FIL-AM HOME FOR SENIORS: LANSING'S

Official classification

Type B

Official code

87506(b)(15)

Regulation authority

CCR

What the official deficiency says

(b) Each resident's record shall contain at least the following information: (15) The admission agreement and pre-admission appraisal, specified in Sections 87507, Admission Agreements and 87457, Pre-admission Appraisal. 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 in one (1) out R5 of six residents (6) did not have an admissions agreement on file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Licensee will obtain an Admissions Agreement for R5 by POC due date. Moving forward licensee will ensure to obtain Admissions Agreement upon admission.

Official classification

Type B

Official code

87456(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (2) Perform a pre-admission appraisal. 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 in two (2) out of six (6) residents R5 and R6 had an incomplete or no pre-appraisal which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Licensee will obtain pre-appraisals for R5 and R6 by POC due date. Moving forward licensee will ensure to obtain pre-appraisals upon admission.

Official classification

Type B

Official code

87458(c)(1)(A)

Regulation authority

CCR

What the official deficiency says

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. 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 in three (3) out of six (6) residents R3, R5 and R6 did not have proof of TB in files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Licensee will submit proof of physical exam and TB test for staf R3, R5 and R6 by POC due date. Licensee will ensure to obtain physical and TB test upon prior to admission of resident.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 in three (3) out of four (4) staff did not have proof of first aid in file which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Licensee to submit proof of first aid for S1,S2 and S3 by POC due date. Licensee to ensure staff maintain a valid and current first aid certificate on file.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence...(A)Death of any resident from any cause regardless of where the death occurred, including but not limite... to visiting away from the facility. The requirement was not met as evidence by R2 was hospitalized on 04/15/23 and passed away on 04/16/23, however, facility failed to report R2 hospitalization and death to licensing per Title 22 regulations.

Official plan of correction

Administrator to send an incident report (LIC624A) for R2 by POC Due date 05/17/2024. On 04/09/24, Administrator provided a copy of R2’s death certificate to LPA Vaid.

Deadline recorded: May 17, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

87211 (a)(1)(A) a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence...(A)Death of any resident from any cause regardless of where the death occurred, including but not limite... to visiting away from the facility. This requirement wasn't met as evidenced by: R2 was hospitalized on ?? and passed away on 04/16/23, however, facility failed to report R2 hospitalization and death to licensing per Title 22 regulations.

Official plan of correction

Plan of Correction: On 04/09/24, Administrator provided a copy of R2’s death certificate to LPA Vaid. Administrator to send an incident report (LIC624A) for R1 and R2 by POC Due date 05/06/2024.

Deadline recorded: May 2, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

(a) Each licensee shall furnish to the licensing agency such reports...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence...(A)Death of any resident from any cause regardless of where the death occurred, including but not limited to a day program, a hospital, en route to or from a hospital, or visiting away from the facility.

Official plan of correction

Faciility will submit copy of death certificates for R2 and death report for R1 and R2 by 4/16/2024.

Deadline recorded: Apr 9, 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

(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: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Deficient Practice Statement Based on record reviewed, LPA observed Resident#1's daily medication Vitamin D3 (50mcg once daily) and omerprazole (20mg one day before meal) was not listed on the MARs and staff not sure if the resident take the medication or not

Official plan of correction

POC Due Date: 01/13/2024 Plan of Correction Administrator will ensure the medication once ordered by physician and the medication is given according to the physician direction and Administrator will retrain the staff for medication and will send the staff training log by POC due date.

Official classification

Type B

Official code

1569.605

Regulation authority

HSC

What the official deficiency says

On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate, caused by the negligent acts or omissions to act of, or neglect by, the licensee or its employees. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA did not observe the actual liabiltiy insurance policy in place and the facility only has the quote which posed a potentil risk to resident in care.

Official plan of correction

POC Due Date: 01/26/2024 Plan of Correction Administrator will ensure the liabitliy insurnace policy is in place and administrator will submit the copy of actual insurance policy by POC due date.

Official classification

Type B

Official code

87507(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. (1) The text of the admission agreement, including any attachments and modifications, shall be: (A) Printed in black type of not less than 12-point type size, on plain white paper. The print shall appear on one side of the paper only. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA observed all residents' admission agreement was not on one side of the paper only. They were all on double side which post a potential risk to residnet in care.

Official plan of correction

POC Due Date: 01/26/2024 Plan of Correction Administrator will ensure all the admission agreement print shall appear on one side of the paper only and will update all residents' agreement and send it to LPA by POC due date.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, LPA did not observe any emergency drill was conducted in the past year and staff admitted they did not conduct any fire drill last year which pose a potential risk to residents in care.

Official plan of correction

POC Due Date: 01/19/2024 Plan of Correction Administrator will ensure the facility shall conduct a drill at least quarterly for each shift. Administrator will conduct a fire/emergency drill with staff and residents and send the copy of the recent drill report to LPA by POC due date.