VICTOR ROYALE, LLC

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights... (a) Residents in all residential care facilities for the elderly shall... (1) ...be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: Based on interviews and record review, the licensee did not comply with the section cited above by permitting Staff #1 (S1) to be disrespectful towards residents, which posed a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Licensee to conduct an in-service training to all staff on the cited section and issue a written notice to Staff #1 (S1)

Deadline recorded: Jul 24, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(3)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents... shall... (3) ...be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... This requirement was not met as evidenced by: Based on record review and interview, the licnesee did not comply witht he section cited above in allowing Staff #1 (S1) to hit Resident #1 (R1) which posed an immediate Health, Safety, or Personal Rights to persons in care.

Official plan of correction

The licensee has agreed to suspend Staff #1 (S1) until they complete further investigation into the abuse and will ensure S1 does not come into direct contact with residents.

Deadline recorded: Mar 12, 2025. 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

Maintenance operation: (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 be...maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of... ... not less than 105 degree F...and not more than 120 degree F...This requirement was not met, evidenced by; based on water temperature ranged from 102.0 to 125.6 degrees. This is a potential health and safety risk to residents in care.

Official plan of correction

Plan of Correction completed during the visit. Water was adjusted and re-tested. LPA measured water at 120.0 degrees, which is in compliance.

Deadline recorded: Jun 27, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in all Facilities (a) Residents in all residential care facilties for the elderly shall...(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by: LPA observed S1 yelling at residents who were about to shower. Staff and R1 also stated the R1 yells at residents in care. This poses a potential health and safety risk to residents in care.

Official plan of correction

The Licensee shall submit in writing to Licensing by 06/25/24, how they will ensure that all residents in care are treated with dignity and respect.

Deadline recorded: Jun 26, 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. 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: Based on observation and interview the licensee failed to ensure complete safe walkway flooring with the facility for residents in care which poses a possible health and safety risk to residents in care.

Official plan of correction

Administartor will send a picture when floorings are change and replaced.

Deadline recorded: Apr 23, 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

87303(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: Based on the observation, licensee failed to ensure that the outlets in room #6 and room #22 had a wall plates, wich poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Administrator already contacted the electrician to replace/fix the outlet today. Proof of picture shall be submitted to LPA by POC date.

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

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (a) ...The plan...shall provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange...for medical care... appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on documents reviewed and interviews conducted, facility staff failed to call Emergency Medical Services (EMS) personnel in a timely manner. Staff called 911 EMS approximately 2 hours after 2nd fall was discovered. This poses an immediate health and safety risk to residents in care.

Official plan of correction

Administrator shall submit in writing how this deficiency will be addressed, understanding of regulation, and facility procedures regarding timely medical care. 1.Submit plan by tomorrow. 2. Submit proof of staff training by Oct. 19,2023.

Deadline recorded: Oct 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements-General. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement was not met by evidence of: Based on document review and interviews conducted, on May 5, 2022 facility staff failed to meet the needs of resident (R1) after 2 fall incidents; by not conducting body assessments or providing adequate supervision subsequent to falls. This posed an immediate safety risk to this resident in care.

Official plan of correction

Administrator agreed to (1.) submit a plan of correction that addresses staff scheduling and supervision of residents. When applicable resident’s care plans shall be updated, and staffing scheduling shall be reevaluated. (2.) Submit proof of staff training i.e., needs and services of residents, resident care, and supervision.

Deadline recorded: Oct 13, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs.....the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met evidenced by: Based on record review on May 5, 2022, R1 had 2 falls, (one in incontinence care room & the other in their room); staff did not provide appropriate care and supervision after both falls. This poses a potential health and safety risk to residents in care.

Official plan of correction

Administrator agrees to conduct training with all staff regarding observation of residents and changes in condition. When changes in condition are observed residents shall be assessed and records and Appraisals Needs and Services plan shall be updated.

Deadline recorded: Oct 19, 2023. 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

87303-Maintenance & Operation (a) The facility shall be clean, safe sanitary and in good repair at all times. Maintence shall include provision of maintence services and procedures for the safety and well-being of residents, employees, and visitors. This requirement was not met as evidenced by: LPA observed many flies in resident room #14. LPA observed both flies that were dead and alive. This poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee shall place fly strips in room #14 in order to deter flies. This citation has been cleared on this visit. Administrator placed the strips in room #14 during this visit..

Deadline recorded: Oct 26, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(c)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements(c)Any suspected physical abuse that does not result in serious bodily injury... shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency...This requirement is not met as evidenced by: Based on interviews, observation and record review the licensee failed to ensure that suspected physical abuse was reported to the appropriate agencies in a timely manner.

