HARVEST AT FOWLER, THE

Official classification

Type B

Official code

87468.2(a)(8)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse. This requirement was not met as evience by: interviews conducted, video surveillance and records reviewed. The licensee did not comply with the section cited above in that S1 and S2 had a loud verbal altercation in the main living room of the facility with residents in the surrounding vacinity. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Administator stated they will hold an all staff training. In -service sign in sheet and training material will be provided to CCL by POC date. Administrator stated that an internal investigation is still ongoing pending the disciplinary action for S1 and S2's.

Deadline recorded: Jun 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report...(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: Records review and interviews conducted. The licensee did not comply with the section cited above in that a report of an incident involving S1 and S2 occurring on 05/21/26 was not reported to the Department. This poses a potential health safety and or personal rights risk to residents in care.

Official plan of correction

Administator stated they will hold an all staff training. In -service sign in sheet and training material will be provided to CCL by POC date.

Deadline recorded: Jun 12, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c)… facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on review of records, the licensee did not comply with the section cited above in that 1 of 4 records reviewed disclosed medication is not being provided as prescribed. R1's MARS shows medication (Ondansetron HCL 4 mg tablet, generic for Zofran 4 mg tab with instructions take 1 tablet by mouth every 6 hrs as needed for nausea/vomitting) should have a count of 27 but has 26. Medication is short 1 tablet. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/27/2026 Plan of Correction Administrator stated they will provide their plan of correction in writting. Plan is to include all staff training. In-service sign in sheet and training material will be provided to CCL as proof of correction.

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 for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the 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. This requirement was not met as evidence by: file review. The licensee did not comply with the section cited above in that it was noted in the staff log book R2 was observed to be ill on 2/13/25 and was not taken to the physician. R2 was sent out via EMS to the hospital on 2/21/25. R2 did not receive timely medical attention for their illness. This poses a potential health safety and or personal rights risk to persons in care.

Official plan of correction

Administator stated they feel everything was completed by them with the expception of lack of documentation. Administrator stated they will generate a contact form to log attempts with family in getting timely medical attention for residents. Administrator stated they will provide a copy of this form to CCL by POC date as proof of correction.

Deadline recorded: May 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observation, the licensee did not comply with the section cited above in that 2 of 6 bedrooms observed with chemicals accessible to residents in care. Gardening tools observed unlocked and accessible to residents in care. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/08/2025 Plan of Correction Items immediately removed/locked. Care Coordinator stated during meeting on 4/30/25 regulation will be discussed. In-serivce sign in sheet and training material will be sent to CCL as proof of correction.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in that 2 of 3 files reviewed did not have pre-admission appraisal. Reappraisals are not being completed. Reappraisals observed to have not been completed in 2 of 3 files reviewed. (3rd file reivewed was a new resident). This poses a which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/08/2025 Plan of Correction Facility requested to be referred to TSP for assistance. Care Coordinator and Licenced Vocational Nurse will work on updating files to include updated documents needed. Facility stated they will keep an ongoing list of updated files and submit to CCL as proof of correction by POC date.

Official classification

Type B

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 LPA observations, the licensee did not comply with the section cited above in that various resident bathrooms and activity cabinet was observed with chemical/items that could pose a danger to residents in care unlocked and accessible. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Administrator stated they will place all residents belongings (chemical/hygeine products) in locked rooms until cabinets can have locks added. Receipts/pictures to be sent to CCL by POC date.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA observations, the licensee did not comply with the section cited above in that room #305 was observed with an oxygen tank inside without " oxygen in use signs posted as required. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Posting was immediately posted outside the room. Training to be completed with all staff. In service sign in sheet and training material to be provided to CCL by POC date.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident and include the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on LPA interview with Administrator, the licensee did not comply with the section cited above in that R1 was admitted on hospice 5/18/24. A hospice care plan/training was not secured by the facility at time of admittance. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/31/2024 Plan of Correction Administrator to contact Hospice agency to get Care Plan. A copy of the care plan will be sent to CCL by POC date.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a) 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 evidence by: LPA observation of Incident report. On 3/9/23 R1, jumped fence and AWOL'd from the facility resulting in an injury requiring medical attention.602 dated 2/17/23 stated that R1 was " not able to leave the facility unassisted " . This posed an immediate health, safety and or personal rights risk to resident in care. Civil penalty assessed.

Official plan of correction

Administrator to provide email to CCL by POC describing actions to be taken by facility. Administrator to provide in-service training to all staff. Training material and in-service training sheet to be provided to CCL by 8/14/23.

Deadline recorded: Aug 5, 2023. A deadline is not proof that correction was completed.