KERN VILLAGE ASSISTED LIVING FOR SENIORS

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. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular 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 is not met as evidenced by: Based on interviews conducted and records review, R1 and R2 had physical altercation where R2 was sent to the hospital for medical treatment after R2 had wandered into R1’s room without supervision, which poses an immediate health and safety risks to persons in care.

Official plan of correction

Facility will submit a statement letter providing steps how the facility will ensure the residents who wanders are safe. Statement will be submitted to the Fresno CCL by POC due date 05/28/26.

Deadline recorded: May 28, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.185(e)

Regulation authority

HSC

What the official deficiency says

HSC 1569.185(e) Fees for license or applications; use of revenues; collected; denial or forfeiture. The failure of an applicant for licensure or a licensee to pay all applicable and accrued fees and civil penalties shall constitute grounds for denial or forfeiture of a license. This requirement was not met by: Deficient Practice Statement The facility annual fee is overdue with a past due amount of $1,485.00, this poses potential health and safety risk to residents in care.

Official plan of correction

POC Due Date: 10/10/2025 Plan of Correction Licensee to bring account current prior to due date 10/10/25. Facility Transaction History report CLF551M0 provided. Licensee shall provide proof of annual fees have been renewed and current to Fresno CCL by due date 10/10/25.

Official classification

Type B

Official code

87411(f)

Regulation authority

CCR

What the official deficiency says

87411(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 when LPA reviewed and A1 confirmed S1 and S2’s files and observed no health screening were on file, which poses a potential health or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/26/2025 Plan of Correction Administrator obtain S1's physical health screening during visit. Administrator will submit proof of S2’s health screening to Fresno CCL by POC due date 09/26/25.

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, the licensee did not comply with the section cited above when LPA review R1’s file, whose currently receiving hospice care with no 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: 09/19/2025 Plan of Correction Administrator will obtain R1’s hospice care plan and submit it to Fresno CCL by POC due date 09/19/25.

Official classification

Type B

Official code

87609(b)(4)

Regulation authority

CCR

What the official deficiency says

87609 (b)(4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident’s medical condition(s). 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 review R2’s file, whose currently receiving home health with no home health records and care plan on file, which poses a potential health or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/19/2025 Plan of Correction Administrator will obtain R2’s home health record and submit it to Fresno CCL by POC due date 09/19/25.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355(e)(2) 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: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c)… This requirement is not met as evidenced by: Deficient Practice Statement Based on records reviewed, interview conducted and observation, S2 is working providing care for residents. S2 is fingerprinted cleared who is not associated to facility, which poses an immediate risk to the health and safety of the residents.

Official plan of correction

POC Due Date: 09/17/2025 Plan of Correction S2 is to be removed from the facility immediately. S2 is not permitted back until associated. Licensee is to submit LIC 9182 or associate S2 on Guardian. Proof of S2 associated to the facility will be submitted to Fresno CCL by POC due date 09/17/25.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements - Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This was not met as evidenced by: Based on the interviews conducted and records reviewed, facility staff did not monitor R2’s glucose level. The facility staff also did not ensure R2 received his medications to treat his insulin-dependent diabetes condition. This resulted in R2’s hospitalization and death, which poses an immediate Health and Safety concern.

Official plan of correction

POC addressed during NCC.

Deadline recorded: Aug 3, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(d)(2)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties - Knowledge of and ability to conform to the applicable laws, rules and regulations. This was not met as evidenced by: Based on interviews conducted, Administrator did not ensure resident’s care needs were met, which poses an immediate Health and Safety concern.

Official plan of correction

POC addressed during NCC.

Deadline recorded: Aug 3, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(4)

Regulation authority

CCR

What the official deficiency says

Basic Service - Personal assistance and care as needed by the resident and as indicated in the pre-admission appraisal, with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications… This requirement was not met as evidenced by: Based on interviews conducted and records reviewed, facility staff left resident soiled and failed to ensure resident received medications, which poses an immediate health and safety concern.

Official plan of correction

POC discussed during NCC.

Deadline recorded: Aug 3, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(j)

Regulation authority

CCR

What the official deficiency says

In all facilities licensed for sixteen (16) persons or more, one or more employees shall be designated as having primary responsibility for assuring that each resident receives needed first aid and needed emergency medical services and for assisting residents as needed… This requirement was not met: Based on interviews conducted, it was confirmed, S1 refuse to assist resident with first aid which poses a potential health and safety and personal rights risk to the person in care.

Official plan of correction

Licensee shall submit steps and documents of how the facility will assist the resident with first aid to Fresno CCL office by POC due date 07/22/24.

