WOODRUFF CARE HOME INC

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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above as during tour along side of Administrator multiple resident restroom sinks and shower water temperatures were tested and observed to be below the required range of 105-120 degrees F, they had readings that ranged from 79.9-101.1 degrees F, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/05/2025 Plan of Correction Administrator had maintenance adjust the water heater during visit. Administrator/Licensee to create a water temperature log and monitor water for the next 3 days (beginining 1/31/25, ending 2/2/25), water temperatrure is to be tested throughout facility and each measurement must be within the required range of 105-120 degrees F, water must be tested 3x a day (morning, afternoon, evening) and all must be documented on water temperature log to clear the POC. Water temperature log to be emailed to LPA by POC due date at tena.herrera@dss.ca.gov

Official classification

Type A

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 observation, interview, record review, the Administrator did not comply with the section cited above in which the medications administered on 1/29/2024 to Resident #1 (R1) were not properly documented/logged on the Medication Administration Record (MAR) which poses an immediate health, safety or personal rights risk to residents in care.

Official plan of correction

POC Due Date: 01/31/2024 Plan of Correction The Administrator agreed to submit a plan of correction to avoid medication errors focusing on the proper documentation of Medication Administration Record (MAR) to CCL/LPA by POC due date.

Official classification

Type B

Official code

87307(3)(C)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (3) Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of:(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths.

Official plan of correction

The quantity shall be sufficient to permit changing at least once per week or more often when indicated to ensure that clean linen is in use by residents at all times. The linen shall be in good repair. The use of common wash cloths and towels shall be prohibited. This requirement was not met: LPA Ramirez observed several brownish-red stains of different sizes on Resident#6 (R6) pillowcase. **Facility staff provided clean linen to R6 during visit. No further correction required**

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

Official classification

Type B

Official code

87211(a)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements-(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: No SIR was was sent to this licensing agency to report bed bugs.

Official plan of correction

Licensee will retrain staff on this regulation and provide proof of retraining by 01/22/2024, via email. Facility will back date SIR and report bed bugs in facility by 01/22/2024.

Deadline recorded: Jan 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

87303 Maintenance and Operation(a)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 was not met as evidence by: Based on observations, interviews and records reviewed, the facility was being treated for bed bugs on 10/25/2023 and 12/19/2023.

Official plan of correction

*Facility provided proof of pest control service report dated 12/19/2023 for bed bug treatment. No further action required. Administrator advised LPA Ramirez that the facility is in the process of conducting a revised pest control proposal. Licensee will submit to LPA once received.

Deadline recorded: Jan 8, 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

(a) 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 being met as evidenced by: Administrator, staff and residents interviewed confirmed that the facility has bed bugs. LPA observed Orkin inspection report dated 10/2/23, which also confirms that the facility has bed bugs. This poses a health and safety risk to residents in care.

Official plan of correction

Administrator will send copy of Orkin treatment report for treatment done on 10/25/23 to LPA, by POC due date. Administrator will continue to send reports to LPA until the facility is free of bed bugs.

Deadline recorded: Nov 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(b)(2)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation ... (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms...between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. This requirement is not met as evidenced by: Based on observation and interviews, theAdministrator did not comply with the section cited above in which (8) out of (12) residents rooms measured over 85 deg F and (6) residents stated their rooms are uncomfortable because of hot temperature.

Official plan of correction

Administrator willl ensure that the facility shall cool rooms to a comfortable range (78-85 deg F) and agreed to install portable a/c to the rooms without a/c. Addiitonally, an electrician will install breaker panels designated for a/c only. Proof will be submitted to CCL/LPA by POC due date.

Deadline recorded: Jul 31, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

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 in that Rooms 109 and 112 did not have " No Smoking In Use " signs on the door; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/15/2023 Plan of Correction Staff posted signs on the doors during the visit. CLEARED.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 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 observation, the licensee did not comply with the section cited above in that rooms 119, 123, 126, 127, 233 had hot water temperatures that were below 105 degrees Fahrenheit; which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/15/2023 Plan of Correction Administrator agreed to submit proof of correction by tomorrow. Maintenance staff stated that circulation pumps are in need of repair.

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, the licensee did not comply with the section cited above in that the last emergency drill was conducted on 1/13/2022; which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/21/2023 Plan of Correction Administrator agreed to submit proof of emergency drill training.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation 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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in that rooms 108, 112, 127, 233, and 239 were missing window vertical blinds, and Room 242's floors were dirty. which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/21/2023 Plan of Correction Administrator agreed to submit picture proof evidence that the room windows have complete vertical blind panels, and that room 242 has been cleaned.

Official classification

Type B

Official code

87465(a)(2)

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(2)The licensee shall provide assistance in meeting necessary medical and dental needs. The requirement is not met ad evidenced by : record review and R1's interview, LPA reviewed R1 phyisican report and discharge paper and R1 required insulin Lispro Sliding scale and finger stick blood sugar and there's no discontinuation paper from doctor in R1's file and facility is not following doctor's order

Official plan of correction

The administrator will ensure the provide assistance in meeting necessary residents' medical needs. The administrator will retrain the staff and ensure each resident has a plan for their incidental medical and dental care and send the staff training log to LPA by POC due date.

Deadline recorded: Dec 23, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Right of Residents in All facilities. (a)(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment The requirement is not met as evidenced by LPA's interviews and recorded review, four out of six residents reported that facility has head lice, either they heard about it or either they are on lice treatment now. Staff also reported facilty has head lice and residents are on treatment now which posed a potential risk to residents in care.

Official plan of correction

The administrator will ensure residents to be accorded safe and healthful and comfortable accomendations..etc. The administrator will send a plan to LPA about how to prevent head lice in the facility by POC due date.

Deadline recorded: Oct 27, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1

Regulation authority

CCR

What the official deficiency says

UNSUBSTANTIATED- NO deficiencies cited. Page created and final printed in error.

Deadline recorded: Sep 16, 2021. A deadline is not proof that correction was completed.