GREEN GABLES CARE HOME III

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355(e) (1) 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 was not met as evidenced by: Licensee did not ensure S1 had a Criminal Record Clearance. S1 was working on 1/16/24 at the facility. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

AD removed S1 from the facility. S1 cannot return to the facility unless requirements for Criminal Record Clearance is obtained. DEFICIENCY CLEARED

Deadline recorded: Mar 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)(c)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services (f) Basic services shall at a minimum include: (1) Care and supervision as defined… in (c) " Care and supervision " means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered… Requirement not met as evidenced by: Licensee did not provide basic services such as care and supervision resulting in R1 exiting the facility without staff knowing. R1 passed away in the hospital. This poses an immediate health, safety or personal rights violation to persons in care.

Official plan of correction

AD has agreed to submit a formal written statement which will include the plan and procedural changes that will be implemented to keep this type of incident from happening again. Training and timeframe to be included. This statement will be submitted to CCLD by POC date.

Deadline recorded: Mar 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed... Licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. Requirement not met as evidenced by: Licensee did not ensure that R1's Responsible Party was notified that R1 was taken via ambulance to the hospital after being found by staff to have exited the home and experiencing a fall outside. This poses a potential health, safety or personal rights violation to persons in care.

Official plan of correction

AD has agreed to provide inservice to all staff on the facility procedure of contacting required parties when a resident is sent out or experiences a significant change. A copy of procedure and a sign in sheet with names and signatures of staff will be submitted to CCLD by POC date

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

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care 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 when LPA observed at approximately 01:49PM, resident’s insulin injections box stored in unlock refrigerator accessible to residents which poses an immediate health, safety or personal rights risk to person in care.

Official plan of correction

POC Due Date: 11/02/2022 Plan of Correction Caregiver and Designee immediately locked medications in medication lock box in refrigerator. POC cleared during visit.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

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 when LPA observed at approximately 01:55 PM, two Bleach bottles stored and unlocked in laundry cabinet. Two ambulatory residents were observed in the common area when Bleach bottles was unlocked in the laundry room. Bleach bottles was observed stored and unlocked accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/02/2022 Plan of Correction Caregiver immediately removed Bleach Bottles into locked cabinet in the laundry room. POC cleared during visit.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

HSC

What the official deficiency says

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: (2) Request a transfer of a criminal record clearance… This requirement is not met as evidenced by: Deficient Practice Statement Base on observation, LPA observed Staff 1 (S1) providing resident care and supervision during inspection. LPA reviewed and confirmed on Facility Personnel Report Summary dated 10/18/22, S1 not associated with facility. S1 is not associated and has been providing resident’s care and supervision which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/02/2022 Plan of Correction Staff person is to be removed from the facility and not permitted back until associated with facility. POC cleared during visit.