LAVERNE SENIOR CAREHOME

Official classification

Type A

Official code

87203

Regulation authority

CCR

What the official deficiency says

Fire Safety. All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. U-Lock observed at upper lefthand corner of front entry door. U-Lock not able to be unlatched without use of ladder & /or step stool, unless tall enough to reach. Immediate Risk

Official plan of correction

Facility agreed to remove lock @ time of visit. Lock in process of being removed @ time of visit. Photo of door lock removed to be submitted before end of day in order to stop accrual of civil penalties. Immediate Civil Penalty Issued. ($500.00)

Deadline recorded: Jul 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(A)

Regulation authority

CCR

What the official deficiency says

87307 (a)(3)(A) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (A) A bed for each resident, except that married couples may be provided with one appropriate sized bed. Each bed shall be equipped with good springs, a clean and comfortable mattress, available pillow(s) and lightweight warm bedding. Fillings and covers for mattresses and pillows shall be flame retardant. Rubber sheeting shall be provided when necessary. This requirement is not met as evidenced by: Based on interviews conducted, observation, records reviewed, R1 sleeps on comforter. No bed was observed provided for R1, which poses/posed a potential health and safety and personal rights risk to the resident in care.

Official plan of correction

An exception with supporting documents will be submitted to the Fresno CCL by POC due date 07/17/25.

Deadline recorded: Jul 17, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

87202 (a)(2) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. (2) Bedridden persons. This requirement is not met as evidenced by: Based on observation and records reviewed, R1 is bedridden and resides at the facility with no fire clearance for bedridden, which poses/posed an immediate health and safety and personal rights risk to the resident in care.

Official plan of correction

Facility is not fire cleared for bedridden residents therefore cannot obtain bedridden residents to the facility. Licensee will provide a written statement detailing steps the facility will take to ensure to meet regulations by POC due date 07/12/25.

Deadline recorded: Jul 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (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. The following requirement has not been met as evidenced by: Resident 1's Physician Report was last updated on 02/02/2020 which poses a potential, health, safety or personal rights risk to residents in care.

Official plan of correction

Administrator will send current Medical Assesment for Resident 1 to LPA by 11/29/2023 POC date.

Deadline recorded: Nov 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(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, the licensee did not comply with the section cited above when LPA and caregiver observed a paint bucket and a bottle of Muriatic Acid outside on the side of the facility accessible to residents in care this poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/02/2022 Plan of Correction Caregiver immediately removed paint bucket and Muriatic Acid bottle into locked garage. POC cleared during visit.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 (h)(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, the licensee did not comply with the section cited above when LPA and caregiver observed a three medications bottle on kitchen counter unlocked which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/02/2022 Plan of Correction Caregiver immediately removed and stored medications in locked medication shelf. POC cleared during visit.

Official classification

Type B

Official code

87555(a)

Regulation authority

CCR

What the official deficiency says

87555(a) General Food Service Requirements-The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents ...All food shall be selected, stored, prepared and served in a safe and healthful manner. 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 and caregiver observed a expired milk date of 11/24/22 and two hamburger bun package expired date of 09/14/22 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/07/2022 Plan of Correction Licensee agrees to audit food once a week. Licensee will submit to the department with documentation of plan to ensure regulations are met which includes date of the week food will be audit. Documentation shall be submitted by the 12/7/22.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

87202 (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above when LPA observed in bedroom 4 exit door blocked by 5 drawer dresser which an immediate health and safety risk which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Staff moved the 5-drawer dresser over to the side of the bedroom. POC cleared during visit.

Deadline recorded: Aug 16, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements – General All personnel shall be given on the job training… This training and/or related experience shall provide knowledge of and skill…by safe and effective job performance, Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement was not met: Based on interviews conducted, on three occasions, staff did not meet R1’s need when requested to be taken out of bed which poses a potential health and safety and personal rights risk to the person in care.

Official plan of correction

Licensee shall have in-service training for staffs regarding meeting residents’ need. Documents of staff in-service training including rooster of attendance shall be submitted to CCL by due date. Licensee will submit a plan of correction detailing the steps that will be taken to ensure the regulations will be met in the future to Fresno CCL by the due date.

Deadline recorded: Aug 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

87405(d)(2) 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 Based on observation, Fire Extinguisher has a service date of 06/16/2020, which poses an immediate health and safety risk to the residents.

Official plan of correction

POC Due Date: 10/14/2021 Plan of Correction Administrator states fire extinguisher will be replaced or serviced with a current date. Proof of correction will be submitted to the CCL office by the 10/14/21.