GOLDEN VILLA HOME

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 in that LPA observed R1's sliding glass door be secured closed with a wooden stick placed on the slider track, preventing the door from being opened. In addition, the gate on the left side of the entrance to the house is secured closed with a lock in place.which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/25/2026 Plan of Correction Administrator immediately removed the wooden stick that was securing R1's sliding glass door from opening.

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, intereview, and record review, the licensee did not comply with the section cited above in that LPA observed that four out of four residents most recent IPPs on file are over one year old,which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/03/2026 Plan of Correction Administrator stated that a request will be made to KRC to obtain all four residents IPPs and provide proof to CCLD of request made by POC due date of 03/03/2026. In addition, once IPPs are received Administrator will provide a copy of IPPS to CCLD.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors This requirement is not met as evidenced by: LPA observed an old sink/counter cabinet, 2 bedside toilets, 2 night stands, and miscellaneous items in need of removal. LPA observed outside wooden deck in need of repair. LPA observed deck to have uneven walking service, loose boards and broken board during inspection. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/07/2025 Plan of Correction Administrator to remove items on the side of the house and obtain an estimate for repair or removal of outside wooden deck in the backyard.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

87458 Medical Assessment (a) 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... This requirement is not met as evidenced by: LPA found that R1 did not have a complete medical assessment. The medical assessment on file was missing the primary diagnosis, secondary diagnosis (if any), prior medical services/history, indication of whether medication should be centrally stored, identification of physical limitations, ambulatory status, and was not signed by a physician, or any information applicable to the pre-admission appraisal, which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will submit proof of a completed medical assessment for R1 to CCL by POC due date.

Deadline recorded: Oct 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health. Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. 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 two out of two staff. S1 and S2 both do not have health screenings. S1 started 1/2/21 and S2 started 7/12/19, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/03/2022 Plan of Correction Licensee will submit proof of heath screenings for S1 and S2 to CCL by POC due date.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 one out of two staff. S2 first aid training certification expired 9/27/21, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/03/2022 Plan of Correction Licensee will submit proof of first aid training certification for S2 to CCL by POC due date.