CHATEAU MAGNOLIA

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

This requirement is not met as evidenced by: Except as specified in subsection 87309(a), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/17/2025 Plan of Correction Staff immediately removed the knives/sharp objects and locked them in the medicine cabinet in the kitchen. Staff also removed the kitchen chemicals and detergents immediately and locked them in the garage. Administrator will ensure training is provided and will submit proof of training to LPA by the POC date.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on video observation and interview the licensee failed to have client free from punishment, infliction of pain and humiliation by Staff S 1 calling the client an " asshole " and threatening the resident with physical restraints, and by Staff S 1 hitting R1 with a pillow and placing the pillow over R1's face which posed an Immediate Health and Safety Risk to resident's in care.

Official plan of correction

Administrator will ensure all residents are free from any type of abuse from staff or other residents. Administrator will create a plan outlining the steps taken when they are notified by staff or persons about possible abuse. Plan will be submitted to LPA via fax only by POC due date. Administrator to review Title 22 Regulations, Section 87468.1 on Personal Rights, and conduct an in-service staff training on Personal Rights and Mandated Reporting. Submit a copy of the sign in sheet of all attendees along with the topics covered during the in-service training.

Deadline recorded: Jun 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(5)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties 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 Good character and a continuing reputation of personal integrity. This requirement is not met as evidenced by: Administrator was not forthright with the Department by denying knowledge of the incident and saying client left because of constipation issues and did not disclose the incident which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator to review Title 22 Regulations and submit self certification by POC due date that she will show good character and integrity at all times.

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

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

Personal Rights of Residents in All Facilities Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on video observation and interview the licensee failed to have client free from punishment, infliction of pain and humiliation by Staff S 1 calling the client an " asshole " and threatening the resident with physical restraints, and by Staff S 1 hitting R1 with a pillow and placing the pillow over R1's face which posed an Immediate Health and Safety Risk to resident's in care.

Official plan of correction

Administrator will ensure all residents are free from any type of abuse from staff or other residents. Administrator will create a plan outlining the steps taken when they are notified by staff or persons about possible abuse. Plan will be submitted to LPA via fax only by POC due date. Administrator to review Title 22 Regulations, Section 87468.1 on Personal Rights, and conduct an in-service staff training on Personal Rights and Mandated Reporting. Submit a copy of the sign in sheet of all attendees along with the topics covered during the in-service training.

Deadline recorded: Jun 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87219(e)

Regulation authority

CCR

What the official deficiency says

Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption. This requirement was not met as evidenced by: Based on interview, record review and observation, 1 sttaff S2, did not have background clerance or assosicated with facility.

Official plan of correction

Administrator will obtain background clerance associated S2 prior to working at facility. S2 was sent home during visit. Civil penanty assesesd $100

Deadline recorded: Oct 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

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 was not met as evidenced by: LPA observed PRN and tylenol in 3 of 4 rooms.

Official plan of correction

Administrator locked and removed all PRN and medication at time of visit. ***No further Action required***

Deadline recorded: Oct 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87470(c)(1)(f)

Regulation authority

CCR

What the official deficiency says

87470 (c) (1) (f) 87470 - Infection Control Requirements..An Infection Control Plan shall be developed by the licensee and shall be included in the Plan of Operation required by Section 87208. (1) The Infection Control Plan shall include all of the following: (F) Staff shall demonstrate knowledge of and skill in infection control, as appropriate to the job assigned and as evidenced by safe and effective job performance. The requirement is not met as evidenced by: On 4/26/22 1 staff was observed not wearing a mask.

Official plan of correction

The administrator will ensure the facility is following infection control plan and the administrator will retrain the staff about the infection control and send the staff training log to LPA by POC due date.

Deadline recorded: Oct 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

87411 Personnel requirements: (d)(3) Skill and knowledge required to provide necessary resident care and supervision. This requirement is not met as evidenced by: Based on observation and interviews conducted with staff and residents, One staff is unable to communicate with english speaking residents.

Official plan of correction

Licensee will review Title 22 Regulations, Section 87411 and submit a written plan detailing on how licensee will ensure that staff are receiving the required in-service trainings according to the Regulation and send proof of training by the POC due date.

Deadline recorded: Oct 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)(9)(10)

Regulation authority

CCR

What the official deficiency says

Personnel Records The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: Termination date if no longer employed by the facility. Reasons for leaving. This requirement is not met as evidenced by: Based on interviews and file review licensee failed to maintain personnel records for former Staff S1 regarding termination date and reason for leaving which posed a potential risk to residents in care.

