HERITAGE CARE HOME

Official classification

Type B

Official code

87469(a)

Regulation authority

CCR

What the official deficiency says

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 1 out of 5 residents did not posess a Consent for Medical treatment form which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/18/2025 Plan of Correction LIcensee agrees to have the Consent form completed and submitted to CCLD by POC due date.

Official classification

Type B

Official code

1569.69(e)(2)

Regulation authority

HSC

What the official deficiency says

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 1 out of 5 residnents did not possess an Appraisal Needs and Services plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/18/2025 Plan of Correction Licensee agrees to have the Appraisal Needs and Services plan completed and submitted to CCLD by POC due date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

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 as specified in Section 87355(c) This requirement is not met as evidenced by: Deficient Practice Statement LPA observed S1 and S2 working, fingerprinted, cleared and not associated to facility which poses an immediate risk to the health and safety of the residents.

Official plan of correction

POC Due Date: 01/30/2024 Plan of Correction S1 shift was over and left the facility during inspection. S2 was removed from the facility immediately. S1 and S2 is not permitted back until associated. Licensee to submit LIC 9182 Fingerprint transfer request to Fresno CCL office by POC due date 1/30/24.

Official classification

Type A

Official code

87411(c)

Regulation authority

CCR

What the official deficiency says

All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and staff interviews, staff did not have required trainings which poses an immediate risk to the health and safety of the residents.

Official plan of correction

POC Due Date: 01/30/2024 Plan of Correction Licensee stated will provided a written statement of how POC will be completed and submitted to Fresno CCL office by 01/30/24. All staff trainings records of completion shall be submitted to Fresno CCL office by 02/29/24.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidenced by: Deficient Practice Statement At approximately 10:30AM, LPA and House manager observed medication tablets for R2 stored inside a zip lock bag and not in original container which poses an immediate risk to the health and safety of the residents.

Official plan of correction

POC Due Date: 01/30/2024 Plan of Correction Licensee agrees to review regulations and submit a written statement understanding regulation 87565 to Fresno CCL office by POC due date 01/30/24.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

Administrator-Qualifications and Duties. The administrator shall have the knowledge of and ability to conform to applicable laws, rules and regulations. This requirement is not met as evidenced by: Deficient Practice Statement Fire extinguisher was observed with a purchased date of 2/28/22, which poses an immediate health and safety risk to the residents.

Official plan of correction

POC Due Date: 01/30/2024 Plan of Correction Fire extinguisher shall be replaced or serviced with a current date. Proof of correction will be submitted to the CCL office by the 01/30/24.

Official classification

Type B

Official code

1796.45

Regulation authority

HSC

What the official deficiency says

Health and Safety Code 1796.45 TB Testing (a) Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease. This requirement is not met as evidenced by: Deficient Practice Statement LPA reviewed S1 did not have a TB result on file which poses a potential risk to the health and safety of the residents.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction Licensee shall ensure all staff have a TB result on file. S1 TB result shall be submitted to the Fresno CCL office by POC due date 02/14/24.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above when LPA reviewed all residents; file and observed R2 did not have a Physician report assessment on file which poses a potential health and safety risks to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction Licensee shall ensure that all residents have a Physician Report on signed, completed, and on file. Licensee shall submit to obtain Physician report for R2 by POC due date and submit to the Fresno CCL office by 02/14/24.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review and interview with staff, Licensee did not comply with the regulations above by not having a centrally stored medication log for all four resident’s PRN medications and log for PRN medications being administered which poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction Licensee to provide staff training on documenting and logging resident’s medication in centrally stored medication list and in resident’s MARs. Licensee will submit documentation of training topics and staff attendance roster to Fresno CCL office by POC due date 02/14/24.

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

The licensee shall complete an individual written admission agreement for each resident. This requirement is not met as evidenced by: Deficient Practice Statement Based on records review, the licensee did not comply with the section cited above when LPA reviewed all residents; file and observed R1 did not have an Admission Agreement which poses a potential health and safety risks to persons in care.

Official plan of correction

POC Due Date: 02/14/2024 Plan of Correction Licensee shall ensure that all residents have an Admission Agreement on signed, completed, and on file. Licensee shall have an Admission Agreement for R1 completed and signed by POC due date. Copy of R1’s Admission Agreement shall be submitted to Fresno CCL office by POC due date 02/14/24.

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...locked place not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Key to open locked drawer in facility kept on wall opposite locked drawer making contents accessible to residents.

Official plan of correction

Key was made inaccessible @ time of visit.Facility will develope written plan how key will be made & maintained inaccessible to resients. Plan to include commitment to do training & date(s) of training. Copy of plan to be emailed to this LPA by due date. Failure to submit POC's by due date may result in Civil Penalties.

Deadline recorded: Dec 22, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

Plan of Operation. Each facility shall have and maintain a current, written definitive plan of operation....including...plan that describes the capacities... ( & )the uses intended and a designation of the rooms to be used. Vacant designated resident room being used as a staff bedroom.

Official plan of correction

Licensee to determine if will have awake staff at all times or to designate a room for staff. Licensee to notify the Department by due date. Licensee to follow-up with Department on how to implement changes if needed. Licensee may email notification of decision to the LPA. Please reference facility by name & number. Include follow-up contact telephone number.

Deadline recorded: Jan 5, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

Incidental Medical...Care. A plan for incidental medical...care shall be developed by each facility. Facility staff...may assist persons with self-administration (of medication) as needed. Medication observed to be given past d/c date due to lack of plan. MARs not being signed at time Rx given, requiring a plan to ensure records are maintained correctly @ all times.

Official plan of correction

CHM has agreed to submit a plan of how medication communication will be documented & handled in a timely manner, as well as maintaining correct med record keeping (MARs). Plan to include brief outline to be shared with staff & date(s) staff will be trained. Facility to maintain personnel training documents.. POC may be emailed to the LPA by date indicated.

Deadline recorded: Dec 22, 2023. A deadline is not proof that correction was completed.