ST MATTHEWS HOME FOR THE ELDERLY II

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 in 6 out of 6 residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/14/2024 Plan of Correction Staff removed disinfectant during inspection. *This clears 24 hour correction.** Licensee will retrain staff on this regulation and send proof of retraining by 10/18/24, via email.

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, the licensee did not comply with the section cited above in 6 out of 6 residents, staff, and/or visitors, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee will submit proof of liability insurance by 10/18/24, via email.

Official classification

Type B

Official code

87632(d)(2)

Regulation authority

CCR

What the official deficiency says

(2) The licensee shall notify the Department in writing within five working days of the initiation of hospice care services for any terminally ill resident in the facility or within five working days of admitting a resident already receiving hospice care services. The notice shall include the resident's name and date of admission to the facility and the name and address of the hospice. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, licensee did not send the above information for R1,R2, and R2, the licensee did not comply with the section cited above in 3 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee will send the above information for R1, R2 and R3 by 10/18/24, via email.

Official classification

Type B

Official code

87633(a)(2)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (2) The licensee remains in substantial compliance with the requirements of this section, with the provisions of the Residential Care Facilities for the Elderly Act (Health and Safety Code Section 1569 et seq.), all other requirements of Chapter 8 of Title 22 of the California Code of Regulations governing Residential Care Facilities for the Elderly, and with all terms and conditions of the waiver. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the facility is only approved for 2 hospice residents, however, the facility is providing care for 3 hospice residents, the licensee did not comply with the section cited above in 1 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee will apply for hospice increase by 10/18/24. Licensee will certify plan to address how the facility plans to remain in compliance with terms and conditions of hospice waiver.

Official classification

Type B

Official code

87633(h)(5)

Regulation authority

CCR

What the official deficiency says

(h) For each terminally ill resident receiving hospice services in the facility, the licensee shall maintain the following in the resident's record: (5) A statement signed by the resident's roommate, if any, or any resident who will share a room with a person who is terminally ill to be accepted or retained as a resident, indicating his or her acknowledgment that the resident intends to receive hospice care in the facility for the remainder of the resident's life, and the roommate's voluntary agreement to grant access to the shared living space to hospice caregivers, and the resident's support network of family members, friends, clergy, and others. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, R3 & R4 roomates did not sign above acknowledgment, the licensee did not comply with the section cited above in 4 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee will obtain written acknoledgment from R3 & R4's roommates. Proof must be submitted via email by 10/18/24

Official classification

Type B

Official code

87412(13)(B)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, S2 did not have personnel file at the facility which documents criminal clearance, the licensee did not comply with the section cited above in 6 out of 6 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/18/2024 Plan of Correction Licensee will describe future plans to affirm and maintain ongoing complaince with this regulation. Proof must be submitted by 10/18/24, via email.

Official classification

Type A

Official code

1569.618(a)

Regulation authority

HSC

What the official deficiency says

(a) The administrator designated by the licensee pursuant to paragraph (11) of subdivision (a) of Section 1569.15 shall be present at the facility during normal working hours. A facility manager designated by the licensee with notice to the department, shall be responsible for the operation of the facility when the administrator is temporarily absent from the facility. 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 in having the administrator being present at the facility during normal working hours, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2023 Plan of Correction Licensee will submit a written plan and schedule indicating how they will comply with having the adminstrator at the facility sufficient time during normal business hours to be responsible for the operations of the facility and who their designee is/will be in case administrator is not available (LIC308). Send to LPA via email by POC due date.

Official classification

Type A

Official code

87412(a)(13)(B)

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: (13) For employees that are required to be fingerprinted pursuant to Section 87355, Criminal Record Clearance: (B) Documentation of either a criminal record clearance or a criminal record exemption as required by Section 87355(e). 1. For Certified Administrators, a copy their current and valid Administrative Certification meets this requirement. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in maintaining proof of a current and valid adminstrator certificate available at the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2023 Plan of Correction Licensee will provide LPA with the facility administrator current and valid certificate and will submit additional request to update adminstrator, if changes are needed, to LPA via email by POC due date.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in making available staff records for 3 of 5 staff, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will submit a written plan on how the facility will ensure to maintain all staff records readily available for licensing agency to inspect during normal business hours. Submit to LPA via email by POC due 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 observation, interview, and record review, the licensee did not comply with the section cited above in 3 of 5 staff files were not maintained on the administrator and 2 staff, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will create a file and keep at the facility for all staff employed at the facility. A copy of files for administrator and S4-S5 will be provided to LPA via email by POC due date.

