BELMONT VILLAGE BURBANK

Official classification

Type A

Official code

87705(k)(8)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia, (k) The following initial and continuing requirements must be met for the licensee to utilize delayed egress devices on exterior doors or perimeter fence gates: (8) Delayed egress devices shall not substitute for trained staff in sufficient numbers to meet the care & supervision... of all residents who leave the facility. This requirement is not met as evidenced by. The Licensee did not ensure to provide required assistance to R1 who was not able to leave facility unassisted. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Within 24 hours the Licensee will provide a written plan of action explaining the steps they will follow providing health and safety measures of dementia residents. Including the measures taken to ensure that Dementia resident can not leave the facility unassisted

Deadline recorded: Oct 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(19)(2)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities. (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: (19)To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the community standard for photocopies.

Official plan of correction

The Licensee will provide a written plan of action explaining the steps they will follow to provide residents records in a timely manner.

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

Official classification

Type A

Official code

87555(b)(9)

Regulation authority

CCR

What the official deficiency says

87555(b)(9) General Food Service Requirements. Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above as LPA and Chef Manger observed many itmes with expired dates. (List on 809 report)

Official plan of correction

Chef Manager disposed of all the expired food and LPA wintness all the food thrown into trash cans. Administrator will have all staff in food service attend training in stroring, and preparing food and send proof to LPA by POC date. Also, make sure food is checked everyday and rotated to prevent expired food to be strored at facility.

Deadline recorded: Oct 17, 2022. A deadline is not proof that correction was completed.

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 as water temperature in Room 217 measured 122.9 degrees F in bathroom sink. Room 219 water temperature measured 72 degrees F. Room 317 water temperature measured 121.7 in sink and 120.5 in bathroom sink. Town Hall sink water temperature measured 120.9 degrees which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/08/2022 Plan of Correction Licensee will adjust water temperture and send photos and certify that water temperture is within 105-120 degrees F by POC date.

Official classification

Type A

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 LPA and Food Manger Andrew Zumbado observed lack of 7 day non-perishable food supplies. The licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/08/2022 Plan of Correction Licensse wiil purchase additional non-perishable food for 7 days and send invoice/reciepts as proof to LPA by POC.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

(c) All window screens shall be clean and maintained in good repair. 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 LPA and maintance manager oberved 3 screens in disreapir which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/10/2022 Plan of Correction Licensee will repair/replacce window screens and send photos as proof to LPA by POC date.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs. 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 one count as toliet in room 219 was not fllushing and in need of cleaning. Which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/07/2022 Plan of Correction Toliet was repaired and clean at time of visit and no further action is required.