Deadline recorded: Jul 22, 2024. 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 requirement is not met as evidenced by: Based on observation and interviews conducted, at 12:01PM, Room 7 a shared room, was missing a bathroom door and has not been replace for a while which poses a potential health and safety risk for the person in care.

Official plan of correction

Licensee shall ensure the facility is in good repaired at all times. Licensee shall ensure that there is a door to the bathroom in Room 7 by POC due date. Proof shall be submitted to the department by the POC due date of 06/14/24.

Deadline recorded: Jun 14, 2024. 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

Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on records review and observation, R1 and R2 medications were not administered by staff as instructed by physician which poses an immediate health and safety risk for the person in care.

Official plan of correction

Licensee shall submit documents of steps the facility will take to ensure facility meets the regulation which will include auditing the MARS and medications to Fresno CCL office by POC due date 06/12/24. Licensee shall have all staff retrained Health-Related Services regulations 87465. Licensee will submit documentation of training topics which include process of administering medications with staff attendance rooster to the Fresno CCL office by 06/21/24.

Deadline recorded: Jun 12, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews conducted, S1 uses social force on R1 to take showers which poses a potential health and safety risk for the person in care.

Official plan of correction

All staff In-Service training on resident’s personal rights is to be completed. Staff rooster of attendance of in-service training and training materials is to be submitted to Fresno CCL by POC date 06/21/24.

Deadline recorded: Jun 21, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)(1)

Regulation authority

CCR

What the official deficiency says

Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement was not met as evidenced by: Based on observation, in resident’s room 11, mold was observed in the bathroom shower floor and wall which poses a potential Health, Safety, and Personal Rights risk to the resident.

Official plan of correction

Licensee shall ensure there are no molding in resident’s bathroom shower by deep cleaning or replace shower. Proof shall be submitted to Fresno CCL office by POC due date 2/26/24.

Deadline recorded: Feb 26, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(16)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities To receive or reject medical care or other services. This requirement was not met as evidenced by: Based on interviews conducted, the resident had requested to go to the hospital and the facility staff refused to call for the resident to be taken to the hospital, which poses an immediate health and safety risks to persons in care.

Official plan of correction

Licensee shall submit a written statement of the understanding the regulation and how it will be met by POC due date 02/13/24. In-service training for all staff will be completed for “Personal Rights.” In-service training documents with staff attendance shall be submitted to the Fresno CCL office by POC due date 02/26/24.

Deadline recorded: Feb 13, 2024. 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

If the resident's physician has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can communicate his/her symptoms clearly, facility staff designated by the licensee shall be permitted to assist the resident with self-administration…(2)… the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on interviews conducted, records reviewed and observation, R1’s medication and MARs were reviewed and observed that staff did not administer medication: Lidocaine 5% patch at 7AM for multiple dates in February 2024, on 2/9/24 7PM and 2/11/24 7PM. Medication Morphine 15mg was not administer on 2/9/24 8PM and 2/10/24 8PM. Morphine 15mg was administered on 2/10/24 and 2/11/24 after medications were changed on 1/29/24 to Morphine 30 mg. Medication Morphine 30 mg was not administer on 2/10/24, 2/11/24 8AM, and 2/12/24 8AM. Medication Valproic Acid 250 mg was not administered on 2/5/24 12PM and 2/11/24 8PM. Diclofenac Sodium 1% gel was not administered on 2/6/24 8AM and 2/7/24 8AM. Several medications not being administered to R1 poses an immediate health and safety risks to the person in care.

Official plan of correction

Licensee shall submit a written statement detailing steps the facility will take to ensure the requirements of Health-Related Services are met. Statement shall be submitted to Fresno CCL office by POC due date 02/13/24. All staff will be retrained on Health-Related Services regulations which includes medication pass and medication checks. Training documents and record of staff attendance will be submitted to the Fresno CCL office by 02/26/24.

Deadline recorded: Feb 13, 2024. 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(a)(3) Personal Rights of Residents in All Facilities To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement has not been met by: Based on interviews conducted, reviews of photos and records, on 12/10/23 S1 had slapped R1 on the hand multiple times leaving R1 bruises on the forearm. S1 scold and demanded the resident to go to the resident’s room which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

S1 was terminated on 12/12/23. All staff have been retrained in-service training on 12/13/23. In-Service training on elderly abuse including emotional, physical, mental, and verbal. Rooster of staff attendance and training documents was received. POC cleared.

Deadline recorded: Dec 19, 2023. A deadline is not proof that correction was completed.