Official plan of correction

At the time of the visit the administrator complete the appropriate required reporting forms and submitted to the appropriate agencies. The administrator will conduct an in-service on reporting requirements and mandated reporting and submit by email to LPA by POC due date.

Deadline recorded: Aug 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.157(c)

Regulation authority

HSC

What the official deficiency says

Health and Safety Code section 1569.157 provides:(c)If a resident council submits written concerns or recommendations, the facility shall respond in writing regarding any action or inaction taken in response to those concerns or recommendations within 14 calendar days. This requirement is not met as evidenced by; Based on interviews, the facility did not respond to resident council’s written recommendation within 14 days which poses a potential health, safety, and personal rights risk to residents in care.

Official plan of correction

The Administrator will respond to the written recommendation by the POC due date, will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to Health and Safety Code section 1569.157; The written letter must be sent to the LPA by the POC due date.

Deadline recorded: Jun 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

Personnel Requirements – General (d)All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe and effective job performance: (3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement is not met as evidenced by: observation, interviews conducted and record review. A resident that required supervision was able to elope from the facility unsupervised and remains missing. This poses a health and safety risk to residents in care.

Official plan of correction

Administrator shall review the regulation 87411 and residents' Physician's Report. Administrator shall submit the list of residents who cannot leave the facility unassisted and the plan to ensure those residents do not elope by POC due date. Plan can be submitted via fax or email to LPA.

Deadline recorded: Mar 29, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(e)

Regulation authority

CCR

What the official deficiency says

Personal Rights At the request of the Department, and immediately if the request is made during an inspection, a licensee shall provide the Department with a confidential list of residents that includes the language(s) read by each resident, which is to be kept confidential to the extent permitted by law. This list shall be maintained in an accurate and current status at all times. This requirement was not met as evidence by: based on record review, sections of the LIC 602 was completed by the facility that should have been completed by the resident or physician. This poses a potential risk to clients in care

Official plan of correction

Facility will discontinue completing sections of the LIC 602 and obtain an updated copy of R1’s physician report. The report must be completed by R1’s Physician. Proof of correction must be sent to LPA via fax or email by POC due date.

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

Official classification

Type B

Official code

87467(a)(3)

Regulation authority

CCR

What the official deficiency says

Resident Participation in Decision-making: The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident’s condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals. This requirement was not met as evidence by: Based on interviews conducted: Residents have not been participating in the needs and services plan assessments. This poses a potential risk to clients in care.

Official plan of correction

Facility will conduct a review of the needs and services plan with R1 collaboratively and any resident with the capability moving forward. Facility must submit an updated plan for R1 via fax or email by POC due date.

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

Official classification

Type B

Official code

87555(b)(8)

Regulation authority

CCR

What the official deficiency says

(b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and iinterview, the licensee did not comply with the section cited above in several cans of food located in the kitchen, emergency supplies, and in the basement were expired, were inflated, and some were popped and spilling, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/27/2023 Plan of Correction Administrator will have staff inspect all food items in the facility and discard all damaged and expired items. Moving forward, all food supplies will be inspected upon delivery by staff, including expiration dates. A copy of the returned/exchanged food items from the food delivery company will be emailed to LPA by the POC due date.

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement is not met as evidenced by: Based on interviews, Staff did not report R-1's aggressive behavior to the Administrator which poses a potential health and safety and personal rights to residents in care.

Official plan of correction

The Administrator shall conduct a staff training to ensure the proper protocol to take when they hear or witness a resident on resident altercation. This log shall be submitted to LPA by POC due date 12/7/22.

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

Official classification

Type B

Official code

87411(d)(3)

Regulation authority

CCR

What the official deficiency says

Personnel Requirement - General (d) All personnel shall be given on the job training...(3) Skill and knowledge required to provide necessary resident care and supervision, including the ability to communicate with residents. This requirement is not met as evidenced by: Based on interviews, Staff did not report R-1's aggressive behavior to the Administrator which poses a potential health and safety and personal rights to residents in care.

Official plan of correction

The Administrator shall conduct a staff training to ensure the proper protocol to take when they hear or witness a resident on resident altercation. This log shall be submitted to LPA by POC due date 10/20/22.

Deadline recorded: Oct 20, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

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: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This standard is not met as evidence by: (4) ouf of (6) interviewed staff indicated they have either witnessed or have received reports in regards to S-6 yelling at residents. (4) out of (5) interviewed residents indicated S-6 yells at residents.

Official plan of correction

Facility Administrator provided staff training on Resident Rights on 08/08/2022 (copy provided). Facility Administrator to provide a written statement in regards to actions that will be taken pertaining to S-6. Written statement to be provided to LPA Irra by POC due date. Civil Penalties issued (repeat violation).

