MCNULTY VILLA

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 evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 1 out of 1 kitchen gas tove 2 out 4 are only working and the bathroom are missing a door knob and cracks in the shower corner, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 04/23/2026 Plan of Correction Licensee will have kitchen gas stove repaired/ replaced; bathroom will be repaired by POC date.

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. LPA observed a cleaning solution in the backyard area available to residents in care. This poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/12/2025 Plan of Correction Lhe licensee immediately moved and stored cleaning solution inside the staff room, which is locked at all times.

Official classification

Type B

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, LPA measured the hot water in bathrooms to be 136F, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/16/2025 Plan of Correction Licensee/ Administrator will adjust the water temperature by POC due date and will provide proof of water temperature.

Official classification

Type B

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction. 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 having obstructions/ boxes, tools, broken furniture etc on emergency exit areas, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/13/2025 Plan of Correction Licensee immediately cleaned the obstructions which were present on emergency exit.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review the licensee did not comply with the section cited above. Staff files were incomplete and missing required forms. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/16/2025 Plan of Correction The licensee / Administrator will email missing forms and the entire employee file for LPA review by POC due date.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. 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 breakfast area is cluttered. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/16/2025 Plan of Correction The Licensee will provide a picture of a clean kitchen and breakfast area.

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. LPA observed the fridge was broken and the kitchen had clutter. This is a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/16/2025 Plan of Correction The Licensee/Administrator will clean the kitchen area and will provide the new fridge receipt and picture by POC due date.

Official classification

Type B

Official code

87468.2(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights...(a)In addition to the rights listed in Section 87468.1...(2)To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement is not met as evidenced by: Based on the observation and interviews the administrator violated residents personal rights by exposing residents' personal and confidential records to the public which poses immediate Health, Safety or Personal Rights risks to person in care.

Official plan of correction

The Administrator and staff will conduct training on Personal Rights of Residents and will provide copy of the training materials to RO/LPA by the POC due date, which is 10/11/24.

Deadline recorded: Oct 11, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

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. LPA observed the fridge was unclean and the kitchen had clutter and an insect killer bottle. This is an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/30/2024 Plan of Correction The licensee immediately removed the insect killer and locked it in a cabinet and started cleaning the kitchen fridge.

Official classification

Type A

Official code

87309(a)

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. 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 a cleaning solution under the kitchen sink in an unlocked cabinet. This poses an immediate health, safety, or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/30/2024 Plan of Correction the licensee immediately removed all cleaning solutions under the kitchen sink

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. The kitchen door screen is torn which allowed filies in the kitchen. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction The licensee will provide proof of purchase of new door screening by the POC date.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on record review the licensee did not comply with the section cited above. S1 and S2 are missing CPR certificates, LIC 501 and 508. The licensee and Administrator folders are incomplete. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction The licensee will email S1 and S2 missing forms and the entire employee file for the Administrator and the Licensee.

Official classification

Type B

Official code

87555(b)(27)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (27) All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects. 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 breakfast area is cluttered. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction The Licensee will provide a picture of a clean kitchen and breakfast area.

Official classification

Type B

Official code

87555(b)(28)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. 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 spoiled food in the fridge. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction Licensee will provide a picture of clean fridge and proof of purchase of fruits and vegetables.

Official classification

Type B

Official code

87465(c)(3)

Regulation authority

CCR

What the official deficiency says

(c) If the resident's physician 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: (3) A record of each dose is maintained in the resident's record. The record shall include the date and time the PRN medication was taken, the dosage taken, and the resident's response. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. LPA was unable to complete medication audit due to incomplete forms. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction The Licensee will email LPA completed medications forms by the POC date.

Official classification

Type B

Official code

87506(b)(13)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (13) Continuing record of any illness, injury, or medical or dental care, when it impacts the resident's ability to function or the services he needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above. R4 have redness in the buttocks area and Licensee didn't notify CCL. This poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction Licensee will email SIR reporting the redness and skin condition of R4 by the POC date.

Official classification

Type B

Official code

87458(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any and results of an examination for communicable tuberculosis, other contagious/infectious or contagious diseases or other medical conditions which would preclude care of the person by the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above. R3 doesn't have LIC 602 which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2024 Plan of Correction Licensee will email LPA R3 LIC 602 by the POC date.

Official classification

Type B

Official code

87468.2(a)(20)

Regulation authority

CCR

What the official deficiency says

Additional Personal Rights of Residents in Privately Operated Facilities: Residents in privately operated residential care facilities for the elderly shall have the following personal rights: To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those permitted by state law or regulations and shall comply with all eviction and relocation protections for residents. This requirement was not met as evidenced by the admission of the licensee that R1 was relocated without proper notice.

Official plan of correction

As POC, both the licensee designee and administrator will review this section of the regulation and self certify that they have read and understood this section. As proof POC is made, a written self-certification is due to the licensing agency by 11/17/22

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

Official classification

Type B

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

Eviction Procedures. The licensee may, upon thirty (30) days written notice to the resident, evict the resident for nonpayment of the rate for basic services, failure to comply with state or local law, failure to comply with the general policies of the facility, development of a need not previously identified, and/or a change of use of the facility. This requirement was not met as evidenced by the admission from the licensee that R1 was not given proper 30 day notice. Furthermore, it was revealed that R1 was compliant with pay, state & local law and general policies of the facility.

Official plan of correction

Contintued: R1 also did not develop a change in condition in which the facility could no longer meet their needs since being admitted in February 2022. There was no documentation on file. As POC, both the licensee designee and administrator will review this section of the regulation and self certify that they have read and understood this section. As proof POC is made, a written self-certification is due to the licensing agency by 11/17/22

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