MAGNOLIA PLACE

Official classification

Type A

Official code

873559(e)

Regulation authority

CCR

What the official deficiency says

873559(e)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… This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, S1 and S2 are not fingerprinted cleared and not associated to the facility, which poses an immediate risk to the health and safety of the residents.

Official plan of correction

POC Due Date: 04/09/2026 Plan of Correction S1 and S2 were off and left the facility during visit. S1 and S2 are not permitted back until fingerprinted cleared and associated. POC cleared during visit.

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

87309(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 was not met as evidenced by: Deficient Practice Statement Based on observation and records reviewed, R3 and R4 cannot have access to chemicals. Cleaning chemicals were observed in R3’s bathroom and under R4’s bathroom and kitchen sink unlock, which poses/posed an immediate health and safety risk for the person in care.

Official plan of correction

POC Due Date: 04/09/2026 Plan of Correction Administrator immediately removed chemicals to lock storage. POC cleared during visit.

Official classification

Type B

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

87465 (d)(3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record. This requirement was not met as evidenced by: Deficient Practice Statement Based on observation and records reviewed, R2’s PRN medication Acetaminophen 650mg order on 08/20/25 was not recorded in the resident’s MAR, which poses an immediate health and safety risk for the person in care.

Official plan of correction

POC Due Date: 04/09/2026 Plan of Correction Staff recorded medication PRN medication Acetaminophen 650mg in R2’s MAR during visit. POC cleared during visit.

Official classification

Type B

Official code

87633(b)

Regulation authority

CCR

What the official deficiency says

87633(b) A current and complete hospice care plan shall be maintained in the facility for each hospice resident… This requirement is not met as evidenced by: Deficient Practice Statement Based on record review and interview conducted, the licensee did not comply with the section cited above when LPA reviewed R1’s file who is currently receiving hospice care has no current hospice care plan on file, which poses a potential health or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/09/2026 Plan of Correction Administrator obtain current hospice care plan for R1 from hospice during visit. POC cleared during visit.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

87303(e)(5) Non-skid mats or strips shall be used in all bathtubs and showers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above no non-skid mat and/or strip was observed in the residents’ shower in room 19, room 17, and room 217, which poses/posed a potential health, safety or personal rights risk to person in care.

Official plan of correction

POC Due Date: 04/14/2026 Plan of Correction Proof of non-skid mat or strips in residents’ bathroom shower shall be submitted to the Fresno CCL by POC due date 04/14/26.

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 was not met as evidenced by:

Official plan of correction

A plan detailing steps the facility will take to ensure to meet the regulations is to submitted to the Fresno CCL office by POC due date 07/23/25.

Deadline recorded: Jul 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(d)(5)

Regulation authority

CCR

What the official deficiency says

87411(d)(5) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (5) Knowledge necessary in order to recognize early signs of illness and the need for professional help. This requirement was not met: Based on interviews and records reviewed, staff did not seek medical attention timely for resident’s fracture with resulted from an unwitnessed fall, after R1 complained of pain, which poses an immediate health and safety and personal rights risk to the person in care.

Official plan of correction

Licensee will submit a written plan to include when to contact medical attention timely for resident’s care and also will include date of when all staff in-service training including Administrator will be scheduled and completed. Written plan will be submitted to Fresno CCL by POC due date and all staff in-service training materials and rooster will be submitted to the department immediately after trainings has been completed in written plan.

Deadline recorded: Jul 23, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411(a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs…. This requirement is not met as evidenced by: Based on interviews and records review, staff did not provide care and supervision when R1 went AWOL on 11/24/24, and facility was not aware until the facility was notified by the neighbors. R2 went AWOL on 12/01/24 and the facility was not aware until the hospital called and informed the facility. R1 and R2 went AWOL poses an immediate health and safety risks to persons in care.

Official plan of correction

Licensee agrees to have AWOL policy and procedures in place to ensure the requirements and submit to Fresno CCL by POC due date 12/09/24.

Deadline recorded: Dec 9, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465 (h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year… This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above when resident’s medication and MARs was reviewed and observed medications were not logged into residents’ Centrally store medication log, which poses a potential health, safety or personal rights risk to person in care.

Official plan of correction

In-service training for all medication technicians shall be completed on documentation of medications. Training materials and rooster of staff attendances shall be submitted to the department by POC due date 04/05/24.

Deadline recorded: Apr 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

87465(a)(5) Incidental Medical and Dental Care The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not ensure staff administer medications residents as prescribed by physicians, which poses an immediate health and safety risks to persons in care.

Official plan of correction

Plan of correction of action plan the facility will take to ensure regulations is met at all times shall be submitted to CCL. POC of action plan will be submitted to department by 03/20/24. All medication technician staffs shall be retrained on administering medication. Copies of trainings and rooster of all staff attendance will be submitted to department by 04/05/24.