Deadline recorded: Sep 5, 2022. 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

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: Based on interviews and documents reviewed, bed bugs and cockroaches were recently observed at the facility, which poses a potential health and safety risk to residents in care. LPA observed cockroaches in Room #2 bathroom on today's visit.

Official plan of correction

Licensee shall provide proof of treatment of bed bugs and cockroaches and plan to prevent the pests from spreading in the facility. The proof shall be submitted to LPA Rea by POC due date of 8/24/22.

Deadline recorded: Aug 24, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

1569.50(a)(3)

Regulation authority

HSC

What the official deficiency says

The department may deny an application for a license or may suspend or revoke a license issued under this chapter upon any of the following grounds and in the manner provided in this chapter: Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California This standard is not met as evidence by: During facility tour, LPA observed all hand sanitizer stations to be empty in cottages 1511 and 1515.

Official plan of correction

Administrator to ensure all hand sanitizer stations have hand sanitizer liquid at all times. CORRECTED AT TIME OF VISIT.

Deadline recorded: Aug 11, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(b)(2)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. This standard is not met as evidence by: At approximately 11 A.M,, LPA toured cottages 1511 and 1515. In cottage 1511, room#1, the room temperature measured 89.2* and in room #4 the temperature measured at 89.6*. In cottage 1515, room #5, the temperature measured at 89.2*.

Official plan of correction

Administrator to provide a written plan as to how this deficiency will be rectified and how this facility will maintain indoor temperature comfortable as per 87303(b)(2) and provide this to LPA Irra by POC due date of 08/15/2022.

Deadline recorded: Aug 15, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

(a)Residents in all residential care facilities for the elderly shall ....have personal rights: (1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met by evidence of: Per interviews conducted, staff did not treat resident with respect and dignity. 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 will review and train staff per Title 22 Regulations, Section 87468.1. Licensee will ensure that staff are receiving the required in-service trainings according to the Regulation. Administrator will provide a copy of names and signatures of all staff in attendance of trainings. POC is due to CCL by 08/22/22

Deadline recorded: Aug 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(e)(2)

Regulation authority

CCR

What the official deficiency says

(2) The licensee shall conspicuously post in a location accessible to public view in the facility a complete copy of the approved admission agreement, modifications and attachments, or notice of their availability from the facility. This requirement was not met as evidenced by: LPA Rea observed that the facility did not have admission agreement posted or notice of availability on today's visit.

Official plan of correction

Administrator posted during visit.

Deadline recorded: Aug 8, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468(c)(1)

Regulation authority

CCR

What the official deficiency says

(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public. (1) The personal rights of residents specified in Sections 87468.1, Personal Rights of Residents in All Facilities and 87468.2, Additional Personal Rights of Residents in Privately Operated Facilities shall be posted as applicable to the facility. This requirement was not met as evidenced by: LPA Rea observed that the personal rights, nondiscrimination notices, and complaint information were not posted on today's visit.

Official plan of correction

Administrator posted during visit.

Deadline recorded: Aug 8, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(7)

Regulation authority

CCR

What the official deficiency says

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (7) To fully participate in planning their care, including the right to attend and participate in meetings or communications regarding care and services to be provided, according to Health and Safety Code section 1569.80 and involve persons of their choice in this planning... make informed decisions and choices. This requirement was not met as evidenced by: LPA observed that resident council meeting information was not posted on today's visit.

Official plan of correction

Administrator posted during visit.

Deadline recorded: Aug 8, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.38(a)

Regulation authority

HSC

What the official deficiency says

Posting of licensing reports; disclosure to new residents (a) Each residential care facility for the elderly shall place in a conspicuous place copies of all licensing reports issued by the department within the preceding 12 months, and all licensing reports issued by the department resulting from the most recent annual visit of the department to the facility.... shall provide the telephone number and address of the appropriate district office. This requirement was not met as evidenced by: LPA Rea observed that Community Care licensing reports were not posted as required during today's visit.

Official plan of correction

Administrator posted during visit.

Deadline recorded: Aug 8, 2022. 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

87303 Maintenance and Operation (e)(2) Faucets used by residents for personal care ..... the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). The requirement is not met as evidenced by: based on LPAs observation, LPA observed the hot water temperature was measured at Rm#1, #4 and #11 are beyond the required 105-120 degrees F which poses an immediate Health and Safety risk to residents in care.

Official plan of correction

The facility will ensure the hot water temperature will be between 105 degree F and not more than 120 degree F and the administrator will lower the tempature on the water heater send the copy of hot water temperature report to LPA for the upcoming 7 days

Deadline recorded: Jul 1, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87625(b)(2)

Regulation authority

CCR

What the official deficiency says

87625 Managed Incontinence (b)the licensee shall be responsible for the following:(3)(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. The requirement is not met as evidenced by: LPA interviews and 4/7 residents reported they always got soiled or wet diaper and record review. Some residents only got changed twice a day

Official plan of correction

The administrator will ensure the incontience residents are kept clean and dry and will send a plan how to make sure residents would not have soiled or wet diaper for extended long period of time.

