SKYHILL QUALITY LIVING #2

Official classification

Type B

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 ensuring that laundry cleaners/chemicals are kept in locked cabinets, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2025 Plan of Correction In-service training will be also provided to all current and future staff members. Licensee/Administrator will retrain the staff and will submit in writing, copy of the training to the LPA/Department by POC date.

Official classification

Type B

Official code

87309(c)

Regulation authority

CCR

What the official deficiency says

(c) Except as specified in subsection (d), the licensee shall implement reasonable interventions in order to ensure that nutritional supplements, vitamins, alcohol, cigarettes and other potentially toxic substances, such as certain plants, gardening supplies, and auto supplies, are stored so as not to pose a hazard to residents. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above ensuring that medications and supplements are kept in locked cabinets, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/25/2025 Plan of Correction In-service training will be also provided to all current and future staff members. Licensee/Administrator will retrain the staff and will submit in writing, copy of the training to the LPA/Department by 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 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: Based on LPA's observation, LPA observed the bathroom #1 hot water temeperature was measured at 88.5 degrees Fin the tub. Siink in room #1 was 107.6. Bathroom 2 measured at 88.5, bathroom Room #4 measured at 87.2 and kitchen ,easured at 87.2 which poses a health and safty hazard to resident's in care.

Official plan of correction

Administrator will adjust water temperture and provide proof to LPA by POC date.

Deadline recorded: Dec 2, 2022. 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

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: This requirement is not met as evidenced by: LPA and Administtrator observed bathroom screen in disrepiar and window sill uncleaned and toleit uncleaned.

Official plan of correction

Administrator will reapair or replace screen in bathroom number 4 and clean window sill and toilet by POC date

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

Official classification

Type A

Official code

87202(a)(2)

Regulation authority

CCR

What the official deficiency says

Licensee admitted residents that became bedridden resident #1(R1) . Facility does have approved bedridden clearacne for 2 residents but must be in room #1 fire clearance.is required before bedridden residents can reside in any other room other than room #1 This requirement is not met as evidenced by: R1 is bedridden and residing in room #4 which is not cleared for bedridden which poses a helath and safety issue to persons in care.

Official plan of correction

Licensee shall submit appropriate request for bedridden fire clearance. Or move resident to room #1 or get updated Physicans report. LIC200, facility floor plan and plan of care for bedridden residents must be submitted to CCL by POC due date.

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

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental: (e) For every prescription and nonprescription PRN medication... there shall be a signed, dated written order from a physician,... maintained in the residents file, and a label on the medication.... This requirement is not met as evidence by: None of R1 medications had doctor's orders and PRN physician letter was not on file for R1 PRN medications. Cream for skin rash was missing label and doctor's order which poses a health and safety issue to residents in care.

Official plan of correction

Licensee will obtain doctor's orders for all of R1 medications and PRN letters and send proof to LPA by POC date. ****Licensee provided proof of PRN letter to LPA for R1**** NO FURTHER ACTION REQUIRED**

Deadline recorded: Oct 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(5)

Regulation authority

CCR

What the official deficiency says

to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement is not met as evidence by: Staff stated that he transfers the new refill medications to the old bottles to consolidate the medications which poses a health and safety issue to residents in care.

Official plan of correction

Licensee will provide training on proper medication storage and administration and send proof that all staff have attended the training by POC date

Deadline recorded: Oct 21, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities. (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. This requirement is not met as evidence by:: Staff provided medications to resident without keeping log which resulted in medications being short. Medication Sertraline medication 50MG had 36 pills uncounted for based on count. Medication Monteluska 10mg had 31 pills missing and unaccounted for. Tamsulin medication .4mg had 5 pills missing. Caregiver could not account for the missing pills which poses a health and safety issue to residents in care.

Official plan of correction

Licensee will conduct training in personal rights for all staff and send proof to LPA by POC date.

Deadline recorded: Oct 20, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(e)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental: (e) For every prescription and nonprescription PRN medication... there shall be a signed, dated written order from a physician,... maintained in the residents file, and a label on the medication.... This requirement is not met as evidence None of R1 medications had doctor's orders and PRN physician letter was not on file for R1 PRN medications. Cream for skin rash was missiing label and doctor's order.