Deadline recorded: Mar 20, 2024. 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

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 LPAs and A1 observed cleaning chemicals in janitor and mechanical rooms unlocked. LPA and A1 observed chemical bottles and a knife in room 123, and chemical bottles in room 103 stored unlocked 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: 03/12/2024 Plan of Correction Administrator immediately locked janitor and mechanical room. Chemical bottles and knife were immediately removed from the residents’ room to locked area by Administrator. POC cleared during visit.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

Centrally stored medicines shall be kept in a safe and locked place... not accessible to persons other than employees... 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 A1 observed medications in room 130 and 103 stored unlocked 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: 03/12/2024 Plan of Correction Administrator immediately removed medications to locked area. POC cleared during visit.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above when LPA and A1 observed a square hole in the back wall under R1’s kitchen sink. Under ice machine in the kitchen LPAs and A1 observed mold, which poses a potential health, safety or personal rights risk to person in care.

Official plan of correction

POC Due Date: 04/03/2024 Plan of Correction Ice machine was cleaned immediately. Wall under kitchen sink in R1’s room shall be repair and proof of repaired shall be submitted to the department by POC due date 4/3/24.

Official classification

Type B

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities(a)(1) Residents in all residential care facilities for the elderly shall…be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:

Official plan of correction

Facility conducted an internal investigation and Administrator stated S1 have been terminated on 07/13/23 and all staff in-service training on Abuse was completed on 07/06/23, 07/07/23, 07/10/23, and on 07/20/23. Copies of S1 termination, all staff in-service training, and staff attendance for in-service training was received. POC cleared during visit.

Deadline recorded: Aug 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

HSC

What the official deficiency says

87411(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required… The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement was not met as evidence by: Based on records reviewed and interviews conducted, the licensee did not comply with the section cited above when Resident 1 a non-verbal and paralyzed resident had an unwitnessed fall on 12/14/23 and was not sent to the hospital until 12/16/23 which poses/posed an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

Facility has agreed to provide an all care staff in-service training to review all aspects of care and supervision. A review of when to call for Emergency Medical Services will also be conducted by due date. Administrator will submit staff attendance rooster which will include include date, signature of facility staff who attended and as well as a copy of training materials to CCLD via email by 05/11/23.

Deadline recorded: May 11, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

87465(a)(5)(A) Incidental Medical and Dental Care Facility staff…shall not administer injections, but staff designated by the licensee may assist persons with self-administration as needed. Assistance with self-administered… (A) Medications…prescribed for self-administration which have been authorized by the person's physician. This requirement was not met as evidence by: Based on record reviewed and interviews conducted, the licensee did not comply with the section cited above when staff administered Norco to resident 1(R1). Medication was not prescribed by the resident’s physician which poses/posed an immediate health, safety, or personal rights risks to the person in care.

Official plan of correction

Licensee shall have all med tech to be retrained on administering medication. Copies of trainings and rooster of staff attendance which will include signature of staff who attended and date. Trainings and rooster will be submitted to department by 5/11/23. A plan of correction of an action plan the Licensee will take to ensure regulations are met. Action plan shall include double checking medications with MARs before administering medications to resident and ongoing staff trainings on administering medications. POC of action plan will be submitted to department via email by 5/1/23.

Deadline recorded: May 1, 2023. 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

87465(a)(5) Incidental Medical and Dental Care The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews and records review, the licensee did not ensure staff administer medications to 31 residents on the evening of 01/17/23 which poses an immediate health and safety risks to persons in care.

Official plan of correction

Licensee stated all medication technician staffs has been retrained on administering medication on 01/31/23. Copies of trainings and rooster of staff attendance will be submitted to department by 02/07/23. A plan of correction of action plan the Licensee will take shall be submitted to CCL. POC shall include facility MAR to be reviewed by staff and ongoing staff trainings on administering medications. POC of action plan will be submitted to department by 02/07/23.

Deadline recorded: Feb 7, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.49(c)(1)

Regulation authority

HSC

What the official deficiency says

§1569.49 Civil penalties (c) The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation for any of the following serious violations: (1) Any violation that the department determines resulted in the injury or illness of a resident. This requirement was not met as evidenced by LPAs review of hospital and facility records evidencing R1 was not receiving the required blood sugar readings and or insulin injection per the physician's orders, resulting in hospitalization on two occasions. This poses a direct and immediate risk to the health and safety, or personal rights of resident's in care. A civil penalty in the amount of $500 is being assessed. This poses a direct and immediate risk to the health and safety, or personal rights of resident's in care.

Official plan of correction

Administrator provided LPA with a Diabetic policy/plan covering procedures effective 08/2022. An in-service training was completed with all Memory Care staff on 01/23/23. LPA received signed training attendance logs evidencing the training. **POC Cleared**

Deadline recorded: Jan 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by LPAs observation of pictures, records review and interviews. R1's hands/arms were held while staff were attempting to assist in daily living needs. This poses an immediate risk to resident's in care.