Official classification

Type B

Official code

87412(a)(11)

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: (11) A health screening as specified in Section 87411, Personnel Requirements - General. 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 in 2 avilable staff files did not have health screenings, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Proof of Record of Health Screening for S1-S2 will be emailed to LPA via email by POC due date.

Official classification

Type B

Official code

87412(c)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. 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 in 2 available staff files reviewed did not have proof of required staff training and orientation, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will email LPA proof of required annual training and orientation records for S1-S5, by POC due date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review… shall prior to working… in a licensed facility: (2)Request a transfer of a criminal record clearance… This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 staff not being associated to the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/09/2023 Plan of Correction Licensee will provide LPA with S4 and S5's request for transfer of criminal record clearance, copies of Identification, and criminal record statemen, via email by POC due date.

Official classification

Type B

Official code

87208(a)(7)(A)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (a)… The plan and related materials shall be on file in the facility... Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval...: (7)Sketches, showing dimensions, of the following:(A)Building(s) to be occupied, including a floor plan that describes the capacities of the buildings for the uses intended and a designation of the rooms to be used… This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in submitting a change of facility sketch for the room proposed for staff use, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will submit a new facility sketch to licensing, requesting approval to use the closet as a propsed room designated for staff use, to LPA via email by the 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 observation and record review, the licensee did not comply with the section cited above in providing licensing with a copy of their current and valid liability insurance information, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will submit proof of the current and valid liability insurance for the facility to LPA via email by the POC due date.

Official classification

Type A

Official code

87307(c)

Regulation authority

CCR

What the official deficiency says

(c) Individual privacy shall be provided in all toilet, bath and shower areas. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in a staff room has been created inside a resident room, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/08/2023 Plan of Correction The licensee will remove all staff items and revert the closet to it's normal state as is noted in the facility sketch by the POC due date and will send LPA a pictue via email.

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) (interview) (record review)], the licensee did not comply with the section cited above in 2 knoves and a pair of scissors were found in a drawer in the kitchen accessible to residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/08/2023 Plan of Correction Staff removed the items and placed them away while LPA observed. This deficiency is cleared.

Official classification

Type A

Official code

87555(b)(26)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (26) Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in insufficient 2-day perishables for 6 of residents, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/08/2023 Plan of Correction Licensee will purchase food for residents and send a picture of the refrigerator filled with food as well as purchase receipts to LPA via email by the POC due date.

Official classification

Type B

Official code

87208(a)(12)

Regulation authority

CCR

What the official deficiency says

(a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (12) The Infection Control Plan pursuant to Section 87470. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee was requested to submit an infection control plan to the licensing agency by 7/28/23 and has yet to receive it, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will submit the infection control plan to LPA via email by the POC due date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

(a) 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 is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [6 of 6 residents not having complete files, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will send LPA a written plan of how will monitor and ensure resident files are maintained complete and at the facility at all times, via email by POC due date.

Official classification

Type B

Official code

87457(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) Prior to admission a determination of the prospective resident's suitability for admission shall be completed and shall include an appraisal of his/her individual service needs in comparison with the admission criteria specified in Section 87455, Acceptance and Retention Limitations. (1) The appraisal shall include, at a minimum, an evaluation of the prospective resident's functional capabilities, mental condition and an evaluation of social factors as specified in Sections 87459, Functional Capabilities and 87462, Social Factors. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 6 out of 6 residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will submit a Pre-Placement plan for 6 residents to LPA via email by POC due date.

Official classification

Type B

Official code

87458(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 6 out of 6 residents, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will submit a medical assessment for 6 residents in care to LPA via email by POC due date.

Official classification

Type B

Official code

87507(d)

Regulation authority

CCR

What the official deficiency says

(d) The licensee shall retain in the resident's file the original signed and dated admission agreement and all subsequent signed and dated modifications. This does not apply to rate increases which have specific notification requirements as specified in Health and Safety Code section 1569.655. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in1 of 6 residents do not have an admissions agreement on file, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will submit an admissions agreementfor Resident# 1 to LPA via email by the POC due date.

Official classification

Type B

Official code

87608(a)(3)

Regulation authority

CCR

What the official deficiency says

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions: (3) A written order from a physician indicating the need for the postural support shall be maintained in the resident's record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 3 residents not having a written order for bedrails indicating the need for it, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will obtain written orders for R1, R5, and R6 to use bed rails on their beds, sent to LPA via email by POC due date.

