ALEXO MANOR INC

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. 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 out of three staff not having documented the annual 20 hours of training which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Administrator agrees to conducted the required annual training for each staff that has not completed their annual training and provide a copy of the training and sign in sheet to LPA by POC due date 1/02/2026.

Official classification

Type B

Official code

1569.695(c)

Regulation authority

HSC

What the official deficiency says

(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. 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 not having conducted or documented a quarterly emergency disaster drill for the year 2025 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 01/02/2026 Plan of Correction Administrator agrees to conducted an emergency disaster drill training for each shift and provide a copy of the sign in sheet to LPA by POC due date 1/02/2026.

Official classification

Type A

Official code

87355(d)(3)

Regulation authority

CCR

What the official deficiency says

(d) All individuals subject to a criminal record review shall be fingerprinted...(3) The licensee shall submit these fingerprints to the California Department of Justice... prior to the individual's employment, residence, or initial presence in the facility. This requirement is not met as evidenced by: Based on interviews and record review the licensee did not comply with the section cited above, in one staff identified was not fingerprint cleared for the facility. This poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

According to the Lead Caregiver the staff is no longer working in the facility. Licensee with review the regulation cited and submit a statement of understanding to LPA by POC due date 05/07/2025.

Deadline recorded: May 7, 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

(a) Each licensee shall furnish to the licensing agency... 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...This requirement is not met as evidenced by: Based on interviews and record review the licensee did not comply with the section cited above, in incidents involving R4 and R1 not reported to CCLD within seven days of occurrence which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Lead Caregiver provided Unusual Incidents/Injury Reports involving R1 to LPA on todays visit. Licensee will submit Unusual incident reports of R4 to LPA by POC due date 05/16/2025.

Deadline recorded: May 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(a)

Regulation authority

CCR

What the official deficiency says

87507 Admission Agreements (a) The licensee shall complete an individual written admission agreement, as defined in Section 87101(a), with each resident or the resident's representative, if any. This requirement is not met as evidenced by: Based on interviews, and record review Licensee failed to complete a written admission agreement with R1 for this facility with admission 10/01/2024 which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee will email LPA a scanned copy of completed agreement between R1 and this facility by POC due date 05/16/2025.

Deadline recorded: May 16, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(f)(2)

Regulation authority

CCR

What the official deficiency says

(f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants. 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 where LPA observed over the counter medication in resident #4's (R4's) bedside table and the facility has residents diagnosed with Dementia, which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/04/2024 Plan of Correction Administrator Designee removed medication immediately. Administrator will conduct in-service training with all staff regarding the regulation cited and send LPA a copy of sign-in sheet of staff that participated in training.

Official classification

Type B

Official code

87411(c)(1)

Regulation authority

CCR

What the official deficiency says

(1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. 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 two (2) out of three (3) staff not having current 1st aid and CPR on file at time of visit, which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/20/2024 Plan of Correction Administrator agrees to submit copies of staff 1st aid and CPR certification to LPA by POC due date.

Official classification

Type B

Official code

87507(c)

Regulation authority

CCR

What the official deficiency says

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. 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) out of five (5) residents admission agreements which poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/20/2024 Plan of Correction Administrator agrees to submit a copy of R4's completed admission agreement to LPA by POC due date.

Official classification

Type B

Official code

87705(c)(5)

Regulation authority

CCR

What the official deficiency says

(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 as specified in Section 87458, 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 interview and record review, the licensee did not comply with the section cited above in three (3) residents with Dementia (resident #1 (R1), resident #2(R2) and resident #4 (R4)) by not conducting medical assessments annually which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 12/01/2023 Plan of Correction Administrator will schedule R1, R2 and R4 for a medical assessment and conduct reappraisals. Administrator will email a copy of each residents' physician's report and reappraisals to LPA by POC due date.

Official classification

Type A

Official code

87355(e)(1)

Regulation authority

CCR

What the official deficiency says

87355(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or 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 1 out of 2 staff not obtaining proper criminal background clearance working at the facility which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/02/2022 Plan of Correction Administrator will find a replacement and will get S2 out of the facility immediately. Administrator will ensure all staff working at this facility are cleared before starting employment.