SPRINGVILLE

Official classification

Type A

Official code

87555(b)(28)

Regulation authority

CCR

What the official deficiency says

(28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed several cans of food had expired on the kitchen shelves which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/17/2026 Plan of Correction Licensee / Administrator shall conduct an inventory of all canned food / goods and discard all expired canned food. Submit a written plan stating what was done, and proof of staff training by POC due date.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 the backyard LPA observed old kitchen utensils, bed rails, broken wood frames, window glass, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/22/2026 Plan of Correction Licensee / Administrator shall ensure that all outdoor passageways are free of obstruction by the POC date and provide proof to the department.

Official classification

Type B

Official code

87608(a)(5)(B)

Regulation authority

CCR

What the official deficiency says

(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: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. 4 residents have a full bed rail on their beds and are not under hospice care, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/22/2026 Plan of Correction Licensee / Administrator will switch full bed to half bed rails per the physician's half bed rail request / order and submit to the department pictures of the bed with half bed rails by POC due date. or will communicate with family and physician to evaluate the need for hospice care and will

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. At the time of inspection, LPAs observed medication in rooms #122 and #125 , on a bedside table and in a cabinet, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/17/2025 Plan of Correction Administrator removed and locked the medicine. Deficiency cleared at the time of visit.

Official classification

Type A

Official code

87465(h)(4)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Prescribed medication (Nystatin cream), was observed without a prescription label, original box with prescription label was disposed of, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/17/2025 Plan of Correction Deficiency corrected at time of visit. Administrator called pharmacy and requested new label to affix to medication tube. Administartor labeled Nystatin cream tube with resident's name per physcian's order

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (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 is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. At the time of inspection, LPA observed medication in the room #202, on bedside table which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/21/2024 Plan of Correction Administrator removed and locked the medicine. Deficiency cleared at the time of visit.

Official classification

Type B

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed that there's not enough food supply for 7 days non-perishable, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/21/2024 Plan of Correction Grocery shopping was done at the time of visit. The administrator will ensure the supplies of non-perishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. Deficiency cleared at the time of visit.

Official classification

Type B

Official code

87618(b)(3)(B)

Regulation authority

CCR

What the official deficiency says

(3) Ensuring that the use of oxygen equipment meets the following requirements: (B) “No Smoking-Oxygen in Use” signs shall be posted in the appropriate areas. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. LPA observed that facility does not have " No smoking oxygen in use " signs posted on the residents’ rooms who are in hospice and use oxygen, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/21/2024 Plan of Correction " No smoking oxygen in use " signs were printed and posted throughout the facility, outside of residents rooms. Deficiency cleared at the time of visit.

Official classification

Type B

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required The requirement was not met as evidenced by LPA's interviews, the administrator admitted the facility was lack of staffing and they did not have any isolation room during that period of time and R1 was still having COVID symptoms which posed a potential risk to residents in care.

Official plan of correction

Administrator will ensure to follow the Title 22 regulation about Eviction and Administrator will send the plan to LPA by POC due date and state how the facility would ensure the they follow the regulation in the future.

Deadline recorded: Feb 15, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(6)

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:(6)...to not be locked into any room, building, or on facility premises by day or night. This requirement was not met as evidenced by: Based on observation and interview, the administrator admitted to tying a stanchion red rope accross resident room doors to enforce isolation requirements put forth by the facility, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator to submit a written plan on how they will ensure to not violate resident's personal rights under any circumstances. Written plan to be emailed to LPA by the POC due date.

Deadline recorded: Jan 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(11)

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 (11)To have their visitors... permitted to visit privately... This requirement was not met as evidenced by: Based on observation and interview, the administrator failed to allow residents their private visits at any given time by requiring them to schedule visits and visits to not be in their rooms if preferred, which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator will conduct in-service training for all facility staff regarding all resident personal rights. Training material and Sign-In sheet for participants will be emailed to LPA by POC due date.

