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

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.