BELMONT VILLAGE CALABASAS

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

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: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidence by: Based on interviews conducted, licensee did not comply with above section cited. Staff went into resident's room without prior permission and removed resident #1's medications.

Official plan of correction

Executive Director shall provide a plan of correction on how they will maintain future compliance with Personal Rights of Residents.

Deadline recorded: May 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement is not met as evidence by: Based on records review and interviews, licensee did not comply with section cited above. R1 was billed for services not provided by facility staff.

Official plan of correction

Executive Director shall provide evidence that the billing errors have been resolved. Also include a statement of future compliance plan.

Deadline recorded: May 30, 2025. 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

Personal Rights of Residents in All Facilities To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: Based on records review and interviews conducted, the licensee did not comply with the section cited above. R1 is to be on continous oxygen use. Staff did not ensure R1 was with oxygen when out the room from approximately 1/9/2025 to 1/17/2025.

Official plan of correction

Executive Director shall provide a plan of correction on how they will maintain future compliance with Personal Rights of Residents.

Deadline recorded: May 30, 2025. 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

(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. This requirement is not met as evidence by: Based on interviews conducted, the licensee did not comply with the section cited above. R1's portable oxygen charging cord was missing/lost.

Official plan of correction

Executive Director shall provide a plan of correction on how they will maintain future compliance with regards to safeguarding residents' personal property.

Deadline recorded: May 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

87465(a)(4) Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility…(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: Based on record review and observations, the licensee did not comply with the section cited above, as the facility staff did not properly assist with R1’s self-administered medications per physician’s order which poses an immediate health and safety risk to residents in care.

Official plan of correction

The ED will submit a statement of understanding of the regulation and how they will continue follow their their medication procedures.

Deadline recorded: Apr 10, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

87468.2(a)(4)residents…shall have all of the following personal rights: To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement is not met as evidence by: Based on interviews, and records review, the licensee did not comply with the section cited above as Staff did not respond to residents calls for assistance in a timely manner due to staff lacking room’s keys to access residents, which poses a potential health and safety risk to residents in care.

Official plan of correction

The deficiency has been cleared due to new FOB key system, which ensures all staff have a key to access residents in their rooms.

Deadline recorded: Dec 20, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.312(a)

Regulation authority

HSC

What the official deficiency says

Basic services shall at a minimum include: (a) Care and supervision as defined in Section 1569.2. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above. Due to a lack of supervision, R1 sustained multiple falls resulting in multiple injuries, which posed an immediate health and safety risk to residents in care.

Official plan of correction

Licensee agreed to submit a plan on how they will ensure appropriate care and supervision to meet the needs of residents. Submit to CCL via e-mail by COB 08/30/2024

Deadline recorded: Aug 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental and Medical Care: ....Once ordered by the physician the medication is given according to the physician's directions. This requirement has not been met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above as R1 did not receive their prescribed medications on 12/30/23,which poses an immediate health and safety risk to residents in care.

Official plan of correction

The Licensee has agreed to review regulation cited and submit a statement of understanding to CCL via email by COB 08/30/2024.

Deadline recorded: Aug 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)(3)

Regulation authority

CCR

What the official deficiency says

Any illness, injury, trauma, or change in the health care needs of the resident that results in a circumstance or condition specified in Sections 87455(c) or 87615, Prohibited Health Conditions. This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above as R1 was observed to have sustained (8) falls and a reappraisal was only conducted (2) times. This poses / posed a potential health, safety and personal right rights risk to persons in care.

Official plan of correction

Licensee agreed to review section cited and provide a statement of understanding to LPA via email by COB 09/06/2024.

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(1)(B)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency...(B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision.This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not submit incident reports for R1’s numerous unwitnessed falls which required hospital visits, which posed a potential health and safety risk to residents in care.

Official plan of correction

The licensee will submit a plan describing how you will ensure reporting requirements are followed. Submit proof to CCL via email by 09/06/2024

Deadline recorded: Sep 6, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

The licensee shall notify the Department in writing within five working days... name and date of admission to the facility and the name and address of the hospice.This requirement is not met as evidenced by: Based on records review, the licensee did not comply with the section cited above. Licensee did not submit hospice notification to CCL when R1 was placed on hospice 07/30/2023, which posed a potential health and safety risk to residents in care.

Official plan of correction

The licensee will submit a plan describing how you will ensure the Department receives hospice notifications. Submit proof to CCL via email by COB 09/06/2024

Deadline recorded: Sep 6, 2024. 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 water temperature was tested throughout the visit including resident unit restroom and common areas, and water measured between 107.4– 121.0 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 03/21/2024 Plan of Correction The ED stated that the facility staff will adjust water temperature within required range and send proof to the LPA.

Official classification

Type B

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

87465(h)(6) Incidental Medical and Dental Care. The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement is not met as evidenced by: Deficient Practice Statement Based on an observation and record review, the licensee did not comply with the section cited above, as the records, CSMDR were not updated or were missing for six (6) out of six (6)resident medications which poses a potential health and safety risk to persons in care.

Official plan of correction

POC Due Date: 04/05/2024 Plan of Correction The Director of Resident Care Services, Kelly Penrose, stated that facility staff will receive medication training and look for the missing CSMDR by due date and moving forward will ensure that CSMDR are completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211(a)(2) Reporting Requirements. Occurrences, such as epidemic outbreaks, poisonings, catastrophes or major accidents which threaten the welfare, safety...shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement is not met as evidenced by: Based on interview, the licensee did not comply with the section cited above as the facility is not following reporting requirements to the local public health department, which poses an potential health, safety and personal rights risk to persons in care.

Official plan of correction

The Executive Director agreed to do the following: 1. Review reporting requirements as communicated by local public health. Submit a statement of understanding, indicating how the facility will maintain voluntary compliance. Submit statement no later than 3/8/2023.

Deadline recorded: Mar 8, 2023. A deadline is not proof that correction was completed.