A FAITHFUL HOME OF COVINA

Official classification

Type B

Official code

87307(a)(3)(C)

Regulation authority

CCR

What the official deficiency says

(a) Living accommodations and grounds shall be related to the facility's function. (...) The following rules shall apply: (3) Equipement and supplies (...) the licensee shall assure provision of: (C) Clean linen, including (...) top bed sheets (...) to ensure that clean linen is in use (...) at all times. The regulation is not bed as evidenced by: Based on observation, LPA determined that the bed sheets of R1 have multiple stains on them that resemble blood stains, which poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator is to ensure that clean linens are available to residents at all times. Administrator is to change or clean the linen in R1's room and send proof of correction to LPA by the POC due date.

Deadline recorded: Jun 9, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.618(c)(3)

Regulation authority

HSC

What the official deficiency says

(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR. 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 four (4) out of four (4) staff did not have a valid CPR/First Aid on file which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/02/2025 Plan of Correction Staff in charge will submit staff's current CPR to LPA by POC due date.

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 review, the licensee did not comply with the section cited above in one (1) resident did not have terbinafine 1%, brimonidine 0.2%,ciclopirox 0.77%, mupirocin 2%, betamethasone 0.05%,calprotect 0.44%,nyamyc 1000 powder, nystatin 10000, and nicotine patch which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/02/2025 Plan of Correction Staff in charge will contact doctor and get updated medication log with all medications that have been discontined or fill prescription and send new list to LPA by POC due date.

Official classification

Type B

Official code

87305(a)

Regulation authority

CCR

What the official deficiency says

(a) Prior to construction or alterations, all facilities shall obtain a building permit. 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 [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type B

Official code

87608(a)(5)(A)

Regulation authority

CCR

What the official deficiency says

(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed. 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 [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: Plan of Correction

Official classification

Type B

Official code

87468.1(b)(1)

Regulation authority

CCR

What the official deficiency says

(b) All residents in all residential care facilities for the elderly shall be protected from all of the actions... A licensee or facility staff may not take any of the following actions…of a resident: Deny admission to a facility … or discharge or evict a resident from a facility. This requirement was not met by evidence of: The facility did not accept resident #5 back to the facility after discharged from hospital.

Official plan of correction

Administrator will review Title 22 regulations and provide a written statement by POC date confirming their understanding of the citation issued. Administrator shall obtain resident’s medical assessment to determine whether there is probable cause not accepting resident back to the facility.

Deadline recorded: Nov 29, 2024. A deadline is not proof that correction was completed.

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. The requirement is not met by evidence of: A pipe outside the front door was leaking water and the audio devices on the back door that access to the patio was not operable. Based on interviews and observation, the Administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to provide the repair the leaking water pipe and the audit device on the patio door by POC due date. Licensee agreed to provide the proof of the repair to Licensing.

Deadline recorded: Oct 25, 2024. 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

To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. The requirement is not met by evidence of: The call button was not accessible to residents. Based on interviews and observation, the Administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee agreed to provide a necklace to attach to the call buttons and make it accessible to the residents by POC due date.

Deadline recorded: Oct 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(h)(6)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care 87465(h)(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained. This requirement is not met as evidenced by: Upon reviewing medication and medication log, Resident#3's medication (# of pills in bottle) and medication log did not match. Medication (Rx) of Senna 8.6mg was 1 pill short and no documentation regarding the discrepancy on resident’s Rx log. Licensee did not have an explanation regarding the discrepancy of Rx record. Deficient Practice Statement Based onobservation and record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/22/2024 Plan of Correction Licensee agreed to provide (1) additional medication administration assistance training to all staff and provide proof to the department; (2) review Title 22, Section 87465 and provide a signed statement indicating the review of this section detailing how to prevent future medication errors by the POC date.

Official classification

Type B

Official code

89705(f)(2)

Regulation authority

CCR

What the official deficiency says

The following shall be stored inaccessible to residents with dementia: (2) …toxic substances…cleaning supplies and disinfectants. This requirement is not met as evidenced by: Hazardous items, such as laundry detergents, Clorox, and many other bottles of cleaning supplies, were not locked in the garage which was accessible to residents. Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/24/2024 Plan of Correction Licensee agreed to keep hazardous items locked and inaccessible to residents at the facility. Also, Licensee agreed to provide training to all staff regarding providing care to residents with dementia and provide proof to the department by the POC date.

Official classification

Type A

Official code

87465(a)(4)

Regulation authority

CCR

What the official deficiency says

(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. 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 1 out of 5 residents which poses an immediate health, safety or personal rights risk to persons in care. Facility did not have the medications Erythromycin Ophthalmic 0.5% ointment and Women's Pack Therapeutic Multiple Vitamins & Minerals for Resident 1 (R1). Resident was admitted to the facility on 04/28/2023.

Official plan of correction

POC Due Date: 05/17/2023 Plan of Correction Facility is to ensure that Title 22 Section 87465 regulations are met at all times. Additionally, facility will communicate with R1's hospice agency to obtain the missing medication and submit proof to CCLD by 05/23/2023.