BELMONT VILLAGE CALABASAS

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.