Official plan of correction

Facility to submit by POC due date personnel records for Staff S1 regarding termination date and reason for leaving. At today's visit facility submitted S1's personnel records. Deficiency cleared.

Deadline recorded: Oct 5, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.50(a)(3)

Regulation authority

HSC

What the official deficiency says

The department may deny an application for a license or may suspend or revoke a license issued under this chapter upon any of the following grounds and in the manner provided in this chapter:(3) Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. This requirement was not met by evidence of On January 26, 2022 2 staff were observed not wearing face coverings. On 4/2622 1 staff was observed not wearing a mask. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee shall ensure that facility is following California Dept of Public Health and CCLD requirements. Provide a written statement stating that facility staff were re-trained and will comply with CDSS requirements and regulations, and will maintain a safe and healthful environment for residents and staff.

Deadline recorded: May 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.This requirement was not met by evidence of: Based on observation licensee failed to have personnel competent to provide services necessary with LPA observing staff member unable to answer questions and stated she did not understand English very well. This poses an immediate health and safety risk to residents in care. Prior violation within 12 months.

Official plan of correction

Facility to submit a plan by POC due date addressing staff's competency to provide services necessary to meet resident's needs in the future.

Deadline recorded: May 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

97465(h)(2)

Regulation authority

CCR

What the official deficiency says

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 was not met by evidence of: LPA observed PRN and tylenol in 3 of 4 rooms.

Official plan of correction

Administrator locked and removed all PRN and medication at time of visit.

Deadline recorded: Apr 26, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87219(e)

Regulation authority

HSC

What the official deficiency says

Criminal Record Clearance. Prior to working, residing or volunteering in a licensed facility, all individuals subject to a criminal record review shall obtain a clearance or criminal record exemption This requirement was not met as evidenced by LPA Observed S2 working at facilty and not associated to facility.

Official plan of correction

Administrator will associated S2 prior to working at facility. S2 was sent home during visit. Civil penanty assesesd $100

Deadline recorded: Apr 26, 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 in B1 water temperature was tested at 124.9 degrees F. and B2 water temperature was tested at 124.4 degrees F. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/21/2022 Plan of Correction Licensee will ensure water temperature is kept within the required 105 - 120 degrees F. at all times and will certify in LIC 9098 by 4/21/22. Licensee will maintain a water temperature log for the next 7 days and submit to the department by 4/27/22.

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. (1) Storage areas for poisons, and firearms and other dangerous weapons shall be locked. 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 cleaning supplies under the sink, medication on drawer across the stove, and cooking knives on drawers to the left of the sink were not lock which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/21/2022 Plan of Correction Licensee will ensure all cleaning solutions, chemicals, medication, and sharps at lock at all times by certifying in LIC 9098 and submit to the department by 4/21/22.

Official classification

Type A

Official code

87705(j)

Regulation authority

CCR

What the official deficiency says

(j) The licensee shall have an auditory device or other staff alert feature to monitor exits, if exiting presents a hazard to any resident. 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 main entrance, exit door to the backyard, and exit door on bedroom #5 did not have an auditory device which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/21/2022 Plan of Correction Licensee is to install auditory devices chime in all exit doors to ensure the safety of dementia residents in care and submit a picture to the department by 4/21/22.

Official classification

Type A

Official code

1569.50(a)(3)

Regulation authority

HSC

What the official deficiency says

The department may deny an application for a license or may suspend or revoke a license issued under this chapter upon any of the following grounds and in the manner provided in this chapter:(3) Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. This requirement was not met by evidence of: On January 26, 2022 2 staff were observed not wearing face coverings. On 3/2/22 1 staff was observed not wearing a mask. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Licensee shall ensure that facility is following California Dept of Public Health and CCLD requirements. Provide a written statement stating that facility staff were re-trained and will comply with CDSS requirements and regulations, and will maintain a safe and healthful environment for residents and staff.

Deadline recorded: Mar 3, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met by evidence of: Based on observation licensee failed to have personnel competent to provide services necessary with LPA observing staff member unable to answer questions without use of a mechanical translator This poses an immediate health and safety risk to residents in care.

Official plan of correction

Facility to submit a plan by POC due date addressing staff's competency to provide services necessary to meet resident's needs in the future.

Deadline recorded: Mar 9, 2022. A deadline is not proof that correction was completed.