Deadline recorded: Jul 14, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(10)

Regulation authority

CCR

What the official deficiency says

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) residents in…shall have all of the following personal rights: ... The licensee shall post the telephone numbers and addresses for the local offices of the … ombudsman program,... This requirement is not met as evidenced by Based on observations, interviews the licensee did not comply with the section cited above by not having the Obudsman poster posted, which poses an pontiential health, safety, or Personal rights risk to persons in care.

Official plan of correction

Licensee shall ensure the required postings are posted in a location that is easily accesible to residents and provide picture proof of the required postings to LPA by POC date.

Deadline recorded: Jul 1, 2022. 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 ...personal rights:(2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement is not met as evidenced by: On 12/15/2021 LPA observed no screenings of COVID-19 for temperature or symptoms were done for visitors of the facility. Based on observation and interview, 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

Administrator will provide proof of visitor log for temperature check and symptom check for COVID 19 and proof of staff training of how to screen visitors and residents for COVID-19 to LPA by POC date

Deadline recorded: Dec 23, 2021. 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

87303 Maintenance and Operation (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: On 12/15/2021 LPA observed white picket fence on side of facility, adjacent to a walkway, with detached pieces of fence and broken pieces of fence wooden fence on side of facility, adjacent to a walkway, with broken pieces of wooden fence, a wooden bench located in the back yard area with back support detached on one side, a wooden bench located in the back yard area with metal support in disrepair. window on door leading to back area with cracks in glass, utility door on side of facility, adjacent to walkway and wooden fence, off door hinge, water pipe on side of facility building, with a missing screw to secure water pipe in place, bathroom fixture in room 1 of cottage 1511 in disrepair, missing base and bar of towel rack, door of room 1 in cottage 1511 with a crack, missing bathroom tile inside shower of shared bathroom in cottage 1511, wall in room 4 of cottage 1511 with a crack, window in room 3 of cottage 1511 with a crack. window of shower area with mold Based on observation, interview, 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

Administrator will repair or replace all items and send picture proof to LPA Nina Galarza by POC date

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

Official classification

Type A

Official code

87307(d)(2)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (d)The following space and safety provisions shall apply to all facilities:(2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. On 12/15/21 LPA observed open paint cans outside of cottage 1511 closed paint cans in patio common area by vending machines, which poses an immediate Health and Safety risk to persons in care

Official plan of correction

Administrator will remove all items and send picture proof to LPA Nina Galarza via email by POC date

Deadline recorded: Dec 23, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87307(d)(6)

Regulation authority

CCR

What the official deficiency says

87307 Personal Accommodations and Services (d)The following space and safety provisions shall apply to all facilities:(6)All outdoor and indoor passageways and stairways shall be kept free of obstruction. This requirement is not met as evidenced by On 12/15/21 LPA observed planks of wood, metal chair, plastic chair, concrete, dry wall, plastic bucket and plastic boxes blocking walkway on side of facility, bags of sand blocking walkway to patio area, which poses an immediate Health and Safety risk to persons in care.

Official plan of correction

Administrator will remove all items blocking walkways and send picture proof to LPA Nina Galarza via email by POC date

Deadline recorded: Dec 23, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(c)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (c) All window screens shall be clean and maintained in good repair. This requirement is not met as evidenced by: On 12/15/21 LPA observed window screen in room 3 of cottage 1511 in disrepair and bent out of shape, window screen in bathroom of room 1 of cottage 1515 with a tear window screen in room 6 of cottage 1515 with a tear, window screens in main facility in rooms 6,8,15,16,19,23, 29, 27, and bathroom window in room 2 with tears in screen. Based on observation, interview, 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

Administrator will repair or replace all items and send picture proof to LPA Nina Galarza by POC date

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

Official classification

Type B

Official code

87468.1(a)(3)

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: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature... . This requirement was not met as evidence by: Staff #1 grabbed Resident #1 by the arm and shoved the resident away from the reception area causing the resident to hit the table/dresser and it falling towards the resident. Staff #1 also grabbed a walking cane from Resident #4 and swung the cane towards Resident #5.

Official plan of correction

Adminstrator will conduct Elder Abuse/Personal Rights training with all staff. Administrator stated he will have a meeting with Staff #2 and give the staff a written warning. Administrator also conducted training on 10/2020 and will send all documentation to LPA Administrator will send proof of training conducted for this month, and from 10/2020 along with written warning issued to Staff #2.

Deadline recorded: Sep 22, 2021. A deadline is not proof that correction was completed.