SKYHILL QUALITY LIVING

Official classification

Type A

Official code

87309(a)

Regulation authority

CCR

What the official deficiency says

(a) Except as specified in subsection (b), 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. 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 ensuring to lock a small scissor and a large sharp kinfe in a kitchen cabinet, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/07/2025 Plan of Correction Staff immediately locked the sharp objects in a locked kitchen drawer. Administrator will ensure staff are retrained and will always keep the sharp objects in locked drawers.

Official classification

Type B

Official code

87470(a)(2)(B)

Regulation authority

CCR

What the official deficiency says

(a) A licensee shall ensure that infection control practices are maintained as follows: (2) Environmental cleaning and disinfection activities shall be performed following the manufacturers' instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: (B) Walls and window coverings in resident care areas shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary and when they are visibly contaminated or soiled. 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 ensuring the walls/doors in the hallways were clean, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/24/2025 Plan of Correction Administrator will have the walls/doors to be cleaned or painted and will send pictures 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. LPA observed loose faucet in rear bathroom and a loose toilet flusher in front bathroom. This which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/12/2024 Plan of Correction Licensee will ensure that all bathroom fixtures shall be in good repair. Proof of correction is for licensee to replace or repair faucet and toilet flusher must be sent by due date. Proof of correction with photos must be sent to ernand.dabuet@dss.ca.gov

Official classification

Type B

Official code

87705(c)(4)(A)

Regulation authority

CCR

What the official deficiency says

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, record review, the licensee did not comply with the section cited above. LPA identified (1) out of (6) residents is diagnosed with dementia and (4) residents are on hospice care. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/26/2024 Plan of Correction Licensee will ensure include a night shift " awake " staff. Proof of correction is for licensee to submit an updated LIC 500 to include proof of night staff on duty between 7pm- 7am. POC must be sent by due date. Proof of correction with photos must be sent to ernand.dabuet@dss.ca.gov

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. LPA identified resident room #4 is missing a window screen. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/12/2024 Plan of Correction Licensee will ensure that all windows have screens and are maintained in good repair. Proof of correction is for licensee to purchase screen or make repairs must be sent by due date. Proof of correction with photos must be sent to ernand.dabuet@dss.ca.gov

Official classification

Type B

Official code

87303(a)(1)

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. (1) Floor surfaces in bath, laundry and kitchen areas shall be maintained in a clean, sanitary, and odorless condition. This requirement is not met as evidenced by: Deficient Practice Statement Based on observatin, the licensee did not comply with the section cited above. LPA identified (2) range burners and oven non operarable. LPA identified grease stains on kitchen wall and ceiling and over range exhaust fan. This violation which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/12/2024 Plan of Correction Licensee will ensure all kitchen equipments are in working conditon and kitchen area is clean and sanitary. Proof of correction is for licensee to replace or purchase stove and have perform deep cleaning of walls and ceiling. Proof of correction with photos must be sent to ernand.dabuet@dss.ca.gov

Official classification

Type A

Official code

87505(j)

Regulation authority

CCR

What the official deficiency says

87705(j) Care of Persons with Dementia. 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 was not met as evident of: Facility retains dementia resident and alarms on exit doors were not working properly.

Official plan of correction

The Administrator stated that she will fix the alarms on all 3 exit doors. Administrator will inform CCL in writing explaining how she fixed the alarms. The pictures of the doors and alarms must be submitted to CCL by POC due date. ***Administrator fixed all 3 door alarms during visit and no further actions is required***

Deadline recorded: Dec 2, 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: Based on observation, the licensee did not comply with the section cited above by Bathroom 1 water temperature tested at 139.7 Degrees F at 10:38am. Shower by room #3 tested 146.7 at 10:55 am, kitchen sink tested at 145.3 at 10:21am Bathroom #2 tested at 144.9 at 10:30am which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator agrees to adjust water temperture and send proof of correction to LPA by POC date.

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

Official classification

Type A

Official code

87303(2)

Regulation authority

CCR

What the official deficiency says

2. Hot water temperature is to be maintained between 105-120*F.(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) LPA's and admiistrator observed that the hot water measured from a low of 122.1 to degrees F. to a high of 123.7 degrees F. in the kitchen and restrooms.

Official plan of correction

Licensee will adjust water temperture and provide evidence to LPA and certify that water temperture has been adjusted and within range of 105 degrees F and 120 degress F by 5/27/22.

Deadline recorded: May 27, 2022. A deadline is not proof that correction was completed.

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. LPAs, Administrator and DSP observed cleaning soutions and knifes unlocked and accesible to residents.

Official plan of correction

Licensee locked up the cleaning solutions and knife during visit. Deficiency is cleared as of 5/26/22.

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

Official classification

Type A

Official code

87204(a)

Regulation authority

CCR

What the official deficiency says

87204 Limitations - Capacity and Ambulatory Status: (a) A licensee shall not operate a facility beyond the conditions and limitations specified on the license, including specification of the maximum number of persons who may receive services at any one time... This requirement is not met by evidence as: Licensee did not ensure R2 and R3 ambulatory status was within the limitations of the license which allows 1 bedridden resident which poses an immediate health, safety, or personal righs risk to persons in care.

