MAPLE TREE CARE HOME 2

Official classification

Type B

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above, LPAs observed fire extinguisher last serveiced on 06/2023, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/23/2024 Plan of Correction licensee will have fire extinguisher serviced and provide proof to LPA by 8/23/24 POC date

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on, observation and record review, the licensee did not comply with the section cited above, LPAs during record review observed that staff 1 did not have TB test included on Health Screening Report, however was not associated with facility. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/23/2024 Plan of Correction Licensee will ensure Staff has correct health screening, and send proof to LPA by POC 8/23/24.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(a) (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:This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in LPAs observed in facility resident restroom, and laundry room, chemical containers unlocked, and accessible to residents. LPAs also observed chemicals not in their original container and placed in food containers, which poses an immediate health, safety or personal rights risk to persons in car

Official plan of correction

POC Due Date: 08/10/2024 Plan of Correction Licensee will provide training to staff on proper storage and handling of cleaning solutions, and send proof to LPA by POC date of 08/10/2024.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information.(1) The specific symptoms which indicate the need for the use of the medication.(2) The exact dosage.(3) The minimum number of hours between doses.(4) The maximum number of doses allowed in each 24-hour period. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in Resident 1 does not written prescription for PRN sleeping medication, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/23/2024 Plan of Correction Licensee will provide written prescription for Residents PRN sleeping medication, and provide proof to LPA's by POC date of 08/23/2024.

Official classification

Type B

Official code

87705(a)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (a) This section applies to licensees who accept or retain residents diagnosed by a physician to have dementia. Mild cognitive impairment, as defined in Section 87101(m), is not considered to be dementia.(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. 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 Resident 1 did not required have annually updated Physician's report. which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/23/2024 Plan of Correction Licensee will update Resident 1's Physician's report, and send proof to LPA's by POC date of 08/23/2024.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, record review, the licensee did not comply with the section cited above, Resident 1 did not have requeired TB test, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/23/2024 Plan of Correction Licesee will submit R1 TB record to LPA by POC date of 8/23/24.

Official classification

Type A

Official code

87468.2(a)(1)

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... (1) To have a reasonable level of personal privacy in accommodations, medical treatment, personal care and assistance, visits, communications, telephone conversations, use of the Internet, and meetings of resident and family groups. This requirement was not met as evidenced by: Based on observation, Licensee did not ensure residents have a reasonable level of personal privacy as evidenced by cameras installed in 6 out of 6 resident bedrooms.

Official plan of correction

Licensee agreed to submit a written statement detailing the steps the facility will take to ensure the requirements of section 87468.2 are met to the Fresno CCL office by the POC due date. Licensee also agrees to remove the cameras in the resident bedrooms and submit proof of removal to the Fresno CCL office by 08/19/2022.

Deadline recorded: Aug 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87202(a)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when the fire exits in rooms 3 and 6 were blocked by furniture which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/19/2022 Plan of Correction Licensee agrees to remove the furniture from blocking the fire exits by the POC due date and submit proof to the Fresno CCL office.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as evidenced by the facility not having a week supply of non-perishable foods and 2 day supply of perishable foods in the facility which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/18/2022 Plan of Correction Licensee agreed to purchase the required amount of food items and will submit a written statement detailing the steps the facility will take to ensure the requirements for section 87555 are met to the Fresno CCL office by the POC due date.