GLEN TERRA ASSISTED LIVING

Official classification

Type B

Official code

87555(b)(3)

Regulation authority

CCR

What the official deficiency says

87555(b)(3) General Food Service Requirements(b) The following food service requirements shall apply: (3) Between meals nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician. This requirement is not met as evidenced by. On 01/09/26 and before licensee failed to ensure that snacks are available or accessible to residents between meals.

Official plan of correction

By POC due date, the licensee wil submit a written plan describing how snacks will be consistently available between meals. The facility menu will be updated to include snacks times and options, and a current weekly menu with snack information will be submitted to CCLD.

Deadline recorded: Apr 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

87463-Reappraisals- (a)The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated, in writing as frequently as necessary or once every 12 months, whichever occurs first,......This requirement is not met as evidenced by: Based on record review and interviews the licensee did not comply with the section cited above by not updating R1's Appraisal Needs and Services upon observing change in condition which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Executive Director agreed to complete and update Appraisal Needs and Services Plan for all the residents and provide training to all staff to meet all residents needs accordingly. The proof of completion should be communicated with LPA via e-mail by the POC due date.

Deadline recorded: Sep 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

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... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding R1's hospitalization on 03/11/2025, which poses a potential health and safety risk to persons in care.

Official plan of correction

Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. R1's incident report shall be submitted to LPA by POC date.

Deadline recorded: Sep 25, 2025. 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

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..... . This requirement is not met as evidenced by: Based on the interviews, medical record review and R1's facility file review the facility did not ensure to provide proper/enough care to R1 to prevent multiple falls which poses a potential risk to residents in care.

Official plan of correction

The Executive Director agreed to provide staff training on Personal Rights of Residents and will provide copy of the training materials to RO/LPA by the POC due date, which is 09/25/2025.

Deadline recorded: Sep 25, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(e)

Regulation authority

CCR

What the official deficiency says

87506 Resident Records.(e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident. This was not met as evidenced by: R1 was discharged on 10/25/18 and file for R1 was requested in April and May of 2021 but staff could not provide the file. This shows a potential health and safety risk for residents in care and supervision.

Official plan of correction

Facility to conduct in service training for management staff regarding Title 22 Regulations on Resident Records. Sign in sheet of start participating to be provided to CCL by POC due date.

Deadline recorded: Aug 10, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident.. The licensee shall ensure...observed for changes in physical, mental, ...functioning .... appropriate assistance is provided...physical health condition are observed, the licensee shall ensure that such changes are documented...resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews conducted, the facility did not take any action to mitigate the falls for R1. R1 had multiple falls from September 2020 to March 2022 which resulted in serious injuries, this poses an immediate risk to residents in care.

Official plan of correction

Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Administrator to submit a faxed or mailed copy of POC by due date.

Deadline recorded: Jun 3, 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

87466 Observation of the Resident.. The licensee shall ensure...observed for changes in physical, mental, ...functioning ....appropriate assistance is provided...physical health condition are observed, the licensee shall ensure that such changes are documented...resident's responsible person, if any. This requirement is not met as evidenced by: Based on interviews conducted, the facility did not take any action to mitigate the falls for R1. R1 had multiple falls from September 2020 to March 2022 which resulted in serious injuries which posed an immediate risk to residents in care.

Official plan of correction

Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Administrator to submit a faxed or mailed copy of POC by due date.

Deadline recorded: Apr 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87405(d)(1)

Regulation authority

CCR

What the official deficiency says

87405 (d)(1) Administrator Qualifications and Duties (d) The administrator shall have the qualifications specified in Sections 87405(d)(1) through (7). If the licensee is also the administrator, all requirements for an administrator shall apply. (1) Knowledge of the requirements for providing care and supervision appropriate to the residents. Based on interviews conducted, the facility did not take any action to mitigate R1’s falls. Additionally, the facility did not contact R1’s PCP and failed to make updates to R1’s case plan which posed a potential risk to residents in care.