Official plan of correction

Licensee will contact primary physicain for R2 and R3 and verify ambulatory status for the R2 and R3 and will submit physician's report to the department by 5/27/22.

Deadline recorded: May 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

87217 Safeguards for Resident Cash, Personal Property, and Values: (b)... facility shall take appropriate measures to safeguard residents' cash resources,...which have been entrusted to the licensee.... The licensee shall give the residents receipts for all such articles or cash resources. This requirement is not met as evidence by: Based on documents reviewed licensee did not ensure to maintain record receipts for items purchase with P & I funds for R1,R2,R4 which poses a potential health, safety, personal rights risk to the persons in care.

Official plan of correction

The licensee will refund P & I funds for R1 amount $2329, R2 amount $1104, and R3 amount $996 and proof must be submitted to the deparment by 5/27/22.

Deadline recorded: May 27, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Personal 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. This requireement is not met as evidence by: Based on record review observations during the visit dated 9/1/21 in reference to complaint # 28-AS-20210824090807, residents' files were incomplete and/or missing required forms i.e. P & I ledgers, hospice care plans, original receipts of P & I expenditures, and authorized representative contact information. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to ensure that all resident records are complete and accurrate.Administrator is to review Title 22 regulations section 87506(b)(1-17) as a guide to required resident record information. Submit a signed statement of understanding and intent to abide by the cited regulation.

Deadline recorded: May 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(b)

Regulation authority

CCR

What the official deficiency says

87217 Safeguard for Resident Cash, Personal Property, and Values (b) Every facility shall take...measures to safeguard residents' cash resources, ... have been entrusted to the licensee...The licensee shall give the residents receipts for all such articles or cash resources. This requirement is not met as evidence by: Based on documents reviewed licensee did not ensure to maintain record receipts for items purchase with P & I funds for R1,R2,R4 which poses a potential health, safety, personal rights risk to the persons in care.

Official plan of correction

The licensee will refund P & I funds for R1 amount $2329, R2 amount $1104, and R3 amount $1104 and proof must be submitted to the deparment by 5/10/22.

Deadline recorded: May 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(c)(1)

Regulation authority

CCR

What the official deficiency says

87217 Safeguards for Resident Cash, Personal Property, and Valuables: (c)... facility shall account for any cash resources entrusted...(1) Cash resources include but are not limited to monetary gifts,...personal and incidental need allowances from funding sources such as SSI/SSP. This requirement is not met as evidence by: Based on documents reviewed licensee did not ensure to be accountable for resident's cash resources which poses a potential health, safety, or personal rights risk to residents in care.

Official plan of correction

Licensee will implement policies and procedures regarding resident's cash resources and valuables. Licensee will provide a copy of the policies and procedures to the department by 5/10/22.

Deadline recorded: May 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87217(e)

Regulation authority

CCR

What the official deficiency says

87217 Safeguards for Residents, Personal Property,and Valuables: (e)Cash resources... which are handled by the licensee... shall not be commingled... used as the facility funds or petty cash, and shall be separate,...from any liability ... in the use of his own or the facility's funds and valuables... This requirement is not met as evidence by: Based on documents reviewed licensee did not ensure to maintain a separate account for residents' cash resources wihch poses a potential risk to the health, safety, or personal rights of the persons in care.

Official plan of correction

Licensee will open a separate trust account fo resident P & I funds. A document regarding a new bank account will be submitted to the department by 5/10/22.

Deadline recorded: May 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87216(a)

Regulation authority

CCR

What the official deficiency says

87216 Bonding: (a) Each licensee,... entrusted to safeguard...cash resources, shall file or have on file with the licensing agency a copy of a bond issued by a surety company to the State of California as principal. This requirement is not met as evidence by: Based on document review the licensee did not ensure to obtain a proper surety bond prior to handling the resident's cash resources which poses a potential health, safety, or personal rights risk to the persons in care.

Official plan of correction

Licensee will obtain a required surety bond. A proof of adequate bond will be submitted to the department by 5/10/22.

Deadline recorded: May 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(2-3)(5)

Regulation authority

CCR

What the official deficiency says

Administrator - Qualifications and Duties.The administrator shall... If the licensee is also the administrator, all requirements...apply. (2) Knowledge of and ability to conform to... laws, rules and regulations. (3) Ability to maintain or supervise... financial and other records. (5) Good character and a continuing reputation of personal integrity. This requirement is not met as evidence by: Based on documents review licensee did not ensure to maintain accuracy of financial records which poses a potential health, safety, or personal rights risk to the persons in care.

Official plan of correction

Licensee will attend continued education classes provided for Administrators. Licensee will secure the appoitment to attend classes and provide proof of enrollment by 5/10/22.