Deadline recorded: Jan 16, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(1)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties (d)The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. The requirement was not met as evidenced by Department review of medical records was completed which revealed systemic failures at the facility in preventing pressure injuries which posed a potential risk to residents in risk

Official plan of correction

Administrator is to reassess all residents in placement and ensure a reappraisal is developed based on residents personal needs and maintained in the residents file for review by the licensing agency. Administrator to submit

Deadline recorded: Nov 19, 2023. 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 Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...assistance and care as... This requirement is not met as evidence by: Based on document review and interviews conducted licensee did not ensure staff provided a two person assist for R1 which poses an immedicate risk to the health, safety, or personal rights to the persons in care.

Official plan of correction

Administrator will schedule and conduct an in-service training with all staff regarding proper transfer, and incident reporting and will submit schedule of training by POC due date 10/13/23 and copies of training log sign-in with duration of training and topic by 10/19/23. *An immediate Civil Penalty of $500.00 is being assess during this visit*

Deadline recorded: Oct 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities shall...:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidence by: Based on document review, and interviews licensee did not ensure to seek medical care in a timely manner for R1 which poses an immediate risk to the health, safety, or personal rights to the persons in care.

Official plan of correction

Administrator will schedule and conduct an in-service training with all staff regarding section 87468.1. and will submit schedule of training by POC due date 10/13/23 and copies of training log sign-in with duration of training and topic by 10/19/23.

Deadline recorded: Oct 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87615(a)(1)

Regulation authority

CCR

What the official deficiency says

87615 Prohibited Health Conditions (a) Persons who require health services for or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a residential care facility for the elderly: (1) Stage 3 and 4 pressure injuries. The requirement was not met as evidenced by record review, R1 had a total of 4 pressure injuries and determined to be stage 3 and R1 was still retained in the facility which posed an immediate risk to residents in care.

Official plan of correction

The administrator will ensure person who required health services shall not be admitted or retained in a residential care facility. The administrator will submit a plan of correction to ensure facility is meeting the Title 22 regulation by POC due date.

Deadline recorded: Sep 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities(a)(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4)(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. The requirement was not met as evidenced by record review, when R1 was admitted to facility and facility staff was aware of R1 had a red mark on buttock area and facility did not update and develop a plan of care which posed a potential risk to residents in care.

Official plan of correction

Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Licensee to submit a faxed or mailed copy of POC by due date.

Deadline recorded: Oct 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. The requirement was not met as evidenced by LPA's interviews and R1's family reported they never got any updated from facility about the resident's change of condition until the day the family took R1 out from facility.

Official plan of correction

Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Licensee to submit a faxed or mailed copy of POC by due date.

Deadline recorded: Oct 5, 2023. A deadline is not proof that correction was completed.

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, LPA observed all the staff do not have first aid and CPR in file except Administrator which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/06/2023 Plan of Correction The administrator send all the staff first aid certificate and CPR to LPA by POC due date.

Official classification

Type B

Official code

1569.696(a)

Regulation authority

HSC

What the official deficiency says

(a) All residential care facilities for the elderly shall provide training to direct care staff on postural supports, restricted conditions or health services, and hospice care as a component of the training requirements specified in Section 1569.625. The training shall include all of the following: This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, LPA did not observe any training record for staff in file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/06/2023 Plan of Correction The administrator will updated the staff training record and send it to LPA by POC due date.

Official classification

Type B

Official code

87507(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. (1) The text of the admission agreement, including any attachments and modifications, shall be: (A) Printed in black type of not less than 12-point type size, on plain white paper. The print shall appear on one side of the paper only. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA observed Resident#1 and #2 admission agreemnt was printed less than 12 point type size and on double side of the paper which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/06/2023 Plan of Correction The administrator will update the resident#1 and #2 admission agreement and send it to LPA by POC due date.