Official classification

Type B

Official code

87633(a)(1)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician and surgeon and who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility, when all of the following conditions are met: (1) The licensee has received a hospice care waiver from the department. This requirement is not met as evidenced by: Deficient Practice Statement Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in 3 residents in care on hospice and facility only has approval for 2, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/15/2023 Plan of Correction Licensee will submit a written request to retain more hospice residents than currently, to LPA via email by POC due date.

Official classification

Type B

Official code

87411(c)(6)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General:(c) All RCFE...(6)The licensee shall maintain documentation pertaining to staff training in the personnel records, ... For on-the-job training,.. This requirement is not met as evidence by: Based on document review and observation licensee failed to ensure staff #1 and #2 files were available for review during the visit conducted on 11/3/23 and to provide documents after which poses a potenital risk to the health, safety, personal rights of the persons in care.

Official plan of correction

Administrator will certify on LIC 9098 that files will be available for review at the facility and will submit the requested trainings to the department by POC due date 8/29/23.

Deadline recorded: Aug 29, 2023. 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: Based on observation licensee did not ensure staff did not wear mask properly as observed on visit conducted on 11/3/22 which poses an immediate risk to the health, safety, personal rights to the persons in care.

Official plan of correction

Administrator will submit training provided to staff between September 2022 and February 2023 regarding COVID 19 protocols and will submit LIC 9098 certifying to adhere to 87468.1(a)(2) signed by licensee by POC due date 8/23/23.

Deadline recorded: Aug 23, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(f)

Regulation authority

CCR

What the official deficiency says

(f) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Records may be removed if necessary for copying. Removal of records shall be subject to the following requirements: This requirement is not met as evidence by: Based on observation Licensee did not ensure personnel records are available at the facility for licensing agency to review fjor all staff which poses a potential health, safety, or personal rights risk to the persons in care.

Official plan of correction

Licensee will ensure files are maintain at the facility or accessible and will provide a copy of staff roster, caregiver schedule for the week of 09/26/22 - 11/3/22, staff training on COVID guidelines for the past 6 months, and any COVID related exemption letters for all staff to the department by POC 11/7/22.

Deadline recorded: Nov 7, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (e)Water supplies and plumbing fixtures shall be maintained as follows:(6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. 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 when LPA observed the toilet in bathroom# 2 was not in good repair as it was missing the toilet seat and top pump cover, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2022 Plan of Correction Administrator will obtain a cover for the top pump and toilet seat and will repair it. A picture of the correction will be faxed to LPA by the POC due date.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (e)All individuals subject to a criminal record review…shall prior to working, residing or volunteering in a licensed facility:(2)Request a transfer of a criminal record clearance… This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in 3 of 3 staff working at the facility were present without being associated to the facility, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/21/2022 Plan of Correction Adminstrator will submit LIC9182 Criminal Background Clearance Transfer Request for each staff with the respective documents and ID's to associate them, as she states she is unable to access Guardian for now.

Official classification

Type B

Official code

87632(a)

Regulation authority

CCR

What the official deficiency says

87632 Hospice Care Waiver (a)In order accept or retain terminally ill residents and permit them to receive care from a hospice agency, the licensee shall have obtained a facility hospice care waiver from the Department. To obtain this waiver the licensee shall submit a written request for a waiver to the Department on behalf of any residents who may request retention, and any future residents who may request acceptance, along with the provision of hospice services in the facility. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above as LPA discovered that the facility has an approved hospice waiver for 2, but currently has 4 residents on hospice, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2022 Plan of Correction The administrator will submit a request to LPA by fax, for a request in increase of hospice waiver to accomodate the current residents they have on hospice, completed by POC date.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records (a)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 is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited aboveas LPA observed 3 of 6 resident files to be missing required documentation, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2022 Plan of Correction The administrator will complete and submit a copy of completed resident files to LPA via fax, by the POC date.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

87412 Personnel Records (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: (11)A health screening… (c)Licensees shall maintain in the personnel records verification of required staff training and orientation. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in 3 of 3 staff files being incomplete, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2022 Plan of Correction The administrator will complete and submit a copy of completed staff files to LPA via fax, by the POC date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (c)Licensees who accept and retain residents with dementia shall be responsible for ensuring the following:(5)Each resident with dementia shall have an annual medical assessment… and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above in 2 of 6 residents with dementia did not have an updated medical assessment or reappraisal in their file, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/19/2022 Plan of Correction Administrator will schedule and obtain an updated medical assessment for residents with dementia. A copy of the udpated records will be faxed to LPA by the POC due date.