Official plan of correction

Licensee will obtian doctor's orders for all of R1 medications and PRN letters and send proof to LPA by POC date.

Deadline recorded: Jul 15, 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

Resident Records. 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 requirement was not met evidenced 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, and R6's file was not observed. 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(c)(1)

Regulation authority

CCR

What the official deficiency says

Safeguards for Resident Cash, Personal Property, and Valuables. Every facility shall account for any cash resources entrusted to the care or control of the licensee or facility staff. Cash resources include but are not limited to... personal and incidental need allowances from funding sources such as SSI/SSP. This requirement was not met evidenced by: Based on the Trust Audit report, record review, and interviews conducted the findings indicate Licensee did not distribute P & I funds to residents (R1 & R2), and did not keep proper records of funds entrusted to her. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to: 1. Pay back residents (R1 & R2) all P & I amounts due. Licensee owes: Resident (R1) $1,518.00 Resident (R2) $690.00. 2. Submit proof (bank statements) that the amounts due were issued to R1 & R2.

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

Safeguards for Resident Cash, Personal Property, and Valuables. Cash resources and valuables of residents which are handled by the licensee for safekeeping shall not be commingled with or used as the facility funds or petty cash, and shall be separate, intact and free from any liability the licensee incurs in the use of his own or the facility's funds and valuables... This requirement was not met evidenced by: Based on Trust Audit report and record review Licensee is commingling facility funds with personal and incidental funds. Facility bank statements were obtained. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to deposit residents' P & I funds into a bank trust account. Facility bank account should not have any residents' monies. Provide copies of bank statements showing P & I funds have been deposited into a trust account.

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

Bonding. Each licensee, other than a county, who is entrusted to safeguard resident 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. The amount of the bond shall be in accordance with the following schedule: Total Safeguarded Per Month- Bond Required $750 or less= $1,000, $751 to $1,500= $2,000 $1,501 to $2,500 =$3,000. This requirement was not evidenced by: Based on record review and interviews conducted Licensee acknowledged that a Surety Bond was not in place on 9/1/2022. The bond provided covers the corporation and does not cover each license. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to submit a copy of the Surety Bond by POC due date. NOTE: The Surety Bond should cover the facility and not the corporation.

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 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. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. (3) Ability to maintain or supervise the maintenance of financial and other records. (5) Good character and a continuing reputation of personal integrity. This requirement was not evidenced by: Based on the Trust Audit report and record review the findings indicate Licensee failed to maintain financial records; and provided DHS and CCL inaccurate documentation and information.

Official plan of correction

Licensee/Administrator will schedule vendorized training related to the cited section as well as all other sections cited on this report. See below: Licensee will attend continued education classes provided for Administrators. By POC due date, the Licensee will secure the appointment to attend the classes and inform CCL about the attendance.

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

Safeguards for Resident Cash, Personal Property, and Valuables. (b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources. This requirement was not met evidenced by: The Trust Audit findings revealed that Licensee failed to document expenditures of items purchased with P & I monies. Hand written amounts were submitted without original receipts. Receipts were prepared after the fact dated 8/11/21. This poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agrees to give residents receipts for all articles or cash resources, and keep proper documentation for expenditures. Submit a written plan addressing facility procedures and protocols.

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

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 for the elderly of a different license number, regardless of joint ownership. This requirement was not evidenced by: Based record review and interview condcuted during the audit investigation the Licensee failed to maintain accurate financial records; and provided DHS and CCL inaccurate documentation and information.

Official plan of correction

Licensee agrees to provide a copy of the bank statement showing P & I funds have been deposited into a trust account. Submit by POC due date.

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

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 evidenced by: Based on record review and interview conducted during the audit investigation the licensee did not comply with the cited section by providing inaccurate information and documentation to Department of Health Services and Community Care Licensing. This poses an immediate health, safety or personal rights risk to 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: Exclusions Personal 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 27, 2022. 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

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintanence services and procedures for the safety and well-being of the 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 as bathroom #1 and #2 toilet and tub was observed with not clean and in good repair. LPA also observed Mattress, box spring and trash located at the side of the house, which poses an potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/30/2022 Plan of Correction Licensee will ensure Bathrooms toliet and showers are cleaned and good repair. Licensee will also removed bed, box spring and trash on the side of the house. Licensee will submitt pictures of repaired/clean toilets by POC date.

