to CCLD by POC due date.

Deadline recorded: Nov 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(k)(8)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (k) The following initial and continuing requirements must be met for the licensee to utilize delayed egres devices on exterior doors or perimeter fence gates: (8) Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents and to escort residents who leave the facility. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above in by not having trained staff to meet the care and supervision needs for residents (R1) eloping from Memory Care which posed an immediate health and safety risk to persons in care.

Official plan of correction

Administrator agrees to conduct a re-training on elopement with all staff and will review staff schedules to ensure overlapping between shifts. Administrator will submit in-training sign-in sheet and updated staff schedules to CCLD by POC due date.

Deadline recorded: Nov 22, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87707(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: Based on record review, the licensee did not comply with the section cited above by not having current medical assessments for R5 which poses a potential health and safety risk to persons in care.

Official plan of correction

Executive Director (ED) has agreed to obtain current medical assessments for R5. ED will submit documentation to CCLD by POC date.

Deadline recorded: Oct 11, 2024. A deadline is not proof that correction was completed.

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: Based on record review, the licensee did not comply with the section cited above by not having current annual training for S6 and S7 which poses a potential health and safety risk to persons in care.

Official plan of correction

Executive Director has agreed to obtain current annual training for S6 and S7 and will submit completed training to CCLD by POC date.

Deadline recorded: Oct 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87629(b)(1)

Regulation authority

CCR

What the official deficiency says

Injections. Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance. This requirement is not met as evidence by: Based on investigation, licensee did not comply with section cited above by having a staff inject insulin for R1 which poses a potential health and safety risk to the persons in care.

Official plan of correction

Executive Director has agreed to conduct training for staff on injection regulations and submit staff sign in sheet to CCLD by POC date.

Deadline recorded: Aug 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 by not having health screening and TB test for S6 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2024 Plan of Correction Executive Director has agreed to obtain health screening and TB test for S6 and submit a copy to CCLD by POC date.

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 by not having current annual training for S6 and S7 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2024 Plan of Correction Executive Director has agreed to obtain current annual training for S6 and S7 and will submit completed training to CCLD by POC date.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. 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 by not having TB test for R4 which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2024 Plan of Correction Executive Director has agreed to obtain R4's TB test and will submit a copy to CCLD by POC 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 record review, the licensee did not comply with the section cited above by not completing quarterly drills which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2024 Plan of Correction Executive Director has agreed to conduct disaster drill and will submit documentation to CCLD by POC date.

Official classification

Type B

Official code

87707(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 not having current medical assessments for three residents which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 08/30/2024 Plan of Correction Executive Director (ED) has agreed to obtain current medical assessments for R4, R5, and R6. ED will submit documentation to CCLD by POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 visitors. This requirement is not met as evidence by: Based on observation and interview the licensee failed to secure the windows and window screens in memory care which posed an immediate Health & Safety risk to residents in care.

Official plan of correction

Administrator secured the windows by installing a " stopper " and also installed sensors on each window in the memory care unit. Deficiency cleared.

Deadline recorded: Apr 24, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1,...(4) To care, supervision, and services...competency to meet their needs.

Official plan of correction

Administrator stated that additional training was provided and a In-Service Training was conducted to the Med Techs on 02/29/24. Deficiency cleared.

Deadline recorded: Apr 25, 2024. A deadline is not proof that correction was completed.