EAGLE LAKE VILLAGE

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (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 interview and record review, the licensee did not comply with the section cited above in 5 out of 6 staff persons did not have first aid training, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2026 Plan of Correction Licensee will have all staff trained in first aid by POC due date Licensee will put copy of staff first aid training in their files by POC due date

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 4 out of 6 staff persons did not have their health screen, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/14/2026 Plan of Correction Licensee will get copies of missing staff health screenings by POC dute date

Official classification

Type B

Official code

87303

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above common area restroom toilet not functioning, common area refrigerators in both the assisted living and memory care units have locks on the refrigerators,1 of 8 resident rooms had a soiled shower curtain, 2 of 8 resident shower floors were soiled or stained,, 1 of 8 resident rooms door handle is not operating properly, there is a soiled and broken recliner in memory care patio area that needs to be removed, siding on the west side of the memory care unit exterior is broken / worn and needs to be repaired and painted, exterior column in memory care patio area is worn / broken and needs to be repaired, replaced and painted, cyclone fence in front / east side of facility lot (surrounds ditch) has a broken section that needs to be repaired which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2025 Plan of Correction Licensee agrees to submit a plan to LPA with the estimated completion dates of repair of all of the above items by 09/09/2025. As the items are completed the administrator agrees to send LPA photographs / receipts for all repairs as proof of correction.

Official classification

Type B

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 5 of 5 staff files which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2025 Plan of Correction Licensee agrees to send LPA proof of current CPR / first aid training as proof correction.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4) Incidental Medical... A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by: Based on interviews and document review it was determined that R1 ran out of medications for at least a day.

Official plan of correction

Licensee agrees to conduct a medication training for all med techs concerning the requirement to ensure that residents do not run out of their medications and will provide LPA with training subject matter and sign in sheet with dates and staff signatures. In addition, licensee shall submit a plan to LPA that outlines the process that all med techs must follow to ensure that residents do not run out of medications.

Deadline recorded: May 13, 2024. A deadline is not proof that correction was completed.