Official classification

Type B

Official code

1569.695(b)

Regulation authority

HSC

What the official deficiency says

(b) A facility shall provide training on the plan to each staff member upon hire and annually thereafter. The training shall include staff responsibilities during an emergency or disaster. This requirement is not met as evidenced by: Deficient Practice Statement Based on the record review, LPA did not observe staff has any training on emergency and disaster which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/06/2023 Plan of Correction The administrator will retain the staff on Emergency and Disaster and send the training log to LPA by POC Due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA observed the facility does not have any documentation about facility conduct a drll at least quarterly for each shift which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/06/2023 Plan of Correction The facility will send the updated drill(fire and disaster) to LPA by POC due date.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (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 degree C) and not more than 120 degree F (49 degree C). This requirement is not met as evidenced by: Deficient Practice Statement Based on the observation, LPA inspected the Resident room#206 and #101 and their water temperature were tested between 100.2 and 100.7 degrees F which is under Title 22 regulation and posed an immediate risk to residents in care.

Official plan of correction

POC Due Date: 06/23/2023 Plan of Correction The administrator will fix the hot water temperature immediately and send the 7 days hot water temperautre log to LPA by POC due date 6/29/23

Official classification

Type A

Official code

87465(h)(1)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (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 is not met as evidenced by: LPA observed 2 bottles of medication for R1 and R2 sitting on top of a water dispenser machine, in dinning area. Medications were accessible to 35 out of 35 residents in care.

Official plan of correction

Licensee will secure all medications and keep medications centrally stored. Licensee will retrain staff on safeguarding of medications. Licensee will send proof of re-training to LPA by POC due date via email.

Deadline recorded: May 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

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: 1st Floor shared bathroom# 1 and #2 water temperature read at 98.6 degrees F in bathroom # and 96.4 degrees F in bathroom#1.

Official plan of correction

Licensee will maintain water temperature between 105 - 120 degrees F. Licensee will develop a water log and record water temeratures every 24 hrs for the next 5 calendar days. Proof must be submitted to LPA via email.

Deadline recorded: May 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)(13)(c)

Regulation authority

CCR

What the official deficiency says

Licensing 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. (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or needed services. (c) All information and records obtained from or regarding residents shall be confidential. This requirement is not met as evidenced by: At 2:29 pm LPA observed " Blood Glucose Testing and Insulin Injection Sheet " taped to the outside of R3 bedroom door and " Incontinence Log " taped to the outside of R4 bedroom door. LPA observed these logs on several residents doors throughout the facility.

Official plan of correction

Licensee will remove logs regarding care of resident immediately from resident doors. Licensee shall maintain these logs in a secure location and keep information confidential.

Deadline recorded: May 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(1)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (1) Knives, matches, firearms, tools and other items that could constitute a danger to the resident(s). During tour, LPA observed storage door 3 to be unlocked and contained various tools, paint, oxygen tank and other potiential dangerous tools.

Official plan of correction

Licensee will keep storage 3 and all storage doors inaccessible to dementia residents.

Deadline recorded: May 5, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance. (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: (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 observation and record review, the licensee did not comply with the section cited above. During the visit LPA observed that staff Staff 1 (S1) was not have a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/15/2022 Plan of Correction Staff 1 left the facility. The licensee will ensure all individuals subjects to a criminal record shall prior to working, residing or volunteering in a licensed facility.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation the licensee did not comply with the section cited above. Cleaning supplies and toxins were observed in the laundry room unlocked and accessible to residents which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/15/2022 Plan of Correction Citation cleared at the time of visit. Laundry room was locked and cleaning supplies and toxins were inaccessible to residents.

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 the licensee did not comply with the section cited above. The water temperature was tested in a random selection of resident bathrooms. Hot water temperature measured at 122.2 degree F in bathroom #201 and in share bathroom for the rooms #202 and # 203 which is beyond the required 105 - 120 degrees which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/16/2022 Plan of Correction Licensee agreed to adjust hot water and will submit picture for proof.