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 poisions, 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 as disinfectants, cleaning solutions and laundry detergent were not locked, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2022 Plan of Correction Licesee will ensure disinfectants, cleaning solutions and laundry detergent is in a locked storage. Licensee will provide staff training and signin sheet is due to LPA by POC date. The deficency was corrected during the visit.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physican has stated in writing that the resident is unable to determine his/her own need for nonprescription PRN medication but can 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: (2) Once ordered by the physcian the medication is givengiven according to the physcian's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above as R1 medications has not been administered for aprox. 1 week, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/19/2022 Plan of Correction Licensee shall ensure R1 is given his medications as directed in physcians orders. Licensee provide staff training on section 87465 and a copy of sign in sheet is due to LPA by POC date.

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 3 out of 3 bathrooms which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/01/2021 Plan of Correction Licensee will ensure water temperature is maintain within the required range of 105-120 degress F. at all times. Licensee will certify and submit LIC 9098 by 12/1/2021. Licensee will maintain log for 7 days and submit to the department on 12/7/2021.

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 as knives and chemical solutions were not in a locked storage, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/01/2021 Plan of Correction Licensee will provide a lock space for knives and sharps, and will ensure knives and chemical solutions are kept lock at all times. Licensee will provide in-service training, submit pictures of locked space and cabinet, and copies of in-service training agenda and sign-in sheet by 12/1/21.

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 as medications was observed unlocked, refill medication was in an unlocked drawer in the kitchen and PRN medication was observed in resident #1 bedside table, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/01/2021 Plan of Correction Licensee will ensure medications are kept locked at all times. Licensee will provide in-service training to staff and submit a copy of the training agenda and sign-in sheet by 12/1/21.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

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 as bathroom and showers were not observed clean which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/08/2021 Plan of Correction Licensee will ensure bathrooms, showers and toilets are kept clean and in good repair. Licensee will submit pictures of repaired/cleaned toilets and replaced commode toilet seat by 12/8/21

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355(e)(1) 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 by evidence of: Based on observation during the physical plant inspection of the garage " staff room " . Staff (S1) was observed hiding in the restroom. Staff does not have Criminal Background clearance. This poses a potential health and safety threat to residents in care. Civil penalties are being assessed in the amount of $ 500.00.

Official plan of correction

Licensee shall ensure that all staff obtain a Criminal Record Background Clearance prior to starting employment. Uncleared persons cannot return to work until they are cleared and associated to the facility. Submit proof of Livescan and transfer requests by POC due date (tomorrow).

Deadline recorded: Sep 2, 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 (a)(3)(C) Personal Accommodations and Services. Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. This requirement was not met by evidence of: Based on observation during the physical plant inspection none of the resident beds had mattress pads in the beds. Staff confirmed mattress pads are not placed on the bed mattresses. This poses a potential health and safety risk to residents in care.

Official plan of correction

Licensee shall purchase mattress pads for all resident beds. Submit picture proof and receipts by POC due date.

Deadline recorded: Sep 8, 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

87303(a) 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 was not met by evidence of: Based on observation at 10:37 am and 11:59 AM cockroaches were observed in the kitchen area. Staff confirmed there are cockroaches in the home. This poses a potential health and safety issue to residents in care. In addition, discarded stove was observed in the front yard, the exterior sides of the home had discarded mattresses, bed rails, mattress springs, and trash was observed in the backyard.

Official plan of correction

Licensee shall: 1. Remove all discarded equipment and trash from the front/back, and side areas of the home. Provide picture proof of correction. 2. Hire a pest control company and provide proof of weekly treatment for a total of 4 weeks. Submit pest control service in-voice and contract of a minimum of 4 weeks.

Deadline recorded: Sep 8, 2021. A deadline is not proof that correction was completed.