Deadline recorded: May 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87215

Regulation authority

CCR

What the official deficiency says

87215 Commingling of Money: Money and valuables of residents entrusted to the licensee of one community care facility licensed under a particular license number shall not be commingled with those of another residential care facility... This requirement is not met as evidence by: Based on documentation reviewed licensee did not maintain a separate checking account for facility from personal account which poses a potential health, safety, or personal rights risk to the persons in care.

Official plan of correction

Licensee is to maintain a separate checking account for facility funds and a separete account for P & I funds, facility expenses and revenue and submit proof of account designated to facility by 5/10/22.

Deadline recorded: May 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87207

Regulation authority

CCR

What the official deficiency says

87207 False Claims: No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidence by: Based on documents reviewed licensee did not ensure to provide accurate information and records to teh LPAs and other agency representatives which poses a health, safety, or personal rights risk for the persons in care.

Official plan of correction

Licensee/Administrator will schedule vendorized training related to the cited section as well as 87408:Denial or Revocation of a Certificate 87777: ExclusionsPersonal Rights. Verification of scheduled training with the trainers credentials will need to e submitted by 4/29/2022 and completed by 5/13/2022.

Deadline recorded: Apr 29, 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 by Bathroom 1 water temperature tested at 123 Degrees F. which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/08/2022 Plan of Correction Administrator shall mainitain a water temperature of 105-120 degrees F. for bathroom #1. Administrator will submit picture proof to LPA by POC date.

Official classification

Type A

Official code

87355(e)(3)

Regulation authority

CCR

What the official deficiency says

(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: (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, LPA observed upon arrival that S2 was not associated, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/31/2022 Plan of Correction Administrator agrees to complete transfer request through guardian before S2 can be allowed to work. Administrator understands S2 can not be present in the facility unitl they are associated. Transfer request is completed for S2. Proof of correction due to CCLD by POC date.

Official classification

Type B

Official code

87303(e)(5)

Regulation authority

CCR

What the official deficiency says

(e) Water supplies and plumbing fixtures shall be maintained as follows: (5) Non-skid mats or strips shall be used in all bathtubs and showers. 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 Bathroom #1 was missing skid matts, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/08/2022 Plan of Correction Administrator will ensure there are skid matts are located in everybathroom. Proof of correction/ purchase is due back to LPA by email on POC 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 ...shall deliver hot water... maintained to ... 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 evidence by: Based on observation administrator did not ensure water temperature is maintain within the required 105 to 120 degrees F; LPAs tested water temperature in B1 at 145 and B2 at 144.5 degrees F which poses an immediate Health, Safety, and Personal Rights risk to 4 out of 4 persons in care.

Official plan of correction

Administrator will adjust water heater to deliver water temperature between 105 to 120 degrees F and submit LIC 9098 by 9/2/21. Administrtor will maitain a 7 day log of water temperature and will submit to the department by 9/9/21.

Deadline recorded: Sep 2, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

(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: (1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidence by: Based on LPAs observation and records administrator did not ensure S2 does not have a criminal background clearance which poses an immediate Health, Safety, and Personal Rights risk to persons in care. *Civil penalties are being assessed in the amount of $ 500.00.*

Official plan of correction

Admistrator is to ensure all staff obtain a criminal record background clearance. S2 should not return to work until cleared and associated to the facility. Administrator is to submit LIC 9098 to certify, and copy livescan and transfer request and submitted to the department by 9/2/21.

Deadline recorded: Sep 2, 2021. 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 met as evidence by: Based on LPAs observation administrator did not ensure R3's dresser and closet door are in good repair, and living room smoke detector is working properly which poses a potential Health, Safety, or Personal rights risk to persons in care.

Official plan of correction

Administrator will ensure facility is in good repair at all time, will replace dresser and fix closet door in R3, and will replace smoke detector in living room. Administrator to take pictures and submit to the department by 9/7/21.

Deadline recorded: Sep 7, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(C)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accomodations and Services: (a) Living accommodations... shall...(3) Equipment and supplies necessary for personal care...(C) Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads,... This requirement is not met as evidence by: Based on LPA observation administrator did not ensure R1 and R3 did not have all required bedding which poses a potential Health, Safety, or Personal rights risk for persons in care.

Official plan of correction

Administrator will ensure R1 is readily for new admission and that R3 maintains all bedding items available at all times. Administrator will submit pictures to the department by 9/7/21.

Deadline recorded: Sep 7, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87307(a)(3)(B)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accomodations(a) Living accommodations and grounds shall be...(3) Equipment and supplies necessary... (B) Bedroom furniture, which shall include, for each resident, a chair, night stand, a lamp, or lights sufficient for reading, and a chest of drawers. This requirement is not met as evidence by: Based on observation administrator did not ensure each resident in R4, R2, R1 have a night stand which poses a potential Health, Safety, or Personal rights to persons in care.

Official plan of correction

Administrator will ensure that each resident has a night stand in R1, R2, and R4 and will submit pictures to the department by 9/7/21.

Deadline recorded: Sep 7, 2021. A deadline is not proof that correction was completed.