HEAVENLY CASTLE CARE INC

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in water measuring at 96.2 F in residents bathroom, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2024 Plan of Correction Licensee agrees to submit a photo of water temperature measuring in between 105 F to 120 F by POC due date 11/20/24.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in R3 pill count being 1 pill off in two of R3's prescribed medications, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/20/2024 Plan of Correction Licensee agrees to submit a plan to conduct a medication training and submit the date the training will be conducted by POC due date 11/20/24. Civil Penalty was issued for repeat violation.

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 [(observation) (interview) (record review)], the licensee did not comply with the section cited above in R1, R2 and R3 not having a Hospice Care plan which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Licensee agrees to submit a copy of R1, R2 and R3's Hospice care plan meeting this regulation by POC due date 11/22/24.

Official classification

Type B

Official code

87633(b)(6)

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: (6) Identification of the training needed, which staff members need this training, and who will provide the training relating to the licensee's responsibilities for implementation of the hospice care plan. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee not having training for staff for hospice care for R1, R2 and R3, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Licensee agrees to submit Hospice training meeting this regulation for staff for R1, R2 and R3 by POC due date 11/22/24.

Official classification

Type B

Official code

87633(h)

Regulation authority

CCR

What the official deficiency says

(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record: This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee does not have any documentation in Hospice binders for residents on hospice, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Licensee agrees to provide a written statement on how this regulation will be met by POC due date 11/22/24.

Official classification

Type B

Official code

87633(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record: (5) A statement signed by the resident's roommate, if any, or any resident who will share a room with a person who is terminally ill to be accepted or retained as a resident, indicating his or her acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident's life, and the roommate's voluntary agreement to grant access to the shared living space to hospice caregivers, and the resident's support network of family members, friends, clergy, and others. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in Licensee does not have a statement signed by R2's roommate agreeing to share a room with R2 who is on hospice, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/22/2024 Plan of Correction Licensee agrees to obtain a written signed statement meeting this regulation from R2's roommate and will submit by POC due date 11/22/24.

Official classification

Type A

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet. (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation, interviews, and records reviewed the licensee failed to obtain proper documentation for R1 to have full bed rails on the bed. This poses an immediate health, safety, or personal rights risk to residents in care.

Official plan of correction

AD removed the full bed rails from R1's bed. POC completed while LPA was in the facility.

Deadline recorded: Mar 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Based on observation, interviews, and records reviewed the licensee failed to properly log R3's narcotic medication Oxycodone. This poses an immediate health, safety, or personal rights risk to residents in care.

Official plan of correction

Administrator will complete log for Oxycodne. Statement will be provided to LPA by due date. POC completed while LPA was in the facility.

Deadline recorded: Mar 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement is not met as evidenced by: Based on observation, interviews, and records reviewed the licensee failed to provide resident records when LPA’s requested. Staff was asked for resident files to review and told LPAs to wait for the administrator. This poses a potential health, safety, or personal rights risk to the residents in care.

Official plan of correction

Administrator will conduct training with staff to provide requested documents/records to LPAs when requested.

Deadline recorded: Mar 14, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self administered medications as needed. This requirement is not met as evidenced by: Based on observation, interviews, and records reviewed the licensee failed to log centrally stored medication indicated medication started on Monday 4/4/24 and after the count indicated the start date was 3/6/24. There was no verifiable date the medication started and the count of R3's Oxycodone was incorrect.

Official plan of correction

Administrator will have Centrally stored log completed timely. Verification will be provided to LPA. POC completed while LPA was in the facility.

Deadline recorded: Mar 8, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.17(c)(1)(A)

Regulation authority

HSC

What the official deficiency says

(c)(1)(A) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempted from fingerprinting shall obtain either a criminal record clearance or an exemption, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in a facility. 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 in Staff Arusyak Ayvazyan not being fingerprint cleared prior to working in the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/07/2023 Plan of Correction Licensee agrees to not have employees work at the facility until fingerprint cleared. Staff was immediately removed from the facility. POC cleared during visit. Civil Penalty issued.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(4) The licensee shall assist residents with self-administered medications as needed. 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 R1 running out of medications 7 days before the medications should have run out, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/08/2023 Plan of Correction Licensee agrees to conduct a medication training conducted by a skilled professional and submit agenda and sign in sheet by POC due 11/17/23.

Official classification

Type A

Official code

87465(b)

Regulation authority

CCR

What the official deficiency says

(b) If the resident's physician has stated in writing that the resident is able to determine and communicate his/her need for a prescription or nonprescription PRN medication, facility staff shall be permitted to assist the resident with self-administration of his/her PRN medication. This requirement is not met as evidenced by: Deficient Practice Statement Based on interview and record review, the licensee did not comply with the section cited above in R1 ran out of PRN medications and medications were not refilled, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/08/2023 Plan of Correction Licensee agrees to conduct training by a skilled professional on PRN medications and submit agenda and staff trained by POC due date 11/17/23.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 not having health screenings for staff, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/17/2023 Plan of Correction Licensee agrees to submit staff health screenings by POC due date 11/17/23.

Official classification

Type B

Official code

87465(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly, facility staff designated by the licensee, shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: (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 is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in R1's PRN was not logged date or time which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/17/2023 Plan of Correction Licensee agrees to submit a written statement of the understanding of this regulation and how it will be met by POC due date 11/17/23.

Official classification

Type B

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

(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 resident's file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information. 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 not having a written order from a physican on a prescription blank for all residents in care, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/17/2023 Plan of Correction Licensee agrees to submit a written statement on the understanding of this regulation and how this regulation will be met by POC due

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 interview and record review, the licensee did not comply with the section cited above in not having a hospice care plan for R2 and R3 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/17/2023 Plan of Correction Licensee agrees to submit copies of R2 and R3's hospice care plans by POC due date.