Official plan of correction

Administrator to submit written Plan of Correction to ensure the facility is meeting Title 22 Regulation. Administrator to submit a faxed or mailed copy of POC by due date.

Deadline recorded: Apr 18, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(B)

Regulation authority

CCR

What the official deficiency says

Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (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 of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not being met as evidenced by: LPA observed during complaint investigation that Special Incident was not submitted for resident #1 fall and hospitalization.

Official plan of correction

Administrator will ensure that special incident reports are submitted to community care licensing as required. Adminstrator will conduct staff training regarding reporting requirements and will submit proof of training to LPA by POC due date.

Deadline recorded: Dec 9, 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

(e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C). This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above Room 406 water temperture in bathroom sink measure 104.9 and in room #307 the sink in living room measure 103.5 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2022 Plan of Correction Licensee will adjust water temperture and send proof of correction and certify that water temperture is within range by POC date.

Official classification

Type A

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, the licensse did not comply with the above. LPA and Staff observed spoiled lemons in lemon box and stale lettuce and celery which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2022 Plan of Correction Licensee will discard old stale vegtables and replace if necessary with fresh ones and send proof to LPA by POC date.

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 observati some cans of non perisible food had expired which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/12/2022 Plan of Correction Licensee will inspect all non perisible food and discard expired ones and replace if neccesary and send proof to LPA as POC date.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the two double doors which house the dumpsters are unattached at the frames which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 09/11/2022 Plan of Correction Licensee will repair or replace the doors that house the dumpster bins and send photo as proof to LPA by POC date.

Official classification

Type B

Official code

87705(I)(6)

Regulation authority

CCR

What the official deficiency says

87705(I)(6) Care of Persons with Dementia. The following initial and continuing requirements shall be met for the licensee to lock exterior doors or perimeter fence gates: Locked exterior doors or perimeter fences with locked gates shall not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents. This requirement was not met as evidenced by: Based on interviews & record done by LPA Tao the licensee did not ensure that locked gates do not substitute staff to meet supervision needs of residents, on 7/29/21 R1 left the facility unsupervised which poses a potential health & safety risk to residents in care.

Official plan of correction

The administrator agreed to create a plan to ensure that Locked exterior doors or perimeter fences with locked gates will not substitute for trained staff in sufficient numbers to meet the care and supervision needs of all residents. Proof of correction will be submitted via email to gail.johnson@dss.ca.gov.

Deadline recorded: Apr 29, 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)Water supplies and plumbing fixtures shall be maintained as follows: (2)(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). The requirement was not met as evidenced by LPA observation, LPA inspected RM#111, #120 and #214 and hot water was measured between 122.6 to 124.7 which posed an immediate risk to the residents in care

Official plan of correction

The administrator will fix the hot water temperature immediately and send the hot water log to LPA for seven days on 04/05/22 via fax

Deadline recorded: Mar 30, 2022. 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

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. Based on interviews, the licensee did not ensure all the residents get the covid-19 testing which poses a potential health, safety, and personal rights to residents in care.

Official plan of correction

The licensee shall review the Provider Information Notices PIN 21-32.1-ASC on testing guidance. In addition, the licensee shall perform weekly covid-19 testing to all staff and residents until no new cases are identified in sequential rounds of testing covering a 14-day period. The licensee shall submitted a statement acknowledging the PIN has been reviewed and to ensure that testing are performed until the testing is fulfilled by POC due date 2/11/22.

Deadline recorded: Feb 11, 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 for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful andcomfortable accommodations, furnishings and equipment. This requirement is not met as evidence by: Based on observation licensee is not ensuring receptionist is wearing a face mask at all times which poses an immediate personal rights, health, and safety risk to persons in care. *Civil Penalities for Repeat Violation were assess in the amount of $250.*

Official plan of correction

Administrator will ensure all staff are following COVID 19 recommendations and guidelines per state mandates at all times. Administrator will certify with LIC 9098 and

Deadline recorded: Oct 6, 2021. A deadline is not proof that correction was completed.