CARMEL VILLAGE AT CLOVIS

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 following resident's rooms had a water temperature of: Room 110 is 124 degrees Room 226 is 125 degrees Room 239 is 125.2 degrees Room 232 is 128.5 degrees Room 342 is 127.6 degrees Room 308 is 122.4 degrees which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2024 Plan of Correction Administrator to submit statement of intent to adjust water heater temperatures to bring resident's water temperature between 105-120 degrees.

Official classification

Type A

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation 7 out of 7 residents were observed with no shower mats or strips which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2024 Plan of Correction Administrator to submit written statement of intent to check all resident's bathrooms and install shower mats or shower strips.

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 Clorox bleach and Shout observed in 2nd floor laundry room unlocked. Carpet shampoo observed in trash room unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2024 Plan of Correction Administrator to submit a written statement that all chemicals are stored in a locked facility.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation Centrally stored medication log was observed without start date. (R1) medication Ferrous Sulfate was not found in CSMDR which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2024 Plan of Correction Administrator to submit statement of intent to conduct inservice training and complete audit of all resident's medication and submit findings to CCLD.

Official classification

Type A

Official code

87465(c)

Regulation authority

CCR

What the official deficiency says

Medications must be given per the physician’s direction. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when LPA, Administrator and Health Service Coordinator reviewed residents’ MARS and medications. LPA and Health Services Coordinator observed R1 medication was not given as directed which poses an immediate health, safety or personal rights risk to person in care.

Official plan of correction

POC Due Date: 10/03/2023 Plan of Correction POC of documentation of how the facility shall ensure medications are administered as directed by resident’s physicians due by 10/03/23. In-service training on administering medication will submit with documentation of training topics and staff attendance roster to the Fresno CCL office by 10/13/23.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211(a)(1) Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports… (1) A written report shall be submitted to the licensing agency ...within seven days of the occurrence of any of the events… This requirement is not met as evidenced by: Based on record review: Licensee did not ensure a written report was submitted to the Fresno CCL office within 7 days of occurrence on 09/06/22. Licensee submitted written report of incident to CCL on 09/14/22, which this poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee agrees to submit a plan detailing steps the facility will take including trainings to ensure the requirements of Reporting requirements are met by the POC due date.

Deadline recorded: Sep 28, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(g)(B)

Regulation authority

CCR

What the official deficiency says

Admission Agreements (g) Admission agreements shall specify the following: (B) Rate for additional items and services This requirement is not met as evidenced by: Based on records reviewed and interview conducted, the licensee did not comply with the section cited above. Licensee applied surcharge fee to resident that was not included in the admission agreement, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee shall submit a plan of steps that will be taken to ensure the regulation is met by the due date.

Deadline recorded: Sep 6, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a) Personnel Requirements - General Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met as evidenced by: Based on interviews conducted and records reviewed, S1 pinched R1’s nipple twice while giving R1 a shower, which poses an Immediate Health and Safety risk to the resident in care. *Immediate civil is assessed.*

Official plan of correction

The Administrator states staff was let go from employment. Facility will provide training to staff on resident’s personal rights and abuse. POC will be submitted to the CCL office by the due date of 10/8/21.

Deadline recorded: Oct 1, 2021. A deadline is not proof that correction was completed.