BELROSE CARE HOME III

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

1569.652 Termination of admission agreement upon death of resident . . . (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been removed from the facility shall be issued . . . within 15 days after the personal property is removed. This requirement is not met as evidenced by: Statement from Licensee that the $6,000 pre-payment for June 2025 had not been refunded to Witness W1.

Official plan of correction

On or before the due date, the Licensee shall refund the fees paid in advance in full to W1.

Deadline recorded: Oct 8, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

87608 POSTURAL SUPPORTS (a) ... Postural supports may be used under the following conditions ... (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. This requirement was not met as evidenced by: Based on observation and record review, the licensee did not have a physician's order for a bed railing for R1, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Bed raining was removed from resident R1's bed during the visit.

Deadline recorded: Apr 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(g)(1)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (g) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: (1) Obtain a California clearance This requirement was not met as evidenced by: Based on observation and record review, the licensee did not have a physician's order for a bed railing for R1, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Transfer association to facility on or before due date.

Deadline recorded: Apr 13, 2023. A deadline is not proof that correction was completed.

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 ... interfering with daily living functions such as ... elimination. This requirement was not met as evidenced by: Based on observation and interview, the licensee blocked resident R1's ability to leave her bed to use the bathroom, which did not comply with the section cited above, which posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

On or before due date, Licensee shall get an updated Care Plan from R1's physician addressing her night wandering behavior.

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

Official classification

Type B

Official code

87457(c)

Regulation authority

CCR

What the official deficiency says

Pre-Admission Appraisal - General. Prior to admission...an appraisal of his/her individual service needs in comparison with the admission criteria... This requirement is not met as evidence by: Based on record review, licensee did not comply with the section cited above by not obtaining pre-placement appraisal which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to review regulations regarding to admission of a new resident. Administrator will submit a written statement acknowledging that all current and future residents will have a pre-placement appraisal to CCLD by POC date.

Deadline recorded: Sep 2, 2022. 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

Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidence by: Based on investigation, licensee did not comply with the section cited above by not administering medication according to doctor's orders which poses a potential health and safety risk to the persons in care.

Official plan of correction

Administrator has agreed to retrain all staff on medication administration and medication documentation. Administrator will submit staff sign-in sheet and training materials to CCLD by POC date.

Deadline recorded: Sep 2, 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

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

Official plan of correction

POC Due Date: 05/02/2022 Plan of Correction Send proof of completed updates and repairs: (1) updated facility sketch with fence (2) pieces of wood and other junk in back and side yard removed (3) removal of dryer from temporary location in back of facility (4) replace trash bins so that ALL have functioning tight fitting lids (5) lock all outside storage, and (6) repair fence board.