Official plan of correction

Administrator will provide additional dementia training with an emphasis on how staff will handle behaviors including aggressiveness and sun downing.

Deadline recorded: Jan 25, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(3)

Regulation authority

CCR

What the official deficiency says

(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. This requirement was not met aas evidenced by LPAs interviews and records review that incontinence care was not provided by staff due to resident's refusal and cognitive mental state at the time. R1 was left soiled for several hours, on more than one occasion, while facility waited for assistance from R1's family.

Official plan of correction

Administrator will provide incontinence training to all staff with an emphasis on resident's with dementia and behaviors. *POC due date 02/10/2023*

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87218(a)

Regulation authority

CCR

What the official deficiency says

87218 Theft and Loss (a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153 (1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative.

Official plan of correction

Administrator will create an additional resident reocrds checklist that ensures residents receive all the LIC required documents. Administrator will provide checklist by POC due date of 02/10/23.

Deadline recorded: Feb 3, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature..., This requirement was not met as evidenced by LPA's interviews with staff and reporting party that resident was sent to hospital via EMS with only a sheet (naked) wrapped around their lower body.

Official plan of correction

Administrator will conduct an all staff in service reviewing the full regulation 87468.1. Administrator will send a sign in sheet evidencing staff have reviewed and understand the regulation. Plan of Correction due 02/10/23.

Deadline recorded: Feb 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 was not met as evidenced by . During the course of a prior complaint investigation conducted it was observed that the air conditioning in room #10 was not working properly and the toilet seat in resident bathroom #1 was missing.

Official plan of correction

During subsequent facility tour on 8/26/22. LPA observed air conditioning unit in room #10 to have been replaced and working properly. The toilet seat in resident bathroom #1 to be replaced DEFICIENCY CLEARED AT TIME OF CASE MANAGEMENT VISIT.

Deadline recorded: Aug 26, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

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 evidenced by staff not supervising residents in the television room, resulting in R1 assaulting R2, requiring R2 to be hospitalized for fractured ribs and pneumothorax requiring chest tube placement. This is an immediate risk to resident health and safety.

Official plan of correction

Administrator will submit written plan within 24 hours, that details the steps that will be taken to ensure this regulation is met. The plan shall include a date(s) that staff, including lead and supervisory, will be trained on personnel requirements within 10 days of the POC due date (9/12/22). Facility shall submit proof of training to licensing when completed.

Deadline recorded: Aug 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87413(a)(1)

Regulation authority

CCR

What the official deficiency says

87413 Personnel - Operations (a) In each facility: (1) When regular staff members are absent, there shall be coverage by personnel with qualifications adequate to perform the assigned tasks. This requirement was not met as evidenced by interviews with staff and observation of police and facility reports.

Official plan of correction

Executive Director has hired additional staff to provide additional supervision in the Alderbrook Memory Care. Facility requested R1 be seen by their physican for evaluation of behaviors. ** POC Cleared **

Deadline recorded: Jul 22, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.49(c)(1)

Regulation authority

HSC

What the official deficiency says

.The department shall assess an immediate civil penalty of five hundred dollars ($500) per violation and one hundred dollars ($100) for each day the violation continues after citation for any of the following serious violations: (1) Any violation that the department determines resulted in the injury or illness of a resident. This requirement was not met as evidenced by: LPA's observation of hospital medical records. Facility did not seek emergency medical treatment for Resident R1 on 11/20/2020, resulting in hospitalization.

Official plan of correction

Facility has inserviced all staff on seeking appropriate medical care for residents in the facility. In the case of a change in condition, 911 will be dispatched, Resident's Representative and MD will be notified. ***POC cleared/Civil Penalty Assessed***

Deadline recorded: Jul 22, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.80(a)

Regulation authority

HSC

What the official deficiency says

(a) A resident of a residential care facility for the elderly, or the resident’s representative shall have the right to participate in decisionmaking regarding the care and services to be provided to the resident. Accordingly... the facility shall coordinate a meeting with... the resident’s representative... an appropriate member...of the facility’s staff, if the resident is receiving home health services in the facility...and a representative of the home health agency involved,. The facility shall ensure that participants in the meeting prepare a written record of the care the resident will receive in the facility... This requirement was not met as evidenced by interview with Executive Director stating a meeting with Home Health and resposible parties had not happened.

Official plan of correction

Facility has conducted staff meeting to include procedures that will ensure a care conference is conducted upon admission to home health services. Resident, responsible party , Home health and LVN of the facility will be present. ***POC Cleared*** .

Deadline recorded: Jul 22, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

Not listed

Regulation authority

CCR

What the official deficiency says

Deficiency narrative not available.

Official plan of correction

.