LA VERNE MANOR

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 Water temperature measure between 121.5 to 124.0] which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/30/2026 Plan of Correction Administrator will adjust water temperature and keep a log for three days and send to LPA ad proof of correction.

Official classification

Type B

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: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above. Debris around the perimeter of facility. Eaves need repair and paint on one side of facility which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/26/2026 Plan of Correction Licensee will repair eaves and dispose of debris around outside of perimeter and send LPA pictures as proof.

Official classification

Type B

Official code

87219(f)

Regulation authority

CCR

What the official deficiency says

(f) In facilities licensed for fifty (50) persons or more, one staff member shall have full-time responsibility to organize, conduct and evaluate planned activities, and shall be given such staff assistance as necessary in order for all residents to participate in accordance with their interests and abilities. The program of activities shall be written, planned in advance, kept up-to-date, and made available to all residents. The responsible employee shall have had at least one year of experience in conducting group activities and be knowledgeable in evaluating resident needs, supervising other employees, and in training volunteers. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation and record review, the facility does not employ a full-time staff member who is responsible to organize, conduct and evaluate planned activities, the licensee did not comply with the section cited above in 37 out of 37 residents which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/17/2025 Plan of Correction Licensee will certify plan to address how the facility plans to become compliant with this regulation by 2/17/25. Licensee will email plan by 2/17/25.

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: LPA and Administrator observed rooms #2, #8 and #21 with severe water damage on the ceiling and a water bucket in one room to collect leaking water as well as wet bed pads spread out on the floor to absorbed the excess water which poses/posed a health and safety risk to persons in care.

Official plan of correction

Administrator will repair the 3 rooms and send proof to LPA by POC date in form of photos, and invoices of the 3 rooms. Civil penalties for $1000 issued for repeat violation.

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

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, at 2:10 pm LPA observed two 21 oz cans of Comet Bleach powder cleaner on bathroom window of residnet bathrrom #23, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/03/2023 Plan of Correction Licensee/Administrator will secure all 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. Residents that wish to use cleaning or disinfectants, will be supervised during use and staff will secure products after each use. Administrator Tanada removed products and secured in storage room during visit.

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 observation and record review, Resident #1 (R1) MAR indicated on 02/03/2023 at 8pm, R1 consumed 2 Divalprolex 500mg tablets orally at bedtime, resident #2 (R2) MAR indicated on 02/04/2023 at 8am, R2 consumed 1 Pantoprazole Sodi 40mg orally, at 8pm R2 consumed 1 Simvastatini 10 mg orally at bedtime and 1 Amlodipine Besylate 10 mg orally at bedtime, resident #3 (R3) MAR indicated on 02/03/2023 at 8pm, R3 consumed 1 Quetiapine Fumarate 100 mg orally at bedtime, 1 Zolpidem Tartrate 10 mg orally at bedtime, 1 Donepezil HCL 10 mg orally at bedtime, and 1 Gabapentin 100 mg orally at bedtime, the licensee did not comply with the section cited above in which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/04/2023 Plan of Correction Licensee/Administrator will retrain staff on how dispense and record medications. Licensee/Administrator will submit training material and staff acknowledgement of training to LPA.

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, resident bathroom# 16 toilet to be dirty and contain stains on seat. Base of toilet was observed to contain dirt and grime. Sink was observed to be dirty and contain grime around rim, visitor bathroom sink contained grime and dirt, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 02/06/2023 Plan of Correction Licensee/Administrator will clean resident bathroom #16 and visitor bathroom. Licensee/administrator will submit photo proof to LPA.

Official classification

Type B

Official code

87303(b)

Regulation authority

CCR

What the official deficiency says

87303(b) Maintenance and Operation: A comfortable temperature for residents shall be maintained at all times. This requirement was not met as evidenced by... Based on observation and interviews, the licensee did not comply with the above section due to indoor temperature being too hot for 5 out of 9 residents interviewed. This poses a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

The administrator stated that the facility will create a policy to include offering fans to residents upon request and adjusting thermostats to cooler temperatures during hottest times of the day. Administrator will send a copy of policy and send pictures of thermostats to CCL by POC due date.

Deadline recorded: Oct 8, 2021. A deadline is not proof that correction was completed.